Do all exercises help with the Parkinson’s progression?

[Hugh McCrackin]

Hi,

I walk/stair climb, do yoga, and occasionally strength train and even a little martial arts forms practice. For me yoga helps with posture, flexibility and balance while higher intensity exercises (when I can manage) help with strength and cardio fitness. I think anything that keeps you moving helps.

Regards

[David Blacker]

Thanks for opening this discussion Mary. This is an interesting and important question, and I plan to devote the remainder of my career to working this out, with research in collaboration with my neurology and sports science colleagues.

Presently, we don’t really have enough data to be sure about the best approach and how to adapt the best exercise program to different stages of PD. There are now three small published phase 2 trials of high intensity exercise suggesting that PD progression may be slowed. These utilised treadmills, stationary cycles and brisk walking programs, all aiming for 3 one hour sessions per week for up to half a year, and built up to achieve “high intensity” usually defined as heart rate > 80% predicted maximum.

These studies, and animal models of PD and stroke have suggested that at high levels of exercise, increase cerebral blood flow triggering release of stem cells and other factors like brain derived neurotropic factor (BDNF) that enhance neuroplasticity and repair. Some functional brain imaging studies of PD patients doing exercise (off medication) have shown activation of dopamine sensitive motor circuits which look just like the pattern when taking medications.

There are of course benefits in muscle strength and cardiovascular fitness as well.

My feeling is that for PD, the most effective exercise to slow progression is to gradually build up cardiovascular fitness and strength (carefully avoiding injury)  to a point where high intensity interval training (HIIT) can be performed ; that is short bursts of near maximal effort, alternating with rest. This is the level that is likely to produce those beneficial effects; and I can tell you from personal experience there can be a “glow” that you feel after such exercise for several hours that almost makes you forget you have PD!

My team team has  recently shown in a group of 10 early stage PD patients (mean age of 60), that it is indeed possible, and safe to do such high levels of exercise. Our study, Feasibility of Instituting Graduated High Intensity Training (FIGHT-PD) used non-contact boxing training as the key exercise. I developed it with a former Australian boxing champion and now fitness trainer in collaboration with sports scientists. Not only does this training provide an excellent cardiovascular workout, it builds strength and balance, and the moves required to do boxing seem well suited to counter the problems of PD,

We hope to have this published soon, and to use the information to do further larger trials to help answer key questions about optimal exercise regimes and how to adapt through the course of PD. We also plan to try to expand our program to help more people.

There are other important things we should do as well, such as stretching, flexibility and balance- I think yoga is great.

We also have to make exercise fun, and something people are interested in.

The tough thing is, how do we exercise when we have apathy, bad days, injury or advanced disease. There is an interesting line of experimental research looking at taking bloods from exercising rats and giving it to sedentary animals, who gain benefit. This may be a way to help advanced stage PD patients.

I have found working with exercise physiologists to be extremely valuable; they are the experts in this field. Ideally, the combination of an exercise physiologist and a neurophsyiotherapist experienced in PD seems to be the best approach.

I think a great incentive for exercise is to keep PD controlled, whilst we all eagerly await other advances in treatments that may slow the condition.

Merry Christmas

David Blacker

Neurologist with PD

[Andrew L.]

That was great information David, thank you. I am 4 years into PD (65 in a few weeks), a retired physician (anesthesiologist) and have become somewhat of an exercise junkie since I got this diagnosis (actually has always loved exercise, now I have an excuse). I have also experienced that “glow” you  talked about usually after 90 minutes of (outdoor) cycling or running (after a few miles) on the beach. The glow lasts as long as I continue exercising past that point and if I am lucky for a few hours after I am done. At these times I have also felt like I no longer have PD and I feel euphoric (too put it mildly). Unfortunately these big workouts take a heavy toll on my body; in particular I get severe lower back and hip pain when I do this much. Of course I utilize ice, advil, stretching etc. so as not to be crippled. I also like to do Rock Steady boxing a few times per week (big here in Florida for PD), indoor cycling, treadmill, strength training, and pickleball. Plus light yoga 3x per week. I am a lifetime tennis player, but now only rarely as it seems to bother my back (as does pickle ball truth be told).  Often wonder  what is old age pain vs. PD pain.  My neruro PT told me to keep pushing through the pain (she suggested ice baths) while my neurologist/ movement disorder doc thinks I do too much and should back off (which lately my body is forcing me to do anyway).  I would also like to add that when I am on the reclining lifecycle indoors I often do cognitive puzzles, and after an hour of this  I find my cognition improving. Anyway thanks for the exercise physiologist idea, will look into that next. Cheers!  Andrew L.

[Andy C]

I have just bought a treadmill and I do 30 mins morning and afternoon albeit on the lowest program which I will do for 14 days and then move up a level. I use it 6 days a week. And I do feel better for it for about 2-3 hrs and the my midday meds kick in and I am like a complete cripple until I have taken my 2pm and 4pm meds all med times contain either 1/2 – 2 levadopa cardidopa 250mg/25mg tablets. I mentioned to my MS Neuro and he said give more time from couch spud to inspired movement beginner. I also do four low impact strecth and flex programs from fitbit for an hour in morning before riding. For once I am glad of my rotten sleep (max 2 cycles a night even with 2*2mg Clonazepam and 2 Quetiapine tablets.so now instead of ghosting the apartment or watching the TV I stretch and exercise. My wife is buying me an elliptical bike for Christmas so I will replace one treadmill session with a bike experience.   I do get sort of a glow and definitely a sense of achievement which is always helps lift spirits. I am 52 diagnosed when I was mid 30’s and now stage 4 and want to see if I can get back to stage one motor skills, as for non-motor they just suck but such is a YOPD life. Sorry if I ramble, I tend to lose track of what I have dictated and Microsoft does the rest. Take care and keep moving forward Fellow PD Warriors – Andy

[Bari]

It’s true that the latest trends in delaying the progression of PD includes cardio with a focus on intensity. I think anything that slows the advancing beast is useful. But if you’re looking for what will serve you best for the long haul, you need to devote more than half of your exercise time to movements and stretches that have their roots in yoga. Parkinson’s is a progressive disease that we can’t Spin Class our way out of. But we can learn how to use the healing power that exists within all of us, and the practice of yoga is one way to do that.

Yoga first teaches us how to maximize breathing – so important for bringing fresh, healing oxygen to tired or injured muscles. You’ll learn how to stretch your muscles in new ways. It will be hard if you’ve never done yoga-based stretching before. “Hard” in the sense that many will become impatient for instant results and slow to realize how the mind and body are beginning to connect. But once you’ve gotten the hang of breathing – when to inhale and when to exhale – and you start applying it to your movements and stretches, you may be astonished by how much deeper you’re able to sink into poses and stretches, and how good it feels. Yoga-based excercise, tai chi, even some martial arts training force you to clear your mind of all thoughts except your breath and whatever muscle(s) you’re focused on. This focus of mind will enable you to block out or at least minimize any pain you may have to deal with as time goes on. (Think: Lamaze Childbirth)

And what will yoga do for your body? It will tone your muscles, improve your balance, and keep your joints LIMBER. All this will help to prevent falls. And when you DO fall (impossible to avoid as one progresses) or just strain a muscle, your first-hand knowledge of stretches will help prevent your uninjured joints and muscles from going into spasm. (That is the way of injuries; when one muscle in the back is damaged it tightens up. To compensate, the brain tells the opposing muscles in the back to mount a counter-tightening in order to achieve balance, and before you know it, your whole back is a jumble of knots.) Also, if your joints have been kept limber there’s less likelyhood of torn tissue and ligaments should you fall.

I started integrating yoga into my life when I was in college (Are you counting? That would be 1969-1973!) As a teacher of elementary-age kids I was busy and on my feet all day. My classroom was on the second floor, which meant many trips up and down the double flight of stairs each day. After that, my own children had activities that needed my attention. I never worked out at a gym, but considered myself to be in better-than-average shape. Before going to bed I did a few sit-ups, leg-lifts and arm circles, and spent maybe 10 minutes stretching.

It wouldn’t be until I was diagnosed with PD that I would develop a longer exercise program that had its roots in yoga. I cleared out an unused bedroom, installed a ballet barre (a stair rail from Home Depot), and lined up 4 mirors on a wall. My yoga mat and an exercise ball were placed in the middle of the room, and a small TV/DVD player and a CD player were placed on a shelf. A Rebounder (mini-trampoline) provided fun aerobics, the DVDs taught me how to breathe. move, and stretch in proper form, and the CDs provided relaxation guidance after each session.

Other types of exercise that have helped me: Because I have good insurance coverage, I usually sign up for 6 weeks of PT at least every other year. I think that everyone entering the middle stages of PD should go through the LSVT BIG program at least once. Twice would be even better! I hear that lots of Parkies like the Boxing and Dancing for PD programs.

Research seems to support the contention that cardio exercise & high intensity workouts slow Parkinson’s advance, which I have no reason to question. But you can’t take a gym home with you. Make sure you spend time learning techniques that you can put into action immediately after a fall or any injury. Teach your mind NOW how to deal with the pains that will come later.

PS – I am 70 yrs old and have had Parkinson’s since I was 47.

[Dave Green]

Mary Beth, thanks for starting this thread. David, I’m sorry that you have come to deal with Parkinson’s Disease. But the rest of us need people with your background. I believe in exercise as a foundation for dealing with this disease. I was diagnosed a decade ago after several years of denial. In those days, at seminars and workshops, we would be told, “exercise is important, and the best exercise is one that you will do.” I found that very patronizing. Today there seems to be some sensible advice more readily available, mindful that we are all different. Currently, I anchor my weekly exercise with a long slow jog (7 miles) and a second, slightly less slow jog done high-intensity interval training style (2 miles). I let my Garmin keep track of my intensity minutes. In between those two days, I use my rowing machine or my stationary bike. I’m putting yoga back into my daily routine, especially a few minutes before bed. Once a week, I do a Zoom hip-hop class for Parkinson’s; it keeps me humble (and is good for balance). I’ve probably skimped most on the weight training—my New Year’s resolution is to rectify that. Does all this help? I can’t say. However, Parkinson’s seems to weigh less on me than on many people, and it makes me feel better.

[David Blacker]

Bart’s description of yoga for PD is brilliant – I agree completely with his comments.

What I didn’t mention in my earlier piece focused on high intensity training is the fact that I alternate high intensity  days with yoga days. My wife is training  ax a yoga instructor, and we are developing a specific PD targeted program.

Yoga breathing has many applications to PD; balance poses should be helpful, and long, deep stretched as done in Yin yoga might help with rigidity and relieve muscular soreness following high intensity exercise.

i think a mixture of home based ( eg Zoom) and gymnasium based training is optimal.

In our FIGHT-PD study the group camaraderie was a huge factor – 8/10 have continued boxing training with me and Rai, the former boxer. It has almost become a support group (including for me!)

 

Happy New Year

 

[David Blacker]

Thanks Dave – I feel obliged to share my experience, particularly to encourage my neurology colleagues to provide the best possible care, I agree with your sentiment about the insulting comments about exercise prescription

There needs to be much greater precision about exercise prescription – and i think neurologists are not the best people to provide this; I mentioned before the expertise of exercise physiologists who understand how to construct and monitor exercise programs ; I think they are crucial.

Last year, the Parkinson’s Foundation (US) produced a very helpful table summarizing recommended forms of exercise along with duration and intensity.

In my private practice I work through they table and consider the individual patients stage of disease, interests, fitness, cardiovascular and musculoskeletal issues and available time to develop an individual exercise program

happy new year !

 

 

 

[Bari]

Ummm, David Blacker … was your message to “Bart” referring to me, Bari. Just wanted to let you know that I’m a “she,” not a “he.” (tee-hee)

[David Blacker]

So sorry Bari – predictive text and early hours of morning a bad combination

I also find the calmness of yoga very soothing