Lifestyle effects on PD

In a nutshell: Exercise helps to keep your mitochondria working, and that helps to slow down the loss of your dopaminergic neurons. Here we have an application of the old rat race to a rat model of PD – in which treadmill exercise helped to keep mitochondria functioning properly, while sedentary rats lost dopaminergic cells.

Physical exercise protects against mitochondria alterations in the 6-hidroxydopamine rat model of Parkinson’s disease

These “results suggest a neuroprotective and progressive effect of intermittent treadmill exercise, which could be related to its benefits on mitochondrial biogenesis signaling and respiratory chain modulation of the dopaminergic system in PD.”

But other studies and reviews have shown other factors that affect the progression of PD, so don’t put all of your metaphorical eggs in one basket – a review that covers some of those various factors:

Narrative Review of Lifestyle Factors Associated with Parkinson’s Disease Risk and Progression

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A review of non-traditional treatments for PD

Exercise is generally accepted as beneficial for the alleviation of Parkinson’s Disease (PD) symptoms. The Clinical Neurologist International has just published an open-access article that reviews the most recent research with a focus on types of exercise and their benefits for specific motor symptoms:

Martinez-Ramirez D, Kraslow M, Armstrong MJ, Ramirez-Zamora A, Almeida L, Besharat A, et al. Update on Non-Traditional Exercises in Parkinson’s Disease: A Motor Symptom-Focused Approach. Clin Neurol Int. 2019; 1(1): 1004.

From the abstract:

… it is crucial to better characterize the benefits of exercise in PD. … we discuss the most recent studies analyzing the clinical effects of various modalities of exercise in PD, including physical therapy, aerobic exercise, strength and resistance training, and nontraditional forms of activity such as tai chi, dancing, aquatics, and boxing. We also provide … expert recommendations based on current evidence and highlight issues that remain unresolved (e.g. the best type of exercise, symptomatic benefits based on different modalities, optimal frequency and duration, and duration of benefit).

It appears that the authors limited their search to those studies that looked into motor symptoms of PD, and perhaps this is why their list of references doesn’t include Rehfield et al.’s 2018 article on the superiority of a dance program to repetitive physical exercise in increasing brain plasticity. Nor do they look into other approaches, such as musical training and practice, as possible ways to improve cognitive function, brain plasticity, and quality of life.

As a person with PD, I personally find that an eclectic and inclusive approach, using medications, Deep Brain Stimulation (DBS), physical exercise (including dance-related, vocal/singing and breathing exercise), diet, and social activities related to specific interests (like native plants and photography) works best for me. For others, the mix will differ.

The authors of this review reach much the same conclusion:

…evidence suggesting that any and all types of exercise can provide short-term clinical and quality of life benefits. More research is needed to help understand if exercise programs provide generalized benefits or what strategies should be used to address particular deficits. Balance, flexibility, and stretching seem to improve motor symptoms and decrease falls, contributing to an improvement in overall function. Aerobic training appears to improve cognition, cardiovascular health, gait, and reaction time. Resistance training provides the strongest benefit in strength. Nontraditional exercise programs, including tango, tai chi, cycling, aquatic therapy, and boxing are potentially beneficial options for each patient

In short: Find out what types of exercise you like to do, do what you like to do, and keep on doing it to help reduce the symptoms of PD.

(Coincidentally, most of the authors are associated with my alma mater, the University of Florida in Gainesville, FL).

 

Strength training can help with PD symptoms

A review of studies indicates that strength training can help with mild to moderate Parkinson’s cases. (An earlier blog post here noted that a dance training program increased grey matter volume in the brain versus repetitive strength training. So don’t exclude either from your wellness program, is my [non-medical advice).

Review of strength training in people with Parkinson’s Disease

From the abstract:

Objective: To investigate the evidence on efficacy and limits of strength training in rehabilitation of Parkinson’s disease

Method:A comprehensive search on pubmed, clinical keys database using keywords Parkinson’s disease, physical therapy, strength training ,resistance training. The studies including Randomized controlled trails and systematic reviews published since 2005 are reviewed.

Results:36 studies identified through database searching. 25 studies are excluded due to duplicates, irrelevance, based on titles, outcome diversity. 5 systemic reviews and Meta analysis, 6 RCT are included. Review and analysis of articles is going on

Conclusion : The result of this review suggests that strength training program can be effective in people with mild and moderate parkinson’s disease. It can improve functional independency with increased muscle strength, gait parameters, posture and balance, all of these positive role on participation and quality of life

I got rhythm, I got music…

Put together a slide presentation trying to synthesize some of the research on Parkinson’s Disease (PD) and the possibility of music, singing, playing musical instruments, and dance as means to counteract the progressive effects of dopaminergic neurons lost in the course of PD. Due to the length of the presentation and the limits of my computer resources, the narration seems to have gotten a little out of sync towards the end. But it is what it is, as they say: (note: added a PDF file of the presentation on 6-9-19 to make it easier to download and view)

Rhythm, Music, Singing, Dancing and the Brain

2019-06-05-Rhythm Music Singing and the brain  (PDF file)

and an even smaller file with all the blue and yellow intact (6-15-2019):

Rhythm Music Singing Dancing and the Brain

Progressively difficult or complex dance training is superior to repetitive physical exercise

Yep, you read that correctly. This research was done using neuro-imaging and revealed that brain plasticity ( how experiences reorganize neural pathways in the brain) is increased by a program of increasingly difficult dance training. (The title of this entry was edited 04/28/2021 to make it more clear that the variable was increasing the difficulty, and not simply dance vs. exercise. ALL exercise is good, as long as not overdone, but to incorporate research findings into the program (like Power for Parkinson’s or Lew-Ortiz Pabon’s Apollo Rhythm Club do), takes some extra effort).

Dance training is superior to repetitive physical exercise in inducing brain plasticity in the elderly.

… Both interventions increased physical fitness to the same extent. Pronounced differences were seen in the effects on brain volumes: Dancing compared to conventional fitness activity led to larger volume increases in more brain areas, including the cingulate cortex, insula, corpus callosum and sensorimotor cortex. Only dancing was associated with an increase in plasma BDNF levels. Regarding cognition, both groups improved in attention and spatial memory, but no significant group differences emerged. The latter finding may indicate that cognitive benefits may develop later and after structural brain changes have taken place. The present results recommend our challenging dance program as an effective measure to counteract detrimental effects of aging on the brain.

On a personal note, I noticed during a year long period of reduced mobility that my Parkinson’s symptoms had progressed (or regressed, depending on how you look at it). Slurred speech was perhaps one of the more obvious or noticeable symptoms. That has now disappeared, though one has to be mindful to speak clearly and loudly in order to be understood.

Physical exercise of any kind is good, it seems. Weight resistance and other exercises can benefit from the high intensity interval approach. But move to the music, and join a dance class that increasingly challenges the brain (especially if you are classified among the elderly, even if you are Young At Heart).

Put on your dancing shoes

Two links to Internet URLs reporting on recent research.

Comparing Dancing and Fitness

Dancing can reverse the signs of aging

The first link is the actual research article. The second link is an article reporting on the first one.

The results of the research article are not quite as effusive as the non-technical news article. Which is to be expected from a scientific article – don’t claim more than the data actually supports. The “popular ” press isn’t constrained by the same principles.

Bottom line – dance movement therapy is good for you. In my area, dance classes are free of charge and accommodate all levels of mobility, including wheelchair bound folks.

Dance, aerobic exercise and musical training

Today we have a couple of links to articles on the effects of dance and music:

Effects of Dance/Movement Training vs. Aerobic Exercise Training

Abstract only, but the results appear to be in favor of Dance Movement Therapy (DMT) as positive. Aerobic Exercise Therapy (AET) improved cardiovascular health, though, so both aerobic and dance movement therapies should be used for health.

Executive and non-executive composite scores showed a significant increase post-training (F(1,37)=4.35, p=.04; F(1,37)=7.01, p=.01). Cardiovascular fitness improvements were specific to the AET group (F(2,38)=16.40, p<.001) while mobility improvements were not group-dependent (10m walk: F(1,38)=11.67, p=.002; Timed up and go: F(1,38)=22.07, p<.001).
Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions.

Next, a short article on the effects of musical training on brain plasticity.

The-Effects-of-Musical-Training-on-Brain-Plasticity-and-Cognitive-Processes

The link between musical training and its effects on brain plasticity have been studied since the early 20thcentury neuroanatomy research of Ramon y Cajal. In recent decades, studies have observed the contributions of musical training in enhancing auditory, motor, and language processing areas of the brain. The ability of musical training to impact behavior and critical thinking skills may also open the door for new methods of combating age-and illness-related cognitive decline(emphasis added)

In conclusion, whether or not one has a neurodegenerative disease or not, it is good advice to do aerobic exercise for the heart, dance for the mobility, and learn or continue to play a musical instrument to keep the brain plastic and elastic and fantastic.

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Dance and exercise – a study and a publications review

Not much new here – more evidence that dance exercises and physical exercise in general, is beneficial for people with PD.

Shall We Dance – master’s thesis  by Brittni Lynn McAlister, University of North Colorado

 In the words of one participant, the dance classes have been “. . . completely life-changing.”

Systematic review of exercises for Parkinson’s

This review revealed that people with Parkinson’s disease viewed physical activity as an enjoyable and positive experience, which aided with control of their symptoms and enhanced their wellbeing and quality of life.

 

Teamwork helps

An open access article:

Multi-disciplinary approach for rehab to improve QOL

From the abstract:

Results:Patients reported higher functional status (d=0.37,p<0.001), general self-efficacy(d=0.28,p<0.01), and quality of life (d=0.32,p<0.001) at three weeks follow-up, comparedto their baseline scores. The regression analysis showed that having a better initial functionalstatus (β=−0.26,p<0.05) and lower quality of life (β=0.51,p<0.001) were associated withmore improvements in quality of life.
Conclusion:The study suggests that actual functioning in persons with Parkinson’s diseaseis a better predictor of improved quality of life than self-efficacy beliefs and that those whohave lower levels of initial quality of life benefit more from rehabilitation.

The program was only three weeks long, but was inpatient and apparently intensive:

The multidisciplinary rehabilitation program had a duration of three weeks and was an inpatient program. Upon arrival, participants were awarded a primary contact to ensure a unified team working toward goals set by the participant him/herself. The multidisciplinary team consisted of 10 different professions, such as occupational therapists, physical therapists, doctors, neurologists, nurses, sports educators, cognitive behavioral therapists, and nutritionists. Commencing the multidisciplinary rehabilitation program, participants were assessed by the relevant professional/s and typically had close follow-up the first week with individual and group-based exercise

 

Exergame based therapy and other stuff

Rehab through exer-games

Conclusion:Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and atleast as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitivestadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studieslinking game parameters and results with traditional assessment methods, such as UPDRS scores, are required.

Study protocol re: PD movement interventions

The goal of this study is to begin to address this
challenge by piloting a novel, hypothesis-driven, non-
pharmacological intervention to improve motor function
and diminish motor fatigue in PD. This novel approach is
based on the use of hypothesis-driven cognitive task inter-
ventions to stimulate the motor system and ameliorate
motor symptoms

Palmomental reflex is an important clinical marker of REM sleep behavior disorder in patients with Parkinson’s disease Yadav R, Mahale R, Pal PK – Ann Mov Disord