I recently attended a PD Warrior Course in London’s Queen Square Hospital on Saturday 16^th November 2019 so I thought I would write a blog post about PD Warrior and my experience of the course.

The course is in two parts; level 1 which was completed online and level 2 was the practical element. The Level 1 module was the most comprehensive package of presentations and supporting articles that I had received prior to any practical course before. There were 5 modules to complete and a quiz at the end of each module – with only 2 attempts allowed to complete each quiz, so there was an element of pressure when completing these!  

The level 2 Practical course was very well structured and taught by the trainers. We brushed up on our theoretical knowledge to start the day before swiftly going through each of the 10 core exercises taught in the program. Each exercise is specifically designed to combat the symptoms of Parkinson’s and it was a lot of fun working in different pairs to teach and to analyse each other’s techniques. The early afternoon consisted of going through a typical assessment for an individual with Parkinson’s before the trainer led the person through 2-3 appropriate exercises for them. After lunch, we worked in small groups of 3 to complete our own subjective and objective assessments of volunteers with Parkinson’s disease who kindly made their journey to the course. Once our assessment was completed for the volunteer, we led them through each of the 10 core exercises in a circuit and took part ourselves also.

What is PD Warrior?

PD Warrior was developed by two Physiotherapists in Australia and has been growing since 2011/2012. It is an exercise program for people newly diagnosed with Idiopathic Parkinson’s Disease. It is aimed at newly diagnosed people as this group have often been overlooked by health services and traditionally Parkinson’s Disease symptoms are often not managed until later on in the course of the disease.

PD Warrior has been developed from a background of research evidence which shows the benefit of much earlier intervention with the newly diagnosed to improve mobility, confidence and a person’s quality of life. Importantly, the evidence shows the potential to slow progression of the condition.

Who is it for?

PD Warrior has been created for those that are newly diagnosed and have mild symptoms. Usually this group are still working, have a low risk of falling and have no other long-term health conditions. The program is run in a group setting and has proved very successful for bringing together motivated people who are already fit and active, to help them push back against the disease. The exercises within the program can be adapted for those that have more moderate to later stage symptoms and it can be delivered as a one-to-one program with people that have cognitive issues or those that are freezing and falling.  

How does it help?

The exercises within and delivery of the program is very important. To be able to learn or rather Re-learn after an injury or with disease such as Parkinson’s, a process called neuroplasticity occurs. The program is based on 7 core principles in rehabilitation which are required for neuroplasticity to occur. These are;

1. Specificity: Use it or lose it (defer the expected deficits) and Use it and improve it (defeat the existing deficits). The exercises can be adapted to the individual’s impairments.
2. High Effort: this is important as an exercise completed at a high effort of output drives up the level of BDNF (Brain-derived neurotrophic factor) and glial derived neurotrophic factor (GDNF). These proteins are found within the brain and are vital for sustaining current neurons and developing new synaptic connections and therefore learning.
3. Frequency: any learning doesn’t happen straight away. It takes a lot of repetition.
4. Power: Amplitude, Speed and accuracy of movements are encouraged to combat the very symptoms which PD is known to cause such as the slow, rigid and inaccurate movements.
5. Complexity: the exercises have been designed to be complex and involve elements of dual-tasking. This is really important as completing complex tasks help to acquire skill and therefore neuroplasticity but also PD reduces Dopamine levels within the basal ganglia which is an area of the brain responsible for dual task processing.
6. Meaningful: The exercises within this program will all help a functional impairment for an individual and so with consideration of their goals, the right exercises can be selected for them to work on. This empowers the individual to continue.
7. Fun: Due to the nature of the PD Warrior program, being in a group setting with high energy levels, complex and challenging exercises and motivated individuals, there is certainly a fun side to it. There are a variety of equipment items that can be used which keeps it colourful and interesting. Patient satisfaction levels for this program are very high and particularly the variety or exercises and the challenge of the exercises came out on top.   

What next?

I was very happy with everything I learnt from this course and have certainly taken a lot from it. The 10 core exercises included within the program each have their own strengths for treating patients going forward. I particularly like how they are complex and can be progressed or adapted depending on an individual’s impairment.

I have learnt how the effort of the exercise really does have an effect. With the program, the patient should work up to an effort level of 80%. I have found that a person’s movements are so much more powerful and co-ordinated. The patient can tell me when they have maybe put in a 4/10 and importantly, they can tell the difference as its feels slower to them. This is a great way for the patient to be in control of their own rehabilitation when they are able to critique their movement efforts.

Having completed level 1 and level 2, I am now PD Warrior trained and can teach the principles and techniques from this program with patients. There is now the option of obtaining a license to run this program in its entirety having completed level 2. This does require certain logistical and contractual obligations which will need careful consideration.

Meanwhile, I will certainly be putting the knowledge and skills I have acquired on this fantastic course to good use with my patients and I am also looking forward to reviewing other PD specific exercise programs which exist out there.

Please get in contact with me at [email protected] if you have any questions about this program or would like any references for the research articles. It certainly was a detailed course and so I have only included a brief outline in this blog! Alternatively, you can find more information on the PD Warrior site.

Thank you for reading 

Paul