PHYSICAL THERAPY AND PARKINSON’S WHAT’S IT ALL ABOUT

Depending on where you live, the county or city might have started lifting some restrictions of the Stay at Home order. You may be able to return to your normal gym routine, exercise classes, or regular health care appointments. Maybe you are still feeling apprehensive about venturing out or have other health issues that make going out not an option. Either way, we need to keep finding ways to move and ways to stay active inside or outside.

If you have heard me speak in person or virtually at a PRO meeting, you know me as a Doctor of Physical Therapy who works with people with Parkinson’s (PwP). I also consistently promote the importance of exercise as one of the best forms of treatment for PwP. There are multiple resources and studies that I frequently cite that talk about the positive neurological and physical changes that occur because of exercise.

I have shared an abstract of an article that specifically talks about these positive effects. This specific article by Sacheli, et al1 looked at the differences in habitual exercisers with Parkinson’s Disease (PD) versus sedentary PwP. A habitual exerciser was defined as someone who exercised > 180 minutes per week (or more than 3 hours a week). The habitual exerciser showed improved dopamine release, reduced bradykinesia (slow movement), reduced apathy (lack of interest, enthusiasm), and better overall function than before they started exercising.

As you may know, decreased levels of dopamine are one of the major culprits in causing PD. Which means exercise was proven to increase the release of dopamine! Another great and interesting take home from the article was that those who exercise regularly had increased dopamine response to exercise which led to a better mood and thus made it more likely that they would continue exercising. The better you feel with exercise, the more you may want to exercise. It is a positive cyclical pattern.

Habitual exercisers versus sedentary subjects with Parkinson’s disease: Multimodal PET and fMRI study.  Matthew A. Sacheli, MSc, Danielle K. Murray, MD, Nasim Vafai, MASc, Mariya V. Cherkasova, PhD, Katie Dinelle, MSc, Elham Shahinfard, PhD, Nicole Neilson, RN, Jessamyn McKenzie, LPN, Michael Schulzer, PhD, Silke Appel-Cresswell, MD, Martin J. McKeown, MD, BEng, Vensa Sossi, PhD, and A. Jon Stoessl, MD. Movement Disorders, 2018; Online DOI: 10.1002/mds.27498

Background: The benefits of exercise in PD have been linked to enhanced dopamine (DA) Transmission in the striatum

Objective: To examine differences in DA release, reward signaling, and clinical features between 

habitual exercisers and sedentary subjects with PD.
Methods: Eight habitual exercisers and 9 sedentary subjects completed [11C] raclopride PET scans before and after stationary cycling to determine exercise-induced release of endogenous DA in the dorsal striatum. Additionally, functional MRI assessed ventral striatum activation during reward anticipation. All participants completed motor (UPDRS III; finger tapping; and timed-up-and-go) and non-motor (Beck Depression Inventory; Starkstein Apathy Scale) assessments.

Result: [11C] Raclopride analysis before and after stationary cycling demonstrated greater DA release in the caudate nuclei of habitual exercisers compared to sedentary subjects (P < 0.05). Habitual exercisers revealed greater activation of ventral striatum during the functional MRI reward task (P < 0.05) and lower apathy (P < 0.05) and bradykinesia (P < 0.05) scores versus sedentary subjects.

Conclusions: Habitual exercise is associated with preservation of motor and nonmotor function, possibly mediated by increased DA release. This study formulates a foundation for prospective, randomized controlled studies. © 2018 International Parkinson's and Movement Disorder Society.

Keywords: Parkinson's disease; dopamine release; exercise; functional magnetic resonance imaging; positron emission tomography.