Tag Archives: Exercise

Deep Brain Stimulation (DBS), Essential Tremors, movement disorders, Parkinson's, Philosophy, prodromal, Research , , , , , , , , , , , , Leave a comment

Me and My PD – Misdiagnosis and Confirmation Bias

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Non-Artificial Intelligence Summary: The author reveals that he was misdiagnosed with Parkinson’s Disease (PD) over 13 years ago, after initially seeking treatment for Essential Tremors (ET). The article concludes with a link to an open access article on Six Myths and Misconceptions about Essential Tremor.

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Over the summer of 2025, I’ve been undergoing review of my movement disorders, with a reduction in medications as well as no clinical observation of Parkinson’s Disease (PD) symptoms.

Some thirteen or so years ago, after a neurologist or nurse practitioner observed some slight rigidity, providing enough symptoms to make a clinical diagnosis, an old high school girlfriend called to express some concern and to wish me the best. Apparently, she was under the misconception that PD was equivalent to a slow death. Glad to say she must be mighty disappointed after all these years.

I had essential tremors (ET) from my teen years, in addition to several other prodromal conditions or symptoms relating to PD. In 2010 the ET had become somewhat disabling, and after many months of unsuccessful treatment for ET, I opted for Deep Brain Stimulation (DBS), which apparently had a great success rate with ET. However, in order to rule out PD, several months of tests were undergone, with the eventual three of four of the cardinal signs being observed. DBS was scheduled less than two months later. Seven years later, due to a lack of progressive neurological deterioration, a DAT Scan was ordered, with an interpretation that I apparently did have some form of parkinsonism. Apparently, the original diagnosis of PD was premature and made under the influence of confirmation bias. Or, to paraphrase Paul Simon, a person sees what they want to see and disregards the possibility of other underlying causes for a barely detectable symptom.

Finally, after moving to a different state and establishing care with a Movement Disorder Specialist, who conducted their own evaluation on and off PD medications, the original problem (ET) which brought me to a neurologist in 2010, was confirmed. The process of titrating off medications continues.

Naturally, I have been delving into the National Institutes of Health open access in order to learn more about what has been called “familial tremors” and “benign tremors” in the past.

One thing I have learned is the diagnosis of ET and PD can be difficult, due to many overlapping symptoms or conditions, they are linked genetically for some ET cases, and much of the material on PD doesn’t even investigate whether the two conditions are concurrent.

So another reason for me to go on living: educate and advocate for people who may or may not have a diagnosis appropriate to their condition.

We’ll start here, with a recent article on Six Myths and Misconceptions about Essential Tremor.

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Exercise is good medicine

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As several of my Power for Parkinson’s instructors are fond of repeating “Motion is the Lotion.”

As late as 2018, the society for Movement Disorders (or International Parkinson’s and Movement Disorder Society, to be more exact) had stated that there was insufficient evidence that exercise had any effect on the progression of the disease or its symptoms. (The exact reference can be found in an earlier post in which I included a presentation with references to studies linking the effects of music and dance as the best of the best forms of exercise (it goes without saying, however, that the best exercise is the one that you yourself find and enjoyable and reinforcing, and will therefore actually continue to do).)(Although I just said it, in contradiction to the previous sentence.)(Come to think of it, I should update that presentation with more current citations…)

Which brings us up to 2025, just seven years later, in which a review article concludes that:

“These findings provide strong evidence that exercise, even light intensity, benefits general cognition, memory and executive function across all populations, reinforcing exercise as an essential, inclusive recommendation for optimising cognitive health.” (Singh B, Bennett H, Miatke A, et al, Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis, British Journal of Sports Medicine Published Online First: 06 March 2025. doi: 10.1136/bjsports-2024-108589

“Results 133 systematic reviews (2,724 RCTs and 258 279 participants) were included. Exercise significantly improved general cognition (SMD=0.42), memory (SMD=0.26) and executive function (SMD=0.24). Memory and executive function improvements from exercise were greater for children and adolescents than for adults and older adults. Those with attention-deficit/hyperactivity disorder exhibited greater improvement in executive function than other populations. Effects were generally larger for low- and moderate-intensity interventions. Shorter interventions (1–3 months) and exergames (video games that require physical movement) had the largest effects on general cognition and memory. Findings remained statistically significant after excluding reviews rated as low and critically low quality.” (Emphasis added)

For the non-nerds out there, the review has also been been reported as Exercise of Any Kind Boosts Brain Power At Any Age in the Medical Express News by the University of South Australia.

In addition to several quotes from the lead author, Dr. Singh, the article mentioned Senior researcher Professor Carol Maher, who said exercise should be encouraged to boost cognitive health across all ages and fitness levels.

Cognitive decline and neurodegenerative disease are growing global health concerns, according to Professor Maher.

The review, which included over a quarter of a million subjects, presented compelling evidence that exercise should be integrated into health care and education settings to promote cognitive health.

Even small amounts of exercise can improve memory and brain function—especially for those at higher risk—means exercise should be included in clinical and public health guidelines.

You don’t maintain good cognitive health on a diet of hamburgers and diet soda, staying up late and sleeping until noon, one might conjecture. Riding around a golf course on a golf cart doesn’t exactly fit the description of the types of exercise reviewed in this study.

And, as fitting such an occasion, I’ll close out with a self-serving rendition of a “Parkinson’s Parody” of a song written by Christine McVie, originally. performed by Fleetwood Mac, and made even more famous by former President Bill Clinton’s campaign in the late 20th Century:

#Parkinson’s #PowerForParkinson’s #Reviews #Exercise #Cognitive #Memory #ExecutiveFunction #BenefitsOfExercise

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Music, music music (and exercise)

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Dial the wayback machine to 2021, where this digital commons paper from Sacred Heart University on Influence and Effect of Music on Exercise  By Kendall Stewart appeared.

… Lack of adherence to exercise and physical activity, and related programs, is correlated with absence of motivation and enjoyment. Research has proven the presence of music, during physical activity, to be a strong motivator and linked to increased enjoyment, thus increasing exercise adherence. The purpose of this essay is to compile research in order to analyze and explain how the presence of music during physical activity increases mood and affective state of mind to bring about increased adherence and motivation as well as describe how individuals feel as though they are doing less work/exercising less when listening to music while being physically active. In addition, … examine the effect that different music genres, speeds, paces, and preferences have on exercise performance, enjoyment and adherence. (emphasis added).

Among the citations are:

de Dreu MJ, van der Wilk ASD, Poppe E, Kwakkel G, van Wegen EEH. Rehabilitation,
exercise therapy and music in patients with Parkinson’s disease: A meta-analysis of the
effects of music-based movement therapy on walking ability, balance and quality of life.
Parkinsonism & Related Disorders. 2012;18(Suppl 1):S114-S119. doi:10.1016/S1353-
8020(11)70036-0

which also refers to:

Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2008 Apr 15;23(5):631-40. doi: 10.1002/mds.21922. PMID: 18181210.

Evidence supported exercise as being beneficial with regards to physical functioning, health-related quality of life, strength, balance and gait speed for people with PD. There was insufficient evidence support or refute the value of exercise in reducing falls or depression.

On the topic of music and PD, we have:

Poliakoff, E., Bek, J., Phillips, M., Young, W. R., & Rose, D. C. (2023). Vividness and Use of Imagery Related to Music and Movement in People with Parkinson’s: A Mixed-methods Survey Study. Music & Science, 6. https://doi.org/10.1177/20592043231197919

excerpts from the abstract (as always, emphasis added):

… Music is used in interventions for people with Parkinson’s, either to pace movements, or as an integral element of activities such as dance. This study explored self-reported vividness of two forms of imagery – motor imagery evoked by music and auditory (including musical) imagery – in people with Parkinson’s, and whether and how they use these types of imagery in everyday life.

Participants (N = 199) completed:

(i) vividness ratings of visual and kinesthetic music-evoked motor imagery,

(ii) vividness ratings of auditory imagery, and

(iii) ratings and open questions about their everyday use of these types of imagery.

…  <20% reported actively using music to support motor imagery in daily activities. In contrast, participants reported a broad range of contexts and uses for musical imagery (imagined music), from supporting movement (e.g., walking or exercise) to emotion regulation, and concentration.

Correlational analyses associated vividness of music- evoked motor imagery with an urge to dance and musical training, while the use of musical imagery was associated with singing ability.

A minority of participants reported not experiencing either motor or musical imagery, suggesting that interventions based on imagery may not be suitable for all.

… even participants with more severe motor symptoms reported experiencing and using both types of imagery, indicating promise for their strategic use at different stages of Parkinson’s. … musical and motor imagery have the potential to support rehabilitation strategies for Parkinson’s, either separately or in combination.

Not the “hardest” scientific evidence there is, but hey, Einstein (a guy who only has to be referred to by his surname, and we all know who were talking about) reported that he did his though experiments using visual imagery, and only later (and with much labor) worked out the math. (I believe the reference can be found in a book “The Act of Creation” by Arthur Koestler, if memory serves. As Einstein reportedly said, you can always look it up).

How to end this post on music and Parkinson’s Disease? Rather than submit one of my own YouTube videos, how about one from another person whose first name alone is sufficient to identify him:

Elvis

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Prairie Celestials – it was an average year

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One of my favorite wildflowers is the Nemastylis geminiflora, a member of of the Iridaceae, or Iris family, in spite of some of its common names including Pleat-leaf Lily, Prairie Celestial, Celestial, and Celestial Lily. Below are photos from this year and a few years ago. I was on a Power for Parkinson’s Zoom call this past Friday (4/5/24) in which we were asked to share what gives us joy in our lives. I shared this photo:

Neamstylis geminiflora

The first photo was taken in 2021, The other, in 2024.

Both taken with a Canon Elph 190IS Powershot small camera, if I recall correctly (this year’s photo might have been taken with an iPhone 12 Pro). The difference in the photos can be accounted for by four possible influences:

  1. The photographer fell and fractured a femur following 2023’s bloom period, and is more cautious about lying down on the ground to emulate Steven Scwhartzman’s signature technique of using the sky as a background, due to the possibility of not being able to get back up again.
  2. The abundance and proliferation of exotic, invasive species on the berm, such as Japanese Brome, Malta Star Thistle, which reduce the native Nemastylis’ access to sunlight, and
  3. The failure of mowers who maintain the firebreak between the greenbelt and the to practice good hygiene by pressure washing and cleaning of mower blades between sites (one can only assume) and
  4. The setting of mower blades at less than 7 inches above the ground, which results in scalping of top of the berm, inviting aggressive invasive species onto the berm and into the greenbelt.

 

Above: Celestial against the sky.
Second photo: Two blurry Celestials in foreground, blurry Dakota Mock Vrvain middle, and focus on Dakota Mock Vervain in the center, with backdrop of Ashe junipers and grasses.
Tradescantia gigantea (Giant Spiderwort) an early bloomer in late Winter to early Spring, with blooms ranging from pinkish to purple. Provides color during an otherwise bleak season for landscaping.
Finally, Malta Star Thistle (Centaurea melitensis) a very nasty and invasive plant that produces thousands of seeds per plant. Just too many of them on the greenbelt

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Do you wanna dance?

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Costa V, Suassuna AOB, Brito TSS, da Rocha TF, Gianlorenco AC. Physical exercise for treating non-motor symptoms assessed by general Parkinson’s disease scales: systematic review and meta-analysis of clinical trials. BMJ Neurol Open. 2023 Oct 4;5(2):e000469. doi: 10.1136/bmjno-2023-000469. PMID: 37808516; PMCID: PMC10551973.

This study was a systematic review and meta-analysis.  Like many such desk reviews and meta-analyses, it winds up, in layperson’s terminology, comparing apples and oranges and pears and papayas and tangerines and dragon fruit and kiwis to each other. Treatments included “multimodal, aerobic, resistance, dance, conventional physical therapy and other types.” Five studies apparently were vulnerable to bias (in favor of the treatment being studied, one would suppose). They did conclude that, after sifting the studies down to eight, that aerobic exercise had a stronger effect than conventional exercise on non-motor symptoms. This is in conformance with other reviews that I have read (or read the abstracts of) in the past.

And then we have this study, which might have been kicked out due to possibility of bias, or maybe it wasn’t published early enough to be included.

Physical activity based on dance movements as complementary therapy for Parkinson’s disease: Effects on movement, executive functions, depressive symptoms, and quality of life
Duarte JdS, Alcantara WA, Brito JS, Barbosa LCS, Machado IPR, et al. (2023) Physical activity based on dance movements as complementary therapy for Parkinson’s disease: Effects on movement, executive functions, depressive symptoms, and quality of life. PLOS ONE 18(2): e0281204. https://doi.org/10.1371/journal.pone.0281204

Methods used were described as follows:

13 individuals with PD (Hoehn & Yahr I-III, MDS-UPDRS 67.62 ± 20.83), underwent physical activity based on dance movements (2x week for 6 months). Participants were assessed at baseline and after 6 months on movement (POMA, TUG and MDS-UPDRS Part III), executive function (FAB), depressive symptoms (MADRS), quality of life (PDQ-39), and severity of PD (MDS-UPDRS TOTAL).

The results were:

significant improvement in the movement (balance and gait) by the POMA test, p = 0.0207, executive function by the FAB test, p = 0.0074, abstract reasoning and inhibitory control by the FAB, Conceptualization test, p = 0.0062, and Inhibitory Control, p = 0.0064, depressive symptoms assessed by the MADRS test significantly reduced, p = 0.0214, and the quality of life by the PDQ-39 had a significant increase after the intervention, p = 0.0006, showed significant improvements between the pre-and post-intervention periods of physical activity based on dance movements.

The conclusions were obvious:

Physical activity based on dance movements contributed to significant improvements in movement (balance and gait), executive functions, especially in cognitive flexibility and inhibitory control, and the quality of life too. Sensorimotor integration, most cognitive processing and social skills may have contributed to the results.

Personally, I have to wonder whether inhibitory control and executive functions apply to my individual results, based on feedback from others, but it could be that I just need to keep on dancing more and worry less about what other folks think.

For nerds like myself, clicking on the following link will get you a list of similar articles published within the past five years (2019 – 2024)  available with free full text.

So, to reiterate the title of this post:

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Turn off the TV and get some exercise! (Or use it to exercise to Power for Parkinson’s YouTube videos).

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That’s the takeaway message from an analysis of non-identifiable patient data recently reported in this article:

Too much TV watching correlated with higher rates of dementia, depression, and PD

However, the study did find that some computer screen time had a neuroprotective effect. (This blog’s  author’s note: It would not be a bad idea to set a timer to remind yourself to get up every hour or so and get up, stand up, and dance to a little Bob Marley music for a minute or two, or three).

Methods

  • 473,184 participants initially free of dementia, PD, and depression from UK Biobank, as well as 39,652 participants who had magnetic resonance imaging (MRI) data
  • Self-reported screen time exposure variables included
    • TV viewing and
    • computer use
  • Regression models were used to estimate the association between different types of screen time and
    • Incidence of dementia,
    • Parkinson’s disease,
    • depression, and
    • Multimorbidity status.
  • Multiple linear regression models were used to assess the linear relationship between different types of screen time and MRI biomarkers in a subgroup of participants.

Multimorbidity was defined as two or more diagnoses of chronic diseases occurring simultaneously in an individual.

During the study time frame,

  • 6,091 (1.29%) participants developed dementia
  • 23,632 (4.99%) participants developed depression,
  • 1,214 (0.26%) participants developed both dementia and depression,
  • 486 (0.10%) participants developed both PD and depression

Participants

  •  Highest TV viewing time were
    • Older,
    • Typically male,
    • Higher body mass index (BMI),
    • Lower Physical Activity (PA) and
    • More likely  previous or current smokers.

Risk for dementia and depression increased substantially among those with both low PA and highest TV viewing time.

The main novel finding of this study is that TV viewing time was positively associated with an increased risk of dementia, PD, depression and their multimorbidity status. Moderate computer using time (i.e., approximately 0.5–1 h/day) is associated with a lower risk of dementia, PD, and depression.  

Longitudinal analysis and eliminating cases of depression, dementia, and PD that were diagnosed within the first three years are the strengths of the study. Self-reports on the amount of screen time by participants is a weakness.

In conclusion:

 computer using was U-shaped associated with risk of dementia, PD, depression and their multimorbidity status, while TV viewing was associated with an increased risk. And different screen time may affect diseases risk through its association with brain structures. Although associations between different types of screen time and diseases are not strongly attenuated with different levels of PA. Replacing different types of screen time with daily-life PA or structured exercise is associated with lower disease risk. Our results support the potential of limiting different types of screen time and shifting to physical activity to mitigate disease risk.

And this person with PD has spent too many hours in front of the computer screen writing this up, so I will follow their advice and engage in some PA.

Citation:

Wu, H., Gu, Y., Du, W. et al. Different types of screen time, physical activity, and incident dementia, Parkinson’s disease, depression and multimorbidity status. Int J Behav Nutr Phys Act 20, 130 (2023). https://doi.org/10.1186/s12966-023-01531-0

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Just a song and dance man

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[updated April 8, 2025]

Some folks may recognize the title as an allusion to an old interview with Bob Dylan in which a reporter asked about him being considered a protest singer and/or the voice of a generation. If not, do a search on YouTube for the interview – probably in San Francisco, 1965, maybe – If my memory serves me well.

A hallmark of human movement is volitional control – the freedom to move easily, automatically, and safely within the changing demands of daily living. Clinical signs characteristic of Parkinson’s disease (PD) include rigidity and tremor, hypokinesia, stooped posture, vocal alterations, facial masking, and progressive loss of peri- and extrapersonal use of space . These movement aberrations are one of many factors that increase the risk of falling and point to the need for improving fall prevention strategies . These disease-related limitations experienced by people with Parkinson’s disease (PPD) increasingly rob them of movement freedom. Quality of life declines as conscious attention and effort in everyday living replace spontaneity of communication and safety in navigation.

Reading those words in the introduction to this article  flowed off of the page like they  were written in my soul. Many times I have avoided falling by using dance steps learned in my Rhythm and Moves class from Power for Parkinson’s® (PfP) (taught by Nancy Bain) located in nearby Austin, Texas. And certainly the improvisational dance techniques used in the class have improved my quality of life, allowing me to be more spontaneous. Following a fall in April of 2023, I have been on a 6 month journey of rehabilitation, and certainly my quality of life has deteriorated somewhat due to the conscious attention and effort in performing activities of daily living. But  dance, music, and improvisation continue to be the core of my spirit as I strive to improve against this incurable (yet!), progressive, degenerative, neurological disease. Even though I don’t get around much anymore…

This study reported on one of the co-authors’ method in teaching dance to mild-to-moderate stage People with Parkinson’s over a 3-year period (2013–2015). She is a tenured university dance professor also trained in the Mark Morris Dance for PD® program. 

Another (modified) quote from the article is this table, which I find reflects many of the implicit and explicit principles used in dance classes.  Verbal Auditory Cueing (VAC) is the acronym used in the table. Color coding has been added to separate the different methods more clearly:

Principles

and Methods 

Non-judgment

Class advertised as movement class

 

Greeting at entrance by teacher

 

Class offered free of charge

 

Inclusion of carepartners as students

 

VAC that there are no mistakes, only new movement options

Non-competitiveness

All movement is seen as an honest effort

 

VAC focused on action, not quality of movement

 

VAC “Yes, and …” replaces “Not that” or “Rather try this”

Curiosity and

playfulness

Awareness of movement possibilities

VAC “Stay curious in what you are doing” or “Keep going”

VAC “Nothing is precious”

Pacing of VAC does not allow self-editing

Risk taking

Selection of class environment

 

Student self-selection of participation level

 

VAC to validate self-selected level of participation

 

Adaptation of exercises to sitting or at the barre as needed

 

Structured, directive (non-improvised) activity transitions

VAC to attend to constraints of an activity rather than invoke fear

Another point used in the method was to increase challenge by gradually increasing the variety and complexity of movement tasks. In this way, the participants maintained safety while increasing their sense of confidence.  In PfP classes, this is called “Fun.” They even have a t-shirt with the definition of Fun printed on the back.

FUN Tshirt — Power for Parkinson's - www.powerforparkinsons.org

This particular study was published back in 2016,  and most of the authors were associated with Wake Forest University in Winston-Salem North Carolina.

Here’s the citation and a link to the open access article, which goes into more detail about the principles and the practice of the improvisational dance classes.

Batson G, Hugenschmidt CE, Soriano CT. Verbal Auditory Cueing of Improvisational Dance: A Proposed Method for Training Agency in Parkinson’s Disease. Front Neurol. 2016 Feb 17;7:15. doi: 10.3389/fneur.2016.00015. PMID: 26925029; PMCID: PMC4756105.

More information about Power for Parkinson’s®, their classes, and YouTube channel can be found at:

https://powerforparkinsons.org

Another 501(c)(3) charitable organization which happens to be focused on improvisation as a means to offer People with Parkinson’s (and their caregivers) to a safe environment using many of the principles listed above is Yes, and… Exercise (if that sounds familiar, take a look at the methods related to non-competitiveness in the table above) at https://yesandexercise.org.

And since the title says it, here’s a song about dance that I loved as a kid (still do, and probably still will, if I ever grow up)(note 2025-04-08: the original link is no longer available, so I just created a link to a song  that I also loved during my wasted youth, besides, I don’t remember what the original link was about.)

The Contours “Do You Love Me (Now That I can dance?)”

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Music, movement, and PD

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Jerry Coker, who was one of my instructors my first year in undergraduate college, and then again my last semester before graduation , had an hypothesis that for improvisation to be enjoyable, it had to be approximately 75% predictable and 25% unpredictable. Vary too far from those parameters, and you end up with something that is either too boring and predictable, or something that leaves the listener wondering what’s going on, trying to guess where the melody is.

I never advanced far enough to get his insights on swing, or the concept of where the beat is. Duke Ellington, whom I saw at a festival once, did have a short primer on swing. He began with the person who snaps his fingers or taps his feet on the downbeats (ONE-and-TWO-and….). Then he progressed to the folks who tapped their feet or snapped their fingers on the upbeat (1-AND-two-AND..). I forget where it went from there (maybe to Latin rhythm patterns), although I do remember him saying that when he greeted people, he always gave two kisses to the right, and two to the left, one for each cheek.

Love You Madly (ending)

Today’s readings all relate to music and movement –

From  Saluja A, Goyal V, Dhamija RK. Multi-Modal Rehabilitation Therapy in Parkinson’s Disease and Related Disorders. Ann Indian Acad Neurol. 2023 Jan;26(Suppl 1):S15-S25. doi: 10.4103/aian.aian_164_22. Epub 2022 Nov 21. PMID: 37092020; PMCID: PMC10114534. 

(emphasis added to the section quoted below):

Dance, Music, and Singing Therapy in Pd Rehabilitation

Dancing may improve speed of movement, balance, wellbeing, and QOL in patients with PD.[74,75] Multiple dancing interventions and their impact on symptomatology of PD patients have been assessed. In a systematic review of 38 articles that studied the role of various dancing interventions (tango, waltz/foxtrot, Sardinian folk dancing, Irish set dancing, Brazilian samba, Zumba, mixed dance forms, and home-based dance interventions), there was a moderate-to-large beneficial effect of dancing interventions in mild-to-moderate PD. Dancing sessions (once/week to daily for 30 minutes to 2 hours) significantly improved balance, total UPDRS, mobility, endurance, gait freezing, and depression among PD patients.[76]

Music and rhythmic auditory stimulation can improve gait parameters in PD.[77] BEATWALK is a smartphone-based application that initially assesses cadence in PD patients and then progressively increases musical tempo in order to reach the desired speed. A recent study found that BEATWALK significantly improved gait velocity (P < 0.01), cadence (P: 0.01), stride length (P: 0.04), and distance (P: 0.01) among 39 PD patients who could walk unaided and had no gait freezing.[78] The ParkinSong trial studied the effect of singing intervention (at weekly and monthly intervals) in PD and found significant improvements in vocal intensity (P = 0.018), maximum expiratory pressure (P = 0.032), and voice-related QOL (P = 0.043) among PD patients when compared to controls.[79] A recent systematic review and meta-analysis including 67 publications found that tango resulted in significantly improved UPDRS-III scores (Z = 2.87, P = 0.004) and TUG scores (Z = 11.25, P < 0.00001), whereas PD-specific dance resulted in improvement in PDQ-39 scores (Z = 3.77, P = 0.0002) when compared to usual care.[80]

Cox L, Youmans-Jones J. Dance Is a Healing Art. Curr Treat Options Allergy. 2023 Apr 10:1-12. doi: 10.1007/s40521-023-00332-x. Epub ahead of print. PMID: 37361639; PMCID: PMC10088655.

This article is considered an Opinion Statement rather than a “research study,”although they used the same armchair/desk jockey methods used by many reviews and meta-reviews. From the abstract (emphasis added):

The purpose of this review is to evaluate the health benefits of dance and dance therapy in various health domains. Dance interventions included movement therapy with certified therapists, common dances such as ballroom dancing, salsa, and cha-cha as well as ethnic dances, such as the Chinese Guozhuang Dance and the Native American jingle dance. The health domains included depression, cognitive function, neuromotor function, dementia, balance, neurological growth factors, and subjective well-being. The National Library of Medicine, Congress of Library, and the Internet were searched using the terms: dance, dance movement therapy, health, cognitive function, healing, neurological function, neuromotor function, and affective disorders from 1831 to January 2, 2023. Two-thousand five hundred and ninety-one articles were identified. Articles were selected if they provided information on the health benefits of dance in one or more of the above domains as compared to a “non-dance” control population. Studies included systematic reviews, randomized controlled studies, and long-term perspective studies. Most of the subjects in the studies were considered “elderly,” which was generally defined as 65 years or older. However, the benefits of DI on executive function were also demonstrated in primary school children. Overall, the studies demonstrated that DI provided benefits in several physical and psychological parameters as well as executive function as compared with regular exercise alone. Impressive findings were that dance was associated with increased brain volume and function and neurotrophic growth function. The populations studied included subjects who were “healthy” older adults and children who had dementia, cognitive dysfunction, Parkinson’s disease, or depression.

The benefits of dance for PwPs include movements and connections with others:

Jola C, Sundström M, McLeod J. Benefits of dance for Parkinson’s: The music, the moves, and the company. PLoS One. 2022 Nov 21;17(11):e0265921. doi: 10.1371/journal.pone.0265921. PMID: 36409733; PMCID: PMC9678293.

From the abstract:

Dance classes designed for people with Parkinson’s are very popular and associated not only with increasing individuals’ motor control abilities but also their mood; not least by providing a social network and the enjoyment of the music. However, quantitative evidence of the benefits is inconsistent and often lacks in power. For a better understanding of the contradictory findings between participants’ felt experiences and existing quantitative findings in response to dance classes, we employed a mixed method approach that focussed on the effects of music. Participant experience of the dance class was explored by means of semi-structured interviews and gait changes were measured in a within-subjects design through the Timed Up and Go (TUG) test before and after class, with and without music. We chose the TUG test for its ecological validity, as it is a simple test that resembles movements done in class. We hypothesised that the music and the dance class would have a facilitating effect on the TUG performance. In line with existing research, we found that before class, the gait of 26 participants was significantly improved when accompanied by a soundtrack. However, after class, music did not have a significantly facilitating effect, yet gait without music significantly improved after class compared to before.We suggest that whilst the music acts as an external stimulator for movement before the dance class, after the dance class, participants have an internalised music or rhythm that supports their motor control. Thus, externally played music is of less relevance. The importance of music was further emphasised in the qualitative data alongside social themes. A better understanding of how music and dance affects Parkinson’s symptoms and what aspects make individuals ‘feel better’ will help in the design of future interventions.

The entire article is Open Access at the link above. My own impression of the discussion of the contradictory results (from what was expected) reminded me of a quote my statistics professor was fond of repeating: It is meaningless to discuss what the data might have been if the data were something other than what they are. 

As a PwP, one explanation for the lack of significance difference in the TUG post-test could very well be fatigue. I, therefore, suggest that this could be looked into as a possible explanation for the lack of significant difference between external music v no external  music stimulus. Clearly, “Further research is needed.”

Morris ME, McConvey V, Wittwer JE, Slade SC, Blackberry I, Hackney ME, Haines S, Brown L, Collin E. Dancing for Parkinson’s Disease Online: Clinical Trial Process Evaluation. Healthcare (Basel). 2023 Feb 17;11(4):604. doi: 10.3390/healthcare11040604. PMID: 36833138; PMCID: PMC9957486.

The above citation reports on a clinical trial which was conducted with a fairly large and coordinated collaborative effort. Again, an excerpt from the abstract:

Results: Twelve people with PD, four dance instructors and two physiotherapists, participated in a 6-week online dance program. There was no attrition, nor were there any adverse events. Program fidelity was strong with few protocol variations. Classes were delivered as planned, with 100% attendance. Dancers valued skills mastery. Dance teachers found digital delivery to be engaging and practical. The safety of online testing was facilitated by careful screening and a home safety checklist. Conclusions: It is feasible to deliver online dancing to people with early PD.

As a PwP who has participated in Power for Parkinson’s online video dance Rhythm and Moves and other exercise videos, both live and asynchronously, the last line comes as no surprise.

The hour grows late, and I have medications to take before I sleep, oh so many medications to take before I sleep. To sleep, perchance to dream…

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depression, Exercise, Parkinson's, Physical Therapy, prodromal, Research, Reviews, Sleep , , , , Leave a comment

Exercise & Sleep disorders and Parkinson’s – Oh my!

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My first draft of this got lost in the computer (Thanks, all you coders who think you know how to create intuitive, ease to use interfaces). So here’s another attempt to get stuff from one location to another. We’ll see how it it goes…

A while back I posted a Powerpoint presentation on research on music, dance, and singing, which cited a review in the Movement Disorders Society (2018, I believe), in which the conclusion was that exercise did not affect Parkinson’s Disease (PD) symptoms. Since then, there have been many more studies on the effects of different modalities of exercise. In this first article, a meta review of publications, found that exercise is good for you if have PD.

Yang Y, Wang G, Zhang S, et al. Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis. BMC Geriatrics. 2022 Oct;22(1):813. DOI: 10.1186/s12877-022-03510-9. PMID: 36271367; PMCID: PMC9587576.

The purpose of the review was to compare and rank the types of exercise that improve PD symptoms by quantifying information from randomised controlled trials.  Out of 10,474 citations, 250 studies were included involving 13,011 participants. The results (drumroll, please):

  • Power training (PT) had the best benefits for motor symptoms
  • Body weight support treadmill training showed the best improvement in balance, gait velocity  and walking distance
  • Robotic assisted gait training had the most benefits for freezing of gait
  • Dance showed the best benefits for depression
  • Only Yoga significantly reduced anxiety symptom compared with controls
  • Only resistance training significantly enhanced sleep quality and cognition
  • Physical Therapy showed the best results for muscle strength
  • Five types of therapy showed improvement in concerns about falling versus control groups.

If interested, the full free text is available at the linked citation above. Other reviews have shown different results. Best recommendation is to find a variety of exercises that you enjoy, and do them as often as you can. But don’t try so hard that you wind up hurting yourself.

The second meta review alluded to in the title has to do with sleep disorders.

Xu Z, Anderson KN, Pavese N. Longitudinal Studies of Sleep Disturbances in Parkinson’s Disease. Current Neurology and Neuroscience Reports. 2022 Oct;22(10):635-655. DOI: 10.1007/s11910-022-01223-5. PMID: 36018498; PMCID: PMC9617954.

Fifty-three longitudinal studies of sleep in PD were identified, which included:

  • Excessive daytime sleepiness,
  • Insomnia,
  • Obstructive sleep apnea,
  • Rapid eye movement sleep behavior disorder (RBD),
  • Restless legs syndrome, and
  • Shift work disorder were studied in addition to other studies that had focused on either multiple sleep disorders or broadly on sleep disorders as a whole.

RBD is now considered an established prodromal feature of PD, but other sleep disorders do not clearly increase risk of subsequent PD.

I’ll throw in one last citation. Not just because it plays on the title to one of Bob Dylan’s songs, but also because it is one of many nutritional supplements prescribed to aid in cleaning out neural cell debris in (where else?) Bob’s Brain:

Kalyanaraman B. NAC, NAC, Knockin’ on Heaven’s door: Interpreting the mechanism of action of N-acetylcysteine in tumor and immune cells. Redox Biology. 2022 Oct;57:102497. DOI: 10.1016/j.redox.2022.102497. PMID: 36242913; PMCID: PMC9563555. 

and that ends this day.

Dance, Exercise, Music, Parkinson's, Research, Reviews , , , , , , Leave a comment

Don’t Stop Moving To The Music department

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I’m not sure why the line numbers were included in the PDF, my guess is that it is/was pre-publication. At any rate, it just adds to the body of evidence that rhythm and movement helps get rid of the blues. 

Exploring the Use of Music to Promote Physical Activity Adherence: An Integrated Theoretical Approach. Kyoung Shin Park1*, David M. Williams, Jennifer L. Etnier  

Abstract …

Music can help people make more positive evaluations of acute exercise as an affective and
113 ergogenic stimulant. A recent meta-analysis of 139 studies revealed that listening to music during
114 acute bouts of exercise and sport activities increases positive affective valence (g = 0.48, CI [0.39,
115 0.56]), reduces ratings of perceived exertion (RPE; g = 0.22, CI [0.14, 0.30]), enhances physical
116 performance (g = 0.31, CI [0.25, 0.36]), and improves oxygen consumption (VO2max; g = 0.15, CI
117 [0.02, 0.27]) compared with activities without music (Terry et al., 2020). These findings support the
118 notion that music helps physical activity to be more joyous, less arduous, and more energetic and
119 efficient, arguably motivating the exerciser to join additional bouts. It is noteworthy that the
120 beneficial effects of music on affect and RPE were not moderated by physical activity intensity in the
121 meta-analysis (Terry et al., 2020), which indicates that music provides psychological benefits across
122 the full range of intensities.

Don’t Stop Moving To The Music