Feb. 27, 2016
Argentine tango, tai chi and Pilates are activities you’d expect to find on offer in adult education classes, but emerging research shows these and other exercise therapies may also provide a range of benefits for people with Parkinson’s disease.
Exercise therapy is emerging as a new and exciting area of treatment for Parkinson’s, not only because it can lead to significant improvements in symptoms, but also because it has minimal side effects and comes with a whole lot of additional health benefits.
While it is still early days for research on exercise therapy, says Associate Professor Susan Fox, professor of neurology at the University of Toronto, the evidence is mounting.
“People are recognising that it’s good that these patients are moving and exercising,” says Fox. She says evidence suggests exercise can help improve some of the motor symptoms of Parkinson’s – such as tremor or rigidity – in a similar way to adding in a new drug.
“You’re getting equivalent benefit without the side effects, plus all the other added benefits of exercise,” says Fox. “It’s cheap, easy therapy.”
The role of dopamine
Parkinson’s disease currently affects around one in 350 Australians, and 1 per cent of people over the age of 60 will be diagnosed with the disease.
It’s a degenerative neurological condition caused by the loss of cells that produce dopamine deep inside the brain. Dopamine is message-carrying chemical (or neurotransmitter) that is associated with movement. The loss of these cells, and the resulting depletion of dopamine, leads to a range of motor symptoms, including tremor, rigidity, slowed movement and gait difficulties.
In addition, people with Parkinson’s experience other symptoms, such as depression, sleep problems, lethargy and sometimes dementia, not all of these symptoms seem to be related to dopamine depletion.
There is no cure for Parkinson’s, but treatments can reduce the severity of symptoms. Most Parkinson’s treatments have focused on trying to boost dopamine levels in the brain using medications. While these have been very effective in managing motor symptoms of the disease, they have significant side effects and their effectiveness reduces over time.
“[But] there’s now some preclinical evidence that when patients move and exercise that it releases dopamine within the brain, so there’s some biological evidence that it may actually have a positive symptomatic effect,” Fox says.
What types of exercise
The big question is what kind of exercise is best.
At a recent Parkinson’s disease conference in Sydney, researchers presented data on everything from tango to tai chi, and how these many and varied forms of exercise therapy can reduce symptoms of the disease.
Associate Professor Colleen Canning and colleagues recently presented at the conference on findings from a study that used exercise therapy to reduce the risk of falls in people with Parkinson’s disease. Falls are a particular problem in Parkinson’s disease, resulting from poor balance and symptoms such as ‘freezing’ – a sudden, temporary inability to move.
“The approach we took was to target three risk factors that exercise could potentially improve, that is, loss of muscle strength, poor balance and freezing of gait,” says Canning, team leader for Parkinson’s disease research in the Faculty of Health Sciences, University of Sydney.
The largely home-based exercise program consisted of just 40 to 60 minutes of exercises, including balance, stepping and strengthening exercises, three times a week for six months.
The program was particularly effective among people with less severe disease, leading to a 69 per cent reduction in the risk of falls.
“Our results suggest that this particular program has the potential to be quite an effective method of reducing falls in people with lower disease severity,” says Canning. “This is an important finding because that’s the group that often doesn’t get offered exercise, because they don’t have major motor difficulties early on.”
Dance therapy
Dance is one form of exercise attracting interest. A 2009 review concluded that dance appeared to meet many, if not all, of the recommended components for exercise programs specifically designed for people with Parkinson’s disease.
“The benefits of dance include improved balance and gait function as well as improved quality of life,” wrote the review’s author. “Most studies of dance for PD have included primarily individuals with mild to moderate PD [and] while benefits can be obtained with a short, intensive dance intervention, longer interventions may prove to be more effective.”
For example, Argentinian researchers found that a ‘Dance Therapy Program’ involving Argentine Tango did lead to improvements in some Parkinson’s symptoms. Equally importantly, the discovery that their bodies were still able to tango gave many people with Parkinson’s a valuable psychological boost, so the program had a high compliance rate.
Another approach combines exercise with music to help people with Parkinson’s overcome issues such as freezing and shuffling.
The AmbuloSono system, developed by researchers from the University of Calgary, uses music as an incentive to encourage people with Parkinson’s disease to not only take longer steps but to walk faster and further.
The system uses iPod motion sensors to measure stride length and distance walked, and ties to a music program that only switches on above a certain stride length. The device is housed in a pouch strapped above the knee and connected wirelessly to headphones.
“It uses music as a reward, so you have to walk larger steps in order to trigger the music to play and when your step size becomes smaller, the music stops,” says AmbuloSono inventor Professor Bin Hu from the Hotchkiss Brain Institute, University of Calgary.
The results from a pilot study of 42 participants are promising. Researchers found that over nearly a year, participants stride length increased 10 to 30 per cent and their walking speed increased 10 to 20 per cent over long distances. Furthermore, participants of the study improved in other areas, showing a reduction in fear and anxiety associated with tasks such as using an escalator, and were less likely to avoid physical activity during periods of depression or apathy.
Fox says exercise therapy has been one of the fastest growing areas of Parkinson’s research in the last 12 months, and the results are starting to trickle into clinical practice. While researchers are still exploring questions such as what types of exercise and when, Fox has no qualms about recommending it for her patients.
“I think at the moment, current clinical practice is that we just encourage it at all stages [of the disease] but it certainly would make sense for patients to be starting at a much much earlier stage,” she says.
She encourages all her patients to do a minimum of 30 minutes each day, and it doesn’t really matter what they do, as long as they do it.
“The important thing is to do it regularly so don’t take up something brand new that you’re going to do once and then abandon,” says Fox. “I always say ‘do what you enjoy doing and you’ll continue to do it’
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