Category Archives: Exercise

Part 1 of 2017 PWR! (Parkinson Wellness Recovery) Retreat: Pictures With Great Memories

“Just put one foot in front of the other.”  Austin Peck

“Coming together is a beginning; keeping together is progress; working together is success.”  Henry Ford

Introduction to Part 1: From May 28-June 3, >100 people came to Scottsdale, Arizona for the PWR! Retreat. The final tally had >50 people-with-Parkinson’s, more than 30 care partners and ~20 physical therapists/fitness professionals, and PWR! Gym staff.

Simply stated,  participating in my first PWR! Retreat was life-altering, life-changing and possibly even life-saving. It will be hard to put into words what the week meant to me and  what it did for me.

I have decided to write 2 posts describing the PWR! Retreat,  Part 1 contains: (i) overview of week; (ii) instructors; (iii) impressions of format, instructors, teams, and location; and (iv) video presentation describing the entire week.

“Alone we can do so little; together we can do so much.”  Helen Keller

Video presentation describing the entire week:   I want to begin with the finale and show a video compiled to highlight the week of the PWR! Retreat. The vast majority of pictures shown in the video were either taken by or obtained from Claire McLean. A few things I want to highlight about the PWR! Retreat that you will see in the video include the following: a) it was a tremendous amount of fun; b) it was a lot of work physically because we exercised several hours every day; c) there was total camaraderie and synergy throughout the week; d)  every afternoon was spent being educated about Parkinson’s; e)  the physical therapists/fitness professionals that led our sessions were all outstanding people and really knew how to work well with everyone with Parkinson’s, and f)  the week revolved around the exercise program and philosophy created by Dr. Becky Farley  (Founder and CEO of Parkinson Wellness Recovery), and in reality, she was the reason we were all at the PWR! Retreat.

Assembling the pictures and putting it all together into the video format left me somewhat speechless. The video brought back so many wonderful memories of the interactions with everybody and it reminded me of the intensity of the exercise.  Watching the video allowed me to recall the sheer quality and quantity of the education  program presented, and it let me reminiscence about the sincerity and friendliness of everyone present.   It just felt like everyone wanted to be at the PWR! Retreat every single second of that week.

Video of 2017 PWR! Retreat: Pictures With Great Memories (to access the YouTube site, please click here).

“We keep moving forward, opening new doors, and doing new things, because we’re curious and curiosity keeps leading us down new paths.” Walt Disney

PWR! Retreat agenda and overview of the week (Click here to view Program ): There were basically two-sessions per day.  The morning always began for everyone with a PWR-Walk with poles at 6:30 AM, then breakfast and then separate programs for those of us with Parkinson’s (exercise) and Care Partners (a mixture of education sessions, group discussions and/or exercise), and sometimes we were combined together (which was always fun). Lunch was next.  The afternoon session was usually all-inclusive of participants and we listened to experts discuss many aspects of Parkinson’s, we had group discussions, and we had sessions of yoga, meditation, Tai Chi and other modalities (e.g., deep-brain stimulation surgery or DBS) used to treat Parkinson’s. The day usually ended at 5:30 PM and dinner was on our own.  Many came back after dinner to the game room, we had a dance night, I played golf on 4 different evenings, many of us returned to the resort bar/club to socialize and many people checked in early because an 11-hour day was incredibly fun but also it was tiring. All-in-all, the agenda was completell, well-rounded, and most enjoyable.  We were never bored.

“I find that the best way to do things is to constantly move forward and to never doubt anything and keep moving forward, if you make a mistake say you made a mistake.”  John Frusciante

PWR! Retreat instructors (brief biographies of the people who led our instructions; presented in alphabetical order after Dr. Farley):  To me, exercise  was the most important aspect of the retreat, followed by meeting everyone with Parkinson’s, and then equally important, the educational program.   Therefore, I want to present the physical therapists/fitness professionals, volunteers and staff that provided us our workout each day.  Each person was uniquely qualified; in my opinion, together as a team they have no equal. Here are a few comments about each one of the instructors.

•Dr. Becky Farley has a PhD in neuroscience from the University of Arizona, a Masters of science physical therapy from the University of North Carolina at Chapel Hill, and a bachelor of physical therapy from the University of Oklahoma.  During her post-doctorate, she developed the LSVT Big therapy program. Following this, she created the exercise program of PWR!Moves, opened the PWR! Gym that follows a philosophy centered on exercise is medicine and framework call PWR!4Life; in all this is contained within the nonprofit organization called Parkinson Wellness Recovery (PWR!).  The PWR! Retreat begins and ends with Dr. Farley; she’s clearly the heartbeat of why we were in Arizona.

•Dr. Jennifer Bazan-Wigle has her doctorate of physical therapy from Nova Southeastern University. She is an expert in treating individuals with Parkinson’s and various movement disorders and works at the PWR!Gym in Tucson, Arizona.  My history with Jennifer starts in 2016 when she was my instructor for PWR!Moves certification;  she was a motivated teacher, very knowledgeable about Parkinson’s and had intensity and the drive to really focus us to learn the material.  Jennifer is a role model for a physical therapist, and she is an amazing educator for working with those of us with Parkinson’s.

Jan Beyer completed her Masters in health education from Cortland state New York and started her own personal training business called “FitJan”.   She now lives and works in the Vancouver, Washington area where she’s working for the Quarry Senior living as the fitness director/Parkinson’s director.

Dr. Emily Borchers has her doctorate in physical therapy from Ohio State University and she currently works at the PWR!Gym.  Emily was very effective at sharing her expertise in helping teach all of the individuals with Parkinson’s.

Heleen Burghout has a Masters degree in physiotherapy from University of Amsterdam,  the Netherlands; and she has a primary care practice called ‘FhysioAlign’ in Ede,  the Netherlands. One of the main focuses of her practice is dealing with exercise and improving physical and mental conditions of people with Parkinson’s.

Dr. Valerie A. Carter has a doctorate in physical therapy from Northern Arizona University in Flagstaff Arizona and is an associate clinical professor of physical therapy at Northern Arizona University.  She is certified and has taught workshops in both PWR! Moves and LSVT Big.  She owns and operates “Carter rehabilitation and wellness center and outpatient physical therapy clinic” in Flagstaff and she is an expert dealing with Parkinson’s patients.

Dr. Carl DeLuca has a doctorate in physical therapy from the University of Wisconsin-Madison.  He works in Wisconsin Rapids Wisconsin and is focused on a patient population with outpatient orthopedic and neurological including people with Parkinson’s.  He is working to set up a central Wisconsin PT program for Parkinson’s.

Dr. Chelsea Duncan has a doctorate in physical therapy from University Southern California and works as an outpatient neurologic clinic that specializes in movement disorders. She focuses in teaching both one-on-one and group exercise classes  for people with Parkinson’s. And she does live in sunny Los Angeles California.

Marge Kinder has a degree in physical therapy from University of California, San Francisco and for more than 40 years has been practicing and treating neurological disorders.  She is the project coordinator for the Redmond Regional Medical Center in Rome Georgia.

Dr. Claire McLean  has a doctorate in physical therapy  from the University of Southern California and is an adjunct faculty member at both University of Southern California and California State University, Long Beach.  She has extensive training and is a board-certified neurologic clinical specialist and teaches both PWR! therapist and instructor courses. She has started a community wellness program for people with Parkinson’s and this is located in Southern California. My experience with Claire is that she was the voice and instructor for the videos that I use in my own training and for my undergraduate class in highlighting PWR! Moves.  Claire is an incredible PT/educator of exercise-and-life-programs for those of us with Parkinson’s.

Nancy Nelson is an ACE certified personal trainer and fitness specialist with over three decades of work experience in the health and wellness industry. She is an expert in dealing with exercise and Parkinson’s.

Sarah Krumme Palmer  has an MS degree in exercise physiology and have been working with patients with Parkinson’s for over 20 years. She is the owner of ‘forever fitness’ in Cincinnati Ohio. She is certified in PWR! moves professional, and has the Rock Steady Boxing affiliate in Cincinnati and has a Certified Strength and Conditioning Specialist (CSCS) certification through the National Strength and Conditioning Association (NSCA).

Kimberly Peute has an MBA from Webster University and is currently a JD candidate University of Arizona School of Law. She was an active participant in the PWR! retreat and was in charge of the care partner program.

•Lisa Robert has a physical therapy degree from the University of Alberta and Edmonton Alberta Canada and has been working in various settings including acute care, private practice and outpatient setting treating neurological patients.   Lisa has NDT, LSVT Big and PWR! Moves professional training experience, and she is a Master Trainer for urban poling. Lisa is also an excellent golfer; I had the opportunity and pleasure to play golf with her twice during the week of the PWR! Retreat.

•Ben Rossi has nearly 20 years of experience in fitness coaching, eight years dealing with the peak Parkinson’s community and as the founder of InMotion, he owns and operates ATP evolution performance training center.  Ben’s goal is straightforward in that he wants you in motion, helps you achieve a better eating program, encourages a positive attitude and he wants you to become 1% better every day.  He lives in Warrensville Heights Ohio.

Melinda Theobald has her MS degree in human movement from the A.T. Still University, Arizona School of Health Sciences, where she is certified by the National Academy sports medicine as corrective exercise specialist and a performance enhancement  specialist.  She currently works for Banner Neuro Wellness West in Sun City Arizona.

•Christy Tolman  has been a licensed realtor for over a decade and  served on the Parkinson’s network of Arizona at the Mohammad Ali Parkinson Center in Phoenix.  She was everything to the PWR! Retreat in terms of organizational skills;  in other words,  the PWR! Retreat was successful because of Christy’s effort.

“If everyone is moving forward together, then success takes care of itself.”  Henry Ford

Impressions of format, instructors, teams, and location: 
Location– Scottsdale Resort in McCormick Ranch in Scottsdale Arizona was the ideal setting for the PWR! Retreat. The resort itself was well-kept and the rooms we used for the retreat were just right; the staff were helpful; it was adjacent to a golf course (great for me); many restaurants/shopping were only minutes away; and the food was just never-ending and really good quality.   I realize you can’t control the weather, but it was ideal sunny, hot and dry with clear skies.
Format–  the format was described above and it seemed ideal for the participants dealing with exercise in the morning and education in the afternoon with evenings free either to do things with your partner or with the group-at-large.
Instructors– They totally rocked!  I cannot imagine a better group of people to teach PWR! Moves and the other exercise (PWR-pole-walking, Circuit and Nexus) routines associated with the PWR! Retreat.  It was also so nice to see them outside of exercise; some gave talks in the afternoon sessions, we had meals together with them , and they were also active participants in all of our other events. 
Teams–   we had four different teams, my team was the Blue team  (For pole walking it was both the people with Parkinson’s and the care partners together, and for the exercise it was typically just the people with Parkinson’s together) and my group did the following sessions together as illustrated by the blue boxes in the table below.   I will describe the experience in more detail in my next post.  However, this was the vital experience that made the PWR! Retreat so valuable, spending time with these people the majority of whom had Parkinson’s (it was a special treat and honor to have the care partners with us for so much time as well because they were remarkable people themselves).

17.07.22.Group_Assignments

“Don’t dwell on what went wrong. / Instead, focus on what to do next. / Spend your energies on moving forward / toward finding the answer.” Denis Waitley

Pictures With Great Memories:  Below are posted many of the pictures that were contained in the video I showed in the beginning of the post. My second post I will spend more time talking about the exercise routines, education program, team camaraderie, and my personal feelings behind the week of exercise and everything else associated with the PWR! Retreat.   It’s very safe to say as I remarked at the beginning, the impact of  the PWR! Retreat on me was life altering and very meaningful in a profound manner.

My Team/Program Leaders (names of those missing from pictures are given in the video):

 The Team Leaders and Teams:

Exercise Routines (Pole walking, PWR! Moves, Nexus and Circuit):

 

Dance night, game night and meditation:

 

My Keynote presentation and additional ‘stuff’:

 

 

Additional photos of the PWR! Retreat instructors/organizers:
Screen Shot 2017-07-14 at 9.39.41 AMIMG_5228 (1)Golf fun:

 

Giving thanks and saying good-bye to all of the instructors:

 

 

“I do believe my life has no limits! I want you to feel the same way about your life, no matter what your challenges may be. As we begin our journey together, please take a moment to think about any limitations you’ve placed on your life or that you’ve allowed others to place on it. Now think about what it would be like to be free of those limitations. What would your life be if anything were possible?” Nick Vujicic

Cover photo credit:

http://www.genehanson.com/images/photography/777sunset/020_arizona_sunetset_image0001.jpg

 

 

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9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s

“A willing mind makes a hard journey easy.” Philip Massinger

“Lack of activity destroys the good condition of every human being.” Plato

Introduction: Much of my life has been spent exercising. Most of this exercise has been done with sheer delight.  Since receiving my Parkinson’s diagnosis, my opinion of exercise has changed.  With Parkinson’s, I’m now exercising as if my life depends on it.  Why?  Animal models (mouse and rat) of Parkinson’s have convincing shown the effect of exercise-induced neuroplasticity.  These animal studies demonstrated neuroprotection and even neurorestoration of Parkinson’s.  But we’re neither mice/rats nor are we an animal model of Parkinson’s disease; thus, this post is an update on exercise-induced neuroplasticity in human Parkinson’s.

“If you don’t do what’s best for your body, you’re the one who comes up on the short end.” Julius Erving

cartoon-brain-exercise

9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s: Neuroplasticity,  neuroprotection and neurorestoration are catchy words that populate a lot of publications, blogs from many of us with Parkinson’s and from professionals who study/work in the field of Parkinson’s.  It is important for you to develop your own opinion about exercise-induced neuroplasticity. My goal in this post is to provide the basic elements, concepts and key reference material to help you with this opinion. Here is a 1-page summary of “9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s” (click here to download page).

9_things_exercise_neuroplasticity_parkinsons

(1) Parkinson’s Disease (PD): Parkinson’s is a neurodegenerative disorder. Parkinson’s usually presents as a movement disorder, which is a slow progressive loss of motor coordination, gait disturbance, slowness of movement, rigidity, and tremor.  Parkinson’s can also include cognitive/psychological impairments. ~170 people/day are diagnosed with Parkinson’s in the USA; the average age of onset is ~60 years-old.

(2) Safety First: The benefit of an exercise routine/program will only work if you have (i) talked about it with your Neurologist and have his/her consent; (ii) you have received advice from a physical therapist/certified personal trainer about which exercises are ‘best’ for you; and (iii) you recognize that PD usually comes with gait and balance issues, and you are ready to begin. Safety first, always stay safe!

(3) Exercise: Exercise is activity requiring physical effort, carried out especially to sustain or improve health and fitness. Exercise is viewed by movement disorders clinicians, physical therapists, and certified personal trainers as a key medicinal ingredient in both treating and enabling patients at all stages of Parkinson’s.

(4) Brain Health: With or without Parkinson’s disease, taking care of your brain is all-important to your overall well-being, life-attitude, and health. For a balanced-healthy brain, strive for: proper nutrition and be cognitively fit; exercise; reduce stress; work and be mentally alert; practice mindfulness/meditation; sleep; and stay positive.

(5) Neuroplasticity: Neuroplasticity describes how neurons in the brain compensate for injury/disease and adjust their actions in response to environmental changes. “Forced-use exercise” of the more affected limb/side can be effective in driving neural network adaptation.  Ultimately, this can lead to improved function of the limb/side.

(6) Synapses are junctions between two nerve cells whereby neurotransmitters diffuse across small gaps to transmit and receive signals.

(7) Circuitry: A key result of neuroplasticity is the re-routing of neuronal pathways of the brain along which electrical and chemical signals travel in the central nervous system (CNS).

(8) Parkinson’s-specific Exercise Programs:
PWR!Moves (click here to learn more)
Rock Steady Boxing (click here to learn more)
LSVT BIG (click here to learn more)
Dance for PD (click here to learn more)
LIM Yoga (click here to learn more)
Tai Chi for PD (click here to learn more)

What types of exercise are best for people with Parkinson’s disease? Here is a nice overview of the benefits of exercise for those of us with Parkinson’s  (click here). Regarding the PD-specific exercise programs,  I am most familiar with PWR!Moves, Rock Steady Boxing and LSVT BIG (I’m certified to teach PWR!Moves, I’m a graduate of LSVT BIG, and I’ve participated in Rock Steady Boxing). A goal for you is to re-read ‘Safety First’ above and begin to decide which type of exercise you’d benefit from and would enjoy the most.

(9) Brain/Behavior Changes: The collective results found increase in corticomotor excitability, increase in brain grey matter volume, increase in serum BDNF levels, and decrease in serum tumor necrosis factor-alpha (TNFα) levels. These results imply that neuroplasticity from exercise may potentially either slow or halt progression of Parkinson’s.

What the terms mean: Corticomotor describes motor functions controlled by the cerebral cortex (people with Parkinson’s show reduced corticomotor excitability). Brain grey matter is a major component of the central nervous system consisting of neuronal cells, myelinated and unmyelinated axons, microglial cells, synapses, and capillaries. BDNF is brain-derived neurotrophic factor, which is a protein involved in brain plasticity and it is important for survival of dopaminergic neurons. Tumor necrosis factor-alpha (TNFα) is an inflammatory cytokine (protein) that is involved in systemic inflammation.  Some studies of exercise-induced neuroplasticity in human Parkinson’s found the above-mentioned changes, which would imply a positive impact of exercise to promote neuroplastic changes.

What can you do with all of the cited articles listed at the end? Compiled below are some comprehensive and outstanding reviews about exercise-induced neuroplasticity in Parkinson’s.  Looking through these papers, you’ll see years of work, but this work has all of the details to everything I’ve described.

“All life is an experiment. The more experiments you make the better.” Ralph Waldo Emerson

What I believe about neuroplasticity and exercise in Parkinson’s: [Please remember I am not a physician; definitely talk with your neurologist before beginning any exercise program.]  I think about exercising each day; I try to do it on a daily basis.  As a scientist, I’m impressed by the rodent Parkinson’s data and how exercise promotes neuroplasticity. The human studies are also believable; sustained aerobic exercise induces neuroplasticity to improve overall brain health. “Forced-use exercise” is an important concept; I try to work my right-side (arm and leg), which are slightly weaker and stiffer from Parkinson’s. Initially, I used my left arm more, now I ‘force’ myself on both sides with the hope my neural network is stabilized or even improving. If you enjoy exercising as I do, I view it as both an event and a reward; ultimately, I believe it can work and improve my response to Parkinson’s. If you don’t enjoy exercising, this may be more of a task and duty; however, the benefits over time can be better health. Exercise is good for you (heart and brain).  Begin slow, make progress, and see if you are living better with your disorder.  Remain hopeful and be both persistent and positive; try to enjoy your exercise.

“I am not afraid of storms for I am learning how to sail my ship.” Louisa May Alcott

Past blog posts: Both exercise itself and the benefit of exercise-induced neuroplasticity have been common themes for this blog, including (click on title to view blog posting):
Believe in Life in the Presence of Parkinson’s;
Déjà Vu and Neuroplasticity in Parkinson’s;
Golf And Parkinson’s: A Game For Life;
The Evolving Portrait of Parkinson’s;
Believe In Big Movements Of LSVT BIG Physical Therapy For Parkinson’s;
Meditation, Yoga, and Exercise in Parkinson’s;
Exercise and Parkinson’s.

“Do not let what you cannot do interfere with what you can do.” John Wooden

References on neuroplasticity and exercise in Parkinson’s:
Farley, B. G. and G. F. Koshland (2005). “Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease.” Exp Brain Res 167(3): 462-467 (click here to view paper).

Fisher, B. E., et al. (2008). “The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease.” Arch Phys Med Rehabil 89(7): 1221-1229 (click here to view paper).

Hirsch, M. A. and B. G. Farley (2009). “Exercise and neuroplasticity in persons living with Parkinson’s disease.” Eur J Phys Rehabil Med 45(2): 215-229 (click here to view paper).

Petzinger, G. M., et al. (2010). “Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s disease.” Mov Disord 25 Suppl 1: S141-145 (click here to view paper).

Bassuk, S. S., et al. (2013). “Why Exercise Works Magic.” Scientific American 309(2): 74-79.

Lima, L. O., et al. (2013). “Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson’s disease: a systematic review.” Journal of Physiotherapy 59(1): 7-13 (click here to view paper).

Petzinger, G. M., et al. (2013). “Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease.” Lancet Neurol 12(7): 716-726 (click here to view paper)..

Ebersbach, G., et al. (2015). “Amplitude-oriented exercise in Parkinson’s disease: a randomized study comparing LSVT-BIG and a short training protocol.” J Neural Transm (Vienna) 122(2): 253-256 (click here to view paper).

Petzinger, G. M., et al. (2015). “The Effects of Exercise on Dopamine Neurotransmission in Parkinson’s Disease: Targeting Neuroplasticity to Modulate Basal Ganglia Circuitry.” Brain Plast 1(1): 29-39 (click here to view paper).

Abbruzzese, G., et al. (2016). “Rehabilitation for Parkinson’s disease: Current outlook and future challenges.” Parkinsonism Relat Disord 22 Suppl 1: S60-64 (click here to view paper).

Hirsch, M. A., et al. (2016). “Exercise-induced neuroplasticity in human Parkinson’s disease: What is the evidence telling us?” Parkinsonism & Related Disorders 22, Supplement 1: S78-S81 (click here to view paper)

Tessitore, A., et al. (2016). “Structural connectivity in Parkinson’s disease.” Parkinsonism Relat Disord 22 Suppl 1: S56-59 (click here to view paper).

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates

“Life is complex. Each one of us must make his own path through life. There are no self-help manuals, no formulas, no easy answers. The right road for one is the wrong road for another…The journey of life is not paved in blacktop; it is not brightly lit, and it has no road signs. It is a rocky path through the wilderness.” M. Scott Peck

Cover photo credit: http://paper4pc.com/free-seascape.html#gal_post_55564_free-seascape-wallpaper-1.jpg

Brain exercising cartoon: http://tactustherapy.com/neuroplasticity-stroke-survivors/

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7 Healthy Habits For Your Brain

   “Your brain – every brain – is a work in progress. It is ‘plastic.’ From the day we’re born to the day we die, it continuously revises and remodels, improving or slowly declining, as a function of how we use it.” Michael Merzenich

“The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together.” Kurdish Saying

7 Basic Brain Facts [click here for more facts]: (1) The typical brain is ~2% of your total weight but it uses 20% of your total energy and oxygen intake. (2) >100,000 chemicals reactions/sec occur in your brain. (3) The latest estimate is that our brains contain ~86 billion brain cells. (4) In contrast to the popular belief that we use ~10% of our brains; brain scans show we use most of our brain most of the time. (5) There are as many as 10,000 specific types of neurons in the brain.  (6) Cholesterol is an integral part of every brain cell. Twenty-five percent of the body’s cholesterol resides within the brain. (7) Your brain generates between 12-25 watts of electricity, which is enough to power a low wattage LED light.

7 Healthy Habits for Your Brain: With or without Parkinson’s disease, taking care of your brain is all-important to your overall well-being, life-attitude, and health. These are  straightforward suggestions of healthy habits for your brain; hopefully, this list will serve as a reminder about their importance.  Here is a 1-page summary of the “7 Healthy Habits for Your Brain” (Click here to download file).

7-healthy-habits-for-your-brain


[1] Exercise and neuroplasticity:
  Exercise is almost like a soothing salve for your brain.  Some benefits of exercise include helping your memory and increased flow of oxygen to brain, which energizes the brain.  Exercise is good for both your heart and your brain. Exercise can reduce inflammation in the brain and increase hormones circulating to your brain.  For a brief overview on the benefits of exercise to your brain, click here.

Neuroplasticity is the ability to re-draw, re-wire the connections in your brain. What this means is that neuroplasticity is a concerted attempt of neurons to compensate for brain injury/disease. Neuroplasticity ultimately modifies your brain’s activities in response to changes in these neuronal-environments.

There is much positive evidence in animal models of Parkinson’s regarding exercise-induced neuroplasticity.  The same benefits are now being tested in humans with Parkinson’s and the results are most encouraging. One of the numerous backlogged blog drafts that will be completed in the near-future is a “Review of Exercise and Neuroplasticity in Parkinson’s”.

“Exercise is really for the brain, not the body. It affects mood, vitality, alertness, and feelings of well-being.” John Ratey

“Neuroplasticity research showed that the brain changes its very structure with each different activity it performs, perfecting its circuits so it is better suited to the task at hand.” Naveen Jain

[2] Diet and brain food: Your memory is aided by ‘what’ you eat.  Harvard’s Women Health Watch makes the following suggestion to boost your memory through diet (click here to read entire article): “The Mediterranean diet includes several components that might promote brain health: Fruits, vegetables, whole grains, fish, and olive oil help improve the health of blood vessels, reducing the risk for a memory-damaging stroke; Fish are high in omega-3 fatty acids, which have been linked to lower levels of beta-amyloid proteins in the blood and better vascular health; Moderate alcohol consumption raises levels of healthy high-density lipoprotein (HDL) cholesterol. Alcohol also lowers our cells’ resistance to insulin, allowing it to lower blood sugar more effectively. Insulin resistance has been linked to dementia.”  WebMD summarized the role of diet and brain health in “Eat Smart for a Healthier Brain” (click here to read article).

A large group of women (>13,000 participants) over the age of 70 were studied and the results showed that the women who ate the most vegetables had the greater mental agility (click here to read the article). These results suggest for a healthy brain we should eat colorful fruits and vegetables high in antioxidants; and foods rich in natural vitamin E, vitamin C, B (B6, B12) folic acid and omega-3 fatty acids. Furthermore, we should avoid refined carbohydrates and saturated fats. In small amounts, vitamin D3 is almost like candy for your brain.

“Hunger, prolonged, is temporary madness! The brain is at work without its required food, and the most fantastic notions fill the mind.” Jules Verne

“Everything one reads is nourishment of some sort – good food or junk food – and one assumes it all goes in and has its way with your brain cells.” Lorrie Moore

[3] Mindfulness/meditation: Greater Good (The Science of a Meaningful Life) describes mindfulness as “…maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment. Mindfulness also involves acceptance, meaning that we pay attention to our thoughts and feelings without judging them—without believing, for instance, that there’s a ‘right’ or ‘wrong’ way to think or feel in a given moment.”  I recently described mindfulness as “Mindfulness means you stay within your breath, and focus within yourself, with no remembrance of the past minute and no planning for the future moment.”  Here’s a simple mindfulness experience/moment: simply be aware of the steam leaving your morning cup of coffee/tea, clear your immediate thoughts, then sip, focus and savor this moment.

“The picture we have is that mindfulness practice increases one’s ability to recruit higher order, pre-frontal cortex regions in order to down-regulate lower-order brain activity,” a comment from Dr. Adrienne Taren, a researcher studying mindfulness at the University of Pittsburgh. She also said  “it’s the disconnection of our mind from its ‘stress center’ that seems to give rise to a range of physical as well as mental health benefits.”  (Click here to read this article).  “What Does Mindfulness Meditation Do to Your Brain?” (click here to read more)

“Mindfulness practices enhance the connection between our body, our mind and everything else that is around us.” Nhat Hanh

“Mindfulness is a pause — the space between stimulus and response: that’s where choice lies.” Tara Brach

 [4] Stress reduction: When you are under constant or chronic stress your body makes more of the steroid hormone cortisol (a glucocorticoid), which is produced by the adrenal glands above your kidneys.  Over time, chronic stress can trigger changes in brain structure and function. Excess cortisol production reduces neuronal cells, over-produces myelin protective covering to our nerves, and we make more oligodendrocytes.  How do you reduce chronic stress?  Exercise and mindfulness/meditation are both able to lower cortisol levels.  Easier said then done to making life-style changes to reduce chronic stress; however, doing it will allow the neuroplastic process to begin re-wiring your brain. For an overview of stress and trying to manage/reduce chronic stress, click here.

“Stress is an ignorant state. It believes that everything is an emergency.” Natalie Goldberg

“There is more to life than increasing its speed.” Mahatma Gandhi

[5] Work, keep active mentally:  There are 2 sides to this topic.  First, stay engaged at work and you won’t age as fast as someone disengaged.  What I’m trying to say is simply staying active mentally at work will assist your brain during the ageing process.  Keep your brain stimulated with work, thought, challenges; the effort provides your brain with significant growth.  Your reward will be an active-focused and rejuvenated mind.  Second, by contrast, we’re all working long hours balancing too many tasks, all-the-time; ultimately, we’re trying to multi-task when we really can’t multi-task very well.  In a nice article entitled “The Magic of Doing One Thing at a Time“, Tony Schwartz summarized a key problem: “It’s not just the number of hours we’re working, but also the fact that we spend too many continuous hours juggling too many things at the same time. What we’ve lost, above all, are stopping points, finish lines and boundaries.”  As you balance the 2-sides-of-the-topic, focus your energy on the first-side by performing each individual task/topic; clear your mind, keep your brain engaged, focus hard and then let your brain renew.

“To let the brain work without sufficient material is like racing an engine. It racks itself to pieces.” Arthur Conan Doyle

“A fresh mind keeps the body fresh. Take in the ideas of the day, drain off those of yesterday.” Edward Bulwer-Lytton

 [6] Positive and happy is better for your brain:  I truly believe you need to be positive in dealing with Parkinson’s; trying to focus on staying happy will benefit all-around you and bolster your brain’s health. Using positivity will allow you to creatively handle many obstacles ahead, whether in the absence or presence of Parkinson’s.  Susan Reynolds summarized in “Happy Brain, Happy Life” that being happy: “stimulates the growth of nerve connections; improves cognition by increasing mental productivity; improves your ability to analyze and think; affects your view of surroundings; increases attentiveness; and leads to more happy thoughts.”  On the notion of staying positive, she said: “…thinking positive, happy, hopeful, optimistic, joyful thoughts decreases cortisol and produces serotonin, which creates a sense of well-being. This helps your brain function at peak capacity.”


Positive

“Do the best you can until you know better. Then when you know better, do better.” Maya Angelou

“You have to train your brain to be positive just like you work out your body.” Shawn Achor

[7] Sleep: It’s simple; our brains, our bodies need sleep.  Many of us battle with less than adequate daily sleep habits.  However, it’s really simple; our brains, our bodies need sleep.  Much of our day’s success resides in the quality of sleep the night before.  The science of sleep is complex but much of it revolves around our brain.  We use sleep to renew and de-fragment our brain; and sleep helps strengthen our memory.  For more details on sleep science, please look over “What Happens in the Brain During Sleep?” (click here).  Alice G. Walton very nicely summarized several aspects of the sleep-brain interactions focusing on the following 7 headings: “Sleep helps solidify memory; Toxins, including those associated with Alzheimer’s disease, are cleared during sleep; Sleep is necessary for cognition; Creativity needs sleep; Sleep loss and depression are  intertwined; Physical health and longevity; and Kids need their sleep” [click here for “7 Ways Sleep Affects The Brain (And What Happens If It Doesn’t Get Enough)”].  Finally, the Rand Corp. just released a comprehensive study on sleep and the economic burden being caused by the lack of sleep (click here to read the 100-page report).

Sleep is the golden chain that ties health and our bodies together.Thomas Dekker

A good laugh and a long sleep are the best cures in the doctor’s book.   Irish Proverb

A Personal Reflection on the “7 Healthy Habits for Your Brain”:  My fall semester is physically, mentally, and emotionally draining; and I cherish doing all of these tasks, I really do.  The writing of this blog is a deliberate attempt to remind me what I need to be doing, to re-initiate tomorrow in my daily life.  I could explain each point in detail in what poor-brain-health-habits I’ve developed this semester (but I won’t).  However, I am printing out the 1-page handout of 7-healthy-brain-habits to keep it with me as I spend the rest of December re-establishing effective habits for my brain; and doing a better job of balancing work with life-love-fun.

“Your body, which is bonding millions of molecules every second, depends on transformation. Breathing and digestion harness transformation. Food and air aren’t just shuffled about but, rather, undergo the exact chemical bonding needed to keep you alive. The sugar extracted from an orange travels to the brain and fuels a thought. The emergent property in this case is the newness of the thought; no molecules in the history of the universe ever combined to produce that exact thought.” Deepak Chopra

Cover image: https://img1.etsystatic.com/000/0/6392236/il_fullxfull.267319437.jpg

Mindfulness list: http://www.mindful.org/7-things-mindful-people-do-differently-and-how-to-get-started/

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Believe in Life in the Presence of Parkinson’s

“Life is not only merriment, it is desire and determination.” Kahlil Gibran

“Nothing will work unless you do.” Maya Angelou

Dedication: I recently participated in a Parkinson Wellness Recovery (PWR!) Instructor Workshop in Greenville, SC (July 30-31, 2016); now I am certified in PWR!Moves.  This post is dedicated to the workshop instructor Jennifer Bazan-Wigle; and to my classmates, all of the personal trainers interested in working with Parkinson’s disease patients.  Jennifer was simply a great instructor, with a real understanding of Parkinson’s and a true ability to ‘teach’.  The personal trainers who participated were very dedicated in their effort to master PWR!Moves and their willingness to instruct me during the weekend workshop made for a memorable experience.  And not to forget Steve Miller, a PWR!Moves instructor, who also helped teach; you were the inspiration that led me to apply for this workshop. To everyone certified in PWR!Moves and to those involved in my PWR!Moves workshop, thank you, thank you so very much.

PWR! Logo

“There are no shortcuts to any place worth going.” Beverly Sills

Introduction: Coach Lou Holtz said “Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.”  This got me thinking about ability, motivation and attitude but especially how vital both motivation and attitude are for living successfully with Parkinson’s.

Believe in Life in the Presence of Parkinson’s:
I’m a healthy person that happens to have Parkinson’s; this is what I believe:
I believe daily exercise enhances my life in the presence of Parkinson’s.
I believe people-with-Parkinson’s can become healthier with exercise.
I believe sustained exercise can promote neuroplasticity to re-wire my neural network.
I believe I have the ability to do the repetitions to re-train my brain.
I believe staying positive will help control the course of my Parkinson’s.
I believe having courage will provide mettle in the battle against my disorder.
I believe being persistent allows me to restrain my Parkinson’s.
I believe motivation begins from within, and there can be no backing down to this disease.
I believe if I don’t give up I can slow the progression of my disorder.
I believe if you pity me it feeds the hunger of my Parkinson’s.
I believe if you join my team, you can help me stall this slowly evolving disorder.
I believe attitude is the fuel to sustain the effort to combat Parkinson’s.
I believe in science that new therapies/strategies against Parkinson’s are on the horizon.
I believe exercise with ability, motivation and attitude will work to my advantage each day.
I believe that each new day renews my chance of slowing the beast named Parkinson’s.
My daily mantra is to never give up; I refuse to surrender to Parkinson’s.

“Keep your thoughts positive because your thoughts become your words. Keep your words positive because your words become your behavior. Keep your behavior positive because your behavior becomes your habits. Keep your habits positive because your habits become your values. Keep your values positive because your values become your destiny.” Mahatma Gandhi

Cover photo credit: https://c7.staticflickr.com/9/8615/16157237102_f15e505c19_b.jpg

 

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Catching Up, Life-Stories, and Future Posts in Journey With Parkinson’s

“One isn’t necessarily born with courage, but one is born with potential. Without courage, we cannot practice any other virtue with consistency. We can’t be kind, true, merciful, generous, or honest.” Maya Angelou

“Life is not a problem to be solved, but an experience to be had.” Alan Watts

Don’t You Get The Summer Off?: My favorite check out guy at Whole Foods asked me recently, “Don’t you get the summer off from teaching medical students?” And one of my  weekend golf buddies routinely jokes about the fact that I’m in academics and says “I only have to work nine hours a week.”  In reality, being at a medical school has always meant to me to work essentially everyday. As long as my brain is functioning, I will continue to follow this lifestyle.  I have spent the summer getting ready for the fall semester, catching up on my research in the laboratory, and doing all the things I neglected to do during the school year.  Yes, in the summer I do take more opportunity to play golf during the week; however, I make up the hours working either early in the morning or late in the evening.   I realized today that I had not posted a blog in over a month; I have been busy and just not had time to sit at my computer to plan, research, think and write. The goal of this current blog is meant to be an update including future planned posts.

“What I have learned from life is to make the most of what you have got.” Stephen Hawking

Letters of Recommendation:  One of the obligations of a university professor that teaches undergraduate students is to be willing and able to write supportive letters of recommendation (well, that’s my opinion).  Many of the students I’ve taught in the past year are applying to medical school, dental school, graduate school, physician assistant school, pharmacy school, nursing school, and postbaccalaureate programs.   Several of my former students are also reapplying to some of the same programs. In a typical year, I will write 40 to 50 letters of recommendation.  And of course, the goal is to write a uniquely different letter for each student; to describe their key highlights, give evidence of their potential, and to find the most appropriate descriptive adjectives for each person.  Thus, each letter becomes its own journey from my perspective, and it takes time and considerable attention to compose such a supportive type of letter. And writing for me is always a struggle, because I have to be in the right mental  frame of mind to compose any document. My goal for the rest of  July through August is to try and write one or two letters of recommendations every couple of days.

“Life is not easy for any of us. But what of that? We must have perseverance and above all confidence in ourselves. We must believe that we are gifted for something and that this thing must be attained.” Marie Curie

Parkinson’s Empowerment Symposium: Options for Care and Living Well for Patients and Families (June 18, 2016, Asheville, North Carolina): The UNC Movement Disorders Center hosted a 1-day symposium on Parkinson’s. The focus was described as follows: “This educational program is intended for individuals diagnosed with Parkinson’s disease and/or PD care partners, with the goals of reviewing treatment and therapy options, discussing effective coping, and providing a space to ask questions.” Seeking refuge from the summer heat, we combined a fun weekend in the cool Smoky mountains in the wonderfully eclectic city of Asheville with great cajun food for dinner, cool dry mountain air to play 18-holes of golf and just relaxing fun; we also attended the Parkinson’s symposium (see pictures below; the tattoo shop story will be reserved for a future blog post).  Being around a large group of people with Parkinson’s was inspiring and motivated me further to work managing/dealing with my Parkinson’s.  All-in-all, a great experience.

IMG_1741

“Life is like riding a bicycle. To keep your balance, you must keep moving.” Albert Einstein

Awakenings:  Awakenings is a 1973 book by Oliver Sacks; he found beneficial effects of the drug L-Dopa when given to catatonic patients with encephalitis lethargica. Awakenings is also a 1990 American movie on the same topic staring Robin Williams and Robert De Niro. Use of L-Dopa ‘awakened’ the patients after years of being catatonic and now they are confronted with renewed life many years beyond their comprehension. The idea behind the treatment came from the success of using L-Dopa for treating Parkinson’s.

For the past few months, I’ve been feeling more stiffness, moving less-well and generally had a slight foreboding sense of dread.  My Neurologist, during my recent visit, decided that my treatment strategy had become less effective and we needed to ‘add-on’ something.  After several minutes of options and dosing of various compounds, I made the decision to move to Sinemet (the generic formula of Carbidopa-Levodopa 25-100 tablets); in addition to the dopamine agonists (Ropinirole extended release tablets and  Rotigotine transdermal patch).  My ‘awakening’ moment happened with the first small dose of the generic Sinemet. Absolutely felt better, less stiff, more flexible, and totally different.  I am excited to see what the future brings in continuing my new group of drugs; ready to keep exercising with renewed hope and ready to keep the rest of my life moving more efficiently.  So far the addition of the generic Sinemet has been simply positive and my own awakening.

“Life’s challenges are not supposed to paralyze you, they’re supposed to help you discover who you are.” Bernice Johnson Reagon

Coming Attractions: There are 4 categories to posts for this blog: i) “Life Lessons” (describe living with Parkinson’s); ii) “Medical Education” (report emerging medical strategies for treating/managing/curing Parkinson’s); iii) “Strategy for Living” (support mechanism to anyone with Parkinson’s or other neurodegenerative disorder); and iv) “Translating Science” (educate by presenting scientific aspects of Parkinson’s).  Listed below are the posts that are coming later this summer (my hope/plan is to get ~2 posts finished/week):

Medical Education
Immune System and Parkinson’s (Part 2): Role of Innate Immunity.

Anatomy of Parkinson’s.
Traumatic Brain Injury (TBI) Associated with Increased Risk of Parkinson’s but not of Alzheimer’s.
Update on the Anti-leukemia Drug Nilotinib and Treatment of Parkinson’s.

Strategy for Living
Parkinson’s Wellness Recovery (PWR!) Exercise Program and Neuroplasticity.
Part 5: Journey to Parkinson’s and Transradial Cardiac Catheterization.

Part 4: Journey to Parkinson’s and Electromyography.
Part 3: Journey to Parkinson’s and Polysomnography.
Part 2: Journey to Parkinson’s and Magnetic Resonance Imaging.

Life Lessons
New Face of Parkinson’s and the World Parkinson Congress.
A Simple Plan.
Where Were You When?
Love in the Presence of Parkinson’s.

Translating Science
c-Abl and α-Synuclein Interactions Linked to the Development of Parkinson’s.
Less Clueless About Parkinson’s.
Genetic Profiling of Parkinson’s Disease and Parkinson’s Dementia.
Arginase in Alzheimer’s: A New Hope.
Deletion of Huntingtin Gene in Adult Mice Suggests a New Treatment Strategy for Huntington’s.
NAD+  is Neuroprotective in a Drosophila Model of Parkinson’s.

“Life is an opportunity, benefit from it. Life is beauty, admire it. Life is a dream, realize it. Life is a challenge, meet it. Life is a duty, complete it. Life is a game, play it. Life is a promise, fulfill it. Life is sorrow, overcome it. Life is a song, sing it. Life is a struggle, accept it. Life is a tragedy, confront it. Life is an adventure, dare it. Life is luck, make it. Life is too precious, do not destroy it. Life is life, fight for it.”  Mother Teresa

Cover photo credit: http://www.pixelstalk.net/wp-content/uploads/2016/05/HD-Summer-Desktop-Wallpaper.jpg

Parkinson’s Treatment With Dopamine Agonist, Complementary and Alternative Medicine (CAM), and Exercise

“Stop taking identity in illness and start taking identity in wellness” Nina Leavins

“The thought of hope is the seed to healing.” Shilpa Menon

Précis: Several of you have asked for an update on my strategy for treating my  Parkinson’s.  My current plan consists of traditional Parkinson’s medication,  augmented by a complementary and alternative medicine (CAM) approach, and supplemented by exercise.

Is current Parkinson’s therapy similar to the new models of personalized medicine?:  Those of us with Parkinson’s have a  constellation of symptoms that vary from person-to-person.   There is no doubt that people with Parkinson’s have a movement disorder with unifying clinical features. However, expression and rate of progression of the common physical symptoms (rigidity; slowness of movement; postural instability and gait problems; and tremor) differ in each of us. This degree-of-difference in how we express our Parkinson’s is likely a combination of environmental  influences [both internal (physiologic) and external (life-style)] and genetics.

Ask 10 people with Parkinson’s to describe their symptoms and their therapy; I wouldn’t be surprised if you get 10 (slightly) different answers. In someway we are lucky (okay, relieved is likely a better word choice) because we received the diagnosis, we began being treated, and probably we started feeling better.

There is a new (and developing) trend in treating patients using a more personalized approach aimed at preventing disease with individualized treatment once the disease is diagnosed (and includes individual genetic tests). This is called personalized medicine or precision medicine (‡given at the bottom is a fuller definition).   Although there is no specific genetic test for the most common form of Parkinson’s (termed idiopathic or sporadic), I believe our neurologists are already using a form of personalized medicine to manage our individual and varied (but still somewhat similar) symptoms.

“When you got a condition, it’s bad to forget your medicine.”  Frank Miller

“If you suspect that you have Parkinson’s, knowing for certain will be much better than uncertainty.” Glenna Wotton Atwood

My Parkinson’s treatment strategy involves traditional drugs, complementary and alternative medicine (CAM), and  exercise: Compared to others, my treatment plan may seem relatively simple. It has been devised by many conversations with my Neurologist and Internist. Combined with a lot of reading and internet searching of the medical literature on what has worked in Parkinson’s treatment, the CAM list continues to evolve and be refined [e.g., I believe that NAC travels to the brain in a usable form to then boost intracellular  glutathione levels.].  The diagram below  presents an overview of the strategy for treating my Parkinson’s.

16.04.28.Brain.Med.CAM.Exercise

-Dopamine agonists: For the past two years I’ve been taking the dopamine agonist Ropinirole. Recently, we decided to add the Neupro transdermal patch, which is another dopamine agonist (Rotigotine).  By  using the dopamine agonist patch, the thought is to normalize the amount of dopamine agonist in my body throughout the day (i.e., smooth out the peaks and valleys). I have tried to  draw it schematically below.

16.05.02.Normalizing.DA.Levels

Isradipine: An FDA-approved calcium-channel blocker (CCB) named Isradipine penetrates the blood brain barrier to block calcium channels and potentially preserve dopamine-making cells. Isradipine may slow the progression of Parkinson’s. The primary use of Isradipine is in hypertension; thus, to treat my pre-hypertension I switched from the diuretic Hydrochlorothiazide to the CCB Isradipine.  A CCB is a more potent drug than a diuretic; importantly, my blood pressure is quite normal now and maybe I’m altering the progression of my Parkinson’s. [Please consult with your physician before taking any type of new medication.]

-Complementary and Alternative Medicine (CAM): “Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care. ‘Complementary medicine’ refers to treatments that are used with standard treatment. ‘Alternative medicine refers to treatments that are used instead of standard treatment.”  (http://www.cancer.gov/cancertopics/cam). My CAM strategy for treating Parkinson’s goes as follows: compounds (reportedly) able to penetrate the blood brain barrier; compounds (possibly) able to slow progression of the disorder; compounds that are anti-oxidative and anti-inflammatory; compounds that don’t adversely alter dopamine synthesis/activity; and compounds that support general brain/nervous system health. [Please consult with your physician before taking any type of supplements.]

-Exercise: Exercise improves flexibility, builds muscle mass,  aids sleep, and reduces stress. Exercise is neuroprotective in Parkinson’s (see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136051/ and http://www.neurology.org/content/77/3/288 and http://www.ncbi.nlm.nih.gov/pubmed/21375602 ).  For anyone with Parkinson’s, it is important to stretch and exercise on a very regular basis. Brian Lambert remarked: “With Parkinson’s, exercise is better than taking a bottle of pills. If you don’t do anything you’ll just stagnate.”  My strategy is relatively simple, make time in each day to exercise (it’s that important): stretch every couple of hours (the exercises in LSVT BIG are fantastic); and try to exercise every day for 30-60 minutes (playing/walking 18 holes of golf takes ~4-5 hr). I do a lot of exercises with range of motion sports like golf and boxing on a reflex bag (more tennis this summer).  Most importantly, I do exercises that I really enjoy doing and it brings a lot of enjoyment to the way my body feels. [Please consult with your physician before beginning any new exercise routine.]

 -The Table below summarizes my  approach to managing my Parkinson’s:

16.05.04.DailyTherapy*Footnote to Table: Medical (MED), Experimental (EXP), Complementary and alternative medicine (CAM), Exercise (EXERC).

 -Past References: In previous posts linked here, I have described various aspects of my treatment strategy (click on word/phrase):  first treatment plan; complementary and alternative medicine (CAM); Isradipine; exercise-1; exercise-2; exercise-3; LSVT BIG.

“Exercise is king. Nutrition is queen. Put them together and you’ve got a kingdom.”   Jack LaLanne

“There’s always a moment that separates the past from the future, and that moment is now.” Aniekee Tochukwu

Managing Parkinson’s: While we wait for a cure, we manage our disorder by many methods. While we wait for the potion that slows progression, we exercise and remain hopeful. While we live with a neurodegenerative disorder, we strive to remove the label and we stay positive.
Please stay involved in managing your disorder.
Please work with your Neurologist to develop your own ideal strategy.
Please stretch and exercise, it’ll make a difference.
Please use hope and positivity to remain focused and persistent.
Please use loved ones and support team to help sustain your treatment plan.
What you do in managing your disorder will help you today and for many more future days.

 “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” Atul Gawande

‡”Personalized medicine is a medical model that separates patients into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease.” (https://www.google.com/search?q=personalied+medicine&ie=utf-8&oe=utf-8#q=personalized+medicine)

Cover photo credit: http://az616578.vo.msecnd.net/files/2016/03/19/635940149667803087959444186_6359344127228967891155060939_nature-grass-flowers-spring-2780.jpg

Brain image modified from: http://cdn.playbuzz.com/cdn/bb0810a8-aeff-403b-b38a-e1e9fc9f7c81/79502c61-ec41-4802-8e22-92a0ddc0cc20.jpg

 

 

Déjà Vu and Neuroplasticity in Parkinson’s

“Continuous effort – not strength or intelligence – is the key to unlocking our potential.” Winston S. Churchill

“…remember that what has once been done may be done again.” Alexandre Dumas

Introducing the terms:
D
éjà vu: “A feeling of having already experienced the present situation.” (http://www.oxforddictionaries.com/us/definition/american_english/)

Neuroplasticity: “The brain’s ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.” (http://www.medicinenet.com/script/main/art.asp?articlekey=40362 )

Do you remember learning how to ride a bike, throw/catch a baseball, and/or hit a golf ball? Yes, yes, yes; when I was a child with my father.
Learning to ride a bicycle
–  training wheels, then two wheels with support from my dad going down the street, and then he let me go on my own; never to forget how to balance and pedal the bicycle.
Learning how to catch and throw a baseball– wrapping up the ball in the mitt to get it conditioned, the  correct throwing motion, watching the thrown ball into the mitt and working on my hand-to-eye coordination.
Learning the basics of the golf swing– the complexity and intricate timing of swinging a golf club with my dad showing me how to do it from grip, set-up, back swing to follow through.
We likely all have childhood memories of activities where our brain and body were trained/taught to do something.

“Neurons that fire together wire together. Mental states become neural traits. Day after day, your mind is building your brain. This is what scientists call experience-dependent neuroplasticity,” Rick Hanson

Déjà vu and physical activity with Parkinson’s: As someone who has loved to exercise almost every day for most of my life, Parkinson’s is a most disagreeable disorder. Why? Let me give you an example of playing golf. I think about playing golf almost every day although I play maybe once a week and try to practice a couple of times per week. It used to be, every time I addressed the golf ball, my body remembered what it’s supposed to do while waiting for the signals from the brain. Now today, approaching the golf ball I remind myself this is a golf shot. As Yogi Berra said “It’s like déjà vu, all over again” and I remember I’ve been here many times before. It’s as if a short circuit exists and I’m realigning this circuitry every time I swing the golf club. For the most part, my brain-body connection still works and I successfully hit the golf ball; but not every time (maybe I just need to practice more?). This might be analogous to a car running very low on transmission fluid (i.e., in my case low on dopamine); the gears are still working but just not working very smoothly.

“Never give up. It’s like breathing—once you quit, your flame dies letting total darkness extinguish every last gasp of hope. You can’t do that. You must continue taking in even the shallowest of breaths, continue putting forth even the smallest of efforts to sustain your dreams. Don’t ever, ever, ever give up.” Richelle E. Goodrich

Neuroplasticity and physical activity: Kleim and Jones (2008) and Petzinger et al. (2013) describe neuroplasticity as a process where the brain encodes experiences and is able to learn new behavior. They define neuroplasticity as the modification of existing neural networks by adding or modifying synapses in response to changes in behavior or environment, especially when done with exercise. Thus, neuroplasticity can help repair and strengthen the circuitry of the brain.  There is substantial evidence in human studies and in rodent-experimental models that have validated numerous exercise-associated effects on “brain health”.  A regular aerobic exercise program likely helps to promote the appropriate conditions for the injured brain to undergo neuroplasticity. 

“Among other things, neuroplasticity means that emotions such as happiness and compassion can be cultivated in much the same way that a person can learn through repetition to play golf and basketball or master a musical instrument, and that such practice changes the activity and physical aspects of specific brain areas.” Andrew Weil

Neuroplasticity and physical activity in Parkinson’s: [Please remember I am not a physician; I’m not making recommendations for you to do something.  Please talk with your neurologist and/or family practitioner before beginning any of these exercise programs.]  Balance, gait-improvement and flexibility are some of the obvious things a person with Parkinson’s needs to address on a frequent basis, in fact, on a daily basis. Clearly this needs to be self-motivated in the interest of possible neuro-rehabilitation. Most experts suggest that the exercise program should be repetitive, intense, and challenging.   Of course, you must enjoy the exercise program.   Ultimately, exercising should hopefully improve motor functions  and also assist  in improving cognitive function.

The exercises that have been most widely studied and proven to be the most beneficial in promoting neuroplasticity are  treadmill training, amplitude training, tai chi, tango dancing, boxing and cycling  (there are many other exercises to consider, don’t be limited by these above). In my opinion, it’s doing the aerobic exercise you enjoy on a daily and sustained basis,  it’s getting range of motion, and its challenging to you mentally.  As a scientist, I’m impressed by the data in rodent Parkinson’s models and the ability of exercise to promote neuroplasticity, to provide neuroprotection, and even offer neurorestoration. In human studies, the results are remarkably strong as well; showing that sustained aerobic exercise induces neuroplasticity in a damaged brain to improve overall brain health.

“Things don’t go wrong and break your heart so you can become bitter and give up. They happen to break you down and build you up so you can be all that you were intended to be.” Charles Jones

Neuroplasticity and physical activity on overall brain health in Parkinson’s. There is substantial scientific evidence that goal-directed aerobic exercise can improve and strengthen motor circuitry. This is due to structural modifications of synapses and overall improved brain health (increased blood flow, enhanced innate immune system and possibly neurogenesis). Overall brain health initiated by exercise-dependent neuroplasticity alters behavior (affecting many areas of the brain, e.g., the basal ganglia,  cortex, thalamus, and cerebellum). Ultimately, the net effect of sustained exercise and neuroplasticity results in improved motor skills, executive function, cognitive function and mood and motivation.  The diagram below illustrates the changes that can occur with exercise-induced neuroplasticity in Parkinson’s.

Neuroplasticity_4.16.03.13

“Any man could, if he were so inclined, be the sculptor of his own brain.” Santiago Ramón y Cajal

Three comments on déjà vu, neuroplasticity  and physical activity in Parkinson’s:
#1,  Maybe you’re thinking that I’m 62 y.o. and just less coordinated on the golf course with or without Parkinson’s. No doubt this is true but I have my déjà vu feeling, there’s clearly some brain-body disconnect with Parkinson’s (I do need to keep practicing to get more consistent).
#2,  Exercise-induced neuroplasticity will not reverse the effects of Parkinson’s. However, many different studies suggest some restoration of brain circuitry due to exercise-induced neuroplasticity. This implies with time and effort to exercise one could somewhat improve motor learning and behavior performance.
#3, We have much to learn about neuroplasticity and yes even déjà vu. The brain is a powerful organ capable of many different changes when impacted by damage. As we further delineate the mechanism of exercise-induced neuroplasticity, we will better understand Parkinson’s.  Hopefully, from this research (some references are below), there exists the prospect of improved treatment of Parkinson’s. Always remember, a regular aerobic exercise program is good for both your heart and your brain.  Stay positive, be focused, remain hopeful and enjoy your daily exercise.

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.” Rainer Maria Rilke

Cover Photo Credit: https://c1.staticflickr.com/9/8210/8205735122_25302e7cce_b.jpg

References-

Alberts JL, Linder SM, Penko AL, Lowe MJ, Phillips M. It is not about the bike, it is about the pedaling: forced exercise and Parkinson’s disease. Exerc Sport Sci Rev. 2011;39(4):177–86. [PubMed]

Combs SA, Diehl MD, Staples WH, et al. Boxing Training for Patients With Parkinson Disease: A Case Series. Phys Ther. 2010;91(1):132–42. [PubMed]

Corcos DM, Comella CL, Goetz CG. Tai chi for patients with Parkinson’s disease. N Engl J Med. 2012;366(18):1737–8. [PubMed]

Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res. 2005;167(3):462–7. [PubMed]

Fisher BE, Wu AD, Salem GJ, et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil. 2008;89(7):1221–9. [PMC free article] [PubMed]

Fox CM, Ramig LO, Ciucci MR, Sapir S, McFarland DH, Farley BG. The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang. 2006;27(4):283–99. [PubMed]

Gajewski PD, Falkenstein M. Physical activity and neurocognitive functioning in aging – a condensed updated review. European Review of Aging and Physical Activity. 2016;13:1. doi:10.1186/s11556-016-0161-3.

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