A decade ago, conventional wisdom held that little to nothing could be done to delay the progression of Parkinson’s disease (PD) and movement disorders. Today, increasing awareness of the potential benefits of physical activity, goal-oriented exercise programs and rehabilitation has changed the landscape for patients with neurodegenerative diseases.
“Exercise and rehabilitation are incredibly important for patients with Parkinson’s disease and other movement disorders,” says Mya C. Schiess, MD, professor of neurology and director of UT MOVE, the Movement Disorders and Neurodegenerative Diseases Program at McGovern Medical School at UTHealth. “Thirty percent of PD patients are physically less active than age-matched controls. We know that a sedentary lifestyle leads to co-morbidities, and research suggests that longevity in PD is correlated with physical exercise. We also know that exercise improves cortical motor pathways and excitability, drives neuroplasticity and tends to upregulate endorphins and neurotrophins, which restore health in the neuronal-glial environment.”
Cardiovascular fitness has been associated with improvements in cognition, motor symptoms, depression, apathy, constipation, sleep patterns, balance coordination and motility, all of which are critical symptoms in patients with PD. It also improves bone health.
“Most people with Parkinson’s disease fall within the osteoporosis timeline,” Dr. Schiess says. “Cardiovascular fitness helps lower the risk of osteoporosis and can help regulate hypertension, which is critical because of the extreme blood pressure fluctuations identified in patients with PD. Recent research has suggested that physical activity can be neuroprotective and may even help prevent PD. A significant study, published in Movement Disorders in 2016,1 linked the mechanisms of disease with oxidative stress at the cellular level and inflammatory conditions, and suggested that physical activity countered these two mechanisms. That’s a powerful statement. At the meeting of the International Congress of Parkinson’s Disease and Movement Disorders held in June in Vancouver, the article was noted as the best reference to date on the topic.”
Dr. Schiess emphasizes that exercise doesn’t have to mean a workout at the gym. “Aerobic physical activity sufficient to increase the heart rate to 70 to 80 percent of the maximum three times a week for 20 minutes can put us where we want to be,” she says. “It can be tai chi, dancing, yoga, swimming, hiking, walking, running or cycling – and recently it’s been shown that PD patients benefit from boxing because it builds agility, muscular endurance, speed, accuracy, hand-eye coordination and balance.” (Visit rocksteadyboxing.org for information about boxing classes for PD patients.)
When devising treatment plans, Dr. Schiess works with TIRR Memorial Hermann from day one for the entire scope of motor disorders. “We have a very special relationship with TIRR, and are a huge advocate of their programs for people with movement disorders,” she says. “They’ve taken their neuro-driven rehab programs and perfected them for PD patients, whether they’re inpatients or outpatients. The results we see in patients who participate in TIRR programs are day and night compared to those who choose other programs. We refer patients over to their physical medicine and rehabilitation specialists and consult with them. We’re interdigitated like the pieces of a puzzle. The medical regimen can be complicated in PD patients. We get them started with physical activity and plug them into rehabilitation, particularly after the implantation of intrathecal baclofen pumps, Botox® injections or deep brain stimulation surgery. After these interventions patients have to learn how to move in new ways without developing compensatory movements. We do as much as we can and then call on physiotherapy to take them to the next level.”
Jacob Joseph, MD, director of medical affairs and services at TIRR Memorial Hermann and vice chair of clinical operations in the department of Physical Medicine and Rehabilitation at UTHealth, works with patients to develop specific therapy strategies that can lead to significant improvement. “If the neurologist recognizes that special rehabilitation needs are developing, we evaluate patients in the Outpatient Medical Clinic and get them involved with the appropriate therapists,” Dr. Joseph says. “A social worker looks at resources available to them that may not have been previously explored. In some cases, state-supported programs may provide help. We work with Dr. Schiess and other neurologists to do a comprehensive, in-depth evaluation that involves the entire therapy team. Together we identify areas where we can intervene to improve functional independence.”
Because PD is a progressive disease, patients’ needs are always changing. “We have tailored our Parkinson’s disease programs to patients’ specific needs because research has given us a better understanding of the underlying causes of movement disorders,” he says. “If a patient declines and needs to be admitted to the rehab hospital for aggressive medical management, we work closely with neurology. Our goal is always to prevent further deconditioning. Exercise and therapy are important from diagnosis onward, because we know that maintaining activity helps reduce functional decline.”
Learn more about programs at TIRR Memorial Hermann for patients with Parkinson’s disease and other movement disorders.
1LaHue SC, Comella CL, Tanner CM. The best medicine? The influence of physical activity and inactivity on PD. Mov Disord. 2016 Oct;31(10):1444-54.
Jacob Joseph, MD, and Mya C. Schiess, MD, are among the featured speakers at an upcoming continuing education course on Evidence-based Rehabilitation of Patients with Parkinson’s Disease and Movement Disorders, to be held June 2018, in Houston. Also speaking will be Erin Furr-Stimming, MD, associate professor of neurology at UTHealth and chief of neurology at Lyndon Baines Johnson General Hospital; Joohi Shahed-Jiminez, MD, assistant professor of neurology and director of the Deep Brain Stimulation Program at Baylor College of Medicine; Eugene Lai, MD, a clinician-scientist with a special interest in the causes and treatment of neurodegenerative diseases; Lisa Musgrave, BSN, MHA, RN, vice president of home-based care for Memorial Hermann Health System; Heather Smith, MA, CCC/SLP, senior speech language pathologist at TIRR Memorial Hermann Outpatient Rehabilitation-Memorial City; and Randi Carraba, daughter and caregiver of a patient with Parkinson’s disease.