Can You “Learn” Yourself Out of Parkinson’s Disease?

Can you “learn” yourself out of Parkinson’s disease?

That’s the thrilling question that a 2013 article in The Lancet, the highly-respected, peer-reviewed medical journal, asks in its conclusion.  The article, “Exercise-Enhanced Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson’s Disease,” reviews over one hundred studies that examined the effect of physical exercise on people with Parkinson’s (PD), as well as on laboratory mice that had Parkinson’s-induced symptoms.

And how does the article answer this question?  The authors say that “On the basis of the published studies…the most obvious response is no.”  But their next sentence starts to shift:  “However, exercise studies may be pointing towards potential and important neuroplastic mechanisms that, through restoration of some degree of basal ganglia circuitry, provide an opportunity to improve motor learning and behavioral performance.”

At least it asks the question!  And it makes me think that maybe, in a few years, after more research is carried out, the response will change from “no” to “possibly” or even “yes.”  To my mind, it offers hope for those of us suffering from a disease that many consider a drawn-out horrific death sentence.  In fact, just yesterday I heard a medical researcher on NPR describe Parkinson’s as “horrible” and “terrible.”

The studies that the Lancet article reviews suggest plenty of ways that Parkies can greatly reduce their symptoms and perhaps halt the disease’s progression.  Specifically, the article focuses on two general types of exercise that it finds successful:  (1) goal-based motor skill training, and (2) aerobic exercise.  Let’s examine them one-by-one, after a brief boat ride through the land of “Neuroplasticity,” taken directly from the article (and tweaked, as are all the subsequent quotes, for American punctuation and spelling):

Neuroplasticity is a process by which the brain encodes experiences and learns new behaviors, and is defined as the modification of existing neural networks by addition or modification of synapses in response to changes in behavior or environment, which can encompass exercise.  Neuroplasticity includes a wide range of structural and physiological mechanisms including synaptogenesis, neurogenesis, neuronal sprouting, and potentiation of synaptic strength, all of which can lead to the strengthening, repair, or formation of neuronal circuitry.  Importantly, exercise-induced benefits on brain health (i.e., blood flow, trophic factors, and the immune system) might help to create the optimum milieu needed for neuroplasticity to happen in the injured brain.

 

Goal-Based Motor Skill Training

As I understand it, goal-based motor skill training occurs when you practice some physical skill and intend to improve your performance.  For example, if you take tango lessons, you pay attention to the instructor and work on how you move your body so you become a better dancer.  It requires conscious effort at first, but eventually the movements become automatic.  Here are some examples of goal-based motor skill training that the Lancet article reviews:

• Treadmill training.  If you have gait impairment (that is, walking with a limp or tiny, shuffling steps) you may be able to correct it through treadmill training.  It works like this:  Starting out slowly, you walk on a treadmill and receive feedback from an instructor, who says, perhaps, “Lift your right foot a little higher before you put it down,” or “Swing your left arm more like your right arm.”  As you improve, the instructor increases the treadmill’s speed and/or gradient, forcing you to pay continual attention to your body and eventually make these movements automatic.  According to the Lancet article, “Studies of treadmill exercise…have shown that through exercise practice, individuals with mild to moderate Parkinson’s disease can improve gait performance, including velocity, stride length, cadence, postural stability, gait rhythmicity, and joint excursion.”  These effects often last several months after the training ends.

• Tai Chi. I’ll quote the Lancet directly:  “Tai Chi focuses on dynamic postural control via exercises that involve weight shifting. Individuals also become cognitively engaged while practicing the control of their center of gravity during maximal movements.  Findings from these studies show that after 24 weeks of twice weekly sessions, Tai Chi leads to improved stride length and maximum excursion and reduced falls compared with resistance training or stretching.  These benefits were retained for at least 2 months.”

• Tango Lessons. One study found that “after 12 months of tango dancing, individuals with Parkinson’s disease had improved balance, walking, and dual tasking capability.”  Not to mention that a year of tango lessons probably makes you a terrific dancer!

• Boxing. Same as above.  Boxing classes for Parkies are quite well known now, and you can read about them in many online articles, not just this Lancet  article.  (Note:  In these boxing classes, nobody hits anyone else.  It’s all about hitting punching bags, jumping rope, and doing other boxing-related exercises.)  One online video I saw reported the following about Rock Steady, a boxing program for people with PD:

There is some evidence that this exercise program is effective.  A handful of boxers were tracked over two years, their abilities compared to other people with Parkinson’s who did other types of training.  The boxers did well.  Their balance was better.  They could walk faster.  They had more endurance.  And they reported their overall quality of life was higher.  

Another online news video of Rock Steady in Brooklyn reported similar outcomes.  The results:

• The disease did not progress over the two-year period.
• In some cases, people were better off at the end of the two years than they were at the beginning.
• Participants showed a vastly improved quality of life.
• It also appeared that high intensity workouts such as Rock Steady are neuroprotective, meaning that the brain is improving along with everything below the neck.

 

Aerobic Exercise

The Lancet article defines aerobic exercise as “vigorous and sustained activity that leads to increased cardiopulmonary function resulting in improved oxygen consumption (maximum oxygen uptake) and blood flow to the brain. This amount of intensity typically targets a goal of 60% to 85% maximum heart rate.”  The increased blood flow to the brain is in and of itself helpful for Parkies, as it improves the brain environment essential to learning and good brain health.

For example, one study concluded that “after a 6-month aerobic exercise program, individuals with Parkinson’s disease showed improved executive function.”  (Executive function refers to your ability to figure out how to manage a task, set priorities for accomplishing it, then avoid distractions as you do it.  People with Parkinson’s commonly lose this executive function.)  Another study that looked at the benefit of aerobic training for Parkies reported “improvement in cognitive functions such as working memory and verbal fluency.”

 

Goal Based Motor Skill Training + Aerobic Combo:

If you combine aerobic exercise with goal-based motor skills training, the boost is tremendous.  One example of this combo approach can be seen in the research that looked at “forced cycling,” which happens when people are forced to pedal on a bicycle faster than they’re used to, thus combining cognitive engagement with heart-pounding aerobic exercise.  Even though forced cycling primarily works your lower body (that is, your legs) along with your heart and lungs, it also, rather strangely, improves your upper body motor skills, including manual dexterity.  An example I found elsewhere:  one Parkie who previously could not write legibly with a pencil or pen (she had micrographia) suddenly regained this ability after just one very long day of forced cycling.

 

Conclusion

All of this is very exciting for me.  I have read conflicting statements before on how much control a Parkie has over the disease.  On the one hand, the Partners in Parkinson’s website says “There is no evidence that exercise affects the progression of Parkinson’s disease, but regular exercise or physical therapy may help people with Parkinson’s with their strength, mobility, flexibility and balance.”

On the other hand, the Northwest Parkinson’s Foundation website contains an article that states, “The brain has the capacity for neurogenesis — the development of new neuronal cells — [neuropsychologist Paul David] Nussbaum said. Exercise, nutrition, socialization, mental stimulation and meditation are all thought to contribute to neurogenesis. That’s good news for people with Parkinson’s…. This is because having plentiful neuronal connections—a ‘brain reserve’—is thought to stave off the onset and progression of brain diseases like Parkinson’s and Alzheimer’s, Nussbaum said.”  (See page 5 in the link.)

So I understand that the situation is not settled – not with the Lancet article, not with other online resources.  But I’m not going to wait until science and doctors agree on the issue.  With the Lancet article firmly in hand, I’m off to the gym…and to the shoe store, to fit myself out for tango lessons.

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P.S.  Caveat:  This Lancet article was written not for a general audience but for researchers and medical personnel.  Much of the article was difficult (OK, impossible) to understand, as it talks about sections of the brain that I, as a lay person, am ignorant about.  I merely culled from it the parts that were accessible and that provide exercise guidance for me as a Parkie.  Your doctor might refute much of what I said here, and indeed might refute much of the article.  For example, the article says nothing about the benefits of yoga or stretching exercises, even though movement disorder specialists often say these are worthwhile activities.

My main take-away from the article is the idea that aerobic exercise helps clear up the brain’s internal environment, and that aerobic exercise that also entails some kind of cognitive activity has major pay offs.

For me as a swimmer, this means not just competing in long-distance, open water swims (click!  click!  click!) but also training for, and competing in, short distance sprints (50 yards, 100 yards, and 200 yards), where I try to set personal bests.  Those, believe it or not, are more exhausting and more cognitively demanding than the one- and two-mile ocean races I’ve been doing this summer.