Exercise therapy for Parkinson's disease
Posted 25 August 2013 - 07:21 PM
by Bianca Nogrady
Researchers are exploring how exercise therapies - ranging from tango to tai chi - might help people with Parkinson's disease.
Argentine tango, tai chi and Pilates are activities you'd expect to find on offer in adult education classes, but emerging research shows these and other exercise therapies may also provide a range of benefits for people with Parkinson's disease.
Exercise therapy is emerging as a new and exciting area of treatment for Parkinson's, not only because it can lead to significant improvements in symptoms, but also because it has minimal side effects and comes with a whole lot of additional health benefits.
While it is still early days for research on exercise therapy, says Associate Professor Susan Fox, professor of neurology at the University of Toronto, the evidence is mounting.
"People are recognising that it's good that these patients are moving and exercising," says Fox. She says evidence suggests exercise can help improve some of the motor symptoms of Parkinson's – such as tremor or rigidity – in a similar way to adding in a new drug.
"You're getting equivalent benefit without the side effects, plus all the other added benefits of exercise," says Fox. "It's cheap, easy therapy."
The role of dopamine
Parkinson's disease currently affects around one in 350 Australians, and 1 per cent of people over the age of 60 will be diagnosed with the disease.
It's a degenerative neurological condition caused by the loss of cells that produce dopamine deep inside the brain. Dopamine is message-carrying chemical (or neurotransmitter) that is associated with movement. The loss of these cells, and the resulting depletion of dopamine, leads to a range of motor symptoms, including tremor, rigidity, slowed movement and gait difficulties.
In addition, people with Parkinson's experience other symptoms, such as depression, sleep problems, lethargy and sometimes dementia, not all of these symptoms seem to be related to dopamine depletion.
There is no cure for Parkinson's, but treatments can reduce the severity of symptoms. Most Parkinson's treatments have focused on trying to boost dopamine levels in the brain using medications. While these have been very effective in managing motor symptoms of the disease, they have significant side effects and their effectiveness reduces over time.
"[But] there's now some preclinical evidence that when patients move and exercise that it releases dopamine within the brain, so there's some biological evidence that it may actually have a positive symptomatic effect," Fox says.
What types of exercise
The big question is what kind of exercise is best.
At a recent Parkinson's disease conference in Sydney, researchers presented data on everything from tango to tai chi, and how these many and varied forms of exercise therapy can reduce symptoms of the disease.
Associate Professor Colleen Canning and colleagues recently presented at the conference on findings from a study that used exercise therapy to reduce the risk of falls in people with Parkinson's disease. Falls are a particular problem in Parkinson's disease, resulting from poor balance and symptoms such as 'freezing' – a sudden, temporary inability to move.
"The approach we took was to target three risk factors that exercise could potentially improve, that is, loss of muscle strength, poor balance and freezing of gait," says Canning, team leader for Parkinson's disease research in the Faculty of Health Sciences, University of Sydney.
The largely home-based exercise program consisted of just 40 to 60 minutes of exercises, including balance, stepping and strengthening exercises, three times a week for six months.
The program was particularly effective among people with less severe disease, leading to a 69 per cent reduction in the risk of falls.
"Our results suggest that this particular program has the potential to be quite an effective method of reducing falls in people with lower disease severity," says Canning. "This is an important finding because that's the group that often doesn't get offered exercise, because they don't have major motor difficulties early on."
Dance is one form of exercise attracting interest. A 2009 review concluded that dance appeared to meet many, if not all, of the recommended components for exercise programs specifically designed for people with Parkinson's disease.
"The benefits of dance include improved balance and gait function as well as improved quality of life," wrote the review's author. "Most studies of dance for PD have included primarily individuals with mild to moderate PD [and] while benefits can be obtained with a short, intensive dance intervention, longer interventions may prove to be more effective."
For example, Argentinian researchers found that a 'Dance Therapy Program' involving Argentine Tango did lead to improvements in some Parkinson's symptoms. Equally importantly, the discovery that their bodies were still able to tango gave many people with Parkinson's a valuable psychological boost, so the program had a high compliance rate.
Another approach combines exercise with music to help people with Parkinson's overcome issues such as freezing and shuffling.
The AmbuloSono system, developed by researchers from the University of Calgary, uses music as an incentive to encourage people with Parkinson's disease to not only take longer steps but to walk faster and further.
The system uses iPod motion sensors to measure stride length and distance walked, and ties to a music program that only switches on above a certain stride length. The device is housed in a pouch strapped above the knee and connected wirelessly to headphones.
"It uses music as a reward, so you have to walk larger steps in order to trigger the music to play and when your step size becomes smaller, the music stops," says AmbuloSono inventor Professor Bin Hu from the Hotchkiss Brain Institute, University of Calgary.
The results from a pilot study of 42 participants are promising. Researchers found that over nearly a year, participants stride length increased 10 to 30 per cent and their walking speed increased 10 to 20 per cent over long distances. Furthermore, participants of the study improved in other areas, showing a reduction in fear and anxiety associated with tasks such as using an escalator, and were less likely to avoid physical activity during periods of depression or apathy.
Fox says exercise therapy has been one of the fastest growing areas of Parkinson's research in the last 12 months, and the results are starting to trickle into clinical practice. While researchers are still exploring questions such as what types of exercise and when, Fox has no qualms about recommending it for her patients.
"I think at the moment, current clinical practice is that we just encourage it at all stages [of the disease] but it certainly would make sense for patients to be starting at a much much earlier stage," she says.
She encourages all her patients to do a minimum of 30 minutes each day, and it doesn't really matter what they do, as long as they do it.
"The important thing is to do it regularly so don't take up something brand new that you're going to do once and then abandon," says Fox. "I always say 'do what you enjoy doing and you'll continue to do it'."
Posted 25 August 2013 - 08:16 PM
Was thinking of trying ballroom dance to modern music with my of my girlfriends,,,that could be similar to tango right?
Posted 26 August 2013 - 06:34 PM
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Posted 26 August 2013 - 07:55 PM
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Posted 27 August 2013 - 02:10 PM
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Posted 28 August 2013 - 06:29 PM
Posted 28 August 2013 - 06:43 PM
I'm curious, since protein is so integral to building muscle, and protein is essentially the enemy of Sinemet absorption, how does it work that you can be something other than skinny fat?
I have been timing my protein for 2 hours between my doses and it isn't easy while working....but can't even fathom trying to build muscle with this amount of protein..but then its hard for me to think of holding much more than a 2lb weight at this point and I am scared to even try to squat or deadlift (can barely do my own body weight at this point)
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Posted 30 August 2013 - 05:22 PM
A friend of mine used to work out at a gym with a former Marine drill instructor, and kept in very good shape. He did time his meals/meds carefully, but said his daily workout improved his symptoms. But if weightlifting is a problem right now, perhaps a cardio workout, such as cycling might help? If it did improve PD symptoms, then weightlifting might be next. Maybe a stack machine instead of free weights, to start with.
Regarding fatigue, I'm certain that with MCV your physician has tested for ferritin levels, but I would double-check, it's often overlooked; it's not impossible to have ferritin deficiency with normal iron levels. Strangely, a subset of folks with PD have iron deficiency.
Posted 30 August 2013 - 06:51 PM
I do believe ferritin has been checked but I will look through my paperwork and check for sure.
I checked the recipe for Liquid Sinemet, and at this time of day and after a long week, my brain just cannot compute it yet, lol..I will look again when I'm more well rested and also ask my MDS..I am having medication issues at the time anyway (it was working and seeming to work less the past few days grrr) I want to find out how I can manipulate my meds for my symptoms but am sooo new to this (one month on Sunday) that I am nervous to change without asking her fist.
As always, thank you very much
Posted 05 September 2013 - 05:38 PM
I am currently taking siminet-4 pills a day. How do I know if protein is interfearing with absorbtion?
Also, in regards to exercize, I am trying yoga and Tai chi to help with my balance. I am not sure if, on those days when I am really exhausted, or just not having a good day, should I lay low, or push through and do my exercize class anyway? I am trying to be proactive and feel like I have at least a little control. LOL.
Thanks for the feedback.
Posted 06 September 2013 - 05:34 PM
Also, most people just starting out don't have a problem with Sinemet absorption, although a few people are very protein-sensitive right from the start. If you take the Sinemet with meals and PD symptoms go away, you are fine, regardless of protein. If you take the Sinemet with meals and the PD symptoms continue without letup, then protein is likely interfering with absorption; so, when the nausea goes away, take the Sinemet about 30 minutes before meals. It will be absorbed into the bloodstream well ahead of the protein in your meal.
Regarding exercise, if you are totally exhausted, it may not be a good idea to go to exercise class that day -- serious exhaustion could make matters worse. But if it's a milder fatigue, try going to class anyway -- sometimes the activity can improve the way you feel. Also, there is mounting evidence that exercise, especially vigorous exercise, can improve PD symptoms, possibly by causing additional dopamine release. So you are doing the right thing -- being proactive and taking control of your health. Keep up the good work, and let me know if you have other questions.
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