Today I am responding, via my six Reader Response Questions, to a published report titled The Effects of Physical Activity in Parkinson’s Disease: A Review. It was written by Martine Lauzé, Jean-Francoics Daneault, and Christian Duval, and appeared recently in the Journal of Parkinson’s Disease.
Click here to read the background of the six Reader Response Questions.
- Describe in your own words what happened in the pages you just read. What are the main points?
This article looks at 106 research studies which examined the effect of physical activity (PA) on people with Parkinson’s disease. The studies were reported in peer-reviewed journals from 1981–2015. They varied widely in scope, but all of them started with a baseline assessment of some group of Parkies; the Parkies then participated in some kind of physical exercise or therapy, after which they were tested again to ascertain any improvement.
The three review authors analyzed all 106 articles and tabulated some 868 outcomes. They grouped the results into four main categories:
- Physical Capacities – for example, lower limb strength; upper limb strength; flexibility; endurance
- Physical and Cognitive Functional Capacities – for example, gait and balance
- Clinical Symptoms of PD – for example, the specific tests that your neurologist gives you to decide where you are on, say, the UPDRS (the Unified Parkinson’s Disease Rating Scale)
- Psychosocial Aspects of Life – a lot of Quality of Life sub-categories
The authors then ranked the outcomes based on the proportion of positive results. This allowed them to say which Parkinson issues derived the greatest benefit from physical activity.
They found that PA most helped Parkies improve their physical capacity (especially strength, endurance, and speed for lower and upper limbs) and physical and cognitive functional capacity (especially daily living activities, gait, posture, and balance). Gross motor skills also improved a lot, but fine motor skills not so much. Improvement in flexibility was fair, not great.
As for the third category (clinical symptoms), individual items related to, say, gait and posture scored high, but other items showed little or no improvement (tremors, freezing, bradykinesia). Non-motor aspects of living with PD did not fare well, either.
And in the fourth category (psychosocial aspects of life), the total score for Quality of Life showed improvement as a result of physical activity, but certain sub-categories (depression, cognitive functions) did not.
- What’s your reaction to the article?
This is a kind of birds-eye-view of the forest, with little attention paid to individual trees. It’s great as a motivator to get us up off the sofa and do something physical: take a walk, go to the gym, disco dance. On the positive side, the article suggests that if you engage in physical activity, practically any physical activity, you can expect good results in quite a few areas. Having better balance, for example, helps you avoid falls.
So it greenlights physical activity for Parkies, which, I think, everyone already realizes. And it’s helpful to note that so far, exercise has not been shown to help much with, say, tremors or bradykinesia. But the article doesn’t give much more direction than that. For example, it doesn’t look at what specific exercises produce specific results.
In the authors’ own words:
For the purpose of this review, physical activity is simply defined as a body movement produced by the action of skeletal muscle that increases energy expenditure. This may include, but is not limited to, fitness exercises, sports, dance, martial arts, walking, physical therapeutic movements and occupational therapy. It is the authors’ view that physical activity can bring benefits as long as it raises the level of energy expenditure, engages the musculoskeletal system, and causes some level of physical exertion. Modality and intensity of exercise were not taken into consideration.
My reaction is that I’m already on board with the idea of exercising to combat the effects of PD. I’m ready for the next step. That is, I’m keen to know where the really stunning results are so I can replicate them in my life, and what kind of exercise gives the most bang for my buck.
Furthermore, some of the specific areas that received low scores in this analysis had very few studies reporting on them. Whereas gait, mobility, posture and balance had 377 separate outcomes in this meta-analysis (meaning that many of the 106 studies focused on these issues), cognitive functions was measured only 31 times, and depression only 18 times.
I’d like the three authors to write a follow-up article, in which they say, “Wow! Here are some specific stunning results that other researchers have found.” And I’d like other researchers to notice that, say, there’s a paucity of research on the relationship between exercise and depression in Parkies, and set up experiments to further examine – and ameliorate – that issue.
- What does the article make you think about from your own life?
What I’m going to write here is based on my own experience. I don’t intend it to apply to everyone. I’m operating under the assumption that everyone agrees that exercise is vitally important to combating many Parkinson symptoms. And, as precursor to what the article makes me think about from my own life, let me quote two visitors to my blog who, months ago, left the following comments:
Beth: My father has Parkinson’s. I’m a big fan of physical therapy, having had it help me with some range of movement issues. After many years of dealing with his PD (he’s now 92), he finally went for his first session with a physical therapist just last week and — lo and behold, much to his surprise — the professionals had something beneficial to offer him. He’s quite pleased with the advice and exercises they recommended. He’s also doing Chi-Gong at home (with my mother who is 87) and says that it helps him with the Parkinson’s. (Chi-Gong and Tai Chi are recommended by the National Parkinson Foundation.)
Beverly: I went to a [Rock Steady] boxing class on Wednesday. “Only” 30 min, but what a workout. Wish it was offered more than 1/week!
And now my story:
When I was diagnosed with PD, my neurologist wrote me a prescription for physical therapy. I went to a big physical therapy center near my town, which was basically equipped like the gym I already belonged to, except every day there were about a dozen therapists who worked one-on-one with me and the other clients. I had a different therapist each time, but he/she carried around my workout chart, which was based on exercises that the therapy center decided were right for someone with PD.
I believe they treated me as they treated all the other clients there, and I think they assumed that I was like every other 60-ish client they had. When I saw other senior citizens come in for whatever problem they had (not just PD), they often were started on the same routines.
Unfortunately, the exercises the therapists asked me to do were way below my ability level. Throughout my adult life I’ve been a competitive swimmer and triathlete, and I’ve worked out frequently at a gym, which they didn’t seem to take into consideration.
For example, on the first day, the therapist sat me at a table and had me do wrist curls with a two-pound dumbbell. (Wrist curls are when you lay your forearm on a table with your wrist and hand hanging off the table’s edge, palm facing up. You hold on to the dumbbell and let the weight pull your hand down towards the floor. Then you curl your wrist, raising your hand above the level of the table. See photos.)
I was already doing wrist curls at my regular gym with 15 pound weights. I said to the therapist, “This weight is really light. It’s only two pounds. I do this on my own already with heavier weights. Can you give me something heavier?”
The therapist blanched, then refused my request because “your chart indicates that you should work with two pounds.”
This happened with many/most of the exercises they wanted me to do. After a few weeks, I noticed that all the clients were doing the same thing – that is, all the senior citizen clients. They were all doing exercises similar to mine, with very light weights. (The other clients tended to be high school athletes recovering from some injury; they were treated differently.)
When I finally had a therapist who seemed relaxed about working with me, I told him that I really wanted heavier weights, because that’s what I used on my own. We were at the wrist curl table again, and, surprise!, he gave me the heaviest dumbbell they had: 8 pounds.
“Eight pounds?” I asked.
“Nobody here ever gets up to that,” he replied. “You’re the first person I’ve seen here who can handle it.”
“But on my own I’m using 15 pound dumbbells, sometimes now even 20. Can the manager here buy heavier weights?”
“Don’t count on it.”
So I stopped going and now just work out at my gym and the town pool.
So that’s what this article makes me think about regarding my own life. And it’s what irks me about forest-not-the-trees aggregate articles such as this. They don’t tell, or allow for, individual stories and differentiation. They suppress amazement. They’re great for an overview, but I’m looking to be dazzled.
- Copy a sentence from the article that you find especially interesting or unusual. Use quotation marks and write the page number:
“Even though the American College of Sports Medicine (ACMA) considers regular exercise as an adjunctive to PD treatment and provides general guidelines for the prescription of PA [physical activity], specific guidelines for exercises remain to be determined, particularly in terms of identifying the optimal type, frequency and intensity of PA.” – page 693
- What makes this sentence interesting for you?
I’m surprised by this quote, because it seems like other researchers have already worked on this. For example, in 2013 the Lancet published an article titled “Exercise-Enhanced Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson’s Disease” (click here for my review), and at the recent World Parkinson Congress, researchers reported on a welter of studies that seemed to suggest specific exercises for Parkies (click here for that).
- What questions does the article raise in you? What questions are you left with?
What are the really outstanding, impressive results of exercise for Parkies?
How can I work even more exercise into my weekly routine?
What are the benefits of meditating for Parkies?
Where can I find a therapist who can truly work with me on exercise? Or am I alone on this, as I live in the suburbs and work long hours at a full-time job?
