Patients with PD do not coordinate breathing with locomotion as seen in normal individuals.63 Combining this with fatigability of the respiratory pump during repetitive actions,46 it is not surprising that patient with PD have prominent fatigue and poor exercise tolerance. However, patients are able to improve pulmonary function through a pulmonary rehabilitation program.64 Furthermore, those who engage in regular aerobic exercise may maintain good pulmonary function.65,66 These types of studies suggest that nonpharmacological measures may be as important in addressing pulmonary dysfunction as dopaminergic therapy. Because of limitations due to postural instability and freezing of gait, strategies to maintain aerobic capacity can be more challenging. Multidisciplinary care is often necessary. The PD population is increasingly using alternative medicine approaches. The effect of interventions such as Qigong, yoga, and tai chi on respiratory system are not entirely understood but certainly warrant further investigation.
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