Research and anecdotal experience continue to show the critical importance of exercise for people with Parkinson’s. Regular physical exercise can improve mobility and coordination, boost mood, reduce stiffness, minimize soreness and fatigue, and may even slow down the progression of Parkinson’s itself.  

During the event, we talked to some of the most sought-after experts in the field about what kind of movement to do, how much to do, when to do it, and how to know when enough is enough. We addressed topics such as neuroplasticity, intensity, the value and differences between cardio and strength training, and more. It was a day of information, connection, inspiration, and movement! 

Thank you for attending! 

Victory Summit Exercise Cover Photo

recordings

welcome and agenda

You can read the transcript below or download it here.

Note: This isn’t a flawless, word-for-word transcription, but it’s close.

Polly Dawkins (MBA Executive Director, Davis Phinney Foundation):

Good morning Davis, and welcome to the Victory Summit all about exercise.

Davis Phinney (Founder, Davis Phinney Foundation):

Yes. My favorite tip.

Polly Dawkins:

So, Davis, tell us when you were diagnosed back over 20 years ago, what were you told about exercise or, really, about anything?

Davis Phinney:

I was not told much about anything other than that I should be feeling fine for some time to come and to take it easy. And-

Polly Dawkins:

How have you done with that prescription?

Davis Phinney:

And I listened to that prescription for about a week and then I sort of found my own way.

Polly Dawkins:

Well, and what did your personal experience tell you? What did you find by trial and error?

Davis Phinney:

Well, I mean, for me, I’m in a lifelong athlete, so it was, it was harder to say take it easy than to not. Mm. But, I’ve, what I’ve discerned over time was that exercise is extremely helpful in slowing my symptoms. And so, in the course of the disease and be that I’ve found a pace for myself that works well and so that I’m not either pushing it too hard or else taking it too easy.

Polly Dawkins:

How, over the last 20 years, how has your approach to exercise evolved or changed?

Davis Phinney:

Well, and I think part of that is, was the answer that I just gave with finding a pace that sustainable and enjoyable. I mean, the thing with exercise is you have to find something that you’re going to do continuously and that you find an enjoyment of. Otherwise, it’s just like torture and we’re tortured enough with hers so it, if there’s anything I’ve learned, it’s that finding a sustainable pace for something that I like to do is important.

Polly Dawkins:

So, what types of exercises are you doing today compared to 10 years ago?

Davis Phinney:

Well, 10 years ago I didn’t have access to the classes that I do now. And that’s the, unfortunately, somewhat changed by the pandemic, but there’s still access to classes through technology like this and those classes have been really lovely. Like David Leventhal stands for pre-classes, just one example of many that are out there that are, that are catered to our needs and our level of ability and so does that. But 10 years ago, I was ride riding my bike and I’m still riding my bike. I just use, again, technology to my advantage by riding an e-bike and electric bike so that I have that little bit of assist as need as needed. And that’s been very, very, very helpful. So, the e-bike has been one way to moderate what I’m doing, but all the 10 years ago I was not riding indoors, and I started doing that with the spent spinning class peddling for Parkinson’s Cup at the health club here in Boulder. And that was really lovely. Yeah. Lovely, a lovely class. That was inspiring and engaging and touched a lot of important things with my Parkinson’s, which were not just taking advantage of the exercise to improve my overall health, but also, it was a way of connecting me, with the community. And we had a fantastic group. And I’d say that unfortunately in the past tense because that went away when COPE came in.

Polly Dawkins:

Yeah. Well, hopefully, those opportunities will come back as people feel more comfortable getting back out into the community and doing.

Davis Phinney:

Right. And I think that that is true. And so, I mean, but I’ve kept up the variety both indoors and out just because it’s so good for me and I feel that it’s good for me. And my Parkinson’s has been fairly stable now for a long time. That’s largely due to my ability to exercise.

Polly Dawkins:

And it probably affects your mood as well when you affect it.

Davis Phinney:

Yeah, there’s no question. I mean, I don’t get quite the buzz that I used to from exercise, but it’s still a pivotal part of my day and I feel like as a lifelong athlete that it’s long been the cornerstone of my successfully managing this disease and part of that is being upbeat and staying positive. And if I was not exercising, I would find that tremendously difficult. Yeah. To stay positive and not be,

Polly Dawkins:

Yeah. What is the best exercise that you’ve found while living with Parkinson’s?

Davis Phinney:

Well, I mean, that’s an interesting question because I feel like the best exercise is the one that you’re going to keep up with. And if you’ve heard anything from me, you’ve heard my moniker that something is better than nothing. And so even if you have just something that doing motion-wise, it’s flexing some muscles for five or 10 minutes, that is fine because it’s better. It’s five or 10 minutes more than what nothing would give you. And so, there is that, and for me, I mean, my corner cornerstone is always going to be cycling because it’s something that I’ve done for so long and I continue, continue to be able to ride safely and successfully and

Polly Dawkins:

Yeah. So, something is better than nothing.

Davis Phinney:

Yes.

Polly Dawkins:

It’s, and so the type of exercise really doesn’t matter to you as long as you’re moving.

Davis Phinney:

I mean, it’s, it doesn’t, it matters to a degree, but it’s all in degrees of what you’re trying to improve. And if, you know, if your hands are struggling working, then, you want to them in some form of exercise or if you’re losing all your muscle top, then you want to engage yourself in other ways. So, there’s a myriad of ways with which you can get exercise.

Polly Dawkins:

Yeah.

Davis Phinney:

But what’s the very best, again, at least initially, it’s the thing that you’re going to keep doing. And for me, at the end of the day, if I’ve done nothing else, I’ll pull out my kettlebell and heft this thing off over my head a few times.

Polly Dawkins:

That makes sense. You know, I know you’ve mentioned our friend and movement disorder neurologist, Helen Bronte Stewart has often advised us that you are training your weaknesses. So perhaps not always doing the thing that’s easiest or

Davis Phinney:

Right. Do you

Polly Dawkins:

Have any comments on

Davis Phinney:

That? That would be, I would say it’s for someone who, who’s committed to exercising and is found a form of exercise that they can, they’ve may, may the habit. And then I would say that you can look beyond your ha your habit somewhat and start to include that philosophy because it is easy to train your strengths, so to speak. But it’s hard to look at yourself critically and say, well, you know, geez, I’m, I’m just so weak and I need to work on that aspect, which I can relate to because my, one of my weak points is my voice could, and yet I could work harder on it, but I just choose not to, which is unfortunate for me and all of you,

Polly Dawkins:

We could hear you fine. Well,

Davis Phinney:

I know, but you know what I’m saying. Yeah. The, you know, you, I just don’t get as much bang for the buck by doing voice drills as I do for other things. Like, listen, this guy

Polly Dawkins:

So, Davis, as we wrap up and are getting started to spend the morning and a better part of the day about exercise and learning about the different modalities, any words of wisdom that you’d like to send folks out with?

Davis Phinney:

Well, I would just say that, you know, we are so fortunate to have the level of presenters that are joining us today with Boss being the headliner. And so, I would say that I welcome you all, and please take these messages to heart from everyone and get busy with some form of movement. Because you are only hurting yourself by being passivity and Parkinson’s don’t go well together. In terms of Parkinson’s, it has the upper hand. And you just don’t want that to ever hap happen. Yeah. So, enjoy your day, and let’s get on with this great show.

Polly Dawkins:

Thank you, Davis.

To download the audio, click here.

cognition, mood, and exercise

You can read the transcript below or you can download it here.

Note: This is not a flawless, word-for-word transcript, but it’s close.

Melani Dizon (Director of Education and Content, Davis Phinney Foundation):

Dr. Bloem, Professor Bloem, can you tell us a little bit about yourself and how you got into the field of Parkinson’s, and then in particularly interested in the effects of exercise on people living with Parkinson’s?

Bastiaan (Bas) R. Bloem, MD, PhD, FRCPE (Consultant Neurologist at the Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands):

That’s a lot of questions.  all in one go. Yes. so, I’m Bas Bloem. I’m a neurologist. I see patients every week, I should say individuals living with Parkinson’s. I don’t like the word patience or persons. And I’m the director of one of the largest Parkinson’s and movement disorder centers in the world. We’re growing fast, like a Dutch cabbage, you could say. They grow very fast. We’re very active in the field of innovative healthcare, patient-centeredness digital medicine healthcare innovation in general. Large scientific group, about 36 Ph.D. students. And I wear multiple hats. I’m a longstanding advisor to the Michael J. Fox Foundation. And I serve on many other boards including being the co-editor-in-chief for the Journal of Parkinson’s Disease. And my interest in Parkinson’s was a lucky coincidence.

My mother had multiple sclerosis. She got married in a wheelchair. And as a young child, as long as I can think, I wanted to become a doctor and not just a doctor, I wanted to become a neurologist and not just a neurologist. I wanted to become a multiple sclerosis expert. So, I went into medical school and in the third year of medical school, started to work on neuroimmunology because that was relevant for multiple sclerosis. And within a few months, I realized that in order to obtain a residency position, which was horribly difficult, it still is I wanted to go to the United States to boost my career. And I asked my professor, could you somehow help me on my way to do some work in the United States as an intern? And he said, well, yeah, Bill Langston happens to be here next week, and I can introduce you to him.

I said, oh, is he an MS expert? Said, no, he’s one of the leading guys in the Parkinson’s field. And I said, But that’s no good. I want multiple sclerosis. And he said, Well, but Bill lives in the Bay Area. I said, All right. All right. Somebody needs to do the dirty work. So, I went to the United States to do a project on Parkinson’s and balance control, which is still one of my sort of sub-specialties. And from the day I met people with Parkinson’s, I have become fascinated by the complexity of the disease, and by the resilience and the extreme creativity of families with Parkinson’s in dealing with this ordeal. And I’ve basically forgotten all about MS. I couldn’t even treat multiple sclerosis anymore, and now it’s been my life mission. It sounds maybe pathetic always, but, or, or, or, but I, you know, it’s my mission to help people with partnerships, to create a better world for all those families in the world and forgotten all about MS. And here I am

Melani Dizon:

Wow. Well, that is a very happy coincidence for us.

Bas Bloem:

It is, yes.

Melani Dizon:

Good. And so, you want to talk a little bit about your center, because it was, it’s, you know, served as a model for so many in the world. And how did you know, like when did you decide, hey, this needs to be a holistic thing? We can’t just be treating this one aspect of somebody with Parkinson’s. How did you know, and when did you know, and when did you get it started?

Bas Bloem:

Well, part of it was inspired by my quote-unquote, other life. I’ve also been a semi-professional athlete. I used to be a volleyball player in the Dutch national volleyball team, the under 18. I played in the Dutch Premier League, the highest volleyball level for several years. And as a volleyball player, I became really aware of the fact that volleyball is a multidisciplinary team effort. I was really good at the service reception, but I received virtually no sets because we had three guys that were exceptionally good at spiking the ball. And then we had a setter and a guy for the defense. And together still gives me great pride. We beat the Russians for the first time at an international competing event. The Russians always came from Moscow, beat the out of everybody, pardoned my French, and then went back with a gold medal, and we beat the Russians in a wonderful game that ended well after midnight with this multidisciplinary team.

Bas Bloem:

And in fact, I was in the starting lineup, and five out of the six players in that starting lineup, one Olympic gold in Atlanta. And the sixth guy sitting right here in front of you, he became a doctor. So, and then all fairness, I was a good player. I was a really good volleyball player, but not good enough for the real to become a real athlete. I had my part, my MS mission still. So, there was no time to become a full-time athlete, but my volleyball career did convince me that multidisciplinary teamwork is necessary. And then I also developed a firm belief in physiotherapy because I was regularly injured as an athlete. And physios brought you back onto the pitch. So developed a firm belief in physiotherapy, but at the same time, I also realized we needed better evidence for physiotherapy.

Bas Bloem:

So, this is what stirred, you know, my research into this allied health arena. And I’ve always been, I think as a child onwards, a very we say in Holland, I like flat organizations. So, I think very horizontally. There’s no hierarchy in my team. The youngest student, you know, the greatest junior on day one is as important as I am. And if anybody speaks, we all listen. And if there’s something valuable, you know, we’ll pursue it. So, I strongly believe in this teamwork, in horizontal thinking, and collaboration that includes the role of individuals living with Parkinson’s. In my team, we do nothing for people with Parkinson’s. We do everything with people with Parkinson’s. Co-Creation is a core word in our, in our team, and that gives me, you know, so much pleasure, and it makes the work so much more valuable and worthwhile.

Melani Dizon:

Yeah, I mean, I think when we, you know, talk to our community, the people who are living the best with Parkinson’s are taking that holistic approach. They’re looking at every sort of aspect of their life. They’re looking at how much they’re exercising, they’re looking at their nutrition, their community connections, their mental health, and all of those things. And so, I think it’s really great that you have this model that everyone else can look at and say, oh, well, we’re having success, right? Like, these people are living better than people that, that don’t pay attention to these other

Bas Bloem:

Friends. Absolutely. You know, in many ways. So, when I lecture about Parkinson’s one of my sort of opening slides is two cyclists it’s Mathieu van der Poel, a famous Dutch athlete these days. And Valin art is equally famous, a wonderful cyclist from Belgium. And in the round of longs macho on the pool beats the other guy by less than the thickness of a tire. I mean, it is the closest finish in the world. And I show that photo, which is brilliant. And I say the reason the one guy beats the other guy, is because the differences between athletes are so small is you need, everything needs to be perfect. Your sleep, your exercise, your gear, your physiotherapist your, your stress levels, your nutrition, and having Parkinson’s is like being a professional athlete. Everything needs to be perfect. Your sleep, your diet, your stress levels, your exercise. The only way to fight Parkinson’s disease optimally is to have that holistic approach.

Melani Dizon:

Right? Okay. So today part of that, that holistic approach we’re going to talk about is exercise and how it impacts thinking, cognition, mood all of those things. So, can you talk a little bit generally about what exercise does for the brain, not necessarily just the Parkinson’s brain, but the brain? Like what value is that exercise for the brain?

Bas Bloem:

Right. Well, first of all, if I can expand even a little bit further, exercise is not just good for the brain, and I’ll come to the brain in a minute. Exercise is also important to optimize regular bowel movements. Constipation and slow bowel movements is a core feature of Parkinson’s that interferes with the efficacy of oral levodopa medication. So, exercise is part of the multifaceted approach. To maintain regular bowel movements is critical. We know that osteoporosis bone weakness, it’s a common feature in Parkinson’s, which combined with the risk of falls, needs to hit fractures. And maintaining bone strength requires exercise. So, the benefits of exercise extend well beyond the brain. And these are just two examples. Not even talking about cardiopulmonary health, et cetera. Then in general, even before people started to look into the benefits of exercise on the Parkinson’s brain, we know that regular exercise leads to slower cognitive decline and diminishes the risk of dementia, for example, and I’m a strong believer in the user or lose it concept and use it or lose it is both physical and mental.

So, we’re talking mainly today, I suppose, about physical exercise, but for the folks listening mental exercise, and staying cognitively active is also very important. There have been studies to show, for example, that participating in the card game bridge helps to prevent dementia as an example. So, stay active is critical. And if you then look at the specific effects of exercise on the Parkinson’s brain, what we now know from a number of studies is that regular exercise suppresses motor symptoms much like the drugs are doing. So, it is like a symptomatic therapy for Parkinson’s. This has been studied most widely for the motor features, and by the motor features, I mean the slowness, stiffness, the tremor walking disability. So that improves with exercise. But I suppose today it’s, it’s also important to talk about the non-motor benefits. And new studies are popping up almost by the day to show that, for example, sleep improves with exercise mood can improve with exercise. And the benefits of exercise for these non-motor symptoms are probably even more important because many of those non-motor symptoms are more difficult to treat with pharmacotherapy, making exercise all the more important.

Melani Dizon:

Right. And, you know, you said sleep, and I think we can say sleep is just beneficial for everything when people get the right sleep. So, you know, exercise, it’s, it’s those downstream impacts. And so, like you said, it’s exercise tremendously helps with motor symptoms, but using exercise to help with cognition and mood and sleep those have so many downstream impacts that it’s one of those things that I want our community to look at and say, Okay, like, I do have control. I can, I can exercise, and I can impact these areas of my life. So, can we talk a little bit about cognition? First of all, what are you know, people here, mild cognitive impairment, they hear you know, cognitive decline, those kinds of things. What are we talking about when we talk about cognition? And then I know that there are games and things like that that you can do, but how does exercise help with that? How does, like, actual movement help with that?

Bas Bloem:

Right. If I I’ll take the liberty of change. Just one quick word on sleep, you know if people don’t sleep well, the day is horrible. And if you treat the nights, you will create better days. So that cannot be emphasized enough. And Parkinson’s does not go on vacation at night. You have Parkinson’s day and night, and we tend to focus our efforts on treating the days, and we forget about the nights, but you really need good night rest in order to be optimally fit during the day. And regular exercise during the day is part of that multifaceted approach. You need, there are like 10, 12 reasons why people with Parkinson’s sleep badly. I’m not sure if we can address all of those here today, and I’ll focus on your real question in a minute. But if you wake up in the morning and you don’t feel well rested and or if you fall asleep regularly during the day, which is tell that your night is actually not good, then go see your physician and talk about it.

The even if you spend a lot of hours in bed with your eyes closed, it doesn’t mean you sleep well. There’s a phenomenon called sleep fragmentation which keeps people from reaching their deep sleep phase. So even though you may spend a lot of hours in your bed sleeping, it’s a second-ranked sleep that doesn’t give you that proper rest leading to excessive daytime sleepiness during the day. So, people may find themselves falling asleep while reading a book, watching television, even during dinner, or while maintaining a conversation. Very embarrassing. And it’s, it’s a tell-tale sign that actually your night is not okay. So, I’m just taking the liberty to

Melani Dizon:

Yeah, no, and right, like if they don’t sleep well or tired, they’re less likely to exercise, which then

Bas Bloem:

Exactly.

Melani Dizon:

It’s all the other things, and they’re less likely to eat well. Right,

Bas Bloem:

Exactly. Yeah. Then it creates that vicious loop. So back to cognition yes, thinking is impaired for many people. And I’m going to say something to do there that may sound scary, but I’ll, I’ll give them the nuance and the explanation right away. If you go on Dr. Google and you type Parkinson’s and dementia, you will find many hits. And that sounds scary, but, but allow me to explain. When a person has a particular cognitive function, for example, memory or planning or organizational skills, and that ability, that cognitive function has declined to an extent that it hampers you in daily life, that’s when you tick the doctor’s definition of dementia. So according to those criteria, surprisingly, many people with Parkinson’s fulfill doctor’s criteria for dementia. But that’s a completely different type of dementia from say, Alzheimer’s dementia. What does not happen in Parkinson’s is the moment where you don’t recognize your loved ones anymore your children or your spouse that memory becomes severely impaired.

That’s not happening in Parkinson’s. What is happening is that functions that can be ascribed to the so-called frontal lobe, the forebrain become rustier. And I used the word rusty, you know, to describe that it’s not completely gone, but it becomes more difficult. And talking about organizational skills, for example, somebody who used to plan the trip we’re going to Lake Tahoe tomorrow, and then you need to plan the driving, packing your car. And the man or the woman who usually did the planning is now not having the oversight anymore, which may even lead to panic or anxiety initiative making plans. The one who always said, Let’s go out for a hike, is now sitting in the corner of the room and doesn’t come up with a plan spontaneously, multiple tasking, doing two things at the same time. Something simple as walking and talking at the same time can become more difficult.

So those are all that we call executive functions. And those executive functions can definitely become more difficult as the disease progresses. And when it hampers you to an extent that it bothers you fulfill the criteria for dementia. So that’s why if you go on Google, you’ll find it a lot, but it’s a whole different type of dementia. It’s not to say actually that it’s not debilitating, this lack of initiative the doctor’s word is apathy can be really terrible for the spouse and in particular because the individual with Parkinson’s doesn’t bother much, but the spouse goes crazy. Come on John, let’s do something. Oh, it’s okay, I’m sort of sitting here. I’m fine. So cognitive functioning is part of Parkinson’s. All the more reason to try and prevent that decline from happening through regular exercise. And there is some increasingly good evidence to suggest that exercise helps to maintain cognitive functioning.

There are particular drugs originally designed for Alzheimer’s disease that can have a modest effect to improve cognitive functioning, particularly when the impairment is only mild. So, work on, on, on the, on those cognitive issues. And one thing that I should mention before I forget is that another feature that’s quite common in Parkinson’s is depression. Depression is common for at least two reasons. One is you may just feel sad, you feel grief because of the diagnosis, just like when you would lose a leg, right? You’re, you’re sad with the diagnosis. The other reason is that the lack of dopamine, which people tend to equate with motor disability, the same lack of dopamine, is actually the cause for depression. Also, implying that optimizing the dopaminergic medication is a good antidepressant. And the reason I’m mentioning depression is that sometimes depression can Moser or impose itself as cognitive decline.

And I actually just had a person in my clinic who I knew very well actually in through cycling, and he is doing the bike for Parkinson’s and events with us. And he came up to me with tears in his eyes and he said, you know, the, my cognition is beginning to fail and I’m entering a more difficult phase. In hindsight, he had depression. And the good news is, we, we, we worked on the depression, we got him back on his exercise bicycle, and I saw him last that time and he had two thumbs up and was much better. So, when cognition isn’t fine, just like the story about the athlete, everything needs to be right. Your mood, your sleep, you know, everything and you need to work on it,

Melani Dizon:

Right? Yeah. So, the mood is down because the cognition is down, but the cognition can be down because the mood is down there. It’s just there, they’re all working off of each other. So, what is there, I mean, let’s talk a little bit about the right dose and frequency and that kind of thing for people with Parkinson’s and exercise and its ability to impact cognition and mood. So, there might be, is there a prescription that’s more, hey, this is, this is what it takes to help with non-motor or motor symptoms, but this is a little bit different. If you’re working with non-motor symptoms, there’s a, there’s the quicker response if it’s just a few times a week. Like what kind of dose and duration should people expect to do? Yeah.

Bas Bloem:

Yeah, that’s been poorly studied. That’s, that’s the most honest and fair answer, but I can give you

Melani Dizon:

Well, that’s interesting I have to say, because I frequently, and I’m sure you get it way more than we do, but they’re just I heard from one person, they said to do this, another person said this, what is, what am I supposed to do? And there’s so much conflicting information out there and people say, no, it has to be all intense at the same time. Some people say, to break it up, it can be in 32nd intervals. Like, what do we know about it?

Bas Bloem:

Yep. Yeah. So formally not much has been done in this field. It’s probably because exercise is still a relatively young research topic particularly for cognition and the other non-motor symptoms, with hardly any research. But I can give you my opinion and tell you why. This is my view. First of all, there’s two components to exercise that are both beneficial and that’s important to be aware of. This one component is the so-called aerobic component. In layman’s terms, cranking up your heart rate or panting while your exercise. That’s the aerobic component, and that is beneficial, that is a proven effective component of exercise. The right doses here is not well studied. There is one really good study by Daniel CORs and his group published in an elite journal where they compared 60% of maximum heart rate to 80% of maximum heart rate, and 80% was better than 60%, but 60% was better than nothing, meaning that the dose matters.

Nobody studied other doses, but it appears that 80% is just around the optimal is what our current feeling is. And the outcome in that study was in the motor domain, not specifically in the cognitive domain, but I have no reason to believe why it would be any different for the non-motor symptoms. So that is the intensity per workout. And this piece of advice is important for all the folks listening. The nerve that innovates the heart is also diseased in Parkinson’s disease, meaning that for some individuals it is difficult to crank up their heart rate beyond 100 beats per minute. Now that is totally not dangerous, so don’t worry about it. But the practical consequences are that if you try to titrate your workout according to your heart rate, it becomes a frustrating event. And I tell my patients individuals that they should dose their aerobic exercises based on their breathing rhythm.

And the right dose is when you start to pan, but you’re still able to maintain a conversation, albeit with briefer sentences. So, it’s as if I was doing this interview in just about this way, that’s the right dose. So, you don’t need an expensive heart rate monitor. And again, don’t worry about it, just a practical consequence. Now, the second component is the volume of your activities, which in a number of studies now appears to be an independent second component of exercise. So, taking 10,000 steps at a leisurely pace is better than 5,000 steps. So simply doing more is also helpful. So, take the, climb the stairs instead of the elevator. Hop on your bicycle for your shopping instead of taking your car if that’s doable, but the volume of activities is helpful. And then the third element, which I really like is that we always tend to tell people that you need to exercise for 30 minutes per day.

And I think many of us will recognize sort of that feeling of frustration. Where on earth am I going to find 30 minutes in my busy day? And some very recent work from, by Giselle Petzinger, is showing that 30 times, one minute is as good as 30 minutes in one block. And we now tend to refer to this as exercise snacks. And I like that concept. So, you treat yourself with a snack if you climb the stairs and the sort of the volume of activities that you need to reach is about 20 to 22 minutes per day of the snacks. So, and that’s quite doable, isn’t it? So, if you can’t find the 30-minute slot in your daily regime, you know, climb the stairs and you think b there’s another snack. You know you walk the dog, you’ve got your other 12 snacks, and adding up those snacks is as good as one block of exercise. So, volume, an important, aerobic component, is important. And think about snacks, I tell, and finally, you can tell this is close to my heart. I tell the people in my clinic to exercise every day, the norm, the international norm is at least three times a week. But if you have to exercise three times a week, there’s always tomorrow,

Melani Dizon:

Right?

Bas Bloem:

If you have to exercise every day, there’s no ifs and or butts. Get your gear out. Get your, get your in motion, right? And that, that’s

Melani Dizon:

For people with Parkinson’s and everybody, right? Like, I’m much better. I just exercise every day. There’s no, yeah, that’s just the way it is,

Bas Bloem:

Right? It’s just the way it is. Yeah. Make it part of your routine. Consider yourself an elite athlete. And you know, the competition is also strong. The other guys are also out there doing their job. So, get on your bike, get, and then I know what your next question is what type of exercise? So, we talked about the dose, the intensity, the volume, and the snacks. It doesn’t really matter what you do, as long as you do it and enjoy it.

Melani Dizon:

Everyone is happy, you just made everyone very happy, right?

Bas Bloem:

So, if you like boxing, do your boxing classes. If you like cycling, go ahead and do it. If you like running on a treadmill, brisk walking, swimming, doing what you like and or, you know, vary from day to day but do something that you like and that you’re likely to adhere to No study has done. Back-to-back comparisons, what seems to be important is the volume and the aerobic component, not the type of exercise.

Melani Dizon:

Well, I think you mentioned a couple of things that are critical, and I think everybody watching if they could have you as their doctor, they would take that option and this is the advice you’re giving them, right? And so, they’re going to listen to this. I think the part about it not mattering what it is really exciting for people because especially now there’s so many options online. You might take a virtual boxing class one day and take a Yep. Dance for Parkinson’s the next day, and a power Parkinson’s and a Tai chi, and all of those things, which are really fast ways to get your snacks, right? It’s, it’s like a no-brainer. These people are just telling you, to follow along, you’re done for the day, right? The other piece is just sort of like that rate of perceived exertion versus thinking they have to hit a certain thing on their heart rate or certain RPMs, everybody gets really caught up in I didn’t do enough because my RPMs weren’t a certain rate on the bike or that kind of thing.

And so, it’s really great for people to hear that, hey, as long as I’m panting, as long as I’m, you know, moving, right? It’s, it’s enough. It is, it is enough. And then I think the other piece that’s really important and empowering is that this is all an experiment for people, and they can learn, once you start to understand this exercise is important, you’re going to start to feel the effects and the value of exercise. And then you’ll, you might say, hey, actually I feel better when I go for a three-mile walk than I do, you know, after a really intense boxing class because for whatever reason it’s just gentler for me. I actually get benefits from being outside in nature and walking my dog. And those are other impacts that, that go along with my exercise that helps me in my day. But that there is not one path for each person. I think that’s a great, a great takeaway.

Bas Bloem:

Yep. Absolutely.

Melani Dizon:

And so, the research community is starting to look more at that. because I, it feels like a little shift. It feels like a little bit of a shift from like, you have to go this, this, this hardcore versus like, actually volume can make up a little bit for the intensity and, you know, do what feels good and you can split it up throughout the day.

Bas Bloem:

Yeah, no, that is, that is definitely a shift. And like I said, it is a relatively young area of research and I’m sure we’re, you know, we’re beginning to learn more and more about exercise. What I’m happy about is that exercise is now seen as a serious integral part of optimal care for people with Parkinson’s. It is impossible for someone to come to my clinic and not to talk about exercise. Whereas I may have skipped that event, I may have skipped that like 20 years ago. We can also talk in future discussions, which I would love to do about the importance of nutrition and stress management, which are the two other big lifestyle factors which people also need to manage optimally in order to do well. But definitely, you know, exercise is critical, and it just occurred to me that there’s one element of exercise that we haven’t discussed yet. Strength training. Exactly. That’s where I’ll go next?

Melani Dizon:

All right, That’s great. Yeah. So, I want to want to talk a little bit about that. What has been your experience with that? We’re, we’re actually for the first time, I’m really excited, funding a trial or research on strength training this year. So, I’m really happy about that. Can you tell, talk to us about why is that so important? We talked a little bit about osteoporosis earlier, so let’s maybe weave some of that in.

Bas Bloem:

Right. So again, exercise is sort of a container term, isn’t it? And, under that sort of umbrella is aerobic exercise, the volume snacks, but also strength training. And the reason strength training is also important is that loss of muscle strength is a common feature for people with Parkinson’s as the disease progresses and particular loss of muscle strength in the proximal leg muscles, the thighs, the quads, hamstrings become important as it may hamper your ability to rise from a chair or to come, you know, too, or to leave your bed or to rise from the floor after a fall. So, strength training in particular the leg muscles is important. We know that and this is a secondary benefit thicker muscles generate more testosterone, and more testosterone helps as an anti-aging component. So, strength training, in addition to everything we said about moving more and moving more intensely is a separate independent component. I do want to emphasize; you need to add it to what we said before. And, just doing strength training is not enough, but it’s, it’s part of the overall package that you need to do, right?

Melani Dizon:

And strength training is really helps with balance and your ability to catch yourself before you fall. Not only just getting up after you do fall but being able to catch yourself before You fall.

Bas Bloem:

Absolutely. I completely agree.

Melani Dizon:

Right. So, if somebody wanted to start incorporating that, what would on top of the, what we’ve already talked about 30 minutes a day at least of you know, panting and working out hard and working your heart, what would you add to how much strength training would you recommend?

Bas Bloem:

Yeah, that in all fairness, I don’t know. So, what, what I, what I, there’s two things that I would like to say is one is find an exercise trainer. Don’t do this by yourself. And for example, in the Netherlands, you know, we have the luxury of having our Dutch nationwide Parkinson net, meaning that our country is filled with expert physiotherapists who sit down with you and look at your personal abilities, your personal challenges, for example, rising from a chair and then tailor their strategy accordingly. So, if you consider strength training I would try to find a coach that looks at your current strength levels and your abilities. And the second main advice is with that coach is to build it up. You don’t have to be Arnold Schwarzenegger tomorrow, right? But building this up because the last thing you want is an injury. And if you don’t lose your strength training, well, you may run into injuries. And as you grow older, and boy do I know from experience, it takes longer to heal. So, and then an injury is really frustrating, it’s frustrating for me while I’m fit. If you’ve got Parkinson’s and an injury keeps you from exercising, that’s extra frustrating. So, you can set your targets high. But start small, think big, and act fast.

Melani Dizon:

I like it. And the other thing about strength training is it actually makes your other workouts more comfortable and better. Exactly. You actually improve in the other things. So, there’s a lot of great reasons for strength training. Yep. Great.

Bas Bloem:

Absolutely.

Melani Dizon:

So, is there, is there anything else? We’re going to be talking to Daniel Corcos about a lot of the research that’s happening, but is there anything else that you want to share with our community about exercise? And before we, before we say to sign off?

Bas Bloem:

No, listen carefully to Daniel Corcos. He’s a wonderful researcher in the United States. He’s the guy that I mentioned is one of the few people who looked at the dosing. Daniel is also doing some really cool research now, beginning to understand how exercise works in the brain. But well, maybe one thing that that’s nice to mention is and we haven’t discussed that yet, is that there are now two studies, one by Daniel Corcos, and one by my group, to show that exercise not only works as a drug in suppressing the symptoms, but it also appeared to stabilize disease progression. Now, to make the claim that exercise is a disease-modifying intervention goes too far. But my group this year in Amazon neurology, which is one of the elite journals in our field, showed that in a big exercise study where people cycled on a home trainer on a stationary bicycle for 30 to 45 minutes three times a week, what we showed that compared to a control group that was merely doing stretching exercises, the brain atrophy, the shrinking of the brain, which is happening in all of us, was stopped. And that the brain in the exercise group started to make new functional connections between the disease, basal ganglia, and the healthy cortex. So, brain plasticity is induced by exercise in elderly folks with Parkinson’s. Boy, if that shouldn’t stimulate all of you to hop on your bicycle, or jump on your treadmill to start exercising, then I’ve done something wrong today.

Melani Dizon:

Right. That wasn’t just stopping, that was actually improving. That was creating a new neural net.

Bas Bloem:

Exactly. Yeah. It was creating new connections, well not new neurons, but the existing neurons made new connections to other neurons. Hmm. So, I tell people in my clinic, if you are, you know, if you are sitting on the sofa and you’re not motivated to exercise, think all those new connections promoted by exercise, right? I mean, that should really motivate people. So that’s one thing that I wanted to share with folks. It may well be that exercise helps to slow down disease progression. Out of all the drugs, 30, 40, and 50 drugs are being tested today for their disease-modifying potential. Out of all those interventions, exercise is the closest to delivering the promise of becoming the first disease-modifying treatment. People in my clinic who do best are the people who faithfully exercise. Yeah. The other thing that should encourage people is, and Daniel is one of the world stars in that regard, but we are beginning to understand better and better how and why exercise works.

So, my imaging study is one of various studies in the field, but we’re beginning to understand how exercise works as an anti-inflammatory drug. Like to stop the process of inflammation in the brain and how it generates beneficial hormones that have a good effect on the brain. So, exercise has long been a black box. We know what went into 80% cardiac output. We know what came out better health, but now we’re beginning to understand the effective components of exercise better. And I’d like to share that with folks because knowing that there is a good scientific rationale behind the treatment should motivate you, even more, to faithfully exercise.

Melani Dizon:

Right? I will go back to this story all the time, but one of our ambassadors who’s very active in the Parkinson’s community and she’s told us that when she came to an in, you know, long, many, many years ago, came to a Davis Vinny Victory Summit event and met these people and learned about exercise and she said, you know, all of her friends are basically immobile or dying and she’s thriving. And for everyone else in our community that’s like this, this learning about exercise saved them. So, I, you know, I know a lot of times we’re preaching to the choir because everybody that that is, you know, a lot of people in our community are already exercising, but a lot of people are new and it’s really important that they get that message because it can be the difference between the kind of shutting down and thriving and continuing to live a really long, great life with Parkinson’s.

Bas Bloem:

Absolutely. Right. Well, well said.

Melani Dizon:

Thank you so much for talking to me today and I look forward to sharing with everybody.

Bas Bloem:

In closing, I just want to thank the foundation for supporting our work at my center. You’ve been a faithful fan of the stuff that we’re doing. We’re doing work research into the benefits of exercise, not just for people who have Parkinson’s, but really exciting new work to see if exercise can help to prevent or postpone Parkinson’s in those at risk. Your foundation is supporting our work and we’re very grateful for that and we’re excited that I wish

Melani Dizon:

Launched that.

Bas Bloem:

Absolutely. And I want to wish folks on the other end of the line, all the best. Keep up your good work. And we won’t stop until Parkinson’s stops.

Melani Dizon:

Excellent. Thank you.

To download the audio, click here. 

the latest research on exercise and parkinson’s

You can read the transcript below or you can download it here.

Note: This is not a flawless, word-for-word transcript, but it’s close.

Polly Dawkins, MBA (Executive Director, Davis Phinney Foundation):

We are so happy you are here with us today. We have so many questions from the audience. We have so many questions that we’ve prepared for you, but I wonder, could you start off first, may I call you Daniel?

Daniel Corcos, Ph.D. (Professor of Physical Therapy and Human Movement Sciences):

Oh, absolutely.

Polly Dawkins:

Wonderful. Daniel, may I start off by asking you a similar question that Mel asked Bas is, how did you get into this work? Tell us a little bit about your journey tig towards exercise and Parkinson’s.

Daniel Corcos:

Well, in that case, I base my story a little bit on Bas’. So, when I was young or younger I used to run, and I used to play rugby. So, I was an athlete and I loved sports and I loved athletics. I used to play rugby and run into immediate hurdles. I went out to the University of Oregon essentially because people ran in Oregon and I took a class in psychology there from a professor, Steve Keel, and loved it. And I ended up getting a Ph.D. I then moved on to Chicago for a postdoc, and I did relatively basic work in understanding patterns of muscle activation, and that is how people moved their limbs from point A to point B. And at some point, I started reading papers on muscle activation in people with Parkinson’s disease. And fortunately for me at the time, just like Bas went to America to find an expert, I went to England to find an expert.

His name happened to be Professor CD Marsden. And so, I spent a year from 1994 to 1995 working primarily with Professor Rothwell, who’s a well famous neurophysiologist. And we looked at whether people with Parkinson’s disease are weak. And at the time, the conventional wisdom was they’re not okay. But we showed quite clearly in a paper in 1995 in the Annals of Neurology that when you removed dopamine replacement therapy, lo and behold people become weak. And that led me into doing many studies on muscle activation and weakness. And then I did a clinical trial and have carried on in the area of Parkinson’s disease ever since.

Polly Dawkins:

That’s a great origin story. So, some of the questions we are getting today that stemmed from Bas’ talk, and we get these questions every day is, what does the research say is the best exercise that has the greatest impact on the quality of life for people living with Parkinson’s?

Daniel Corcos:

Yes, this is a really difficult question to answer and I’m going to give you a kind of complicated answer here. So, quality of life means different things to different people. So, on a Saturday morning, I’m happy on my bike, and that’s good for my quality of life. That’s not the way my wife likes to spend her Saturday morning. And so, the quality of life means different things to different people. So, the very first thing I want to stress is that activity, in general, is terrific for all of us, and activity in general will lead to an improved quality of life. I’m, I’m looking at a couple of notes here because I listen very closely to Davis Finney, and one of the things that Dr. Bloem and I both do is we listen closely to people with Parkinson’s disease because they have the disease and they can talk in a way, which is, in my view, convincing.

And what he argued was that the pace should be sustainable and enjoyable. And so, for quality of life, you need to find activities which you enjoy, which you’re going to do for the rest of your life. Later on, we are going to be looking at dance. Now for many people, dance is terrific, and dance does enhance their quality of life. Dance is not everybody’s cup of tea. Now, my own view is if you happen to have Parkinson’s disease, you should pay very serious attention to dance because it is very, very good for you. So, part of what quality of life is about what you enjoy, and what you are willing to do. Now, I can rephrase your question a little bit. Okay. And if we replace the quality of life, for example, with quality of health or quality of well-being, and this is slightly different, Okay?

Because the quality of life really is multi-dimensional. If we are just looking at this from a health and well-being perspective the evidence of what people should be doing is actually reasonably clear. So yes, exercise is a new field in many ways, but I think, and this is also the take-home message from Dr. Bloem. Endurance and cardiorespiratory three times a week are clearly good for one. And if it’s at a slightly higher intensity, the evidence is clear. Now, not, not everybody likes that. And so, I’m not saying one needs to do it, but for those of you who really want the best prescription from the current literature, okay, then there’s no question. Three times a week, 30, 35 minutes of endurance exercise, getting your heart rate up reasonably high is important. The resistance training is very important from my point of view. I weigh them absolutely equally.

Weight training is very, very important. And then thirdly, the disease is relentlessly progressive posture, ga, balance, and flexibility is going to change over time. And so, any activity and dance does this. That addresses posture, gait, balance, and flexibility is important. And so that prescription if one’s goal is to optimize one’s health. And early on today, we heard that at any stage in our life, covid can come along, flu can come along, and a lot of other things can come along. The more resilient our body is to deal with any health change, the better off we are.

Polly Dawkins:

Would you mind Daniel summarizing those three points again, just for our listeners, the three things that are ideal for overall well-being and Parkinson’s?

Daniel Corcos:

And then, by the way, we have many people here who are loved ones, who are family members, who are health professionals. This applies to us all. We should all be doing endurance exercises three times a week for perhaps 30 minutes a session. Okay. Whether it’s on a bike, whether it’s on an elliptical, whether it’s on a treadmill, it’s really not that important. But the important thing is that one’s heart rate is getting elevated. The point number one is endurance. Some people call it cardio; some people call it aerobic. It’s all the same thing. You reach a point when your heart rate is elevated. Two, you should be doing weight trading. And I can tell you save is Finn and his dumbbell is a no better example than weightlifting. and he will be acutely aware of this because elite athletes like him. So, when he was at his prime, you can be certain his heart and lungs were quite superior off the charts.

You can be equally super; you can be equally certain that, had his bone density been looked at, it would not have been great. So elite cyclists over time, you have a drop in bone density because you’re not lifting weights because you’re not walking because you have no load placed on the bone. And so, to see him lifting quite an impressive dumbbell. So, point number two is weights. And point number three, any activity that’s good for balance, be it dance, be it tai chi, be it yoga, they’re all terrific. The important thing here is to realize they all are for slightly different purposes. In the chat, somebody asked a question, which of something is better? I don’t look at it like that. It’s a little bit like if you ask a dietician, Should I eat protein? Should I eat fat? Should I eat carbohydrates? They will tell you need the right balance of the three for your body at your stage in your life doing what you are doing. And so, it’s a question of balance.

Polly Dawkins:

Yeah. You’ve made it so understandable. Thank you for that. And accessible folks are asking about ping pong and pickleball. Would you put those into the balance category along with yoga, tai chi, and dance?

Daniel Corcos:

Oh, absolutely. Ping-pong is terrific. Pickleball is terrific. Anything you can do for your eye hang coordination had his fingers up when he was talking about strength, manual dexterity, declines, anything that’s good for eye-hand coordination. The Parkinson’s brain does really well when it has external stimuli coming in. For Those of you have the disease, and those of you who freeze, your PCP will have given you a variety of treatment ideas that basically have stimuli coming in. So, both of those are terrific. Absolutely. Great.

Polly Dawkins:

All right. So, from the beginning of our webinar, we polled people about what they do and how much exercise they’re doing today. So, we’ve got a group here, over 600 people watching right now, and more will watch this afterward, who are maybe not exercisers. Daniel, how do you recommend that folks who don’t exercise have never really exercised, but have heard you now and have heard the science? What do you recommend about getting started getting over that, that hump of getting out of the lazy boy off the, off the couch and starting to exercise? Whoops, we can’t hear you.

Daniel Corcos:

No, no. I’m just, I’m just make, I’m just working on my answer here. Okay. So, I think, you know, for somebody who’s just getting, who’s new to all of this an easy way to start is to tell yourself, I’m going to devote a certain amount of time a day to myself. So, the people who do well with the disease are those who’ve taken ownership of the disease. And you can see this coming in the chat, and you can see this when you listen to Dr. Bloem. And so, I’ve set aside a certain amount of time and then perhaps begin by walking, because walking is relatively easy. Those of you who have a dog, you have it kind of built in. The dog’s going to take you out for a walk. Then once you start to assign time, because part of the problem is time management and you know, Bas talked about snacks, and snacking in terms of exercise.

And I agree if you’re short on time a little here and a little there is good for you. But once you’ve found the time, as Dr. Bloem mentioned it’s good to find experts to really help if you have access. Now, Holland has got a marvelous, marvelous health setup. We’ve got people coming in from all over the world. You’re in different areas. All over America is different. But if you can find an expert to help you, a pt., an exercise scientist, then they can kind of move you in. But I think Mel made the point earlier, it has to become part of routine. So, I think the most important thing to do is to tell yourself, I, whoever you are, deserve for myself, 30 minutes, 45 minutes, 4, 5, 6, 7 times a week to look after myself. start with a little walking and then progress to a health club, a dance class, a yoga class, and then start to build it up to the point. And over the course of a week, you’re doing cardio resistance, Postgate, and balance training.

Polly Dawkins:

Terrific. Thank you. One of the part attendees has mentioned that she’s worried about falling and about balance while doing some of these activities, especially something like pickleball. What would you say that person should lean into when thinking about balance?

Daniel Corcos:

So, when you start with Parkinson’s disease and you first see a neurologist, and if you’re diagnosed very early in the disease, your balance should be relatively normal. There’s what it’s called. And those of you have the disease, you’ve had it done, you have a poor test, and it’s early on in the disease. You don’t move very much. When a physician pulls you from behind. As the disease progresses, your posture gets worse. There’s a scale, the hole in the area scale. And when you are classify three, you have a level of postural instability. It makes you more vulnerable to falling. And so, this becomes person dependent. If you are prone to falling, then everything needs to be done in a much more supervised way. If you have osteoporosis, the consequence of falling is worse if you really are a high risk for falling. There are places, for example, in Chicago where you can do gait training and you have a harness and there’s something called partial body weight support training, where in fact the harness actually takes up a little bit of your weight and so you can’t fall.

And so, what a person who’s just been diagnosed, who is 40 should be doing as opposed to somebody who’s, you know, in stage three, who’s female, has mentioned that because osteoporosis tends to be more prevalent in their seventies and eighties. But I think it is very important people realize that one can be overprotective, and a lot of people do too little. And yes, we’ve done studies, we’ve had a site in Colorado, we got people out in the study, Dr. Bloem referred to. They went up into the mountains, they did more exercise and they fell occasionally. And so, this is a very, very fine line. We walk. and so, I think you have to know yourself. You have to know what levels of support and activities, you know, if you’ve had a fall, you need to really ask yourself why you fail. As an aside, 50% of the people on this call who have the disease will have orthostatic hypotension. So just going from sitting to standing can lead to a little bit of dizziness. So, I think one has to be, one just has to be careful, but one can be too careful, I think is my point. Because if you don’t do activity, the consequences are also not good.

Polly Dawkins:

Such great points. Yeah. We’re going to be doing a webinar this month on orthostatic hypertension. So, for those of you who are curious about that, we’ll send you a link to sign up for that webinar. So, if we could shift a little bit and dig into some general information about exercise and the brain. Can you tell us a bit about what happens in the brain when we exercise and how exercise might slow the decline in brain structure and function, particularly In Parkinson’s?

Daniel Corcos:

Yes. So, Dr. Bloem referred to his very, very recent article in Annals of Neurology. And so, there is clear compelling evidence that you have increased brain connectivity. And the second thing that is important to know, one of the reasons why high intense exercise is pushed to hear intensity referring to heart rate, is that the idea is that the vascularization of the brain improves as the blood vessels in the brain become healthier. As you can take more oxygen to different parts of the brain, that certainly improves brain function. There’s evidence that when you generate large forces, your basal ganglia, that’s the five nuclei deep in the brain, which are in Parkinson’s disease, get activated and this is good for them. So, the evidence that it is good for the brain in terms of connectivity, in terms of different parts of the brain being able to be activated more strongly in terms of improving oxygen flow is it’s overwhelming and quite clear. And by the way, this goes across many diseases. So, you can look at Alzheimer’s disease and there are benefits to exercise. You can look at aging and healthy aging. It’s a kind of universal, it’s kind of universally good at the level of the brain.

Polly Dawkins:

So, you mentioned aging. A person with Parkinson’s has got two, two issues, right? They have Parkinson’s and we’re all aging. Can exercise, make the brain and body younger if you will?

Daniel Corcos:

So, I think it really depends where one starting point is. I think for somebody who’s aging healthily, and I like to hope that I’m aging healthy the best we can do is to stay where we are. So, no change is the goal. I think we need to be kind of realistic. So right now, if I’m privileged enough to be asked to talk in 10 years, if I come back with no change from today, that would be spectacular. Now if one, it’s not in great health, if one, and certainly when I turn 60, I wasn’t in that the same health that I am now when one starts. So, for those of you who’ve been sedentary for a long time, yes, I think one can in fact make oneself younger, certainly in terms of performance metrics that one looks at. But really the goal, so I’ll be out in Colorado, hope to see some of you.

I’m giving a talk on what happens when you age and yes, your cognition goes down, your muscle strength goes down, your inflammatory markers go up. There is one positive note here. I like to think wisdom goes up as you age. And so, as you’ve got all these negative slopes, cause most of its bad cognition, declining muscle mass strength, ability to stand on one leg. If we can just rotate that. And that’s especially true in Parkinson’s disease. Cuz in Parkinson’s disease you have an aging component. And then you have where the disease starts, it gets a little steeper. So, you have a little bit of an acceleration. And what you’re trying to do is to rotate that. And the people that I talk to who really look after themselves, their slope of decline is not very steep. I mean, they’re doing well year in, year out. And all the physicians I talk to, they know which, which of their patients have the des are exercising regularly.

Polly Dawkins:

Yeah. As, as Mel mentioned in her interview with, with boss, we see that in our community day after day, those who are doing better, doing well are those who are really following the, this mantra of do something now and use it or, or lose it. And that, that seems to be pretty stark. The contrast in people,

Daniel Corcos:

The contrast is black and white. It’s absolutely dramatic. I mean, so I think the clearest example that I can give you as to why of evidence, it is anecdotal, but it’s quite compelling. So, during covid 19, many, many, many places were shut down for exercise. Lake Forest is a hospital in the northern suburbs of Chicago, which has a terrific exercise program for people with Parkinson’s disease. And I’m sure wherever you are in the world, there’ll be places which have programs like this. Well, they, when they were shut down, they noticed how quickly people were deteriorating with Parkinson’s disease and they managed to get permission to stay open, which is really quiet, quite impressive. And the argument was made that it was a health medical necessity. So, for those of you who don’t believe it spend three months getting yourself in better shape and then stop for three months and see what happens. And I have a zoom meeting every month with people with Parkinson’s disease and the likelihood of me talking them into not exercising for three months to prove the point to zero, okay. It’s just not going to happen. And you can imagine not taking those of you on Sinemet, not taking Sinemet for three months. I think most of you probably wouldn’t do that. And exercise is exactly the same. And of course, there is this potential, you know Dr. Bloem talked about that his study in my study, which have hinted that there may be protective effect. And so, it’s a long way yet for us to show that’s true. But exercise has so many other benefits that even if it’s not true, it’s still worth doing. But if it has a protective effect, continuing to exercise is very good.

Polly Dawkins:

Yeah, I think, I think you’re right. We find when we speak with people in our community about not exercising for a few days, that is hard to imagine. And

Daniel Corcos:

Yeah, it is. It absolutely is.

Polly Dawkins:

Yeah. I want to ask you a bit about research, current research. What do, what do you see out there, Daniel, that’s most exciting or notable that’s being done today in the field of exercise and Parkinson’s?

Daniel Corcos:

I think the most overwhelming part, the most, the fact which overwhelms me is just the amount. There’s 137 clinical trials and I got that number from another talk Dr. Bloem did, which you can find on YouTube. So, so in terms of interesting, it’s just the number is interesting to me and they’re all showing benefits. So that point number one. Okay. And then I mentioned this earlier, but you talk to movement disorder specialists, and they all tell you my patients who exercise are doing Wow. And when I talk to people with Parkinson’s disease, they say they are doing well. And then if we look at the literature, the evidence that high intensity may have a slightly increased advantage over lower intensity, I think is important. I recognize that it’s not for everybody. Yeah. And I can later on, you know, take a question of how to help people transition from low and moderate to high intensity, but I’ll stay very focused on the interesting findings where we need more research. And the really big question is adherence. So, I think we’re at the point now that we just know exercise is good for you. They are very clever research questions to be asked and answered and they will be. But the really big question is how to get people to start and how to get them to adhere. And that can be a problem. Now, the kind of iTunes in for the biking session this morning.

Polly Dawkins:

Yeah, I know

Daniel Corcos:

And it was great. And so, one reason people adhere is there were 25 or so terrific people. So why would one adhere, what do you get a chance to meet 25 terrific people and you can chat and exercise and, but that’s an important area. Now Bas has done very nice work, and I think we’re five, 10 years away from this, but there are many articles coming out now about gamification. So, you, you can put people into a virtual environment and then we can make it more enjoyable. Now, in the cycling community, of course there is Swift and Strava, so a lot of people will get on Swift and they will get on with their friends. And so, the idea of these multi role player games of feedback being provided, of having an exciting virtual environment, I think that’s going to make a big difference over time. I mean, if they can captivate adolescents and people in their twenties, it should be able to captivate people a little older. Yeah.

Polly Dawkins:

Is that, is that really, Oh, I’m sorry. Did, did I interrupt you?

Daniel Corcos:

No, no.

Polly Dawkins:

Kevin asks in the chat about dual task exercise. Do you have any comments on that or is that related to this virtual reality gamification that you’re dual tasking while exercising?

Daniel Corcos:

Well, this is very, very interesting. So, there are kind of two schools of thought here. And it goes back to the attending’s question on falls earlier on. So, a one extreme, you can simply tell people with Parkinson’s disease don’t cure task because it increases the possibility or probability of falling. So, if you’re walking and talking the likelihood of you falling possibly goes up a little bit. I don’t subscribe to that, but I understand it. I think people should be, or I think, let me put it different way, I think there are clear benefits to dual task training. So, people learn how to dual task, they basically walk in chew gum. But there are also times when if you are out with a partner and they have Parkinson’s disease, there are times when it’s probably not a good idea to do a task. So, for example, if one is walking outside, it’s poorly lit, and if there’s any curvature going on, you’ve now made the walking as hard as you can make it. And then if you now start to have a complicated conversation about what the Joneses have just done today, then that’s not a good idea.

Polly Dawkins:

No stress level goes way up.

Daniel Corcos:

What a stress level goes up. And that gets really, really complicated. So, your tasking studies are very important. Teaching everybody actually how to do multiple tasks at the same time is important. But it is very important to know that if one has the disease aspects of dual tasking become harder. And one, it’s really a question of playing within one’s knowledge about oneself. And so, I believe in dual-task training, and I believe in helping people to come to terms with their disease and the environment.

Polly Dawkins:

Right. A few questions are coming in about folks who no longer can walk and what type of exercise might be available or might be recommended when walking is, is not a possibility. We have a comment from the folks at power for Parkinson’s that they have many videos for chair-based workouts. Do you have any other suggestions for those who are not mobile?

Daniel Corcos:

Oh, absolutely. So, the benefits of exercise remain with one till pretty much the end of life. And people will reach a point that they may be in a wheelchair, they may be in a chair. I think I looked at the dance programs, which were shown on the website, and much of that is done seated. You’ve just spoken about the PWP. I want to make sure I get this correct. Who had the-

Polly Dawkins:

Oh, there’s a person who said Bob has said that he’s restricted to a wheelchair.

Daniel Corcos:

Yeah, so there are, there are lots of exercises that can be done in a wheelchair.  Thebans can be very useful. You actually looked at David Finnie morning. He could have done that. He could have done that wonderful overhead lift with the, with a dumbbell in a wheelchair. So, there’s lots that can be done from a wheelchair. It just requires a little bit of creativity. This is not available everywhere but in many physical therapy departments. Many rehab centers have what is called hand dynamometers. So, a year and a half ago I wasn’t very clever. I managed to rupture my Achilles tendon. And so, for many months, anything with my legs was not possible. But I got on a device, and I just got the same cardiac workout using my arms as I normally would if I was on a treadmill, a cycle, or elliptical.

Daniel Corcos:

And so, there are ways one can have because if you look at people in wheelchairs, and if you look at people with spinal cord injury, for example, and those who had stroke and are confined to wheelchairs, their cardio health suffers, and it suffers dramatically. And so, you know, one can use Thebans, one can dance, and this is all terrific, but they’re not getting the heart rate up. And so, if you are in a wheelchair and if you can find access to what is basically a hand dynamometer, you can then do your endurance workout using your arm muscles instead of your leg muscles. And I did that because I didn’t want to have a reduction of too much in my cardiorespiratory fitness over the four to five months that it took to rehab.

Polly Dawkins:

Great. Thank you for those suggestions. I’m going to take a few questions from the chat now if that’s okay with you. We’ve got

Daniel Corcos:

Sure. Yes, no, absolutely. Whatever’s most helpful to people.

Polly Dawkins:

Great. You had at the very beginning of our conversation, we talked about the ideal prescription and some comments are asking about the resistance training or the strength training. How many days a week you had said endurance training, three days a week, 30 minutes? What about strength training or resistance training? How many days a week would you recommend based on what’s, what’s being studied?

Daniel Corcos:

I would recommend two days a week, I would recommend exercises which cut across muscle, multiple muscle groups. I would say the same thing that badge did and confirm that. I think it’s good to start off with a PT or an exercise physiologist who can really help you. One way one does this is they would take what is called a one-rep maximum. So, we can go back to Davis when he was putting up the dumbbell, we’d find the largest dumbbell that he could push, and then we would say to him, Okay, we are now going to take 70% of that dumbbell weight and we are going to do that eight to 10 times. And you would then exercise all the other major muscle groups. So, one reason why the weight training is very good is the likelihood of having Parkinson’s. Well, I think the likelihood of people on this zoom not having had an episode of back pain is really quite low.

You may find two or three out of six hundred’s, much more likely that people have had episodes of back pain. And so, if one is doing resistance training, working all the major muscle groups, it’s very good for not just Parkinson’s disease. It should also tell you that the best evidence for improved cognition actually comes out of weight training studies. Not endurance exercise studies, but to stick with the question you would maybe take I mean my, my workout is I do eight to 12, I do eight different exercises and I repeat the exercise three times. So, if I’m going to do bench press, I’ll do bench press once a set of eight to 10 to 12 a second, set the third set, and I go onto my next exercise. It’s good to have help and somebody who can walk you through that, to begin with. Because if you have, if you do it badly, you can cause damage to yourself.

This is not something that you can do, going out for a walk is one thing. If you look at what Davis Finney did, and you get your body in a very slightly wrong posture and you end up with a back problem it could happen. He obviously knows what he’s doing. But I fully encourage resistance training. Just to let you know how important it is. If you look up my name and maybe the paper can be sent to you in 2015, my resistance paper in the Journal of Movement Disorders, which is the specialty journal for movement disorder specialists, it was voted paper of the year because it showed quite clearly that resistance training had significant benefits on three measures of cognition. So, if any of you need any motivation, I know people find resistance training hard, I ask my students, they don’t all do resistance training. It’s much easier to do various forms of cardio. There are all these options available to you, but if you really want to do what is best for you, it’s important to do resistance training.

Polly Dawkins:

Wow. So not only does it help with balance and strength, but it also helps with cognition. And what are the other benefits of resistance training?

Daniel Corcos:

Well, I think there, there are so many benefits. Okay. I can I mean I think, you know, do I ask if I answered a general question? What are the benefits of exercise? Math gave a lot of them. Right. But for resistance training, it’s the bone strength, the cognition, and the tone. So, an easy way to think about why you should be doing resistance exercise is when you look at people who are frail, and elderly, and you look at how they get out of a chair, they use their arms as much as their legs.

And that’s simply because they’ve lost the strength and coordination in their lower limb muscles. So anytime you need any prodding to work on your leg muscles, just think that at some point in life, sitting to stand is going to become potentially hard for you. And the stronger your leg muscles are, the stronger your back muscles are. And it turns out that if you need your arm muscles, the stronger you can make them. Because, you know, one way to look at Parkinson’s disease is that it’s a major mobility disorder. And what all of our work is designed to do the work that Bas does, the work that I do, the work that many other people do, we are all trying to help maintain mobility in a disease, which is a movement disorder, and strength training. Does that,

Polly Dawkins:

Thank you. Is there a thing as too much exercise for a person with Parkinson’s?

Daniel Corcos:

The quick answer is yes. Okay. So, but now let me give you a longer answer. The single most important thing is to know one’s body and no one’s disease state.

I try to persuade the zoom group that I meet with every month that a day of rest is good. And one of the people on the phone said, not for me. I need my exercise in the morning, my stretching, my, my mobility routine, et cetera to get me up and going. And so, seven days a week is quite possible for many people with Parkinson’s disease. My own view is it depends on what else you’re doing. If you talk to Davis Finney, I am quite sure he’ll tell you all about really hard days, easy days.  and recovery days on the bicycle. So, as you get more and more into exercise, you have to think more and more like an athlete. So, where fans, and I agree, maybe it’s because we both started off in athletics, is you need to think like an athlete and that means you can overdo it.

Okay. I would never, never recommend high-intensity endurance when that is defined as 30 minutes with your heart rate of at 80% or higher. I would not recommend that more than four days a week. And some people may find that one day too much. the other thing is that exercise does lead to aches and pains. One can have problems with the Achilles tendon. One can have problems with the knees. So, one, certainly over-exercise, it’s a little bit like pills. It’s a little bit like alcohol. You know, perhaps one glass of wine may be quite nice and there’s probably some evidence that it could be potentially quite helpful. But there’s a point at which when you go too far when it’s clearly bad and some people get so into exercise that they forget Dr. Bloem’s kind of six points. And it’s very much an integrated part.

And so, for those of you who, and again, you can think of this like the coach of an athlete, some athletes need to be pushed, some athletes are just fine, and some athletes need to be held back. And I think for those of you who are pushing yourself too much, you should certainly look at your weight. You don’t want to drop too much weight. There comes a point when comes a point in life with one gets older with a possible frailty looming on that. An extra pound or two is no bad thing. Some people get so driven by the exercise. So, one can, one can definitely over exercise, and listen to your body. The other day, last Sunday, I just couldn’t exercise. I was just wiped out. Not sure why did a great session the next day. I didn’t lose anything over time. But listen to your body.

Polly Dawkins:

That’s such a key takeaway. Listen to your body.

Daniel Corcos:

I know. Absolutely.

Polly Dawkins:

Yeah. People are asking about Pilates and that type of exercise. Where would you categorize Pilates in the overall spectrum of exercise?

Daniel Corcos:

Well, I think I’m a big fan of Pilates and I think it is very, very beneficial. I earlier mentioned back problems. I think if one does Pilates then it is very, very good for the core and everything goes around the core. I’m sure David Finney will tell you that if you’re going to be a great cyclist, you need an absolutely phenomenal core because it’s through the core that the power goes to the legs, which drives the pedals. So, I think Pilates is great. It is very good for the range of motion. It’s very good for balance. I saw a Pilates class the other day where they were doing amazing, amazing moves. For me, it probably comes down in the third category. So, it’s not a substitute for endurance exercise, high-intensity endurance. And it’s not a substitute for whole-body resistance training. But it is a wonderful exercise, and I would absolutely encourage it. In fact, there is no exercise I wouldn’t encourage. And so, if Pilates is what you love doing, it is absolutely terrific. You know, it’s two thumbs up. I’ve done it. And I love,

Polly Dawkins:

It’s super, super. Somebody asks about how to protect her knees while doing intense or forced intensity exercise. Is there anything that you’ve seen recommended for the protection of maybe joints in particular?

Daniel Corcos:

Not really. I want to talk a little bit at length cuz I saw one of these questions in the chat and there’s a misunderstanding about the term force exercise. Right. So, you should all understand I’m a huge fan of Jay Alberts. We’re very good friends. I know his work very, very well. And in the literature, his argument is that when you are on a bicycle, especially on a tandem, his early work came out of a tandem. He’s now got devices which control cadence that when a person is forced to rotate their legs at a high rate, that is good for them. So, imagine you are on a tandem and the person in front of you is going 90 repetitions. Forced means you on the back are going at 90 repetitions. Two. And so, increasing the rate at which you pedal is very, very good forced is

It’s, and Jay and I have discussed this at length. It may be an unfortunate use of the term, but really what it really means is you are being constrained to move at a rate faster than you normally would. Now in terms of knees, you should go and see an orthopedic specialist pt. You should also avoid activities that put stress on the knees. So, a minute ago I told you weight training is great for you and it is, you should not be doing a full squat if you’ve got knee problems under any circumstances. So, you need to work with a specialist who can guide you. I’m not sure if it was in the chat or whether it was earlier on today about somebody having to get fit for surgery. When I did my progressive resistance exercise program, many people probably three, went in for joint replacement surgery.

And the orthopedic surgeons were stunned by how quickly they recovered because they were all part of a very, very vigorous resistance program. The muscles around their joints were very strong. And if you’ve got any problems, it is good to strengthen the muscles. You can rest assured if you go in for any kind of knee surgery, the better condition your joints and muscles are the better condition you will come out. And so, the idea of preconditioning is very important, but for, it’s very hard for me to give specific advice because it’s all person dependent. For the person who asked about knees, find a really good orthopedic PT, and find out why you’ve got knee problems.

Polly Dawkins:

Got it. Thank you. Many folks are recommending or saying they do water aerobics and swimming. Any, have any thoughts on those as exercise modalities?

Daniel Corcos:

Well, I can tell you now, you’ll buy you already know what I’m going to say, but I will, I will, I will tell you. Okay. They’re great. They’re absolutely great. Okay. and again, it’s finding what works for you. So, we had the question half an hour ago, you know, about falls. Well, when I’m at the health club and I see the water aerobics class, the very worst you’re going to get when you fall is wet hair. Okay. And so, it has to be great. So, if you’ve got a propensity to fall now if you’re a little bit overweight, the water deals with that very, very nicely. You don’t feel quite the same way. And so, it’s very helpful if you’ve got joint problems. It’s a little bit like earlier on I talked to you about partial body weight support training. The idea that you have a harness that’s really what the water is doing. It’s giving you a safe environment. So, I’m very much in favor of it. If you actually swim now you’re getting very close to cardio. So, you can get your heart rate up to 75, or 80%. And I can tell you that when I go out and run, it’s really hard. Now with my ruptured Achilles tendon, I feel much closer to my age than when I dive into a swimming pool. And when I’m swimming I absolutely don’t feel my age. So, I’m a big fan.

Polly Dawkins:

Yeah. It’s also water aerobics. Whenever I go to a pool and there’s a water aerobics class going on, it’s a hugely social activity.

Daniel Corcos:

Oh, absolutely. I mean I actually sometimes watch the class. So, I’ve done my workout and I may be going to kind of soak in a tub to make sure my back isn’t too bad. And I watch and it just looks to me like an immense amount of fun. And I think this is what is really, really important for

My first main clinical trial was over two years because I wanted to show that people could do it for two years. And they did. I happened to be the principal investigator of Sparks three, which is a phase three clinical trial designed to test two different doses. And that study is over two years because we want to see if people will stay in the study. So, if you look at what is probably most popular, so when I give talks, my favorite slide bar none that I show is the Rock Steady Boxing slide. And in it you have, I’ve got 20 people totally engaged, totally smiling. And as I learned this morning, one big advantage of rocks of rock steady boxing, and this wasn’t my comment the punch bag doesn’t punch back. So, you’re getting a great workout, you’re working out with lots of friends, and one should not underestimate the social side of exercise.

It is my view that it will be part of the future. And what happens is you may not be having a great day, Anxiety may be a little bit up, you may have that little apathy that Dr. Bloem was talking about, but your friend at the health club is waiting for you or your friend on the bike is waiting for you. And it may give you just that little bit of motivation to get over the hump to go out and do it. Yeah. And so, the social aspect of swimming, I think, is great. The social aspect of the six-days-a-week Davis Phinney rides that you can do, I think is great. And I can tell you something else, and I know I’m being recorded, but you know, I’ve been now working with people for Parkinson’s disease for a long time and they, you, you all seem universally nice.

Now sometimes somebody says, Well Daniel, the urologist has only referred to you as somebody who’s nice, but I’ve met lots of people. And for those of you who are undecided or struggling, you know, find a social group. Now not everybody is social, and you know, some people just like to do it themselves, in which case you can get on a lift and tune everybody else out. But the key thing here is the known self. The literature is clear. Okay? The literature is so clear you’ve got this message by now but let me put it to you in a very blunt way. If you look at any disease, any disease out there, and you ask where the biggest difference is, is going to be nothing versus something. And then once we get above the something, then everything else after that is progressively refining it.

And I’ve worked with enough people to know that what they really want is to refine it for themselves, to do the absolute best for themselves based on the current literature. But if you’re, if you find it hard, you know, find a social group, find a walking group, find a dog walking group all kinds of ways. I happen to have suggested to my friends in the past that they use an app. I’m not advertising any apps. I’m absolutely not. It’s not my job to, and I won’t I’m mentioning one because Strava is a way that you can connect with people. So, if you go on and you do your 30 minutes and you suddenly find that now seven other people tell you good job, you find that motivating other people doesn’t resonate with that. They just want to be left alone and do it.

Polly Dawkins:

Yeah. Yeah. We have just a few minutes left, and I’d love to ask you a question about some current literature that’s just come out in September I believe about I think it’s called irisin, the hormone that’s secreted into the blood during high-intensity endurance and aerobic exercise. Do you know anything about that study and what that has to do with Parkinson’s or what it could potentially have to do with Parkinson’s?

Daniel Corcos:

I haven’t read that particular study, but Dr. Bloem and he was actually referring to some of the work that I’m doing now. Certainly, mentioned hormones, and the one thing which we haven’t really talked about, but it is where my research is going to go over the next 10 years is that what I’m hoping to do with my colleagues is to develop a Parkinson’s specific blood panel. So, you know, if one, if one goes and sees one’s PCP, you’ll have a standard blood panel run and that’s great. Now the hormone you refer to and several other hormones I think are going to come to the forefront. So, in my work, we are working closely on cortisol vitamin D, and a hormone called Klotho, which is an aging, anti-aging hormone. So, in Parkinson’s disease, cortisol, which is a stress hormone, is elevated, and when you exercise it gets reduced.

CRO, though, in Parkinson’s disease is reduced, and when you exercise it is increased. So, the idea will be over the next many years that we hope to develop a kind of a panel of markers, which will motivate people to try to get their markers within a healthy range. So just to give you one example, in the video group that I meet with, we have one person who takes this all very, very seriously and he asked me about brain inflammation and what was known. And I mentioned to him that there’s a blood measure which is routinely taken on people as an index of inflammation. It’s CRE reactive protein. And I asked him, Well Michael, what’s your c reactive protein level? And he said it was very, very low, which means his inflammation is very low. And when you look at what he does, you understand why it is very low.

So, the marker you mentioned will be studied in Sparks three, which is my phase three clinical trial. We are drawing we are drawing blood and we are measuring at least 40 different markers, including neurotrophic factors like brain-derived neurotrophic factor, which exercise may increase. It is lower in Parkinson’s disease. And so, we are very, very interested in inflammatory trophic hormonal factors. And the evidence is clear that exercise benefits them all. So, if you really want, so you can look at the brain work, which Bas talked about, you can look at function, the ability to walk, the ability to move, the ability to have less tremor. But you can also ask the question if there is a preferred blood chemistry you want, and you can be certain that exercise improves your blood chemistry that you can take to the bank.

To download the audio, click here.

dance for pd

You can read the transcript below or you can download it here.

Note: This is not a flawless, word-for-word transcript, but it’s close.

Polly Dawkins, MBA (Executive Director, Davis Phinney Foundation):

Before we get started, I wonder, wonder if I can introduce you and ask you a few questions?

David Leventhal (Founder, Dance for PD):

Sure. Happy to answer questions, especially if you’re asking them.

Polly Dawkins:

Well, it’s great to see you here, David. And we have been talking about exercise and sitting for a few hours now, and we’re going to be really thrilled to have you lead us in some movement. But before we do that, could you tell us a bit about how did you get involved in this work? What is the origin of dance for Parkinson’s?

David Leventhal:

Sure. So, I started life, well at, from age eight on training as a dancer. I started with ballet and then in college I got into modern dance, moved to New York, started dancing with a company called the Mark Morris Dance Group. And in addition to being a performing company, we have a mission to engage with our community. When we opened a new dance center in 2001, we opened our doors and one of the people to walk in was o Weimer, who is the founder and director of the Brooklyn Parkinson Group. We didn’t know anything about Parkinson’s. I didn’t know anything about Parkinson’s, but she said, hey, I have a great idea and it’s this dance class for people with Parkinson’s in my group. Will you do it? And we said yes. And so, I had this parallel track throughout my performing career as a teaching artist that was who was offering classes for people with Parkinson’s first in New York. And then as we were a touring company, we started to teach this class all around the world. And that’s really how the Dance for PD program grew.

Polly Dawkins:

I love that. That gives me goosebumps. Do we know yet why dance is so great for people with Parkinson’s?

David Leventhal:

Great question. We know that it is there are more than 45 peer-reviewed published studies on the impact of dance on people with Parkinson’s. And the benefits are a full range from gait, tremor reduction, facial expression, all the way to reduced rates of depression increased social inclusion better self-efficacy, and confidence. And we’re starting to see some studies on cognitive benefits related to dance. We know cognitive benefits from the dementia side, there’s been some study that shows that dance, more than any other activity, dance has a possibility of staving off dementia, but we haven’t seen it yet on the Parkinson’s side until the last few years. And we started to see some good research on the impact of dance on executive function visual-spatial memory and sequencing. So that’s good. We need more, but it’s starting.

David Leventhal:

We don’t always know why. And in fact, we need more work on the mechanisms. One theory is that because dance forces you to integrate music and rhythm in your movements, that there’s a kind of detour that happens around some of the challenges the neurological challenges that happen in Parkinson’s, but it’s, it, we need more, more work. And it’s very hard to do an MRI on a dancing body. Usually, in an MRI, you have to be very still and not move. So, the work that’s been done on imaging so far has been on people imagining that they’re dancing, which is pretty close, but not the same as actually dancing.

Polly Dawkins:

Right. Well, before we start dancing can you tell us a little bit about how people who are watching could get involved in dance, whether it’s virtually or in person?

David Leventhal:

Sure. So, Dance for PD classes are offered in more than 300 communities and 28 countries around the world where in almost every state in some form. And you can visit our website, which is danceforpd.org to find a local class near you. We also offer still a pretty robust schedule of online classes that are taught either by our team, our flagship team in New York, or by Dance for PD-certified teachers around the country. And so those are classes that are at all different times of day, all different time zones and they can be done on Zoom. What’s nice about that is that you don’t have to make a plan to go out to the gym or find something near you. It’s great on a rainy day. It’s great if you’re not feeling like getting out of the house, just turn on your computer. And I think actually dance works. We, I never thought I’d say this, but it actually works pretty well on Zoom better than some other things where you might need some equipment, you might need that punching bag. It works pretty well. And we create a social environment on Zoom so people connect and have time after class to chat and go into breakout rooms.

Polly Dawkins:

Super. All right. So, we’re going to get started here. We’re going to hand over the floor to you. Is there anything our audience needs to know as they get started?

David Leventhal:

I just want to say that in it’s really important for me, and Polly, you heard me say this at all a couple of weeks ago, that you, as someone living with Parkinson’s, wherever you are, think about a portfolio of activities. There is no single activity that is going to address all the things you need to do. So, I recommend finding a cluster of things. It doesn’t have to be 10 things, maybe it’s two or three. And we also have to think about ourselves as athletes and athletes cross-train. I often play a video of Harry Garside, who is a boxer, an Australian Olympic medalist boxer who takes ballet because, for him, it gives him that 1% edge to win. When he, when he does that ballet training, it’s the footwork, it’s the balance, it’s the coordination. It’s the rhythm that helps his boxing.

So, it’s not just one thing or the other. It’s finding those things that intersect, that feed off of each other. So, I highly recommend cross-training. If you’re totally a die-hard Rock Steady Boxing fan, try dance. See how much it can actually improve your boxing practice. If you’re not into dance, try Pedaling for Parkinson’s. See how much it can actually stimulate your endurance and your rhythm that you can then bring back to the dance class. So, it’s a kind of all of the above process that we have to go through in making those choices.

Polly Dawkins:

That’s perfect. That compliments exactly what Daniel Corcos just said. So perfect. Great.

David Leventhal:

So, I know I have 10 minutes, I’m going to kind of dive into a couple things. The other thing is a lot of people think Dance for PD is for folks who, who need to remain seated. That is not true. We offer both seated and standing options in our class. In fact, we offer an all-standing class as well. Today, since I can’t see you, I don’t really know all of you. And I want you to be safe at home. I’m going to show two things that are seated, and then the last thing will be standing. But you always have the option to stay seated if it’s comfortable for you. Do what is safe, do what feels right for you in the moment and have fun.

So, I thought we would start with just a little bit of tango. This is movement based in Argentine tango. And because I don’t have a lot of time to kind of give you a long history and explanation, we’re just going to go into it. We’re going to start with some nice simple articulations through the feet. I know we’ve been sitting for a while, so it’ll feel good to get your feet moving. We’re going to say some, take some simple tango step side to side. So, this is a strong step. And then a slide of the other foot in. We’ll take that a few times. We’ll take some nice long reaches side to side. And then I want you to imagine that you are holding a partner in your arms and you’re dipping that partner forward and coming back. So those are the four elements. Let’s go into it right now. Oh, and before we start, I just want to say that if there’s anything here that doesn’t feel right for your body, please feel free to modify, adapt, change, go easy, listen to the music, whatever feels right for you. All right, here we go. Let me just get the music so that you can hear it. That’s more important than me hearing it. Here we go.

Just slowly pushing up through your feet. If you’re wearing shoes, that’s okay too. And now our steps, we step and slide and step and slide and step. You’ll Notice when I step, I’m taking a nice open stance. Open arms. Good. Now send that foot out. Find your balance in the Middle. Nice. Reach Out And center and reach. Nice, wide base, dipping your partner down and bringing that person up. And the other Side.

Good again, and let’s try that whole sequence again. So, starting with the feet, we push and press. Think about making an impression in the ground to your whole footprint, like pushing that wet, cement out,

Nice And stable, side to side, step And, And step. He’s strong and strong. Now let this be sharp, like a surprise and Ready to dip your partner. We go over, bring that person up to the other side and pushing the floor away. So really connecting with the floor, Pushing That floor Away, Finishing with some anise. These are little improvised patterns on the floor. You can go any direction you want, doing some circles, and you can bring that on the other side as well. Little Circles. You can even Lift the Foot up a little bit If you want.

This foot is my Anchor. It’s very stable Now. Everybody. All right? beautiful. I can’t see you, but I’m sure that was beautiful. Had all the elegance of tango. We’re going to go into a little bit of call and response. The call and response here. Dance is first and foremost a mental activity. We have to think, we have to process, we have to sequence. So, I’m going to do a pattern in my upper body and then I’m going to mirror it in my lower body. So, it’s call and response. And we’re going to go through this all together again. Do what feels good for you in the moment. Have fun with it. And pick yourself up as the song goes. We’re starting with the upper body, just a hand. I’m going to go out and now with a foot, same on the other side. We reach, Echoing That in the lower body, same thing side, echoing in the foot, same other side, Lifting Up and over. Now getting a little more Complex.

This is our heel of our hand. And now then in your heel, app, other stuff. But We’re Following the same pattern, same quality, nice and smooth and around, oh, what does that look like? Other side? Anything, left? I’m sure I did. Forward. Let’s try that one more time. Reach, Bring it back. Reach. Starting with the other side. Yeah. Call a shuffle and tap. Bring it in other side. Shuffle. I think that one deserves one more chance. All right, now we’re going to go back to the beginning and we’re going to start putting everything together. Your upper body and lower body. Ready with our heel. Here we go. And now adding the little extra. Yeah. Other sides. Let’s share that one more time. It’s kind of fun. Scoop. Press Out scoop. Press forward. Thinking out about that impression you’re making on the floor, Your Whole foot pressing down. Good One. New one. Open. Open. Close. Open. Oh, Let’s start on the other side. Nice big finish.

Yeah. Great. All right. Excellent. Now, a lot of what we do in in our dance PD classes is reference specific shows, specific dances. We in New York, like to do a lot of Broadway stuff. So, we’re going to finish in the last three minutes here with a little west side story. So, I can’t see you, but I want your choice whether you’d like to be a jet or a shark. Alright, so your choice, because as we go along, I’m going to call out various choices. And sometimes it’ll be everybody together. The whole, the whole cast. Sometimes it’ll be just the jets, sometimes it’ll be just the sharks. Okay? So, make your choice for yourself, whatever feels right for you today. And let’s go into this. We’re going to start with some really strong pointing. Now this is a choice for you.

If you are comfortable and want to make your way up out of the chair, just do that safely right now. Take a moment to do so. If you’re more comfortable staying seated, you’re welcome to do that too. I am going to show the seat diversion because it’s sometimes a little bit harder to interpolate what the sea diversion adaptation is. So, I’m going to stay here, but all of this can be done standing as well. We’re going to start with some points. We’re going to go back to our side to sidestep, but this time we’re going to add a little bit of rhythm. So, as I step together, I’m going to create that pulse down through my knees, make a sound, wake up your neighbors. S then we’re going to travel in place. So, whether I’m here or whether I’m here, I’m really taking a nice solid step into the floor. Again, we’ve been talking today about making an impression in that cement. This is that chance to do it. You’re going to grow; you’re going to retreat. And then finally you’re going to grow endow. You’re going to explode at the other side. All right? Whether you’re a jet, you’re going to explode in the sharks. The sharks are going to come back to us. Okay? We have to imagine because we’re all on zoom, but let’s try it here all together, starting with our points and moving through. Five, Six. Here we go. Really reaching Beyond Your natural sphere.

Here you’re sending your energy out the room, stepping side to side. We’ll start at the speed to really get the rhythm in our bodies. Nice. Now our steps a little faster. I call these splat blocks. It’s like your foot and your hand are going splat now. Inflate and release and inflate and release. Now we’re going to inflate and then explode. 1, 2, 3, 4, Plie. And if you make a sound so much the better. 2, 3, 4. Whoa. Any sound you want, reach two. Nice wide base scoop. Last one, big as you can, back to the beginning a little faster. Now, point somewhere you haven’t pointed yet. Maybe behind you. Maybe under you. Let’s do our steps a little faster. Big steps in place. Yeah.

Now anchoring your feet into the floor, push that floor away as you expand. One more, just like that. We’re going to do two explosions. Now we go Three, four, plie. Take it out. Plie. Cool. Three, Four, release point. Just finishing with our steps, playing it. Real cool. Thinking of one giant final pose for the very end. Whatever you want to your own space.

Yeah. Good. All right. I’m going to pause there and come back to say thank you. Thank you for the opportunity. Thank you for moving with me next time. Let’s do this where I can actually see you and we can do it as a full communal experience, because that’s the power of dance. And as I said recently at, at all in, you know, we as humans have been dancing together as a communal energy, as a social bond for tens of thousands of years. And this is something that is part of our legacy as a species. And so, it’s just a natural progression for us to do this as we continue in our lifespan, as we continue in our Parkinson’s journey. Let dance be part of your life and thank you so much for the opportunity to share. Thanks Polly.

To download the audio, click here.

yoga and wellness

You can read the transcript below or you can download it here.

Note: This is not a flawless, word-for-word transcript, but it’s close.

Polly Dawkins, MBA (Executive Director, Davis Phinney Foundation):

So far this morning we’ve heard about the value of exercise, about intensity and volume, and the latest research. We’ve done some exercise. We’ve, we’ve talked about the benefits, and I know you’ve got a deep passion for yoga and Parkinson’s. So, as we finish off our day, I’d love to finish off with that topic. But before we dive into it, I think the audience should benefit from knowing who you are and how you got into this work. So, would you, instead of me reading a bio, how about you tell us a little bit about who you are, what your background is, and how did you find this work?

Indu Subramanian (Director, Southwest PADRECC):

Sure, Thank you. Well, thanks for the opportunity to speak about this topic. It’s something that’s near and dear to my heart. And, you know, the guests so far have just done a great job. I’m a huge fan of David and Daniel and Bas talked this morning was very inspirational. So, amazing presentation. Hats off to you. So, I am a neurologist. I’m a western trained neurologist. I’ve been a neurologist here at UCLA and the West Los Angeles VA for about 20 years. I’ve seen the benefits of what we can do with Western medicine and our pharmaceutical and surgical interventions, but I’ve also been quite open-minded too, you know, how we can help our patients in other ways. I myself grew up in a household where Indian, the, and, you know, Indian sorts of traditions, yoga was part of my upbringing.

My mom is a family doc in Canada. But, you know, we certainly had this other sort of approach in our lives. And so, I was always quite interested in these things when I was a resident and a fellow right after that, I had my first child and was balancing work and life in my own life. And had some you know, sort of work-life balance issues as many young women physicians does, and really leaned upon the mind-body approaches to sort of help me in my own personal life. I got more interested in yoga and started doing it and then ended up doing a yoga teacher training, attracted patients who knew that I had this interest in my practice when I was more at UCLA. And then have really been just sort of exploring some of the mind-body spaces.

And as you know, my research has expanded a little bit. I’ve been very interested in the concept of the importance of social connection as well. And this is part and parcel level. I think some of these mind-body practices is doing it in a group, having people around you, having an instructor that cares about you, that you have an energy sort of with and can be in the room with you or even on the zoom screen with you. And so, I think that, you know, this has been kind of part of, sort of just my approach now to caring for Parkinson’s patients or people living with Parkinson’s. And I got boarded in integrated medicine. Given all the sort of time that I had spent learning about the mind-body practices, I did a deeper dive into meditation, and got boarded in integrated medicine, which is this sort of borderland between western traditional medicine, medicine, and these other approaches. And have, you know, been really sort of fascinated by the concept of, you know, how we can help empower our patients with lifestyle choices that include the mind-body practices and exercises, key components to help them live better.

Polly Dawkins:

That’s great. That’s great. I can imagine that the people that you see love having you as a physician given this approach, and I bet they’re doing well, given your integrative approach. Before we jump into yoga specifically, I know you’re leading up a task force with the movement disorder society on the concept of wellness in Parkinson’s. I don’t want to go too far into that, but I’d love to understand what is that and what are we going to be looking forward to seeing out of that?

Indu Subramanian:

Yeah, so wellness is sort of this concept that people living with Parkinson’s or any of us can have proactive lifestyle choices that we can choose every day to help us live better. And the concept is that we are part of sort of driving the bus for our own health, and it takes the sort of you know, healthcare out of the hands of just your doctors, right? You might see a neurologist like me once in six months, I give you a pill and send you home. Well, what do you do in the meantime? So really I think the sort of concept that exercises, medicine, and that social connection is part of the medicine and that we can really sort of use things like sleep, diet, all of these sort of lifestyle choices to really help ourselves live better. And I think the mind-body approaches are kind of part of this global kind of umbrella.

The other things that I think wellness includes are the col sort of cultural context. So understanding who you are as a person, you know, it’s very different as a lived experience for somebody who may have access to a lot of things as a perhaps a Caucasian man with you know, some wealth living in, you know, with a metropolitan area who has access to, you know, a world-class center of excellence versus somebody who might be in a rural space or somebody who is you know, not married, who’s you know, a woman living with Parkinson’s who’s younger, who’s at herself caring for her children or you know, a person of color. So, all of these things matter. I think when we approach Parkinson’s disease. And also, I think thinking about the whole person. So, a holistic approach that’s not just one disease in a body, but really thinking about who you are, what other sorts of things you have can you see, well, can you hear well how’s your, you know, bone health, how’s your gut health?

All of these things can affect how people do. And so, I think mental health is a huge piece of this as well. So, identifying if you have coexisting depression, anxiety, apathy, all of these things are sort of this more holistic approach to Parkinson’s, which historically I think we’ve really just thought about it as a movement disorder or motor disorder affecting tremor, stiffness, and slowness. But I think people who are living with Parkinson’s and their care caregivers can attest to the fact that much of these other things in the mental health realm and these other realms, non-motor issues, really do affect how they’re living in their lived experience and quality of life with Parkinson’s.

Polly Dawkins:

Yeah, yeah. So important. We’re learning that more and more, aren’t we? Yeah. So, let’s, let’s dive into one of your areas of passion, which is yoga. Yoga and Parkinson’s, or yoga or Parkinson’s. Can you describe for those who might be new to yoga what, and why is it a good approach? Is there research supporting yoga and Parkinson’s and Yeah, I’ll follow up with some questions after that?

Indu Subramanian:

Sure. So, I think that yoga is quite misunderstood. People have a sense that it’s just the poses, it’s just another exercise, just like, you know lifting weights in a gym. Yoga is part of this sort of larger tradition of Ira Veda, which is this sort of traditional Indian approach to healthcare. Just like in traditional Chinese medicine, there are certain sorts of facets. Many other healthcare systems outside of western medicine have different approaches that are thousands of years old. So, yoga is a part of this. Yoga has some poses, so we call those the asana. So those are the sort of you know things that you can put yourself, your body into, and the movements that you can create between poses. There’s also this sort of important aspect that I think is very powerful, which is the breath work.

So, this is what we call pro-amma. So modulating breath around poses sometimes or just by itself. So, there are a number of things that you can do in yoga that affect breath. And this is very powerful, especially in Parkinson’s patients, because breathing and controlling your breath, being aware of your breath is actually a very good way to sort of tap into the autonomic nervous system. So that’s that nervous system that includes the sympathetic and parasympathetic aspects that can have you know, some sort of control over things like anxiety. They affect heart rate, it affects you know, blood pressure. It can affect respiratory rate temperature. All these things can actually be powerfully modulated sometimes with controlling breath. And so we are not as neurologists, the first people to realize this. I think the cardiologists have realized this.

A number of other psychiatrists and psychologists use breath in trying to help with a host of symptoms that they take care of, including heart rate abnormalities. And so, the autonomic nervous system is something that we can modulate kind of uniquely with the breath work that we see that we can use in yoga. And then the third component that I think is pretty important is the meditative aspect. So, we have this sort of concept which some people would call mindfulness of paying attention in the moment to you know, within, within your sort of capacity to the thoughts in your mind, sort of what’s happening just sort of checking in in your body and that awareness sort of your present moment, your body sensations your mind. That is al also part of yoga.

And that can actually also be very powerful for a number of things. And mindfulness as a whole has been sort of separated and studied in ways. But within yoga practice, we have ways to become get into the same spaces and that can affect sometimes cognition even. So, there’s been some studies looking at mental state and memory, things like that, using meditation. It can affect sleep sometimes in a positive way. It can also affect anxiety and depression in positive ways. So, these are actually all also very powerful. But when we look at just the things like the poses and the movements I think we have some unique things just from those that are very helpful to our patients living with Parkinson’s as well.

Polly Dawkins:

So, if somebody is in the audience watching this and listening, wondering how do, how do we get started? How do I get started in yoga? Is there specific yoga for Parkinson’s classes? Are there online classes? Are there so many types of yoga? Which, where do I start?

Indu Subramanian:

Yeah, so I mean, I think that there’s a whole host of different types of yoga and you know, there’s probably as many names of different types of yoga as there are sometimes practitioners doing it, right? So, everyone has their own little novel approach. I think to make this accessible and for anyone out there who really wants to get a benefit, I think we have to get away from sort of the complexity of, you know, is it this type, is it that type? And what exactly have we studied? And, you know, how many poses and you know, how many minutes and things like that. Just to sort of take a step back from yoga in general and think about the mind-body approaches in general there are things that people are possibly doing in some of these spaces to get some of the benefits of mind-body approaches which I told you can affect mood and things like that.

It can affect sleep, can affect cognition, perhaps even in things like prayer, things like getting out in nature, things like you know getting together and even dancing, getting into flow states where you’re enjoying something like live music, certain things. So, I think, you know, to make it less complex for people and who are really feeling like overwhelmed, like, you know, today I tuned in and there’s 10 different types of exercise and people are telling me to do all these things, and it gets overwhelming sometimes just making that baby step and adding a little bit of something. So if it might be that you can, you know try some of the meditative aspects by getting out into your backyard and maybe feeling your feet on the ground in the grass, and sort of that feeling of grounding with your feet on the grass, You know, sitting in a chair in a stable chair, that’s something, you know, looking up into the sunshine, looking at the sky, sort of letting that, the sort of natural element sort of wash over you, that is actually a meditative as well.

And we sometimes make these things so complex that patients feel like I can, you know, I don’t have a studio, I don’t have a computer. There’s no way that I’m going to meditate on a map for 20 minutes. But if it’s something where you get together perhaps with your church group once a week and you sing and choir and you’re breathing in this group and you’re sort of in this state of connection with other people and sort of calming your mind just by being in this place disconnecting from all the other things that we’re doing, these things are actually part of the same medicine that we can get from yoga. So, I think, you know, that’s an entry perhaps if it’s super overwhelming, is just to start with these basic, maybe ghetto nature, go to the beach, watch the waves, go to a lake, watch these sort of natural elements.

Then we can sort of think about, you know, if there are some hopes to do some poses, depending on your level of you know, flexibility. It’s really important to be safe, right? So, we want to be careful. Some types of yoga, for example, Bikram or heated yoga, sometimes those are perhaps not the best for our patients because they can affect blood pressure. And it’s a very hot room and it can really drop people’s blood pressure. So, you want to be mindful of, you know, entering something that’s so new and different and perhaps unsafe. So, I think, you know, we don’t want to be signing up for another type of yoga’s vinyasa, which is a flow yoga where people are, you know, moving from one posture to the other. There’s often an aerobic element to it. These are quiet, you know sometimes strenuous classes.

And so perhaps we start with, you know, a chair class and perhaps looking at, there are some Parkinson’s specific classes depending on where you live in the country. There are even some online classes that started in, during the pandemic. They went, they went online. And I think they’ve now transitioned back to sort of in-person. And I think that, you know, the beauty of online is that it is accessible. We can have people who may not be able to drive these distances to come into a room and be together in a place. But I think that from my eye I think it’s always in some ways preferable to try to actually see people in a space and be with a person, be able to have somebody, you know, perhaps touch you, adjust you, things like that. There’s actually quite a lot of beauty in having a shared space where you’re breathing together, where you’re moving together, where you have, you know, the teacher who’s also feeling the room.

So, I think if you can find an in-person place to do this you know, of course, you know, depending on the safety of the pandemic and masking and things like that some people have been doing some of these classes outside. But you know, I think starting in a chair, so you get a sense of some of the movements depending on your level of mobility. And going from there are classes that use modifications. And so, if you have a sense of who the teacher is, you can talk to the teacher beforehand and say, you know, I have Parkinson’s, I’ve had it for this long, you know, this, these are my issues. I have balance issues, you know, would it be better for me to start in a chair or start with standing and, you know, get a sense of things?

And then sort of slowly work your way up. I think you know; you never want to get an injury that’s going to derail your exercise all together. So, I think safety is of the utmost importance. And actually, cheer yoga classes are actually tremendously beneficial in some ways. Sometimes being in the chair can allow you to get sometimes a stretch or sometimes a breathing pattern that you may not be able to access if you are on a mat or standing. So, I’d be open-minded to, you know, starting with a chair class and going from there.

Polly Dawkins:

Right. And is that something that you can find, for example, at a rec center or a senior center? How would you find a chair yoga class?

Indu Subramanian:

Yeah, I mean, I think that you know there are studios that are, do a range of classes. So, I think, again, you know, a beginner’s level class you know, perhaps a senior center, perhaps you know sometimes a yoga that might be affiliated with a medical group that might be, you know, for ger geriatrics patients or, or certain types of, and if you can find a Parkinson’s specific class that’s obviously optimal. Sometimes also if you are seeing a physical therapist as part of your care, which I encourage people to check in with physical therapy to get a sense of where they are, where some of their mobility issues might be, if they have balance issues, if their blood pressure is dropping, if there are certain parts of the body that may be you know, not as functional as the other side, you know, you can get a good sense of that from that pt. You can get a sense of then how to sustain your, you know, exercise or other practices between physical therapy sessions or even after physical therapy may has ended. And then those people can often be a good resource for you to find you know, these sorts of things in your own community. But I think that, you know again, safety starting slow maybe starting with a chair class are, are all very good entry level ways to sort of go about this

Polly Dawkins:

When, tell us a little bit about what’s, what are some of the most important learnings that you have found from teaching yoga to people with Parkinson’s and other neurological diseases?

Indu Subramanian:

So, what have I found? I found that I think when we that the social connection piece is huge, I think that is one thing that I found. I think when the pandemic hit and we couldn’t see our patients and we were doing some symposiums where patients would come in and we would all be doing things together, either dance or boxing or, or yoga. And I think that, you know, being disconnected from each other is profoundly you know, not good for our nervous system and for our brain in general. So, I think that, you know, that social piece, if you can get out and do something with a friend even if you can’t get to the yoga class, if you can get a friend to come over and you do it together or your perhaps your care partner or your daughter it’s, I think, you know, definitely beneficial cuz you get the benefits of doing some group activity.

And loneliness is very bad you know, in general for help and for our Parkinson’s patients. So that’s one thing I’ve found. The second thing is that the mind and the body are very connected. So, I think if you can help with calming the mind, help with calming that autonomic nervous system, it can actually be profoundly beneficial for people living with Parkinson’s with their motor symptoms. And so often we look at something like tremor as a, something that we fixate on, but it’s really that we have some anxiety underneath or that we have some other sort of you know, things that are weighing our minds down, distracting the mind. And so, I think once we kind of tap into that and we realize sort of firsthand that, you know, the breath can really change how I feel and that just feeling sort of into my spaces and my body and you realize, wow, look, I guess my heart rate was really high, you know, at the beginning of this class, I guess when I was breathing, it was much faster.

And now, you know, at the end of the class you’re like, wow, this has transformed me from, you know, where I was to something else. And that was something that you had control over actually within your own body, which is kind of a beautiful thing. So, this doesn’t require any fancy yoga pants or cool, you know, pretty yoga mats or, or, you know, gym membership or anything. It’s something that’s accessible honestly to all of us. And we can take that practice through to honestly even people who are in their last days of life. And I’ve, you know, been able to breathe with people who are in hospice in pain sometimes, not necessarily even from Parkinson’s disease, but you know, other, other problems that happen to family members or, or whatever. And they’ve asked and yoga’s been something that we could do even as a group together, even in those spaces, which I think is a really beautiful practice.

So that’s something that I think is really powerful. And I actually had a c-spine MRI myself recently, and I started to get quite anxious in the MRI scanner and I was going to have a panic attack Dr. Super Romanian and a scanner having a panic attack not, not great sort of mentally sort of thinking about that. So, I realized my heart rate was going faster and, you know, I was just, you know, claustrophobic. And so, I really started to rely on this breathwork kind of just thinking about these things that I’ve practiced not in that same space, right? So, you kind of have to practice, you kind of have to get these things going on a daily basis that becomes part of a regular thing that we drizzle in from if we can diagnosis. And then when you need these things, they’re there in your pocket to sort of use. And I can say that for me in my own lived experience, I’ve really been much more open-minded to how powerful these things are. Probably much more powerful sometimes than the pills that we give or anything else that we do.

Polly Dawkins:

Mel has just put a comment about in the chat about the effects of yoga on sleep and any, any thoughts? Is there been any research on that or any thoughts on the beneficial effects of yoga on sleep?

Indu Subramanian:

Yeah, so I mean, I think that in the Parkinson’s literature itself, I just had another look. I mean, I think there were some, some signals of some benefits. I mean, really in general, if you look at Parkinson’s disease, I think the benefits that I think are amazing with yoga are really in this non-motor realm. So, you know, anxiety, depression those sorts of mood things. There’s also been some benefits and balance, especially around the poses. There’s been some benefits in sometimes the unified Parkinson’s disease rating scale with motor, motor things. Certain walking measures like timed up-and-go scores, things like that, sleep specifically in Parkinson’s, I don’t think have been robustly measured. But the truth is that there hasn’t been a ton of studies that have been well done. A lot of these studies are small, small studies and I think that, you know, the largest study that came out of I think it was Hong Kong really looked at anxiety and depression as beneficial things and in quality-of-life measures.

But I do think that there are, there is data outside of Parkinson’s and other sorts of patient populations to show that yoga can help sleep and certainly mindfulness can also help sleep actually quite powerfully. So, I think, you know, whether it’s the poses themselves or you know, that meditative aspect or the breath aspect, these are all very kind of bound together in yoga. And so, I think that, you know, sleep is definitely something that the more cardio we get often sleep gets more restful we can help run behavior disorder with you know, certain types of exercises that, that, that increased cardio. So, I think there are many benefits for sleep that can happen with yoga. And so, what piece of it is, or what type of yoga specifically and has not been teased out? Well,

Polly Dawkins:

I mean, you can imagine sort of extrapolate, like if you’re, if it’s helping with mood and anxiety, that’s one of the things that might keep people awake.

Indu Subramanian:

Absolutely.

Polly Dawkins:

And if yoga can help with those, that might help with sleep.

Indu Subramanian:

Absolutely. And I know I can tell you that in my 200-hour teacher training sessions, I slept very well. It was like 10 hours of yoga a day. I got the best sleep of my entire life in that time. And you know, I think that you’re, you’re just sort of reset. The other thing that I think the mind-body practices do, which is very practical for these this day and age, is that we really literally unplug completely, right? We put our cell phones away, we turn off our devices, we’re not in front of our computer screen necessarily when we we’re doing some of these things in the same way that we would be if we were, you know, binge-watching Netflix or, or, you know, scrolling through news and things like that. So, I think that if you can you know, I think Zoom is a great technology and has increased our accessibility to many people who would never be able to come and see us you know, in some of the places that we practice medicine or do some of these classes.

However, if you’re able to really get out and disconnect, put your devices completely away in a studio I find that people are just so amazed at how like an hour away from all there, you know multitasking and all this sort of digital craziness is just also very therapeutic. So I think, and if you can add a nature piece, if you can add being present with somebody that you love, or a friend or, or a social interaction, I think that there are so many benefits of these sorts of things to you know, just the whole person, the whole body, the mind, and the autonomic nervous system as well as, you know you, your muscles and your, you know, sort of stiffness, slowness, things like that, because we’re doing the stretches and can really help with posture and a number of other things that affect specifically our motor function in Parkinson’s.

Polly Dawkins:

So, Amazing. In the chat, Kevin here says that he keeps a yoga mat at the foot of his bed, and if he can’t sleep in the middle of the night, he gets up and does a few yoga hoses and it helps with or, and mindfulness and breathing and it helps him get back to

Indu Subramanian:

Sleep. Absolutely. Absolutely. And there are, I think even apps that just do breathe work that you can find. And there are apps that are just for mind mindfulness as well. So, I think all of these things can kind of be you know, used sometimes interchangeably. I think that doing a lot of poses in the middle of the night probably is going to make you more awake. You know, if there, but there are, you know, there’s, there’s things like yin yoga and restorative yoga that are more sort of slow-paced. They’re often tap into that relaxation response. You’re holding some of these poses for six, seven minutes sometimes and you really can you know, sort of tap into this sort of relaxation response and get that autonomic nervous system really calm and so that can automatically help people get to sleep as well.

So, if you’re looking for something to kind of decrease your you know, sort of revved upness, I think that yoga and especially Restoratives can be helpful. And the beautiful thing also about yoga is that you have the ability to use modifications, as I mentioned, so you can do the same benefits of sometimes a whole mat series in in the chair or in bed, and sometimes even, you might be able to do some mini things. And I’ve spent the last couple of years working with some accessible yoga teachers, adaptive yoga teachers, and one of my yoga mentors recently has been Matthew Stanford, who works at Mind-body Solutions in Minnesota. And he’s you know paralyzed in a wheelchair and is able to teach yoga to so many people, even high CS sign, high cine transaction patients who can’t move anything from their neck down or able to get benefits from some of these yoga practices. It’s really remarkable.

Polly Dawkins:

It’s compelling. Yeah. So, Indu, as we are wrapping up our day of exercise and Parkinson’s and closing out our sessions here, is there any words of advice or last thing you’d like to tell our audience that will help them with their exercise, yogini, anything around this topic area?

Indu Subramanian:

Yeah, I mean, I think Parkinson’s is a very treatable disorder. I think that you know, we are inspired by you as people living with Parkinson’s. You’ve taught us a lot. And you know, those of you who run these support groups and stuff as well are doing amazing work, David, and you know, many people who are like literally on the ground doing this amazing work and are inspired by our patients. I do think that, you know, being able to be the agent of your own destiny in some ways, so taking ownership of what you choose to do every day is a person living with Parkinson’s is huge. When you feel like it’s just the doctor giving you a pill and you’re not even sure why you’re taking the pill, it becomes sort of this sense that you don’t have control and that really your outcome then is not in your control.

But I really do think that when we look at those people who are, you know, embodying that secret sauce of who does well, it’s really people who I think have the right mindset and, you know, use these sorts of things that are non-pharmacological approaches to the best of their ability. Obviously, I do believe that, you know, carbidopa, levodopa, these medicines are, are hugely important. Surgeries are hugely important, but the non-motor aspects, the mental health aspects of living better are hugely benefited by lifestyle choices. And I think exercises a central one, and we’re finally getting data to support that. And hopefully, everyone’s getting counseled on the importance of that from day one of Parkinson’s. But these mind-body approaches and these, the importance of sleep, the importance of social connection the importance of, you know, diet, all of these things, I think put together, I think can really help people to live better and not just sometimes, you know I think somebody had mentioned that they, there was a patient that is now in a better state of help than they ever had been with some of these lifestyle approaches.

And I think we can then sort of resort of frame kind of how we approach you know, our day-to-day lives in a way where we’re, we’re feeling more in control.

Polly Dawkins:

Yeah. Such an important piece of this puzzle. Thank you, thank you. And you’re so busy with all that you do for the community as well as for your patients. And we really appreciate you being here with us today fitting in this topic in your busy day and your busy week. Look forward to having you back to talk about more topics that you’re passionate about for our community. Thank you so much, Dr. Indu Subramanian.

Indu Subramanian:

Thank you for having me. Have a good day everyone, and glad that I was able to join. Thank you.

To download the audio, click here.

closing remarks

You can read the transcript below or you can download it here.

Note: This is not a flawless, word-for-word transcript, but it’s close.

Polly Dawkins, MBA (Executive Director, Davis Phinney Foundation):

As we wrap up our day here, I wonder if I might invite my colleague Mel to join me on camera, and if she’s available here, she’s been, you know, instrumental in helping pull together today. Hi, Mel. Hello. Hi. Pulling today together, today’s agenda, interviewing Bas, and getting all of our speakers here. Mel, what a great day.

Melani Dizon (Director of Education and Content, Davis Phinney Foundation):

It was a great day. So much great information, and I feel like just like kind of relieved, right? A lot of information that is not so scary. Like there’s so much to do, there’s so much you can do, and you don’t have to feel like you have to be some sort of Olympic athlete to use exercise to help you live well.

Polly Dawkins:

Isn’t that true? And our speakers have given so many tips and techniques and ways to make it accessible and fun and to see the benefits so it wouldn’t be a complete Victory Summit event without closing the day with our friend Davis Phinney. Thank you all for being here. Oh, this has been a wonderful day and I just have one way to celebrate, which is of course my victory. So please join me in putting our arms to celebrate this big victory every day. Ready? 1, 2, 3. Yes.

To download the audio, click here.

Movement Breaks

A Tai Chi movement break
a power for parkinson’s
Brain & Body movement break
LSVT BIG movement break
“total health total parkinson’s” movement break
a boxing movement break
a movement break from parkinson’s Wellness

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