Parkinson's disease patients and researchers seek exercise 'prescription'

Parkinson’s disease patients and researchers seek exercise ‘prescription’


Retired running coach Bob Sevene, 79, struggled after being diagnosed with Parkinson’s disease in 2019. The long-time runner suddenly started leaning to the right and was unable to straighten up . He started wearing a back brace and using a walker.

A year ago, Sevene began twice-weekly exercise classes designed for patients with Parkinson’s disease, which include bouts of high-intensity non-contact boxing. He also began daily 25-minute speed sessions on a stationary bike and performed brief sprints in the hallway outside his apartment.

Today he is standing and has given up the back brace and the walker. “My doctors did strength, balance and gait tests, and everything improved,” he says. “They decided not to increase my medication. I am convinced that exercise is the reason.

That wouldn’t surprise Parkinson’s disease experts who point to a long-standing and growing body of evidence that supports the positive impact of exercise on the disease. In a new wave of research, scientists are now investigating which exercises at which intensity level provide the greatest gains. The goal is to design an exercise prescription – which will likely include a mixture of high-intensity aerobics and balance, strengthening and stretching exercises – that delay the onset of disease or, ideally, completely prevent it. They also want to better understand the effects of exercise on the brain of someone with Parkinson’s disease, as well as its effects on non-motor functions such as mood and cognition. Granted, exercise can’t cure Parkinson’s disease – there’s 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 patients with Parkinson’s,” says Giselle Petzinger, an associate professor of neurology at the University of Southern California’s Keck School of Medicine and an early proponent of the exercise. exercise for Parkinson’s disease. “What we’re trying to do now is further refine what we already know into practical applications for patients.”

Caroline Tanner, professor of neurology at the Weill Institute for Neurosciences at the University of California, San Francisco, predicted in a recent study that new cases of Parkinson’s could drop by almost half by 2030 if all undiagnosed adults regularly pushed to 80% of their physical capacity. activity capacity. “It could have incredible public health consequences,” says Tanner.

Parkinson’s disease results from the death of key neurons in the substantia nigra region of the brain that produce dopamine, a chemical messenger. Over time, the loss of these nerve cells impairs movement and diminishes cognition; it can also cause slurred speech and depression. Outward signs may include tremors, muscle rigidity, slowness of movement, poor posture and balance, and the inability to perform unconscious actions, such as blinking, smiling, or swinging the arms while walking .

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Scientists consider it a disease of aging because most patients are over 60 when diagnosed, although a small percentage occurs in those under 50. Nearly one million Americans live with Parkinson’s disease 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 primary of these treatments, say it can help at any stage of the disease.

“Usually when someone 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 in which Sevene participates. “Our objective is also improvement but, at the very least, maintenance. Because Parkinson’s disease is progressive, if you can maintain physical and cognitive function, that’s actually an improvement.

Ryan Cotton, interim president and CEO of Rock Steady Boxing, an international boxing program for people with Parkinson’s disease, says he’s seen the value in intense workouts and cites several studies from recent years. that show the positive impact of boxing. The program is designed specifically for Parkinson’s disease.

“A boxer trying to be defensive would be hunched over, but Parkinson’s disease itself puts you in that position,” Cotton says. “We want you to have your chin up and big. Parkinson’s disease is a solitary disease, and many people don’t go out socially. But when you put on those gloves and start punching the bag, that apprehension disappears and a swaggering “I’m kind of a badass” takes its place.

He describes the impact on a retired military officer who started boxing six years ago. Dependent on a walker, the man showed up early for class so he had time to hide the walker before anyone could see it. “He took all his frustrations out on the bag,” Cotton recalled. “Six months later, he was walking on his own and then ran a half marathon. Today, anyone seeing him on the street wouldn’t even notice he has Parkinson’s disease.

laugh and fight

S. Elizabeth Zauber, associate professor of clinical neurology at Indiana University School of Medicine, says boxing sessions also contribute to a sense of community by creating “a support group that is not really a support group. Zauber, who sits on Rock Steady’s board and medical advisory committee, said: “It’s ‘Hey, let’s laugh at Parkinson’s and fight back.’ … It’s empowering when you see your symptoms improving, and it leads to more confidence.

Daniel M. Corcos, a professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine, is leading a multisite clinical study among people with early-onset Parkinson’s disease, that is, people diagnosed with it. less than three years ago and who are not yet taking medication. , comparing two exercise levels.

The trial, which is recruiting participants, will study two groups. Members of one group will walk on a treadmill at a speed of 60-65% of their maximum heart rate, while the second will work at 80-85% capacity. Maximum heart rate – the maximum rate at which an individual’s heart beats – varies from person to person and depends on age. Young people generally have a higher capacity.

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Researchers will determine each participant’s peak rate through testing, then calculate that individual’s walking speed for their assigned ability – either 60-65% or 80-85%. Participants will wear heart rate monitors and walk for 30 minutes, four times a week, for two years.

Previous studies have confirmed the safety and feasibility of both routines and have anecdotally suggested that higher intensity walks produce more benefit.

Jay Alberts, a neuroscientist and vice president of innovations at the Cleveland Clinic Neurological Institute, has studied the effects of cycling on Parkinson’s disease for nearly 20 years. His interest began in 2003 while on a multi-day group bike ride through Iowa. After riding a tandem bicycle with a patient with Parkinson’s disease for several days, he noticed a dramatic improvement in her handwriting when she signed a greeting card.

“It was a real ‘aha’ moment,” Alberts says. “It made me think maybe something was changing in the brain.”

Scientists still don’t know exactly what it is, but have some ideas suggesting there are likely multiple mechanisms at work.

Alberts thinks exercise increases neurotrophic factors, small molecules, usually proteins, that promote brain cell growth and survival. “They don’t produce dopamine, but they can reduce the effects of anything that causes dopamine loss,” he says.

The higher the exercise intensity, the higher the levels of neurotrophic factors, adds Alberts. However, “although high intensity may be optimal, whatever intensity someone can achieve is better than zero intensity,” he says.

A recent study in mice also revealed that irisin, a hormone secreted into the blood during endurance exercise, reduces levels of alpha-synuclein, a protein abundant in the brain that has been linked to the development of Parkinson’s disease.

Tanner thinks that exercise could also help reduce chronic inflammation, which occurs when the immune system activates a never-ending inflammatory response often a hallmark of neurological disorders, she says.

And a recent study that Alberts co-authored with patients with Parkinson’s disease, for example, found that high-intensity aerobic exercise improved their processing ability.

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In the study, 50 patients with Parkinson’s disease cycled at high intensity on stationary bikes three times a week for eight weeks. The researchers measured their ability to respond to a timed task before starting the exercise program and then again after it ended. Collectively, the participants showed faster reaction times compared to their previous performance, indicating that “exercise improves cognitive function,” says Alberts. Such an improvement “could help with the performance of activities of daily living,” he adds.

POP, the program from Monterey, Calif., includes mental exercises alongside physical exercises to keep participants sharp. “As the members hit the bags, we cognitively challenge them by spelling words, answering questions, or doing math problems,” Bellumori explains.

According to experts, exercise also alleviates other physical and emotional symptoms that plague patients with Parkinson’s disease, such as sleep disturbances, mood swings and depression, listlessness, lack of energy and constipation.

The Parkinson’s Foundation already recommends a combination of workouts, and experts say patients shouldn’t wait for scientists to come up with research-based specifics to start exercising. “There’s already enough excellent evidence to suggest that this is a very good thing to do if you’re someone with Parkinson’s disease,” says Tanner.

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