By Bonnie Miller Rubin, Chicago Tribune reporter
December 19, 2012
Some 1 million Americans suffer from Parkinson's disease, a degenerative neurological disorder that results from the loss of dopamine-producing cells in the brain. Although there is no cure, researchers have begun to make progress on finding better treatments with fewer side effects, including medications, surgery and, most recently, the importance of exercise.
For more on this, we turned to Dr. Dennis Keane, a physical medicine and rehabilitation physician at Rush-Copley Medical Center in Aurora. He works with neurologists and other clinicians in the care of movement disorders to help patients regain, maintain or improve their function.
Q: First, what are the symptoms of Parkinson's disease?
A: Classic symptoms include slowing of muscle activity, called bradykinesia; freezing of muscle function; rigidity of muscles; tremors; and loss of balance. Other features may include a shuffling gait, lack of facial expression, small handwriting, a weak voice. Even cognitive function, swallowing and bowel or bladder function may be impacted.
Q: How can exercise benefit those with Parkinson's disease?
A: There are two main roles of exercise, one being controlling the symptoms of the disease, and the second being slowing the disease progression and possibly even (preventing) the disease. There is evidence that exercise can help improve many of the symptoms … including gait speed, balance, tremors, flexibility and strength.
Q: How does exercise help with these symptoms?
A: One key mechanism is felt to be that our brains have neuroplasticity. That is, with activities such as exercise, we stimulate our brains to create new nerve pathways to take over the role of what we may have lost from a neurological disorder. This has been proven quite clearly in other conditions, such as with stroke recovery.
Q: There has been a flurry of research in recent years that shows exercise has a protective effect on those with Parkinson's. Can you explain?
A: Research is showing that this may happen in one of a couple of ways. First, exercise seems to provide a protection against toxins that cause nerve damage. Additionally, with exercise there seems to be an increase in neurochemicals that facilitate nerve growth and improve nerve strength and stability. This is exciting news, as it is believed that symptoms of Parkinson's disease do not manifest until one loses 40 to 60 percent of their nerve function. Perhaps with exercise, those at risk will not have symptoms until later in life or perhaps never at all.
Q: What study has you excited?
A: There's one out of the University of Maryland, just published in the Archives of Neurology last month, that is very positive. It followed 67 Parkinson's patients in three different exercise regimens: One group did high-intensity treadmill exercise (30 minutes at 70 to 80 percent of heart rate reserve), a second did lower-intensity treadmill (50 minutes at 40 to 50 percent of heart rate reserve) and the third did stretching and resistance exercises (such as leg press, three times a week for three months).
All three types of physical exercise improved functioning. Even strengthening exercises improved walking abilities. It was encouraging to see that even lower-intensity aerobic exercise can significantly improve walking abilities. Previously, it was felt that higher-intensity aerobic exercises were needed to improve walking. In order to improve strength, one had to do resistive exercises.
Q: So, does it matter what you do?
A: Really, almost any kind of daily, sustained exercise can help boost strength and flexibility and improve daily functioning. And it's not just Parkinson's. Exercise can help prevent dementia, heart disease and strokes. Just simple walking can be beneficial.
Q: How do you get people with no interest in exercise, who never engaged in physical activity in their lives, to buy into this and get moving?
A: It's not easy to start. Exercise can be arduous, but once you start seeing the gains, even after a short period of time, it gets easier. One should always see a physician prior to starting an exercise program. My advice would be to join a Parkinson's group for exercise, alternate activities to keep things interesting, set reasonable goals with your physician or therapist, make it a routine part of your day and, lastly and most important, make it fun. Although the treadmill and weights can be helpful, one can get similar results with water exercise, dance, yoga and tai chi. In my opinion, exercise is as important as medication. It has become an essential part of managing the disease.
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