Parkinson’s clients can benefit immensely from the Pilates method’s focus on breath. Breath is a basic characteristic integrated into all of the Pilates equipment and matwork exercises, and provides oxygen to the cells promoting better health. The same dynamic that creates difficulty with repetitive movement in people with Parkinson’s Disease can also negatively affect respiration, causing shortness of breath or dyspnea. Breathing exercises providing proprioceptive feedback can “wake up” the muscles of respiration for a deeper breath, but singing can also be a useful and fun tool to incorporate in a Pilates session.
Mayo Clinic Parkinson Specialist J. Eric Ahlskog, Ph.D., M.D. suggests, in The Parkinson’s Disease Treatment Book on page 299, that after other medical conditions are ruled out, Parkinson’s Disease (“PD”) could contribute to dyspnea.
“Consider what happens when we breathe. We repetitively contract and then relax our breathing muscles. Back and forth, the muscles of the diaphragm and rib cage contract to expel air and then relax to expand the lung cavity. (The diaphragm is the large breathing muscle underneath the lungs.) These repetitive movements by the breathing muscles move air in and out of the lungs, and PD occasionally affects these unconscious repetitive breathing movements.”
Most people are not in touch with their shallow breathing until it is brought to their conscious attention. In Parkinson’s clients, since muscular awareness can be diminished, it is often necessary for the instructor to touch the muscles in the ribcage for the person to feel the area expand and contract or have the individual feel it with his/her own hands during the breath.
Since the type and timing of medication will affect muscular coordination, be sure that your client does his/her best to perfect the timing and dosage of medication to be in an optimal physical state for exercise. In the following exercise a Physioball is used as the proprioceptive tool to increase awareness of the chest expansion and contraction.
Physioball Breath Exercise
Have your client sit next to a physioball and lean into it. The physioball “dents in” on the inhalation if the muscles contract sufficiently for a deep breath and “pops back” into the ribs on the exhalation. Assist your client to experience breath in the sideways, dorsal and ventral positions by holding the ball pressed toward the body. Use a smaller ball than the one pictured if your client has shoulder issues and cannot raise the arm comfortably. (Physioball exercise also featured in “Breaking Down the Pilates Hundred.”)
This exercise can “jumpstart” the respiratory muscles and give your client the ability to direct the deeper breath. The expansive breath will facilitate the oxygen exchange when progressing to exercises using the Pilates equipment. Practicing deep belly breaths or diaphragmatic breaths can be useful to start the process, but ultimately the breath needs to derive from the expansion and contraction of the ribcage (without the shoulders rising and lowering), not the belly. Most of the Pilates exercises require costal breathing, since the abdominal muscles are utilized for core stabilization and support.
Singing Breath Exercise
When your Parkinson’s client has a more difficult time directing a deep breath, singing can improve breathing capacity. I will often use the “e” sound with a single tone found in vocal warm-ups to give my client a focus. If the “e” sound gets repetitive, mix it up and use another vowel sound or combination thereof. You can also do scales using the same vowel sound.
You will need a watch or clock with a second hand. First have your client sing “e” in a comfortable tone and see how many seconds the note is held. Inform your client how long the note was held and set a goal for the next breath. Keep going until the client improves and reaches full capacity. Be sure to let your client take a “catch up breath” when needed between singing breaths to avoid getting light-headed. Ten seconds is a good final target for holding the note, but make an individual goal since ten seconds might be too challenging for some people when breathing is difficult.
If the client is able to multi-task, I match the singing warm-up with movement. Sitting or standing exercises are better for this since it is easier to take a deep breath—for example, Standing Chest Expansion with light springs off the end of the Cadillac. Have your client sing the “e” sound in a comfortable tone for the target amount of seconds while pulling the springs, and focus on a deep inhalation through the nose during the return phase of the spring recoil.
I also use well-known songs that the client can sing when performing the exercise, which help with the breath and regulate timing. Most people know “row, row, row your boat” so I often pick that one, but let your client suggest songs too. For example, with parallel heel pushes sitting on the Wunda Chair, I would have my client sing “row, row, row your boat” and indicate that the bar should go fully up and down 3 times (or whatever timing you have in mind) before the phrase finishes.
Client’s with Parkinson’s Disease can often improve the depth of breath with a simple verbal or tactile reminder, but may experience difficulty with this task when medication is improperly timed. Singing is a fun and easy option to facilitate breath in the Pilates exercises and help your client feel more successful. In the words of The Carpenters “don’t worry that it’s not good enough for anyone else to hear, just sing, sing a song.”