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Our Brain, Exercise and Parkinsonism (PD) : A CASE FOR A WELLNESS CENTRE PARKINSON WELLNESS PROJECT

on July 10, 2017

The years between 1990 and 2000 were declared the decade of the brain around the world.
This was mostly due to the findings discovered by Dr Bill Langston in 1983. ‘by isolating MPTP as a toxin that could induce parkinsonism in humans, Langston would translate his findings into the creation of the first pre-clinical model of PD that replicated virtually all of the motor features of Parkinson’s. Now, scientists could re-create the disease in the lab, greatly enhancing their ability to study disease process, in turn, better testing potential therapeutic approaches.’ https://www.michaeljfox.org/foundation/news-detail.php?j-william-langston-pioneer-in-the-field-of-parkinsons-disease-research

Scientists started studying among other things, the effect of exercise on brain function in PD. The results showed
1) if exercise is started early enough it can protect vulnerable neurons (even better if years before diagnosis)
2) In the early and moderate phase exercise helped the circuits become more efficient by sending out more neurotransmitters and blood supply to new circuits ie brain made more dopamine receptors (this can also be shown in humans now, see Dr Jay Alberts research)
3) In the advanced stages, it took longer to see changes but scientists were still able to see recruitment of other parts of the undamaged brain and decreased stress on the brain resulting in better function

Why does it matter that we can change the brain? Exercise may slow disease progression! Timing matters and earlier is better. Intensity of exercise matters. The exercise must be forced use (beyond self- selected effort which means harder than you could ever think of doing your exercises). This is because PD causes loss in self-monitoring and body awareness.
PWP also need exercise immediately at diagnosis and have access to it for life, in order to slow motor deterioration and progression, and to prevent end stage PD. Most PWP do not get referred to physiotherapy until they have a fall or injury. It’s too late.
You may say ‘but activity is in our control’. We can feel better by going for a walk 1-2x a week, or boxing, yoga, gym, swimming etc. Yes, but to actually change the disease progression it takes a lot more than this.
This is because we lose our ability to self-monitor and therefore we need trained instructors to act as coaches for life to push us beyond present levels. We need to be in a safe place where we can build social support networks and surround ourselves by people that empower us to do more than we do on our own. The biggest barrier, reported by PWP, to exercise is Stigma! At Parkinson Wellness Project, we will all be in a safe place to get success.

Our medications alone also are not enough for optimum wellness. They do address most motor symptoms of rigidity, bradykinesia and incoordination however the non- motor symptoms so well-known now with PD; the emotional, cognitive and autonomic are not addressed.
BUT Exercise targets many different motor and non -motor symptoms of PD if they are performed properly with trained instructors.

Parkinson specific exercises and optimum medication regime both lead to better quality of life for PWP. A study done by Dr. Frazzitta ‘Intense Rehab Treatment in Early PD, A Randomized Pilot Study with a Year Follow Up’; published in 2014 Nature Neuroscience; showed PWP who exercise regularly with forced hi- intensity exercises including functional exercises and cognition at the same time for 3 hours/day, 5 days a week actually are able to decrease their meds.

ESSENTIALS FOR PWP WELLNESS RECOVERY
1. Find a team, you can’t do this alone. Get educated and empowered. PWP do better when they hang out with other PWP, come to Parkinson Wellness Project!
2. Optimize your meds, get information from the physicians, nurses and the pros so you can participate fully in exercise and the lifestyle. This includes proper nutrition. Come join us! We will help you navigate
3. Start right at diagnosis: Come to Parkinson Wellness Project where you will find your coach for life.

What will you do at the Wellness Centre?
-progressive aerobics, PD specific skill acquisitions, PWR!MovesTM and integrate these with boxing, circuit, yoga , dance, voice training
How will you do this?
-cognitive engagement, attention focus, emotional engagement, physical effort, shouting, singing and laughter!

IMPLEMENTING EXERCISE AS MEDICINE
1. Progressive Aerobic training beyond self- selected intensity using a bike, treadmill and/or pole walking, and group classes called PWR!MovesTM, boxing , Dance4PD
2. Skill based training to change circuitry, re-inforce damaged circuits and recruit new circuits. The mechanism is brain repair adaptation. This skill training is specific to PD. We are not just training motor skills but training functional movement and cognition.
(Dopamine helps us to move spontaneously without thinking about it, but it also promotes high level problem solving so we can negotiate different environments in our complex everyday life). We need to re- train timing of movement for coordination, for example when our arms move versus our body, timing is critical
3. Cognitive and Motor must go together so exercise will benefit multiple systems. They must be novel, unpredicted tasks in complex environments which necessitate quick decision making and dual tasking. Yoga will be offered to slow our brains down after working so hard.
4. If it’s boring don’t do it as it won’t help your brain. The exercises need to include everyday movement skills to re- train the brain to not have to think about what you are doing, we need to train our brains to work on attention, cognition and effort. Come to Parkinson Wellness Project!

Functional Deficits Targeted in Our Classes
1. Antigravity extension- this is due to stooped posture in PWP –power up!
2. Weight shifting- can’t move without it- power rock!
3. Axial mobility (spinal mobility) power twist!
4. Transitions (up and down, moving with quick turns) to prevent falls- power step!
5. Voice- during exercises and planning to include a choir
6. Cognition –being taught new skills in circuit training and during the PWR Moves, FLOW

Jillian Carson BScPT
Chair Parkinson Wellness Project (formulary ParkinGo)
Reference..Dr. Becky Farley 2017 July 8th talk at Parkinson Voice Project Florida

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