People with Parkinson's disease find that exercise, specially swimming and walking helps to maintain muscle tone and strength and improves mobility. Some doctors recommend physical therapy called muscle strengthening exercises to keep muscles in good tone. Yoga is an useful and effective form of exercise. Performing full range of motion exercises improves balance, voice, walking and strength.

Nutrition does indeed make a significant contribution to the health status of persons living with Parkinson's disease.
A daily menu based on whole grains, plenty of vegetables and fruits, calcium-rich foods and smaller portions of high-protein foods is recommended for the patients with Parkinson's disease. The importance of each of those is as follows:

• Whole grains - contain fiber that helps control blood sugar, cholesterol, heart disease and constipation that often occurs in Parkinson's disease
• Vegetables and fruits - provides antioxidants, phyto-chemicals, minerals and vitamins that nourish and support the muscles, nervous system and organs of the body.
• Calcium - is particularly important as it keeps the bones strong, preventing fractures.
• Protein - is needed to keep the muscular system healthy, which helps to maintain balance and strength.

Constipation occurs because of following reasons in Parkinson's disease:

1. Medications used to treat Parkinson's disease - Levodopa, Selegiline, Amantadine, Dopamine agonists, Anticholinergics and others can lead to constipation, often by slowing peristalsis.
2. Parkinson's disease may cause degeneration of the nerves of the GI tract.
3. Other reasons:
   - Parkinson's disease patients often have a craving for sweets, which contribute to constipation
   - Very few patients drink enough fluids or eat enough fiber which helps in avoiding constipation

Constipation can be avoided by consuming enough fiber and fluids each day. Fiber along with water, keeps our bowels working smoothly. Many people prefer laxatives, but over the time, stimulant laxatives damage the lining of colon, causing even greater difficulty with constipation.

Studies have shown that people with Parkinson's disease often have lower bone mineral density and greater incidence of osteoporosis, fall and bone fractures. Following important things should be kept in mind:

• Staying at healthy weight is important.
• Change any unhealthy habits that cause bone thinning like smoking, excessive alcohol use and inactivity.
• Get enough calcium, magnesium, vitamins D and K by means like diet, sun exposure and medications.

Patients with Parkinson's disease lose weight because of following reasons:

• Depression can cause lack of appetite and desire to eat.
• Some people can't eat quickly enough to finish meals on time in a group setting.
• People with good appetite may mysteriously lose weight.

Problems can be avoided by having frequent small feeds. Food supplies a steady stream of blood glucose, which our body's cells use for nourishment, energy and work. Without glucose, we may feel fatigued, listless and apathetic. People with Parkinson's disease often experience fatigue due to the disease or medications used to treat Parkinson's disease; lack of glucose can make this fatigue worse.

Guidelines to optimize benefits from regular exercise routine:

• Take 5 minutes to "warm up" prior to performing any exercises. This may consist of gentle stretching, walking in place or marching legs while seated etc. This encourages blood flow to the muscles and helps prevent injuries.
• Plan to exercise for a minimum of 15-20 minutes per day.
• Perform each exercise to its full potential. Maximum effort = maximum result
• Allow 4-5 days at a given level of repetition of a movement before increasing the repetitions. This may seem slow, but will give muscles time to adjust to new demands.
• Stretching is crucial to flexibility. The same stretches performed prior to an exercise routine can be repeated after the series.
• At the end of each exercise session, close your eyes for 5 minutes, relax, and practice deep breathing. Imagine yourself strong, flexible and energized. Last but not least, congratulate yourself for taking charge of your life and your health.

Stretching exercise is helpful in following:

• Increase range of motion for improved joint mobility
• Helps maintain and/or improve posture
• Decreases the risk of muscle tissue injury
• Improves circulation
• Releases muscle tension associated with stress

Occupational therapy is a newer allied health profession that has much to offer people with movement disorders. Occupational therapist evaluates muscle tone, range of motion, fine and gross motor control, balance and coordination. Evaluation by an occupational therapist is indicated for the following needs:

• To evaluate and treat persistent problems with changing positions, getting in and out of bed etc.
• When seeking advice for modifying your work station or home setting to maximize safety and efficiency.
• When functional limitations are causing difficulties performing independent activities of daily living (ADL) such as eating, dressing, bathing and handwriting.
• To recommend and teach the use of appropriate adaptive equipment.

To maximize the benefits of physical and occupational therapy for people with Parkinson's disease, it is important that the therapist understand some basic tenets of Parkinson's disease and geriatric rehabilitation.