Exercise Treatments for PD Symptoms

The Exercise Rx

Besides drugs and surgery, researchers are looking into using exercise as an intervention therapy to tame the symptoms of PD.

In 2003, Dr. Jay L. Alberts, a PD researcher and accomplished cyclist, entered the seven-day RAGBRAI bicycle ride across Iowa. He rode on a tandem bike for two days with Cathy Frazier, a 40-year-old woman with PD. He discovered that Cathy’s handwriting was beautiful. Prior to the ride, her handwriting displayed classical micrographia, a cardinal sign of PD.

Each year for the next four years, when he did the RAGBRAI tandem bike ride with parkinsonian stokers, he noticed similar phenomena. His stokers’ parkinsonian symptoms disappeared.

As he went through scientific literatures, Alberts discovered that there was a lot of research on animals that reported similar results. Typically, in these studies, one group of animals is put on a motorized treadmill that forces the creature to run faster than it wants. A sedentary group serves as a control. Then, after a few weeks, both groups are given a neurotoxin such as  MPTP. The sedentary group suffers immediate damage to the substantia nigra and develops parkinsonism; the exercise group partially resists the toxin.

But research on humans had not found comparable benefits. Alberts thought it was because the human experiments test voluntary exercise while the rates are doing “forced exercise.” The rats are forced to run at a faster rate. The same thing is going on with the tandem bikes where the stokers are pedaling faster than they were pedaling on their own.

To test the theory, Alberts carried out a pilot trial that took ten PD patients and randomly assigned them to one of two groups: a treatment group receiving forced exercise and a control group voluntarily exercising. The forced-exercise group was given three 60-minute workouts for eight weeks in which a trainer pedaled at 80 to 90 revolutions per minute. The control group did three 60-minute session each week on a bike by themselves. Each group was evaluated before and after the experiment using the Unified Parkinson’s Disease Rating Scale (UPDRS).

After eight weeks, the forced-exercise group’s symptoms had improved – reducing their average UPDRS part 3 score by about one-third. That’s almost as large an effect as the one brought about by levodopa. The control group saw no benefit. Two weeks later, these gains were still there in the tandem group. But four weeks after treatment, the forced-exercise group was back where they’d started. So force-exercise is like levodopa, the benefit will stop if you stop taking it.

Alberts’s concept of forced exercise is just one of many options out there. Other options such as tai chi, kickboxing, and progressive strength training exercise is as effective. It is more important to select an activity that will address your specific needs and be sustainable.

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But most neurologists are still skeptical about physical therapies. The one exception is the Dutch neurologist Bastiaan Bloem. Bloem believed physical therapy would be a better treatment of gait and balance than just the levodopa therapy.

In 2004, Bloem and Marten Munneke, a physical therapist, started the ParkinsonNet in the Netherlands. Today, the program has 66 regional networks, 2,970 trained professionals and over fifty thousand patients.

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Over the past decade, several companies have been developing technology capable of tracking the PD symptoms outside the clinic. These companies are working on various combinations of advanced wearable sensors to track multiple domains round the clock – tremor, bradykinesia, gait, balance, walking, cognition, and more.

One technology, Kinesia HomeView, designed by Great Lakes Neuroechnologies, comprises a small computer and a finger sensor. Sitting in front of a screen, you perform a set of exercises, that takes about five minutes. Then you will get a report of thirteen metrics, listing the severity of three forms of tremor, dyskinesia, the speed, amplitude, and rhythm displayed during the finger-tapping, hand-movement, and hand-flipping exercises. The main advantage is that you can use it 24/7. It can reveal any changes in motor performance over time, providing a much more detailed picture of your disease than that obtained in an evaluation every six months.

The other system is a set of sensors developed by Portland-based APDM. You wear three small devices, one on your wrist and one on each of your ankles. The wrist sensor detects tremor and dyskinesia. The ankle sensors measure multiple aspects of walking. Your daily activities generate masses of data. When the data are averaged over time, they reveal emerging asymmetries in your gait.

Key Takeaways

• Dr. Jay Alberts discovered force-exercise can relieve PD symptoms.
• Force-exercise is like levodopa, the benefit will stop if you stop taking it.
• Bastiaan Bloem believed physical therapy would be a better treatment of gait and balance than just the levodopa therapy.
• Several companies have been developing technology capable of tracking the PD symptoms outside the clinic.