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"Healing" Parkinson's with Exercise?

"Healing" Parkinson's with Exercise?

An individual diagnosed with a neurocognitive disease like Parkinson’s often face a difficult future, with their quality of life marked by difficult physical symptoms, including uncontrollable tremors. Often these tremors make walking, writing, and other movements that many of us take for granted, difficult, if not impossible. Pharmacological treatments for these tremors and other Parkinson’s symptoms work well, at least in the short term, but eventually, the brain adapts to these drugs and the tremors return. There is promise with more invasive surgeries and electrical stimulations, but these treatments are expensive, and frankly…invasive. No, the long-term story is not often a pleasant one when Parkinson’s is involved.

Now, there is hope from the exercise-front for a non-invasive treatment of Parkinson’s tremors that both protects and returns lost movement functions. A recent review by Alberts and colleagues from the Cleveland Clinic Foundation has shown almost a 40% improvement in tremor control from exposing Parkinson’s patients to exercise. While it has been known for a while that Parkinson’s patients can benefit from exercise, the difficulty with movement often limits these patients to shorter and less intense exercise bouts. The breakthrough from the Alberts research team was when they used ‘forced’ (the investigators’ word) or ‘coupled’ (my description) exercise with Parkinson’s patients.

Dr. Alberts found – quite by accident it turns out - that if you ‘couple’ a Parkinson’s patient with an able-body individual on a tandem bicycle (bicycle built for two), there are almost immediate improvements in fine motor skills. With coupled exercise, the able-bodied individual pedals and while the Parkinson’s patient can pedal as well, they do not have to put in the same effort. Hence, the patient is able to do more total exercise than they would have by themselves. This coupled exercise, so far in the studies completed in both humans and animals, have shown startling results, showing major improvements in tremor control, in rigidity, and in a reduction in bradykinesia (slowness of movement) in the patients. 

So what’s the big deal? Why not just give patients drugs and not worry about exercise? Interestingly, the Investigators took some of their subjects and examined their brain activation patterns with MRI either on medication or after a single bout of coupled exercise. They found that the single-bout (yes, only one exercise exposure!) produced similar brain patterns as did medication, indicating that the coupled-exercise was as effective as the medication. Longer-term studies are being conducted, so it is not clear at this time whether there is a diminishment of the effectiveness of the exercise as there is with long-term administration of Parkinson’s drugs. Regardless, the effect of a single bout of coupled exercise is amazing not only in the functional outcomes, the amount of money saved, and in the ease of administration.

Maybe most exciting from these studies is the apparent ‘neurorestorative’ properties of the coupled exercise bouts. The Investigators observed that the coupled exercise bouts actually restored previously lost neural functioning, allowing the subjects to complete fine-motor tasks, such as buttoning one’s shirt, which they were previously unable to do. The Investigators tested the subjects on a variety of these types of tasks, and on every task, those Parkinson’s subjects that had done the coupled exercise for at least four weeks showed major improvements indicating that their brain was processing and controlling movement similar to a non-Parkinson patient.

While there is certainly much more work that needs to be done in this area, especially to answer the question of how much coupled exercise is needed to provoke these positive changes, this is a huge breakthrough in the treatment of Parkinson’s that will help these patients recover much of their quality of life and perhaps independence. This story is also illustrative of so many scientific stories: the breakthrough happened by accident. In this case, Dr. Alberts tells of noticing an improvement in motor control of a patient that he had ridden a tandem bicycle with in a weeklong fund-raising event. It was a simple observation – an improvement in handwriting – that has led to a truly breakthrough line of research that will have real-world consequences for thousands of patients. And that, is the best story we could tell….

For more information on coupled exercise and the improvements on “Parkinson’s Disease”, click here for the original article (that also contains the story of the ‘discovery’ of this phenomenon). The citation is “Alberts, JL, et al. It is not about the Bike, It is about the Pedaling: Forced Exercise and Parkinson’s disease. Exercise and Sport Science Reviews. 39(4): 177-186, 2011”. 

Until next week, stay active and healthy.

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