Did your doctor prescribe exercise?

Exercise needs to move from a recommendation to a prescription for people with Parkinson’s.”

Dr. Jay Alberts, Department of Biomedical Engineering, Cleveland Clinic

Today, Jay Alberts, PhD, was my guest on Sunday Mornings with Twitchy Women. If you are not yet familiar with his work, you should be if you are a Person with Parkinson’s.

Jay Alberts

At the Cleveland Clinic in Ohio, Vice Chair of Innovations within the Neurological Institute, Dr. Alberts holds the “Edward F. and Barbara A. Bell Family Endowed Chair,” and is a staff member within the Department of Biomedical Engineering. His research is focused on understanding the effects of neurological disease or injury on motor and cognitive function and developing disease-specific interventions to improve motor and cognitive performance. 

In 2003, on a group ride across Iowa for the annual RAGBRAI bicycle race from the Missouri River to the Mississippi River, Alberts noticed that the woman who was riding with him on a tandem bide, start showing improvement in some of her PD symptoms. That one little detail led to research on the effects of forced-exercise’s impacts on motor functioning.

The research

Since 2012, Alberts has been conducting clinical trials to compare the effects of forced exercise cycling on motor and non-motor performance compared to voluntary rate cycling and a non-exercise control group. In one trial, the results showed that an eight-week, high-intensity aerobic exercise program markedly enhances overall motor function, certain aspects of walking, and cognitive function in people with Parkinson’s.

Dr. Alberts and his colleague Dr. Anson Rosenfeldt looked at the effectiveness of Pedaling For Parkinson’s—an existing, low-cost community cycling class—and how participation in the class may slow Parkinson’s progression. Moving from the lab to “real life” is a big step toward increasing access to classes so even more people can live well with Parkinson’s.

With additional grants from the National Institutes of Health (NIH) Alberts and his colleagues have studied the impact of exercise on Parkinson’s building on data recorded in previous studies. The most recent grant from the NIH indicates that cycling may be an ideal mode of exercise for people with Parkinson’s because regardless of disease severity, individuals can achieve and maintain a moderate to high intensity of exercise. *

In light of this, Alberts recommends daily exercise, with at least 3 days a week of 30 minutes intense exercise. If you are riding a stationary bicycle, he recommends getting your cadence up to 75-80 and gradually increase the resistance to get your heart rate up to 60-80% of your target heart rate.

Currently, Alberts is doing research on PwP’s using a Peloton Bike. If you are interested in participating, contact Liz at the Cleveland Clinic. Previous experience with a Peloton bike is not necessary.

Current study using Peloton Bikes
Peleton Study

With all of this evidence, you would think that exercise would be recommended from the day a person receives their diagnosis. It should be a no brainer, right? Unfortunately, many doctors do not even discuss exercise with their patients. Many of them may not even be aware of this research.

We need your help

What can you do to make sure that newly diagnosed PwP’s, and us veteran PwP’s too, know that exercise is essential?

  • Talk to your doctor, physical therapist and other care providers about Exercise as Medicine.
  • If you go to a Movement Disorders Clinic, speak to the head of the clinic about the importance of Exercise as Medicine and ask them to share it with everyone in the clinic. Better yet, ask if you can talk to the group about how exercise helps you every day to live better with PD.
  • Read Jay Albert’s articles on the Davis Phinney Foundation website.
  • Check out other Parkinson’s organizations for their recommendations and literature on exercise for PD.**
  • Take copies of these articles and brochures from the organizations about exercise for PD to your doctor, clinic, etc. and ask them to read them and distribute them to their patients. Especially the newly diagnosed.
  • Find out what your medical insurance covers for exercise. If they do not provide any coverage, send them the same information.
  • Finally, offer to talk to newly diagnosed patients about how exercise has helped you live better with Parkinson’s.

No one knows better than those of us living with PD about the benefits of exercise on our quality of life. So please spread the word.

Do you ride a Peloton? Join our FaceBook group Parkies with Pelotons

*A Timeline of Jay Alberts Parkinson’s Research, Davis Phinney Foundation

**Check out these websites for more information on Exercise and PD.

Parkinson’s Foundation

Michael J Fox Foundation

Davis Phinney Foundation

Brian Grant Foundation

Exercise, Exercise, Exercise

Exercise is your medicine!  Do it EVERYDAY

[re+active] physical therapy and wellness

By now, you know that I am a big fan of exercise.  It has been a daily part of my life since I was young.  Since my diagnosis with Parkinson’s, it has become not just something I enjoy, but something that I must do to keep on moving.  I am sure that many of you feel that way as well.  But for those of you who have never embarked on an exercise program, you need to speak to your Movement Disorders Specialist about how to begin.  You may think that you cannot exercise because of limited movement or pain caused by PD.  That was the prevailing theory 50 years ago.  Today,  however, we know that lack of exercise only makes things worse.  You know the old adage:  use it or lose it.

Scientists, such as Dr. Jay Alberts from the Cleveland Clinic Lerner Research Institute, have shown the benefits of forced exercise on PD.  As a result, many physical therapists and trainers work with PD patients to improve motor function using forced exercise.

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We have been told that Neuroplasticity is crucial to either change or delay the progression of PD.  And exercise is one of those activities that allows the brain to change. Exercise enables more of the dopamine in the brain to be used.  It is important to exercise outside of your comfort zone.  It increases blood flow to the brain and allows the neuroplasticity to occur.  Goal directed exercise allows for these changes in the brain to occur.  It improves the circuitry and improves the connection of the basal ganglia to the cortex.

Physical therapist, Allie Southam, from [re+active] physical therapy & wellness explained all of this in a fascinating talk last Sunday.  Briefly:

  • #1 reason for exercise:  potential to slow the progression of PD through neuroplasticiy
  • Find exercise that you love – otherwise you won’t do it
  • Goal-directed motor skill training through acquisition of skills
  • Learning a skill is hard, practice drives skill aquisition
  • Getting feedback during exercise – allows us to challenge ourselves
    and make ourselves aware ofour movements.  What used to be automatic now requires us to think about what we are doing.  It is also motivational

You can read a summary of her talk here.

Exercise for PD Handout

Tom McLaughlin, a personal trainer whose wife, Linda, has PD, has been working on a training program to improve PD symptoms.   He says that the brain is a learning machine.  Because of dopamine depletion, we have cut off the connection between the brain and our muscles.  The brain doesn’t know the connection is gone, so you have to go back and have your cognitive brain focus on motor function and motor skills.  You have to overcome the “defect” in the brain through exercise.

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Tom’s exercise program tries to activate all of the muscles, and challenge them, in order to improve neuroplasticity in the brain.  There are 16 steps to his program with the goal to work on 8 muscular functions on the top half of the body and 8 on the bottom. Those steps include working with each muscle group to move out to the side, the middle, forward and back, and to the 4 corners.   Focusing on these 16 steps will help the brain reconnect with the body to return to more normal function.

Both Allie and Tom stressed the words Focus and Learning.  To improve your PD symptoms, you must focus on your movements to make them become automatic again, and you must learn new skills to increase the neuroplasticity in your brain.

 

Some related articles:

Study: Biking Restores Brain Connectivity in Parkinson’s

Brain Connectivity