Dr. Giselle Petzinger on Exercise for Parkinson’s Disease

Dr. Jesselle Petsinger on Parkinson’s Disease

• Parkinson’s Disease: progressive neurodegenerative disorder affecting individuals over 50 
  • Primarily affects mobility (slowness, stiffness, tremor)
  • Non-​​motor issues: loss of smell, mood (anxiety, depression), autonomic nervous system (constipation, blood pressure changes)
  • Cognitive issues: mild cognitive impairment in 40% of patients upon diagnosis
• Dopamine loss and cell dysfunction in Parkinson’s Disease 
  • 40–50% cell loss and 60–80% dopamine loss
  • Remaining cells have problems handling dopamine
  • Disruption of circuitry due to dopamine loss causes behavioral problems
• Role of exercise in Parkinson’s Disease 
  • Exploits frontal striatal neuroplasticity to restore automaticity of movement
  • High-​​intensity aerobic exercise has a profound impact 
    • 8 weeks of intensive treadmill training 3 times per week can increase dopamine receptor expression in the basal ganglia by 80–90%
    • 6‑month study: high-​​intensity exercise showed no disease progression, while non-​​exercisers experienced a 15% worsening of motor symptoms
• DHA (omega‑3 fatty acid) may be beneficial in preventing loss of dopamine-​​producing neurons and preventing dyskinesias associated with levodopa (dopamine replacement drug) 

Frontal Stridal Circuit and Parkinson’s Disease

• Frontal stridal circuit: involved in volitional movement, updating movements, learning new movements
• Automatic movement and volitional movement happen together
• Parkinson’s patients lose automaticity due to dopamine depletion, compensate with more volitional movement
• Frontal stridal circuit also involved in executive function (planning, processing)
• Saturation effect: overusing frontal system may lead to falls or other issues

Cerebellum and Parkinson’s Disease

• Cerebellum: important for motor control, motor planning, and cognitive aspects
• In Parkinson’s models, cerebellum is highly active during early stages of learning exercise
• Neuroplasticity and homeostasis: brain adapts to changes and reaches a new balance

Parkinson’s Disease Prevalence and Causes

• 1 in 100 people over the age of 50 have Parkinson’s disease
• Second leading neurodegenerative disorder behind Alzheimer’s
• Genetic factors play a role, especially in young-​​onset Parkinson’s (under 35)
• Environmental factors also contribute, especially in older-​​onset Parkinson’s (over 35)
• Mix of genetic and environmental factors likely contribute to most cases

Environmental Toxins and Parkinson’s Disease

• MPTP: neurotoxin found in the 1980s that causes Parkinsonian symptoms
• Similarities between MPTP and insecticides/​​herbicides like rotinone and paraquat
• Rotinone and paraquat can cross the blood-​​brain barrier and affect dopamine neurons
• Environmental toxins may contribute to neurodegenerative disorders
• Combination of factors (exposure to toxins, sedentary lifestyle, inflammation) may increase risk

Pesticides and Parkinson’s Disease

• Farmers working with paraquat have a higher incidence of Parkinson’s disease
• Rotinone now mainly used as a piscocide in the US
• Paraquat use is restricted in the US, but may still be used in developing countries
• Balancing exposure to toxins with healthy lifestyle choices (exercise, diet) may help mitigate risk 

Lifestyle Factors and Parkinson’s Disease

• Organic food consumption may be a consideration for reducing risk factors
• Exercise is a compelling lifestyle factor that can decrease the risk of Parkinson’s disease and modulate its severity

Exercise as a Panacea

• Exercise can decrease the risk of Alzheimer’s disease and aid in recovery from traumatic brain injury
• Exercise acts as a counterbalance to genetic and environmental risk factors for brain injury and diseases like Parkinson’s
• Exercise promotes synaptic connections, resilience, and repair mechanisms in the brain

Resilience and Aging

• Exercise activates resilient pathways, maintaining connections between neurons and repairing damage
• Exercise acts as a stressor, activating these pathways and making individuals more resilient to other stressors such as aging or disease

Different Types of Exercise

• Different exercises may activate different repair mechanisms in the brain
• More cognitively engaging exercises, such as surfing or tai chi, may activate specific circuits in the brain and drive benefits
• Challenging exercises that require balance, speed, and accuracy can also be beneficial for individuals with Parkinson’s disease 

Getting Out of Comfort Zone and Exercise

• Skillful exercise focuses on problem-​​solving, accuracy, and dynamic tasks
• Intensity of exercise is separate from skillful exercise 
  • Intensity refers to heart rate, vigorousness, and physical challenge
• Two types of intensity: 
  1. Motor learning (e.g., tennis, skateboarding, tai chi, yoga)
  2. Heart rate (e.g., cardio exercises)
• Exercise can engage different parts of the body, such as arm swing and posture

Parkinson’s Disease and Exercise

• Gait (walking) and balance are common targets for exercise programs 
  • Gait is often not normal in Parkinson’s patients
  • Balance issues generally progress as the disease advances
• Exercise can help improve balance, walking stride, and posture
• Rocksteady boxing: non-​​contact boxing for Parkinson’s patients 
  • Focuses on learning patterns of movements

Cognitive Loading and Exercise

• Cognitive loading is present in most exercises, even weight lifting or stationary biking
• Movement through space is a significant cognitive load for the brain 
  • Can be increased through skillful exercise or changing the environment
• Environmental enrichment can increase synaptic connections and long-​​term potentiation
• Natural spaces and movement through them can also impact cognition

Exercise Benefits for Parkinson’s Patients

• Moderate to high-​​intensity exercise can increase BDNF (Brain-​​Derived Neurotrophic Factor) in plasma 
  • BDNF is important for maintaining synaptic connections, growing new neurons, and repairing damaged brain
• Exercise can also produce anti-​​inflammatory cytokines
• These can have positive effects on the brain 

Immune System and Brain Connection

• Immune factors can enter the brain through the lymphatic system 
  • The brain is not a passive recipient; it signals what it needs based on metabolic demands and cognitive load
  • Neurons and synaptic activity have high metabolic demands, signaling the need for more fuel

Exercise and Lactate

• Lactate is generated during exercise and crosses the blood-​​brain barrier
• Astrocytes make lactate, which is used as an energy source for neurons
• Lactate also acts as a signaling molecule, affecting BDNF and other factors
• The brain may signal the need for lactate during exercise

Parkinson’s Disease and Exercise

• Exercise can improve dopamine receptor sensitivity in Parkinson’s patients, making their brains more efficient at using dopamine
• Having a personal trainer or participating in group classes can help challenge Parkinson’s patients and provide feedback
• Mixing up exercise routines and engaging in enjoyable activities can increase compliance and improve outcomes

Intensity of Exercise

• A study in JAMA Medicine showed that Parkinson’s patients who engaged in high-​​intensity exercise (80–85% maximum heart rate) had better outcomes than those who did not exercise or engaged in moderate-​​intensity exercise (60–65% maximum heart rate)
• High-​​intensity exercise can be identified by sweating, flushing, and feeling uncomfortable due to exertion
  

Exercise and Parkinson’s Disease

• Exercise can slow the progression of Parkinson’s disease
• Moderate intensity exercise: 7.5% progression over six months
• High intensity exercise: 0% progression over six months
• Improved quality of life for Parkinson’s patients with regular intense exercise 
  • Maintain ability to dress themselves, retain cognitive function
• Exercise is not a replacement for dopamine treatment (levodopa-​​carbidopa)
  • Exercise and dopamine treatment work together for better results
• Importance of educating patients and families about the benefits of exercise 
  • Goal setting, community support, and resources for exercise
  • Encourage exercise for the whole family, not just Parkinson’s patients

Dopamine Treatment for Parkinson’s Disease

• Standard treatment: levodopa-carbidopa 
  • Replaces depleted dopamine in the brain
  • Helps alleviate symptoms of slowness and stiffness
  • Allows patients to get the most out of exercise
• Exercise and dopamine treatment work together for better results 
  • Exercise cannot replace the need for dopamine treatment
  • Levodopa-​​carbidopa does not slow disease progression, but helps treat symptoms

Nutrition and Parkinson’s Disease

• The role of nutrition in Parkinson’s disease is not well understood
• Further research needed to determine the impact of nutrition on disease progression and symptom management
  

Omega‑3 Fatty Acid DHA and Parkinson’s Disease

• Observational studies show people taking fish oil have a lower incidence of Parkinson’s
• Animal models (rodents and primates) show high doses of DHA can lower LDOPA-​​induced dyskinesia
• DHA affects dopamine in the context of traumatic brain injury in animal models

Diet and Exercise in Parkinson’s Disease

• Mediterranean diet may be beneficial based on epidemiological data
• Exercise is important for Parkinson’s patients 
  • At least 30 minutes, three times a week
  • Intense and skill-​​based activities involving gait and balance
  • One-​​on-​​one therapy recommended

Inflammation and Parkinson’s Disease

• Some data suggests higher pro-​​inflammatory cytokines in Parkinson’s patients 
  • TNF alpha, IL‑6
• Inflammation may not be the cause of Parkinson’s, but could contribute to progression
• Role of diet and microbiome in inflammation needs further investigation

Importance of Lifestyle in Neurological Disorders

• 50% of any neurological disorder is lifestyle
• Clinicians should emphasize lifestyle changes in treatment discussions
• It’s never too late to make lifestyle changes