A psychiatrist recently suggested I read Chapter 2 of The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontier of Neuroplasticity, by Norman Doidge, MD. Chapter 2 is titled “A Man Walks Off His Parkinsonian Symptoms: How Exercise Helps Fend Off Degenerative Disorders and Can Defer Dementia.” It mostly concerns a man in South Africa who came down with Young Onset PD in his thirties, but eventually was able to greatly reduce the physical symptoms of PD and stop taking PD drugs. The book was published in 2015, and the man in question had not taken PD meds for nine years.
Let’s review the chapter’s contents via 20 Questions!
Q: Who is the guy who reduced his PD symptoms and went off medications?
A: John Pepper, a South African man who must be in his eighties by now.
Q: When did he first start to experience PD symptoms?
A: Nearly 50 years earlier, in his mid-thirties. Symptoms included insomnia, difficulty throwing a ball, micrographia, constipation, and occasional freezing (that is, not being able to move). However, as an extreme workaholic who owned and ran a successful business, he ignored these issues.
Q: What happened next?
A: When he was in his fifties, his condition(s) worsened. He developed a tremor; he knocked over glasses at dinner; he choked while eating; he had Restless Leg Syndrome at night; he needed help getting dressed in the morning.
Q: When and how was he diagnosed?
A: In 1991 he made an appointment with his family doctor to discuss the enormous fatigue he was experiencing, then another appointment to discuss depression. At one point, the doctor noticed Pepper’s tremor, suspected Parkinson’s disease, and sent Pepper to a neurologist.
Q: What happened with the neurologist?
A: The neurologist examined him over many appointments and diagnosed Parkinson’s. In addition to the tremors, Pepper had cogwheel rigidity in his neck and wrist. He had a festinating gait. His eyelids blinked every time the doctor tapped him on the forehead. (People without Parkinson’s stop blinking if you continue to do this.)
Q: What happened next?
A: The doctors prescribed Sinemet (carbidopa-levodopa) and a few other drugs, and Pepper’s symptoms started to dissipate.
Q: And then?
A: Pepper’s symptoms eventually worsened. He saw other neurologists, but they all agreed with the diagnosis and merely switched the meds. It didn’t help.
Q: Can you fast forward, please?
A: Certainly. Pepper went through a period of grief. He quit working and sat in a chair a lot. His wife continued to help him dress in the morning. But then he got involved with a walking group called “Run/Walk for Life.” This organization trains all kinds of people to take up walking as an exercise, and the program proceeds very slowly. At first, beginners are allowed to walk for only ten minutes around a schoolyard playing field, three times a week. That’s not a lot of activity! Gradually you’re allowed to work up to longer distances and longer times, and you try to walk at a faster pace. As the book’s author says, “The goal was to get to eight kilometers a session” (about five miles), then continue to walk this distance in shorter and shorter times, almost like a speed walker.
Q: Was that it?
A: Essentially, yes. However, the instructor, who didn’t know Pepper had PD, yelled at him not to slouch, to stand up straight and tall. All of this caused Pepper to realize that if he paid conscious attention to what he was doing with his body, he could control many of PD’s physical symptoms. He could walk normally again. He could pick up a beverage in a glass and not have it slosh around.
Q: And did he gain control of his physical symptoms?
A: Apparently, yes. So much so that eventually, with his doctor’s supervision, he went off all PD meds. Instead he walks fifteen miles a week, doing three sessions of five miles, always conscious of how his is placing his feet and swinging his arms, and always at a fast pace so he works up a sweat. When he walks, his goal is to get his heart pumping above 100 beats/minute, and keep that up for an hour.
Q: Is that it?
A: Not exactly. Pepper still has to carefully monitor every step he takes, and sometimes if he is walking and talking about some thought-provoking topic, his leg starts to drag. Also, he is quick to say that he has not cured himself of PD, he’s just controlling most of the overt physical manifestations. For example, he no longer needs his wife to button his shirt in the morning. However, if for some reason he’s unable to do his walking exercise on a regular basis, the physical symptoms return.
Q: What does the book’s author, Dr. Norman Doidge, have to say about this?
A: Plenty. First, he believes that Pepper is now using a different portion of his brain to monitor and control his body, since PD has destroyed the original part of the brain that concerns itself with movement. Pepper has created new neural (neuronal? Can somebody tell me which is the right term?) pathways. In Doidge’s exact words: “My thought was that, as far-fetched as it might seem, Pepper, by battling aspects of Parkinson’s with the low-tech approach of walking, might indeed be triggering neuroplastic change in his brain” (pg. 36).
Q: And?
A: He thinks we shoot ourselves in the foot by labeling PD a “movement disorder.” It becomes a self-fulfilling prophesy. To quote directly from Doidge’s book:
[Pepper] began to believe that the emphasis on medication in treating Parkinson’s had the psychological side effect of rendering patients more passive in dealing with an illness that can itself promote passivity. In the common medical model, patients take their medicine and wait until a better one comes along. Visits to the doctor consist of checking the progression of the disease and examining for medication side effects. Treatment becomes a race between patients’ deterioration (over which they have no control) and pharmacological research (over which they also have no control). Responsibility for well-being is shifted to others. Pepper worried that reliance on medication alone might hasten a person’s deterioration. (pg. 63)
Q: And?
A: The final pages of Chapter 2 discuss lots of research that has looked at exercise and PD (as well as other diseases affecting the brain, such as Alzheimer’s), with animals as well as humans. There’s a lot of discussion about using both exercise and “enriched environment” to help the brain repair itself. Of course, I’m big on “enriched environment” as well as exercise, but here’s a paragraph from Doidge’s book about just two of these research studies:
A host of discoveries followed, which found that placing animals in enriched environments led to neuroplastic change. The first modern use of enriched environments occurred when the Canadian psychologist Donald Hebb, instead of keeping rats in laboratory cages, brought them home and let them roam freely around his living room as pets. He showed that they performed better on problem-solving tests than those raised in cages. The psychologist Mark Rosenzweig was able to show that the animals raised in enriched environments developed more neuroplastic changes in their brains and produced more neurotransmitters, compared with those raised in typical rat or mouse cages. Their brains were heavier, having a larger volume. (pg. 79)
Q: Does John Pepper also place himself in an enriched environment?
A: Yes. To quote:
A second study by Hanman’s group showed that spending time on the running wheel contributed to the delay of Huntington’s onset in mice, though both cognitive and sensory stimulation were also important. Of course these are the two tasks that John Pepper performs: He walks fast, but he also provides himself with constant cognitive stimulation: the superconcentration he uses [when he walks] to sense and monitor exactly how he places each foot and performs each movement engages his sensory and cognitive capacities. Since his diagnosis, he has also stimulated his mind by doing crosswords and Sudoku; playing bridge, chess, poker and dominoes; by recording CDs of himself singing, by learning French, and by doing a brain program by Posit Science. (pg. 81)
Q: So Chapter 2 is not merely about walking to stave off the physical symptoms of Parkinson’s?
A: No.
Q: What else does it get into?
A: Among other things, reducing your risk of dementia.
Q: How so?
A: Well, here’s an example from the many studies the chapter describes (pg. 96). A team of researchers followed 2,235 men in Wales for thirty years, examining each man regularly and, if the researchers saw something amiss with someone’s mental condition, they sent that man for additional clinical assessments. The results? Men who fulfilled at least four of the following five criteria had a 60% lower risk of developing dementia and cognitive decline:
- Vigorous exercise, such as biking ten miles/day.
- Healthy diet with lots of fruit and vegetables.
- Normal weight.
- Low alcohol intake.
- No use of tobacco products.
Q: Have we reached 20 questions yet?
A: No.
Q: When will we reach the 20th question?
A: We just did.
Note: The photo at the top of this article is a stock picture downloaded from Pixabay, the website with thousands of free public-domain photos. However, here are two videos showing the real thing: John Pepper teaching a man with Parkinson’s how to walk normally again, and Norman Doidge discussing Pepper’s case history.
Important Caveat: While John Pepper’s story is amazing and inspirational, I’m not suggesting that we all stop taking our Parkinson’s meds if we walk a lot. That could easily be dangerous. However, I think his physical workout routine of getting his heart to pump above 100 beats/minute for an hour three times/week is an excellent goal for many of us.
– Bruce Ballard
Leave your thoughts, questions and comments at the bottom.
I have found that walking sticks help me swing my arms, walk more upright and practically eliminate balance issues.