• Let’s face it…we’ve all heard we’re supposed to exercise but we aren’t always told why.  This 4 part blog series aims to demystify this advice.  Part 1 will discuss the general benefits of exercise and then delve into the brain benefit of neuroprotection.  Part 2 will discuss exercise in regards to neuroplasticity, the process of brain repair and reorganization where nerves in the brain can be altered by doing (and not doing).  Part 3 will discuss different types of exercise and our national exercise guidelines. The final blog post in the series will discuss the role of a physical therapist and how PTs can help people with Parkinson’s disease move better through exercise.

    There are many different types of exercise and it’s important that you are doing the right type for your body.  When reading this series, please keep your own personal medical history in mind and consult with your physical therapist or physician before beginning or changing your exercise program.

    So…why exercise?

    I’ll get into the specifics of why it is important for people with Parkinson’s disease to exercise, but first let’s review why everyone – regardless of diagnosis or age – needs to exercise.  Exercise has been shown to improve cardiovascular health, strength, endurance, and speed.  Exercise can also reduce pain and improve quality of life.  Stretching activities can improve flexibility.  And exercise is great for brain health!

    Recent research in animal models suggests that exercise can have a neuroprotective effect on the brain.  Neuroprotection is the slowing, stopping, or even reversing of the neurodegenerative process.  This is exciting news, especially for people living with a neurodegenerative disorder like Parkinson’s disease.

    When you exercise, growth factors are released in the brain.  These factors help stimulate brain cell growth and reduce a neuron’s susceptibility to damage.  Neurotrophic factors, which can influence brain changes and nerve survival, are also released.  Exercise and the consequent release of factors can promote growth and remodeling of the nerve cells in the brain.  Neuron junctions – the communication connections between nerve cells in the brain – also become more effective with exercise.

    Need more convincing?  Dr. Beth Fischer and her team did a study on the neuroprotective effects of exercise in 2004.    The researchers injected a group of mice with MPTP, which creates a Parkinsonian-like condition.  They injected another group of mice with saline to act as controls.  Then, they had half of the MPTP group and half of the saline group exercise intensively on a treadmill for 30 days.  At the end of the 30 days, the MPTP and exercise group improved significantly compared to the MPTP and no exercise group – so much that they almost caught up to the saline and exercise group.  The researchers also found that, while the amount of dopamine and the number of neurons in the mouse brain had not increased, the brain cells were more efficient in using dopamine.  There were also signs of positive brain change in areas where dopamine signals are received.

    With the good news comes the bad news.  Did you know that lack of exercise is actually pro-degenerative?  Research indicates that both inactivity and disuse of a motor skill leads to reduced function and possible disease progression.  Sporadic exercise isn’t necessarily going to contribute to neuroprotection either.  Hirsch and Farley (2009) said it best: “…the molecular mechanisms underlying this protection (and recovery) may require continuous normal use or exercise to be maintained.”

    So if exercise does all of these wonderful things, why aren’t people with Parkinson’s disease doing more of it?  An interesting study came out in 2013 that asked the same question.  Dr. Terry Ellis and her team found that lack of time to exercise, low outcome expectations from exercising, and fear of falling were the primary three barriers to exercising for people with PD.

    In a disease where you may feel lack of control over what is happening to your body, exercise is something you do have control over. As you go about your daily tasks this week, take a moment to reflect on your personal barriers to exercise – we all have them – and consider ways to overcome those barriers.  My biggest barrier to exercise is time, so a strategy I have found helpful is to exercise while my meat is defrosting for dinner.  What are your barriers and how will you overcome them?

    Tune in for Part 2 when I will discuss why you need to use it or lose it.

    All the best,

    Theresa

    References:
    “23 and 1/2 hours: What is the single best thing we can do for our health?”  Video. DocMikeEvans.  Accessed at:  https://www.youtube.com/watch?v=aUaInS6HIGo  Accessed on:  4/15/2014
    Ellis T et al.  Barriers to exercise in people with Parkinson disease.  Phys Ther. 2013; 93: 628-36.
    Hirsch MA, Farley BG.  Exercise and neuroplasticity in persons living with Parkinson’s Disease. Eru J Phys Rehabil Med.  2009;45(2):215-29.
    Fisher BE, Petzinger GM, Nixon K, Hogg E, Bremmer S, Meshul CK, Jakowec MW. Exercise-induced behavioral recovery and neuroplasticity in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse basal ganglia. J Neurosci Res. 2004 Aug 1;77(3):378-90
    Garber CE et al.  Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in aparently healthy adults: guidance for prescribing exercise.  Medicine and Science in Sports and Exercise.  43(7):1334-1359. 2011.
    Kleim JA, Jones TA.  Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage.  Journal of Speech, Language, and Hearing Research.  S225-S239.  2008
    Markus TM et al. Recovery and brain reorganization after stroke in adult and aged rats. Annals of neurology. 58(6):950-953, 2005.
    Monfils MH et al. In search of the motor engram: motor map plasticity as a mechanism of encoding motor experience. Neuroscientist 11(5):471-483, 2005.
    “Neuroprotective Benefits of Exercise.” National Parkinson Foundation.  Accessed at: http://www.parkinson.org/Parkinson-s-Disease/Treatment/Exercise/Neuroprotective-Benefits-of-Exercise  Accessed on: 4/20/2014.
    “Physical Activity.”  Centers for Disease Control and Prevention.  Accessed at:  http://www.cdc.gov/physicalactivity/  Accessed on: 4/15/2014
    Widner, G.  Lecture.  “Neuroprotection and neuroplasticity as a basis for rehabilitation.”  March 27, 2010.