Today he is on his feet and has gotten rid of his back brace and walker. “My doctors have tested my strength, balance, and gait, and everything has improved,” she says. “They decided not to upload my medication. I am convinced that exercise is the reason.”
This would not surprise Parkinson’s experts who point to a long time And growing Body of evidence that supports the positive impact of exercise on disease. In a new wave of research, scientists are now studying which exercises at which intensity level provide the greatest gains. The goal is to design an exercise prescription, one that is likely to include a combination of high-intensity aerobic exercise and balance, strengthening, and stretching exercises, that delay disease onset or, ideally, prevent it completely. They also want to better understand what exercise does to the brain of a person with Parkinson’s, as well as its effects on non-motor functions such as mood and cognition. Sure, exercise can’t cure Parkinson’s, there is no cure, but most researchers believe it can make a positive difference for most patients.
“We’ve known for a long time that exercise is good for Parkinson’s patients,” says Giselle Petzinger, an associate professor of neurology at the University of Southern California Keck School of Medicine and an early advocate of exercise for Parkinson’s. “What we’re trying to do now is further refine what we already know into practical applications for patients.”
Caroline Tanner, a professor of neurology at the Weill Institute for Neurosciences at the University of California, San Francisco, predicted in a recent to study that new cases of Parkinson’s could be nearly halved by 2030 if all undiagnosed adults regularly exert themselves at 80 percent of their physical activity capacity. “This could have staggering consequences for public health,” says Tanner.
Parkinson’s is the result of the death of key neurons in the substantia nigra region of the brain that produces the chemical messenger dopamine. Over time, the loss of these nerve cells disrupts movement and diminishes cognition; it can also cause slurred speech and depression. Outward signs may include tremors, muscle stiffness, slow movement, poor posture and balance, and the inability to perform unconscious actions, for example, blinking, smiling, or swinging your arms when walking.
Scientists consider it a disease of aging, since most patients are over 60 when diagnosed, although a small percentage occurs among those under 50. Nearly 1 million Americans living with Parkinson’s, and about 60,000 new cases are diagnosed each year, according to the Parkinson’s Foundation. Certain medications and other treatments can relieve symptoms.
Experts, who now consider exercise to be the foremost of those treatments, say it can help at any stage of the disease.
“Usually when a person starts a new exercise program, the goal is to get better,” says Maria Bellumori, associate professor of kinesiology at California State University at Monterey Bay and clinical director of Power over Parkinson’s, or POP, the program Sevene attends. “Our goal is also improvement but, at least, maintenance. Because Parkinson’s is progressive, if you can maintain physical and cognitive function, that’s actually an improvement.”
Ryan Cotton, Interim President and CEO of Rock Stable Boxingan international boxing program for people with Parkinson’s, says he has seen the value of intense training and appointment several studies in recent years showing the positive impact of boxing. The curriculum is specifically designed for Parkinson’s disease.
“A fighter who is trying to be defensive would be hunched over, but Parkinson’s himself puts you in that position,” Cotton says. “We want you to have your chin up and high. Parkinson’s is a lonely disease and many people do not go out socially. But when you put on those gloves and start hitting the bag, that apprehension disappears and an ‘I’m a tough guy’ swagger takes its place.”
Describes the impact on a retired military officer who started boxing six years ago. Dependent on a walker, the man would arrive early to class to have time to hide the walker before anyone could see it. “He took all the frustrations out of him in the bag,” Cotton recalls. “Six months later, he was walking independently and then he ran a half marathon. Today, someone who saw him on the street would not even realize that he had Parkinson’s ”.
laughing and fighting
S. Elizabeth Zauber, an associate professor of clinical neurology at the Indiana University School of Medicine, says the boxing sessions also help create a sense of community by creating “a support group that’s not really a support group.” support for”. Zauber, who sits on Rock Steady’s board of directors and its medical advisory committee, says, “Hey, let’s laugh at Parkinson’s and fight back.” … It’s empowering when you see your symptoms improve, and that leads to more confidence.”
Daniel M. Corcos, professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine, leads a multisite study clinical study among those with early Parkinson’s, that is, people diagnosed less than three years ago and not yet taking medication, comparing two levels of exercise.
The trial, which is recruiting participants, will study two groups. Members of one group will walk on a treadmill at a speed equal to 60 to 65 percent of their maximum heart rate, while the second will work at 80 to 85 percent of their capacity. Maximum heart rate, the maximum rate at which a person’s heart beats, varies from person to person and depends on age. Younger people tend to have greater capacity.
Researchers will determine each participant’s maximum rate through testing, then calculate that individual’s walking speed for their assigned capacity, either 60 to 65 percent or 80 to 85 percent. Participants will wear heart rate monitors and walk for 30 minutes, four times a week, for two years.
Earlier studies confirmed the safety and feasibility of both routines and anecdotally suggested that higher-intensity walking produces more benefits.
Jay Alberts, a neuroscientist and vice president of innovations at the Cleveland Clinic Neurological Institute, has been studying the effects of cycling on Parkinson’s for nearly 20 years. His interest began in 2003 during a multi-day group bike ride through Iowa. After riding a tandem bike with a Parkinson’s patient for several days, he noticed a dramatic improvement in his handwriting when he signed a greeting card.
“It was a real ‘aha’ moment,” says Alberts. “It made me think that maybe something was changing in the brain.”
Scientists still don’t know exactly what it is, but they have some ideas that suggest there are likely multiple mechanisms at work.
Alberts believes that exercise increases neurotrophic factors, small molecules, usually proteins, that promote the growth and survival of brain cells. “They don’t produce dopamine, but they can reduce the effects of whatever is causing the loss of dopamine,” he says.
The higher the intensity of the exercise, the higher the levels of neurotrophic factors, adds Alberts. However, “while high intensity may be optimal, any intensity that someone can achieve is better than zero intensity,” he says.
a recent to study in mice also found that irisin, a hormone secreted into the blood during endurance exercise, reduces levels of alpha-synuclein, an abundant protein in the brain that has been bound to the development of Parkinson’s disease.
Tanner believes that exercise could also help control Chronic inflamationwhich occurs when the immune system activates an inflammatory response that never goes off, often a hallmark of neurological disorders, she says.
and a recent to study Alberts, co-authored with Parkinson’s patients, for example, found that high-intensity aerobic exercise improved their information-processing ability.
In the study, 50 Parkinson’s patients participated in high-intensity cycling on stationary bikes three times a week for eight weeks. The researchers measured their ability to react to a timed task before starting the exercise program and then again after it ended. Taken together, the participants showed faster reaction times compared to their previous performances, indicating that “exercise improves cognitive function,” says Alberts. Such an improvement “could help in performance of activities of daily living,” she adds.
POP, the Monterey, California program, includes mental exercises along with physical exercises to keep participants fit. “While members are going to the bag, we challenge them cognitively by spelling words, answering questions, or doing math problems,” says Bellumori.
Exercise also alleviates other physical and emotional symptoms that plague Parkinson’s patients, such as disrupted sleep, mood swings and depression, listlessness, low energy and constipation, experts say.
The Parkinson Foundation already recommends a combination of exercises, and experts say patients shouldn’t wait until scientists come up with specific research-based details to start exercising. “There is already enough excellent evidence to suggest that this is a very good thing if you are a person with Parkinson’s,” says Tanner.
