Parkinson’s Disease: Physical Exercise as Important as Medication
By Michèle Sirois, participating contributor to the AvantÂge programme of the Institut universitaire de gériatrie de Montréal.
On April 12, neurologist Michel Panisset* and physiotherapist Paola Campana** gave a talk about the different options that are available to prevent and slow down Parkinson’s disease. The public lecture was presented free of charge at the Le Groupe Maurice Auditorium of the Institut universitaire de gériatrie de Montréal.
Dr. Panisset mentioned that it is difficult to diagnose this neurodegenerative disease whose origin is still unknown. It simply cannot be detected using magnetic resonance or blood tests. Parkinson’s disease is basically diagnosed by its symptoms.
The most common disorders are slow movement, muscle rigidity, and tremors at rest.
These symptoms have a serious impact on the quality of life of those who suffer from Parkinson’s disease:
- Difficulty and slowness in handling utensils, writing, speaking, walking, running, etc.
- Necessity to actively “think” about each movement, which requires effort and concentration.
- Difficulty to do two things at the same time.
Other symptoms such as anxiety, depression, and sleep disorders may also be present. Another factor that may help identify Parkinson’s disease is the loss of the sense of smell.
As anyone can guess, the disease originates in the brain. The dopamine-producing cells stop functioning normally. Dopamine is an important messenger that transmits impulses between brain cells responsible for controlling movements. A decrease in dopamine causes the message to be transmitted more slowly between the brain and the rest of the body.
Researchers have been actively trying to understand why some cells are malfunctioning.
Although it cannot be cured, the disease can be treated with, among other things, medication that acts as a substitute for the low levels of dopamine.
For some years now, a type surgery called deep brain stimulation has been an option for some patients who suffer from specific conditions.
The neurosurgeon implants electrodes in the deep structures of the patient’s brain. The electrodes are connected to a stimulator that is implanted under the skin. This device generates a direct current that modulates the various signals emitted by the brain. Dr. Panisset describes deep brain stimulation as “a pacemaker for the brain.”
Exercise has a direct effect on dopamine production
Everybody knows that physical exercise helps maintain good health. The second speaker, physiotherapist Paola Campana, provided useful information on the topic.
Studies in animals have highlighted that exercising intensely increases the synthesis and release of dopamine, the chemical that Parkinsonian patients sorely lack.
The dopamine produced after a period of intense exercise is found in the areas of the brain affected by the disease. Even better, new brain cells are formed!
This discovery was a significant milestone for research on treatment of Parkinson’s disease.
But what exercises are beneficial?
Ms. Campana explained that the earlier a patient who has been diagnosed with Parkinson’s disease starts exercising, the longer they can wait before medicines are needed to control their symptoms, and the better their ability to develop skills to cope with the disease.
These exercises include complex movements and involve many joints. Tai chi seems to be the ultimate exercise. Dancing, boxing, and fencing also provide multiple benefits.
Exercises that have a positive effect on Parkinson’s disease
The physical activities prescribed when the diagnosis is confirmed are, just like what is recommended to prevent Alzheimer’s disease, intense exercises that boost the heart rate: cycling, treadmilling, assisted fitness training, running, etc.
Ms. Campana reminded us that intense and regular exercise may increase cortical excitability in people (French only) suffering from Parkinson’s disease. The results of studies show that exercise may be almost as effective as the implantation of electrodes in the brain.
Counterbalancing the symptoms
It is recommended that you see a physiotherapist right away after being diagnosed with Parkinson’s disease to devise a game plan that will help you deal with the situation. Later, and according to the progression of the symptoms, he or she may also recommend simple activities to stimulate areas of the brain that are not affected by the disease in order to facilitate movement. These exercises will make it possible to develop external mechanisms that can trigger the desired movements to eventually take over the degenerating internal mechanisms (automatic movements).
It is also possible to develop other techniques.
Just like Olympic athletes, patients suffering from Parkinson’s disease can learn to:
- Visualize their movements;
- Mentally rehearse the desired movements before executing them;
- Break down a movement into sub-steps; and
- Focus on one task at a time.
The two speakers concluded on an optimistic note: by combining all these approaches, many people with Parkinson’s disease can continue to lead an essentially normal life for several years.
For more information on Parkinson’s disease, visit http://www.parkinson.ca/.
* Michel Panisset is a neurologist at the Centre hospitalier universitaire de Montréal (CHUM).
** Paola Campana is in charge of the physiotherapy department at the Institut universitaire de gériatrie de Montréal (IUGM) and a clinical lecturer for the École de réadaptation de l’Université de Montréal.