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Yoga for Parkinson's Disease Part IV: Do Other Forms of Physical Activity Help?


Hey readers! Welcome back! In my previous installment (part III – click here), I went over what the research suggested about yoga’s effect on Parkinson’s Disease (PD) symptomology. To sum up part III, the science strongly suggests that yoga helps improve virtually every motor and nonmotor symptom of PD. In this installment, I am going to review what the evidence suggests about other forms of physical activity (PA) for those with PD.

As reviewed in parts I (click here) and II (click here), PD is a neurodegenerative disease in which dopamine-producing neurons in the basal ganglia of the brain die off. This results in certain motor (e.g. resting tremor, slowness of movement, muscle tightness, etc.) and nonmotor symptoms (e.g. depression, anxiety, sleep disturbance, etc.) that typically get worse over time as the disease progresses. Truth be told, these symptoms can be pretty debilitating for those with the diagnosis and can really affect one’s quality of life (QOL). The goal with treating PD is to find interventions that reduce the symptoms, improve the QOL, and slow, or best case, halt, the progression of the disease process. Pharmacology and medicines (of which L-Dopa is the most common) are effective for managing the motor symptoms, but they do come with some potential negative side effects. They can also wax and wane with how helpful they are, as the brain can build up a tolerance, requiring the person to go off and on the medicines in cycles. Rehabilitative therapy, “rehab,” (physical, occupational, speech therapy) is also effective for those with PD. Rehab helps improve motor and nonmotor symptoms for those with PD. Rehab can get costly, especially if a person doesn’t have the best insurance coverage. Also, third party payers (e.g. insurance, Medicare) can deny claims for various reasons, making it difficult for some to get the amount, frequency, and duration of the therapy needed. This is an area in which I am well-versed, as I work as a speech therapist, treating PD in assisted living facilities.

Part III (click here) of this blog reviewed the evidence that examined yoga as a potential intervention for PD, and the evidence pretty strongly suggested that yoga is also effective for mitigating motor and nonmotor symptoms. Yoga would be a great addition in the treatment tool bag for PD. Yoga is relatively inexpensive, depending on your monthly budget. Typically yoga studio unlimited memberships cost anywhere between $80 (for a discounted membership – e.g. college student) to $150ish, although this varies studio-to-studio. You can also access free yoga on platforms like YouTube, or at local parks, and also community classes taught by new teachers. Yoga is also pretty safe and accessible; there is a form of yoga for everybody, truly. So, my takeaway from the evidence in part III is that yoga truly helps those with PD in so many different ways.

In this installment, I am reviewing evidence that examined if other forms of physical activity (PA) have an impact on PD symptoms. In the general population, the benefits of PA are extensive. Just to name a few, PA prevents many chronic diseases (e.g. high blood pressure, obesity, diabetes, etc.), improves brain health and mental health outcomes, increases cellular and metabolic health, and enhances QOL. Since PA is so amazing for how we function as humans, could it help ease symptoms for those with PD and maybe even slow the progression of the disease process? Well, read on to find out (spoiler - the answer is yes)!


What Kinds of PA Have Been Studied for PD?

Most of the studies that are represented in this post were randomized control trials (RCTs) or meta-analyses of RCTs, where various forms of PA were compared to other forms of PA, and/or to non-exercise controls or wait-list controls. Most of the studies lasted about 8-12 weeks, where the data collected at the end of the study period was compared to baseline data obtained before the PA intervention began.

The interventions that were examined in the studies referenced in this blog post include:

  • Walking training – walking outside

  • Treadmill training – walking or running in a treadmill

  • Aquatic training – swimming and water aerobics

  • Cycling training – biking

  • Musical dance training – rhythmic dancing, dancing to music, ballroom dancing

  • Qi Gong – a traditional Chinese wellness practice that combines movement, posture, breathing, and meditation

  • Tai Chi – a traditional Chinese martial art in which slow, graceful, and dance-like movements are linked in a continuous sequence

  • Yoga – this was described in detail in part III

  • Virtual reality training – video-game-type system that creates a 3-D image or environment that can be interacted with

  • Resistance training – strength training, weight-lifting, resistance band training

The individual session length for the various forms of PA ranged from 20 – 90 minutes, with the most common and effective duration being about 60 minutes long. Some studies had the participants do carryover exercises, where they would do additional practice for about 20 minutes at home 1-2x per week. The frequency of sessions ranged from 1-5x per week, where the most common frequency was 2x per week. Each form of PA included different movements and exercises based on the unique philosophy for each modality. Let’s dig into what benefits were seen for those with PD when participating in these different forms of PA.


Benefits of PA for PD Symptoms

Similar to what was seen for yoga, PA helped improve many motor and nonmotor outcomes for people with PD. The following areas improved for those with PD when engaging in one, or more, of the PA varieties described above:


Sleep. PA improved quality of sleep and reduced the time to fall asleep as well as daytime sleepiness in individuals with PD.


Cognitive function. PA resulted in improved cognitive functions, including attention, memory, and executive functioning (e.g. problem-solving, planning, sequencing, organizing, etc.) in people with PD.


Functional mobility. Functional mobility basically refers to ease of movement in functional tasks (e.g. chores, work, etc.) and includes things like reaction time, navigating obstacles, and completing ADLs (activities of daily living). PA resulted in significant improvements with functional mobility for those with PD.


Balance. PA resulted in improvements with static (i.e. stillness) and dynamic (i.e. movement) balance, which also translated to reduced fall risk for those with PD.


Posture. Posture and postural stability improved with PA, with reductions seen in the forward flexed posture that tends to happen to those with PD. Reducing this forward flexed posture can reduce back and neck pain for those with PD as well as improving respiratory function.


Gait. PA improved walking speed, initiation of walking, and walking pattern for those with PD.


Muscle strength. Strength refers to the ability of a muscle to overcome resistance, such as from external objects, body weight, or gravity. Muscle strength improved with PA for those with PD, and this was especially pronounced with RT.


Mental health. As reviewed in earlier parts of this blog post, depression and anxiety are common symptoms that can go hand-in-hand with PD. The forms of PA reviewed in this post had some effect on reducing depression and anxiety, but turns out, yoga appears to be the most helpful for improving depression and anxiety symptoms in PD (see part III for more on this).


QOL and wellbeing. QOL can take a pretty severe dip for those with PD due to the motor and nonmotor symptoms. Pretty much all forms of PA resulted in improvements in QOL and wellbeing measures. This is clinically significant because an intervention that really helps someone should improve QOL.


A lot of studies showed comparable effects for the different styles of PA, meaning that pretty much any type of regular, consistent PA could improve PD symptoms. Some studies also showed that a combination of the different forms of PA would be best for those with PD, such as yoga and RT, or rhythmic dancing and treadmill training. Several studies suggested that dancing to music seemed to be one of the most beneficial forms of PA in terms of motor and cognitive improvement for those with PD. But, truly, all forms of PA examined in these studies improved PD symptoms; thus, the individual with PD can choose the form, or forms, of PA that resonate best with their preferences, interest, and lifestyle. Because the data suggested that any type of PA is more helpful when compared to doing usual care only (e.g. rehab, medication) or nothing at all.


How Might PA Confer Benefits to Those with PD?

So, clearly, PA helps those with PD, based on the research presented here. The next question is – how might PA confer benefits to those with PD? What mechanisms might contribute to the positive effects seen? Well, I will provide a few of my hypotheses based on the research I did for this series.

One potential reason that PA (e.g. yoga, RT, rhythmic dancing, etc.) may help people with PD is due to the neuroprotection that is known to occur with physical exercise. Essentially, when people exercise and engage in physical movements, neurotrophic factors (e.g. BDNF, GDNF) get released and quite literally protect and improve brain tissue functioning and health. These neurotrophic factors increase synaptogenesis (i.e. connections between individual neurons), brain volume (due to increased number of cells), and cerebral angiogenesis (i.e. increased blood vessels). All of these effects lead to better and more efficient communication between the various brain regions, particularly between the basal ganglia (in which dopamine-producing neurons are affected in PD) and other motor brain areas. Neurotrophic factors also increase mitochondria biogenesis (i.e. growth of more mitochondria in a cell). Mitochondria are the sites cellular metabolism, so more mitochondria means better, faster, and more efficient energy production for the entire body, allowing the body to move, feel, and think better.


PA also reduces the expression of inflammatory cytokines in the blood while also increasing the activity of free radical scavengers. These two events can reduce oxidative damage within cells. If you recall from parts I and II of this series, oxidative damage in the basal ganglia is one of the prevailing hypotheses for the pathology of PD. PA also reduces expression of the pathogenic protein alpha-synuclein, which if you recall accumulates and aggregates in the basal ganglia in PD, contributing to the pathology of the disease.


PA also requires a certain amount of training the body’s responsiveness and proprioception (i.e. the body’s sense of where it is in space and how it is moving). Depending on the form of PA, there might be starts, stops, rotations, and side steps, all in different directions and in different sequences. The body’s center of gravity can also shift and change with the PA, improving the ability to control balance. Also, there can be weight-shifting and alterations in stance in the different forms of PA, improving functional mobility and balance. Finally, most forms of PA stress awareness of the movement itself (especially yoga, Tai Chi, Qi Gong, and RT), helping the person with PD to simply be more embodied in his/her body. Using a combination approach of PA would hypothetically provide the person with PD even more varied motor sequences to execute, resulting in even more improvement with PD symptoms.


Summary

Thank you so much for reading this post until the end! As the information presented here suggests, PA is a wonderful adjunct intervention to rehab and medication for those with PD. PA seems to positively affect nearly all motor and nonmotor symptoms, and a combination approach might even be better. One thing that every study made sure to emphasize is that whatever form, or forms, of PA are adopted, it needs to be consistent and for the long-term. PA is a journey, and there is no end-point to this journey. In order to reap the benefits of PA in whatever form, it needs to be a lifestyle that happens regularly. PA can also serve as a substitute for rehabilitative therapy and/or medication if a person is not able to access those interventions. In a perfect world, the best approach would be a combination of regular and varied PA, rehabilitative therapy, and medication. Unfortunately, not everyone can afford rehabilitative therapy due to insurance coverage and costs, and sometimes insurances deny claims for therapy or set limits on how long a person with PD can be treated. Thus, PA can help to "fill the gap" between rehab services. Medication can also become costly depending on one's prescription insurance coverage, and it can also bring some negative side effects and/or lose potency over time. Here again, PA might be a perfect alternative for these instances. Please share this blog with anyone you think might benefit. The information presented here is based on several research studies that were pretty well-designed experiments. Stay tuned for part V of this series, where I will use my neuroscience degree to dig deeper into the neurobiology of the brain areas affected in PD.


As always, the information presented in this blog post is derived from my own study of human movement, anatomy and physiology, yoga, and neuroscience. If you have questions about Parkinson's disease specific for you, please follow up with your physician, neurologist, or physical therapist. If you are interested in private yoga and/or personal training sessions with me, Jackie, email me at info@lotusyogisbyjackie.com for more information about my services. Also, please subscribe to my website so you can receive my monthly newsletters (scroll to the bottom of the page where you can submit your email address). This will help keep you "in-the-know" about my latest blog releases and other helpful yoga and wellness information. Thanks for reading!

~Namaste, Jackie Allen, M.S., M.Ed., CCC-SLP, RYT-200, RCYT, NASM-CPT, NASM-CES, NASM-CNC, NASM-SFC, NASM-WLS


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