Tuesday, October 4, 2022

Parkinson’s And Exercise Research

Epidemiological Studies Have Demonstrated The Benefits Of Exercise As It Relates To Pd Risk And Pd Severity

Parkinson’s Disease Exercises: LSVT BIG Movements

These findings are summarized in this paper and include:

  • Those in midlife who routinely engage in moderate to vigorous exercise have a lower risk of developing PD than those who dont
  • Cardiovascular fitness is associated with better cognitive and motor scores in those who have PD
  • Longevity in PD is associated with increased physical activity

Exercise To Change The Brain

A novel exercise modality to improve motor learning in PD

For someone with Parkinsons disease, the simple desire to grasp a glass of water can become an insurmountable task, made impossible by the tremors in their hand or arm. Finding strategies to improve these movement impairments is one of the major goals of rehabilitating people with Parkinsons disease.

At McGill University, Marc Roig, an assistant professor in the School of Physical and Occupational Therapy, is studying the effects of using high-intensity exercise to stimulate the brains ability to learn and change with repeated experiences.

Roig and his team are working with people who have Parkinsons disease, to see if they can improve their ability to move and to complete tasks like grabbing an object. The team is using high-intensity cardiovascular exercise to provoke changes in the brain that make it easier to train itself to relearn motor tasks.

One of the main problems with people with Parkinsons is they lose their ability to do very simple motor tasks, says Roig, a neuroscientist. We want to understand why this happens and try to find interventions to improve that.

After they exercise, the people enrolled in Roigs study will also have to complete a task involving the application of force in a computer game, to measure whether the exercise and the burst of brain chemicals it stimulates also improves their motor ability.

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Designing Clinical Trials For Exercise

Exercise trials present unique opportunities and challenges for investigators and subjects. From an individual subject standpoint, being involved in an exercise trial provides them with the chance to become more physically active, and develop a structured training plan with increased supervision and external motivation. The role of exercise in PD has attained great interest in both research and public forums . For investigators, this increased enthusiasm for exercise may translate into quicker subject recruitment and improved adherence to protocol. Moreover, these trials may be comparatively easy to initiate with less regulatory, intellectual property, and financial hurdles compared to trials investigating new pharmaceutical agents or medical devices. For all parties involved, these trials have lower safety concerns, with several studies demonstrating no or minimal morbidity in individuals with PD, as reviewed in Mak et al. . Lastly, the increased utility of ehealth technology lends itself nicely to designing new exercise trials, as will be expanded upon below.

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A Possible Boost For Quality Of Life

While SPARX3 focuses primarily on motor improvements, Feuerstein noted that exercise helps with other Parkinsons symptoms, including constipation mood disorders, such as apathy, anxiety and depression and sleep problems. Mitigating these symptoms can help to improve quality of life and encourage people to engage with others. All these factors work together to blunt the undeniable challenges of the disease.

I say to patients, We can think about this as a time for you to take a look at your life and figure out new, healthy ways to live, Feuerstein said.

Christiansen added that SPARX3 could give both patients and providers a roadmap for doing that, with something as simple and accessible as walking.

Its easy to tell someone to exercise, but what kind of exercise? The study could offer clinicians the ability to be more precise in their prescription of exercise and the intensity, he said. And once youre dialed in as a patient, you dont really need to go to a physician to tell you to exercise. People will have the ability to be more in charge of their own health.

What Parkinsons Symptoms Can Improve From Exercise

Balance Disorders Laboratory

Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.

Studies have shown that:

  • Engaging in any level of physical activity is beneficial for movement symptoms.
  • For people with mild to moderate PD, targeted exercises can address specific symptoms. For example: aerobic exercise improves fitness, walking exercises assist in gait, and resistance training strengthens muscles.
  • One study showed that twice-a-week tango dancing classes helped people with PD improve motor symptoms, balance and walking speed.
  • Exercise may also improve cognition, depression and fatigue. Research is ongoing in these areas.
  • People who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging.
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    Standard Protocol Approvals Registrations And Patient Consents

    Each PPMI participating site received approval from the local ethics committee before study initiation, and written informed consent was obtained from all participants before participation. Our study strictly adheres to the publication policy in the PPMI study, and we have obtained permission for publishing our research by the Data & Publication Committee of the PPMI study.

    Randomized Controlled Trials Of Exercise And Pd

    There have been many clinical trials, systematic reviews and meta-analyses of exercise as a symptomatic therapy for PD motor and NMS . Nevertheless, the variability in study design, exercise mode and regimen, participant selection, and outcome measurement tool used in the RCTs makes comparison between the studies difficult, and results in the inability to define exercise prescription i.e., the formulation , dose , route , frequency , and duration . While not intended to exhaustively cover all exercise RCTs in PD, this section summarizes some of the more recent and rigorous interventional study data, highlighting RCTs that addressed the important question of exercise prescription in their design. This section aims to lay the groundwork and underline the need for more rigorously designed exercise RCTs, as will be discussed in our final section Designing clinical trials for exercise.

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    Parkinsons Progression May Slow With Four Hours A Week Of Exercise Study Says

    For people with early-stage Parkinsons disease, four hours a week of moderate exercise may help slow the progression of the disease. Symptoms of Parkinsons, which is a movement disorder, generally start gradually but worsen over time.

    But research published in the journal Neurology found that those who were regularly active for at least that amount of time whether with traditional exercise or such physical activity as walking, gardening or dancing had less decline in balance and walking ability, were better able to maintain daily activities and did better on cognitive tests five years later than those who exercised less. The researchers noted that the key to achieving these benefits was maintaining regular exercise over time, rather than how active people had been when their disease started.

    Parkinsons, which is more common in men than women, usually begins about age 60 as nerve cells in the brain become weak or damaged. Symptoms may include trembling or shaking , muscle stiffness , slow movement and poor balance and coordination. As symptoms get worse, people may have trouble walking, talking or continuing to do routine daily activities.

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    How To Start Exercising If Youre Living With Parkinsons

    Safety is key. The first thing you need to do is talk with your neurologist and primary care doctor to make sure that the exercise regimen that you embark upon is safe for you.

    Next, ask for a referral for physical therapy. A physical therapist will be able to figure out what movement challenges you may have and design a program to help you improve. There are certain physical therapists with additional training in Parkinsons. Your physical therapist will work with you for your allotted sessions, and then can help you plan your ongoing exercise regimen that is tailored to you. You can contact the APDA National Rehabilitation Resource Center for Parkinsons Disease for help finding resources in your area.

    Additionally, physical therapy can help counteract the tendency for people with PD to reduce the size of their movements. The Lee Silverman Voice Technique has designed a program called LSVT-BIG which trains participants to make big movements. You can search for an LSVT-trained professional near you.

    Anyone starting out on an exercise program could benefit from APDAs Be Active & Beyond exercise guide which includes clear photos with simple instructions that are easy to follow, with exercises that address all levels of fitness.

    What Kind Of Exercise Can I Do If I Have Trouble Standing Or Walking

    Even with advanced Parkinsons symptoms, you can still reap the benefits of some activities. If you have trouble walking or balancing, hold a bar or rail to exercise and stretch. If standing or getting up is tough, exercise and stretch in a chair or bed. Physical exercise performed in a seated position, such as biking on a recumbent bike can allow you to exert yourself in a safe manner.

    Facial exercises may help combat difficulties speaking or swallowing:

    • Chew your food longer and more vigorously.
    • Exaggerate your face and lip movements when you speak.
    • Make faces in the mirror.
    • Sing or read out loud.

    Mental exercises give your brain a workout and can improve memory. For example:

    • Name as many animals as you can in 1 minute.
    • Play brain games and do puzzles.
    • Solve math problems in your head.

    You can also add activity in small bits throughout your day:

    • Park further away from stores so you walk longer distances.
    • Stretch or do leg exercises while watching TV.
    • Swing your arms more when you walk, and take long strides.
    • Take the stairs instead of the elevator.

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    How Do I Get Started

    Once you have checked with your doctor that Nordic walking is safe and suitable for you, you will need to buy a pair of walking poles. There are various makes to try, so ask others who walk for recommendations and check with specialist companies for advice on choosing suitable poles.

    As Nordic walking poles spend a considerable amount of time behind you, they have a strap which goes around your wrist so that the poles can be released behind you and then quickly held again when in front of you. When choosing poles make sure the grip is comfortable and the strap large enough for you to easily slip your hand in and out. The swing-weight is also an important factor, so dont get anything too heavy or too light you should be able to maintain the natural arm swing without too much vibration. Poles are generally quite slim and have an adjustable length. They usually have two different types of end spikes for gripping grass, mud or ice, or a paw to cover the spike when walking on tarmac or asphalt.

    The only other equipment you need is loose, comfortable clothing and a comfortable pair of shoes with good support under the heel and across the front of the foot. Sports shoes or boots designed for low level walking are usually well suited. You must be able to push off at the toes, so shoes should bend at the front and not on the arch of the foot.

    Cycling And Parkinsons: What We Know So Far

    Exercises For Parkinson

    While wed never say cycling helps everyone with Parkinsons or that it is an exercise you must do if you want to live well with Parkinsons, research studies have shown that many people have experienced significant benefits from pushing pedals on a regular basis. Depending upon pace and intensity, cycling has been shown to improve overall motor function, reduce tremor, reduce bradykinesia, reduce rigidity, improve aerobic capacity, improve mood, improve cognitive function, increase joy and social connection, and decrease UPDRS scores . Check out our timeline for the latest in Parkinsons cycling research, living well stories, and more.

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    Benefits Of Exercise For People With Parkinsons Disease

    Exercise has been shown to have several significant benefits for people with Parkinsons disease. These helpful effects seem to stem from two specific neurological changes that occur when you work out:

    • The release of a chemical called dopamine: This positively impacts your movement, mood, and sensation of pain.
    • Growth and change in the cortical striatum:This is an area of the brain that controls your voluntary movements.

    These two exercise-related changes can result in many concrete advantages for people with Parkinsons, including:

    • Improved balance
    • Reduced sleep disruptions

    Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s Disease

    Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:

    • Counsel you on how intense your exercises can be.
    • Recommend exercises appropriate for your individual health.
    • Refer you to a physical therapist to create a personal exercise program.
    • Warn about exercises to avoid based on your particular challenges or limitations.

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    Where Can I Find Support If I Have Parkinson’s Disease And Want To Exercise

    You can find exercise support in your community. For example, many gyms and community centers offer seated exercise classes for people who struggle with balance. Ask your healthcare provider for ideas if you have Parkinsons disease and want to exercise.

    A note from Cleveland Clinic

    Exercise is an important part of managing Parkinsons disease. Talk to your healthcare provider about your exercise program and choose activities you enjoy so you stay motivated to get up and move every day.

    Last reviewed by a Cleveland Clinic medical professional on 04/08/2021.

    References

    Exercise And The Rate Of Pd Motor And Non

    Exercise and Parkinsons Disease

    Exercise may also be disease-modifying in fully manifest PD as well as in prodromal and preclinical stages. Longitudinal cohort studies have demonstrated that exercise can be a predictor of slower progression of both motor and non-motor symptoms. In the population-based Parkinsons Environment and Gene study in central California, Paul et al. evaluated the association between physical activity and progression of both motor and non-motor symptoms in 244 subjects with early PD . They analyzed the subjects history of ever having participated in competitive sports and their overall physical activity level, in metabolic-equivalent hours per week , across 4 age periods of adulthood. Over 5.3 years of follow-up they observed that those with a history of competitive sports were less likely to suffer a 4-point decline on the Mini-Mental State Exam , or convert to stage 3 on the Hoehn and Yahr scale of motor disability . There was also a trend between higher MET-h/week and slower progression on MMSE and conversion to Hoehn and Yahr stage 3, with HR 0.71 , and 0.73 , respectively, .

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    How Can It Help In Parkinson’s

    Nordic walking can improve fitness in the same way that running does, but it is much kinder to the ankles, knees and hips as it has a much lower impact on the joints. This can be particularly attractive if you experience joint pain.

    Perhaps the most important advantage of Nordic walking if you have Parkinsons is that is allows you to maintain and develop your ability to walk well by:

    • enhancing balance and coordination
    • reducing slowness of movement
    • reducing freezingand gait problems
    • improving mobility and creating more fluid movements
    • correcting posture, particularly the stooped position associated with Parkinsons
    • reinforcing the alternating movements of the arms and legs which can be lost in Parkinsons and so improving stability
    • boosting independence and quality of life.

    Various studies 1,2 have shown that people with Parkinsons who participate in Nordic walking programmes have improved functional independence and quality of life. It seems that mood also improves.

    Once the basic steps have been learnt you can tailor your programme to suit how you feel at any particular time. Walking in a group also has social and psychological benefits.

    Carers and family members who walk with you may find that they too feel fitter and have fewer aches and pains.

    References

  • Nordic walking improves mobility in Parkinson’s disease – van Eijkeren FJ, Reijmers RS, Kleinveld MJ, Minten A, Bruggen JP, Bloem BR. Mov Disord. 2008 Nov 15 23:2239-43 – view abstract.
  • Davis Phinney And Kelsey Phinney Practice Vocal Exercises For Parkinson’s

    In this 23-minute episode of The Parkinson’s Podcast, Davis Phinney and his daughter and podcast host, Kelsey Phinney, practice and explain some vocal warmup exercises before Davis sings a few pop songs. Davis’s voice gets louder and clearer over the course of the session and is a good demonstration of the benefit of speech therapy and daily practice of speech exercises, including singing, for those with Parkinson’s.

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    Exercise Has Been Shown To Improve Specific Symptoms That Commonly Affect People With Parkinsons

    PD is associated with a long list of both motor and non-motor symptoms, many of which can be improved with exercise. In this paper, the authors review the evidence of the health benefits of exercise that can be particularly impactful on people with PD including:

    • Improved cognitive function
    • Stop or slow osteoporosis exercise improves bone strength, which means less of a chance that a PD-related fall will lead to a fracture
    • Improved motor performance exercise can improve strength, balance, posture and gait, among other measures of motor functioning
    • Improved drug efficacy exercise may increase levodopa absorption making medications more impactful

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