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Post of the Week: Physical Inactivity and Parkinson's Disease


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#1 Dr. Okun

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Posted 29 May 2011 - 03:23 PM

Dear forum members,

At the NPF Center of Excellence in the Netherlands they recently reported on the importance of physical activity to Parkinson's disease. Here is an abstract of their findings....time to get exercising!


J Neurol. 2011 May 26. [Epub ahead of print]
Physical inactivity in Parkinson's disease.
van Nimwegen M, Speelman AD, Hofman-van Rossum EJ, Overeem S, Deeg DJ, Borm GF, van der Horst MH, Bloem BR, Munneke M.
Source
Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Abstract
Patients with Parkinson's disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10-44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R (2) = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#2 jb49

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Posted 29 May 2011 - 10:26 PM

Dr Okun,

I'm 53 and as a carpenter there is an obvious relationship between me working harder, getting tireder and feeling less Parkyer. (parkyer meaning "one who has Parkinson symptoms"). Somedays it is hard to get started but I do try. On the flip side, if on a cold winter day and I don't get started, sit around and veg out and pig out, my muscles, not my abs though, tighten up. Worse yet though is the nagging thought of you should be doing something usefull, which leads me to Stress Street and then I am feeling more Parkyer again.

And as for the Ali story that Kathrynne posted the link for, that was a great connection. I wouldn't be shy about dropping that into any conversation. Far out man!

Jb
Don't be hard on yourself, try your best and be strong!

#3 FredericB

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Posted 30 May 2011 - 02:37 AM

Exercise is getting more and more attention for parkinsons, and quantified studies on its benefits are growing.

Within recent Doctor Lisa M. Shulman's presentation of her own study on the subject at a Parkinson's Foundation seminar http://www.pdf.org/p...511_shulman.pdf (PDF file accessible without registration), there's this interesting summary at slides #40-43 that exercise has symptomatic effects of the same order than agonist drugs (e.g. pramipexole) and is only surpassed by the higher doses of levodopa.

Next studies that we are eagerly waiting for is assessment of the disease modifying impact of exercise (with even a potential to measure actual regression of the disease if we end up discovering that brain plasticity is much more extensive than we once thought).

So exercise is a no brainer: any PWP should incorporate exercise (that they enjoy) in their regimen.

Edited by FredericB, 30 May 2011 - 11:45 AM.


#4 shakti

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Posted 30 May 2011 - 09:14 AM

Dear forum members,

At the NPF Center of Excellence in the Netherlands they recently reported on the importance of physical activity to Parkinson's disease. Here is an abstract of their findings....time to get exercising!


J Neurol. 2011 May 26. [Epub ahead of print]
Physical inactivity in Parkinson's disease.
van Nimwegen M, Speelman AD, Hofman-van Rossum EJ, Overeem S, Deeg DJ, Borm GF, van der Horst MH, Bloem BR, Munneke M.
Source
Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Abstract
Patients with Parkinson's disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10-44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R (2) = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD.

because of parkinsons and being over 70 years old, i find it difficult to dicipline myself to a regular workout . sometimes i wake up after a difficult night of nightmares, or twisting and turning, stiffness of the joints, and i am tired and not inspired to move much. so, i try to trick myself into exercise. i go once a week to a parkinson dance therapy class, which is wonderful for me physically and emotionallly. i try to do a qiqong form, for 15 twenty minutes, before i go to bed at night. this is great for me. i''m told that it gathers doparmine. i sleep better if i do this, plus, i the next day , i have more energy. i wish i was more disciplined. i walk a bit, but surely not enough. i need to find a walk friend. i know that when i am in conversation with someone, while i walk, i can walk forever and not feel the tiredness , till later on. well, any help with hints to help my lack of discipline. i do need to walk. my feet swell in the summer if i just sit in front of the computer too long, or sit and do sudoco too long. thank you.

#5 Dr. Okun

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Posted 30 May 2011 - 11:16 AM

Try to have your doc look into treating your sleep disorder and perhaps even getting a sleep study. Exercise and everything in your waking day will be better once you get a good nights sleep!

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#6 StrkL

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Posted 12 June 2011 - 05:19 PM

I've found that if I don't exercise for three days, my medications don't work nearly as well. As it is, I'm taking six sinemet, three COMTAN, one azilect, and three Mirapex daily. I shudder to think what I'd need if I didn't exercise.

I was a runner for forty years before I was diagnosed, and am starting to get back into it. Several years before my diagnosis, I was exercising about thirty minutes a day, three days a week. Now I do at least forty minutes a day, every day. Days that I walk I go about three miles in the forty minutes. I've found that the more I exercise (subject to the caveat that I don't exhaust myself, and increase exercise duration and intensity gradually) the better I feel and the better my symptoms are controlled.

As always, one should note that what works for me won't necessarily work for others, and that people not accustomed to regular exercise should increase gradually. But for me, exercise - particularly strenuous exercise - has almost miraculous effects.
StrkL

#7 Dr. Okun

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Posted 13 June 2011 - 07:38 AM

Thanks for the post.

There is some really interesting research showing that there are chemicals in the brain released when you exercise that may be beneficial to diseases like PD.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#8 sensesoap

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Posted 12 July 2011 - 11:20 PM

Thanks for the post.

#9 Dr. Okun

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Posted 13 July 2011 - 06:22 AM

Thanks to you.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#10 howietx

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Posted 29 October 2011 - 07:16 PM

Exercise has helped me with my PD symptoms. I am 70 and walk for at least an hour five times a week. I use a health club when the weather is bad and walk on a treadmill. It's amazing how much better I feel. Also I use a exercise ball for stretching and sit-ups. Exercise can really be boring, so I listen to music on my I pod and the time goes by faster. I read an article about walking and PD and the author stressed tat we would force ourselves to take large steps to help limit the effects of the pd gait.

Good luck

#11 Dr. Okun

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Posted 30 October 2011 - 08:02 AM

Thanks for the comment.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#12 phaedrus

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Posted 30 October 2011 - 03:57 PM

I posted this in the Young Onset forum, but it seems highly relevant here - I guess this is what Dr. Okun is referring to about exercise releasing chemicals in the brain that are beneficial for PD - neurotrophic factors (NF), which are neuro-protective and neuro-restorative, have been trailed in various PD studies (usually injected directly into the brain, but Cogane is currently being trialed as a way of inducing the NF via a tablet). Well it seems exercise also increases NF in the brain:

http://www.pdf-archi...ffect-in-pd.pdf

The anecdotal evidence of people feeling much better after exercise, and the growing understanding of the theories behind why this may be, have convinced me! Keep on moving!....

#13 davebtwo

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Posted 01 November 2011 - 12:45 PM

We've all heard about the importance of exercising and being active. Frankly, I frustrated hearing about it because I have not seen any guidelines on the type, duration and stressfulness (e.g. Heart rate) that is needed. Do I have to go to the gym daily and work out? I love to fly fish. If I go once a week in the mountains and hike to the stream and then hike up and down the stream for a couple hours, is that enough? The neuropsychologist that I see at UCSF stressed the importance of an exercise program and indicated that in her experience those who participated in a program seemed to progress more slowly, at least on a symptomatic basis. But, there was no guidance on what such an exercise program should consist of.

My wife is a BSRN and recently took a class on Parkinson's.(That's not very lucky, wife's that are RNs don't have much sympathy)LOL. A part of that class dealt with exercise. In that program it was recommended that people with Parkinson's needed to do things like ride a stationary bike, at 80 to 90 revolutions per minute for 45 min. a day. Now, guess what I hear from my wife.

I read some of the notes, especially the one from the Carpenter. I would think that a Carpenter gets a lot of exercise during his workweek. He gets a lot more than I do in my sedentary office job. Does he need to do more than what he gets in his job? He talked about vegetating at times. We all need down time. Are we not allowed to do that?

I, like most people, are very busy between our occupations, social activities and family. I leave for work about 6 AM and don't get home until 6:30 to 7 PM. I want to be reasonable and exercise reasonably. Do I go to the gym and did not get home until six 7:30 PM or 8 PM? Without these answers it's hard to determine how to prioritize.

I don't know where to turn for these answers. Maybe there are no answers?

Sorry about the tone of this, but it is really quite frustrating to me.

#14 Dr. Okun

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Posted 05 November 2011 - 07:28 AM

We are hoping research will bring us answers soon on type, duration, and frequency of exercise. At this point everyone is just guessing.

Personally, I think we must also consider the many general health benefits of exercising and we should try to get a consistent program (daily or every other day), and patients should safely try to get their heart rates up, and sweat!! Also, PD patients need to be careful not to exercise alone and to guard against falls and injury.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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