parkinson’s disease: current trends, evidence to … · parkinson’s outcomes project is the...

PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler

Connect and Learn 2019

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PARKINSON’S DISEASE: CURRENT TRENDS, EVIDENCE TO SUPPORT

THEM

Cari Cooke, PT, Marguerite Wieler, PhD

PD as a spectrum – movement, cognition, behavioural



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Compensatory resources change

Consolidation of learning is compromised

Wu T & Hallett M et al; 2015; Gilat M. et al 2017; Ginis P et al 2018

Fox S et. Al, MDJ 2017



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‘Exercise’ vs. Activity

Exercise refers to a specific regimen to address a specific balance, posture, endurance, flexibility, strength issue

*often supervised

Activity refers to any movement of the body that uses energy

i.e. housework, gardening, grocery shopping, “puttering”

Snider J et al. 2015

General Exercise



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Regular Exercise, Quality of Life, and Mobility in Parkinson’s Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data

Miriam R. Rafferty, Peter N. Schmidt, Sheng T. Luo , Kan Li, Connie Marras , Thomas L. Davis , Mark Guttman, Fernando Cubillos, Tanya Simuni and on behalf of all NPF‐QII Investigators

Journal of Parkinson’s Disease (2017) 193–202

Prospective NPF‐QII cohort study in 3408 PD patients ‐ Follow‐up 2 years

PD who always exercised > 2,5 hours per week

PD who started exercise at study onsetPD consistent non‐exerciser < 2,5 hours per weekPD who started exercise after study onset

Assessed association of lifelong coffee, tea, and alcohol consumption, smoking, and physical activity with progression and survival

prospective community‐based cohort (n = 360)

Physical activity associated with progression

Paul KC et al; MDJ 2019



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CueingVisual Auditory Tactile

https://hackaday.io/project/10997/

Endurance Exercise



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Effect of high‐intensity treadmill exercise on motor symptoms in patients with De Novo Parkinson disease a phase 2 randomized clinical trial

M Schenkman, CG Moore, WM Kohrt, DA Hall, A Delitto, CL Comella, DA Josbeno, CL Christiansen, BD Berman, BM Kluger, EL Melanson, S Jain, JA Robichaud, C Poon, D Montie Corcos

In the high intensity exercise group, an increase in motor symptom severity was preventedunlike in control arms with no or low levels of exercise

p = 0.03

SchenkmanM et al; JAMA Neurol 2018

RCT ‐ 128 de novo participants

6 months treadmill walking 4x/week

When to be cautious of vigorous ex?

*more medical conditions (monitor & adapt)

*low or fluctuating O2 sat, heart rate, blood pressure

*episodes of confusion after vigorous exercise

*extreme fatigue or pain after exercise



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Neurobiology of Exercise

Early and late onset training in MPTP‐mice was equipotent

Palasz E et al, 2019; Francardo et al; 2017 Review; Petzinger et G al; 2015



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PD Brain on Exercise

University of Southern California did study on persons with Early Stage Parkinson’s disease not yet on any medication.

‐24 sessions of treadmill training compared to persons with PD who did not exercise at all

‐ PET scans showed an 80‐90% increase in the dopamine D2 receptor binding in the treadmill exercise group

‐increased use of the neurotransmitter dopamine ‐ in synapse longer and longer signals

Fisher BE, et al. 2013

? Neuroprotection ?

Parkinson’s Outcomes Project is the

largest‐ever clinical study of Parkinson’s

disease with over 12,000 participants in

five countries

● Increasing physical activity to at least 2.5 hours a week can

slow decline in quality of life.

● Interventions providing neuroprotective benefits, such as

exercise, could change the course of the disease.

● Ongoing vigorous exercise and physical fitness should be

highly encouraged



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The brain's ability to reorganize itself by forming new connections.

4 features of exercise that drive neuroplasticity:

intensity, specificity, difficulty and complexity

Neuroplasticity – can we drive it?

Petzinger G. 2013

MDS task force review – insufficient evidence

Movement strategy – exercise basedMovement strategy – technology based

Formalized patterned exercises

Specific

Non‐ specific

Moran.Gilat 2019



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Not better than resistance training

• Meta‐anaysis 355 subjects

o 5 RCTS – 2 studies not blind

o # of fallers measured 1‐6 months

o No tester blinding

Formalized patterned exercise

Liu H-H et al; PD 2019

Tai Chi reduces number of fallers

Fall prevention home PT

• RCT single blind in 474 fallerso PDSafe = usual care + 12 sessions in 6 monthso Control = usual care + DVD-PD

Chivers Seymour K. et al; JNNP 2019



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Chivers Seymour K. et al; JNNP 2019

Falling is not helped by home PT intervention



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Ellis T et al; 2019

M-health mediated exercise

Stepping Training



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“Hope” in the vacuum of evidence

Forceless Spontaneous Release: A Form of Yin Tui Na ‐ “cures’ Parkinson’s disease

Yin Tui Na ‐ Chinese term for light‐touch, hands‐on medical therapy



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Cannabis on Twitter

There are a growing number of uncontrolled trials and case reports that suggest beneficial effects of cannabinoids in PD patients. However, the variety of substances investigated, the varying routes of intake, differing doses and time courses make it difficult to compare data.

Buhmann C 2019

Radon….??!!

Radon therapy (radon baths) improves joint mobility and strengthen the body's immunity.

Indications of radon therapy ‐ Parkinson's disease at an early stage

Spa Jáchymov, West Bohemia

● Tradition from 1906

● Unique radon baths with the highest level of radon

● Team of experienced physicians and physiotherapists

Radon Health Mines of Boulder‐Basin Montana

● levels of the colorless, odorless, tasteless, & highly radioactive

gas fluctuate between 700 to 2,200 picoCuries per liter of air.



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Could food made for CATTLE ease the symptoms of Parkinson's? How farmer left his profession 30 years ago to develop a 'life‐

changing' probiotic drink for humans

Front. Neurosci., 11 January 2016

Turning On Lights to Stop Neurodegeneration: The Potential of Near Infrared Light Therapy in Alzheimer's and Parkinson's Disease



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Grace Winiecki spends 40 minutes each day with a red light bucket on her head — a device she claims is making a significant difference to her life. since using red lights, she shakes a lot less, can dress herself easier, feels happier, lighter and laughs more.

Photobiomodulationred and near‐infrared lights on their heads and stomachs.

parkinson’s disease: current trends, evidence to … · parkinson’s outcomes project is the...

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