Updated Canadian Guideline Reflects Latest Advances and Adds Palliative Care Section

Canadian Guideline Parkinson's

Updated recommendations on Parkinson’s disease have been published in the Canadian Guideline for Parkinson Disease, which includes a new section about palliative care.

Focused on issues relevant to the Canadian healthcare system, the update reflects the latest evidence and advances — particularly regarding diagnostic criteria and treatment options — and draws on recommendations from the United States, Scotland, the United Kingdom, and the European Union.

The Parkinson Canada-funded publication, which was published in the Canadian Medical Association Journal, offers fundamental guidance to healthcare professionals, patients, and families, and was developed with help from experts in Canada from various disciplines.

“This guideline provides evidence-based recommendations to improve the overall standard of care of individuals with Parkinson disease in Canada, not only for healthcare professionals, but also for policy makers, patients themselves, and their caregivers,” Veronica Bruno, MD, a neurologist with a subspecialty in movement disorders at the University of Calgary, said in a news release. “Managing the complexity of Parkinson disease requires clear, standardized procedures that can be used by all actors involved.”

The new guideline has five sections: communication, diagnosis and progression, treatment, non-motor features, and palliative care, which was added in this update. Palliative care, including an option of medically assisted death, should be considered throughout the course of the disease, the publication states.

“End-of-life choices, including advanced care planning with an open and frank discussion with the patient and the person designated as decision-maker, should be initiated early in the disease process,” the guideline says. “Conversations occurring in the ambulatory setting are likely to be more productive and less crises-driven than leaving such conversations until an acute stay in hospital.”

Other highlights include:

“A limitation to implementing the guideline is the lack of access to health care providers experienced in caring for people with Parkinson disease,” David Grimes, a neurologist at The Ottawa Hospital, said.

“In addition to specialist physicians, we need more nurses, and speech, occupational and physical therapists with training in this area, as well as adequate palliative care for Parkinson patients,” he added.

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Parkinson’s Forum Offers Patients and Caregivers Place to Learn, Share, and Foster Community

patient-caregiver forums

Online forums have markedly altered how patients, caregivers, and healthcare professionals communicate and connect. Even when miles apart, individuals can establish supportive relationships, share experiences and information, and sometimes simply vent.

BioNews Services, a leading online health, science and research publication company, has been rolling out its own forums, including one for Parkinson’s disease (PD), a progressive neurodegenerative disorder that affects roughly 1 million U.S. residents, and more than 10 million people worldwide. Moderated by patients and caregivers — nearly all of them BioNews columnists — these forums complement the company’s news and information websites, such as Parkinson’s News Today.

It’s that synergy of science and personal experience that sets BioNews’ forums apart.

“Patient forums are certainly not a new concept, but BioNews has something unique to offer our communities,” said Chris Comish, BioNews’ founder and CEO. “No other company has the ability to deliver such relevant content to our readers and use that as a starting point for driving conversation and discourse. We’ve had some really touching conversations occur, and have seen patients, particularly those newly diagnosed, find sources of hope and inspiration. It’s touched everyone involved.”

The company has introduced nine forums since last January — Parkinson’s was launched last July —  with more launching by year’s end. Its plan is to have a forum, customized by moderators, for each of its 60-plus rare disease sites. Every forum requires registration and moderator approval, and offers features such as private messaging and keyword search.

BioNews is working to add multimedia to each forum, including podcasts, YouTube videos, and flash briefings.

Within each forum are categories, also known as subforums. In A Forum for Parkinson’s Disease Caregivers, for example, members can connect with other caregivers and learn news ways to overcome challenges and practice self-care, like those presented here. Other posts examine Parkinson’s caregiving and income loss, and how to speak to a loved one with this disease.

In the subforum Diagnosis Information and General Questions, people newly diagnosed along with their caregivers and friends can ask questions about the disease and find information, all while supporting each other. Discussion topics range from personal reactions to a diagnosis to reasons for a misdiagnosis, like those detailed in this posted article.

The Living with Parkinson’s Disease subforum is a place for those who understand the day-to-day challenges the disease poses, including difficulties with walking and speaking. It’s also a resource for information about living with a chronic illness. There are posts about disease progression, for instance, and books by those with Parkinson’s about their journey.

Members can use the Parkinson’s Disease Symptoms space for resources to help them understand and cope with how Parkinson’s uniquely affects them. Because symptoms vary from person to person, the subforum is particularly popular. Subjects include trouble rolling over in bed, difficulty swallowing waterimproving handwriting, and the effects of dyskinesia — those uncontrolled and involuntary muscle movements.

In Parkinson’s Disease Alternative Treatments, participants can ask questions and share information about alternative or experimental therapies they’ve tried or are curious about, with the proviso that many suggestions are not science based, and that effects can vary. There are posts about medical cannabis, for example, gluten-free diets and rosemary essential oil.

The subforum Parkinson’s Disease Medications is for sharing information and experiences related to therapies, including levodopa and Xadago (safinamide). The platform Parkinson’s Research News keeps members apprised of the latest study and treatment advances. Members can connect with researchers, healthcare professionals, and other patients. Posts range from a study about sex and Parkinson’s to the preclinical results on a molecule that might reduce toxic protein buildups in the brain and reverse motor symptoms.

In Parkinson’s Disease and Exercise, participants can learn about, and share the benefits and challenges of, exercising. Entries touch on specific forms of exercise like swimming, or being overwhelmed by the volume of exercise required. Members can use the Parkinson’s Disease Awareness and Advocacy subforum to learn how to educate others about Parkinson’s, and to discover current and future efforts to heighten disease awareness.

In all, Jean Mellano, who is the Parkinson’s forum co-moderator along with Ally MacGregor, said she and others have found that levity is often most effective in disease management.

“Laughter is the best medicine,” said Mellano, who was diagnosed in 2015. “Having a sense of humor about the absurdity of some PD symptoms can help with the healing process. If we can share our stories with others, it may lessen the embarrassment caused by our symptoms.”

To help generate conversation, forum moderators regularly post topics within subforums. Sometimes the topic is based on a new column or news article. Other times, it’s something about day-to-day life. Moderators also post about their own lives, for instance, sharing thoughts on movies they’ve seen or their vacation photos. Some forums also have groups, both public and private subforum offshoots.

The forums’ framework was mostly developed by Kevin Schaefer with help from the social media team at BioNews. Schaefer is the company’s community development manager and an SMA forum moderator. He’s excited about the forums, and their growth and future potential.

“It’s just really cool to see a community evolving in each of them,” said Schaefer, who has SMA type 2. “They are as much about fostering community as they are about providing information. We want to do everything we can to engage with our members.”

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Senior Helpers Sending 6 Rock Steady Boxing Coaches from North Carolina to Group’s Conference

Rock Steady Boxing conference

Aware that non-contact boxing routines can improve the lives of Parkinson’s patients, Senior Helpers is sending six Rock Steady Boxing (RSB) coaches to the organization’s national conference.

Senior Helpers, a leading nationwide provider of at-home care, will sponsor the Wilmington, North Carolina, coaches in attending the second annual Rock Steady Boxing Coaches Conference to be held Sept. 4–6 in Phoenix.

At the conference, Rock Steady-certified coaches from around the world will learn the latest in techniques and practices. The non-profit Rock Steady Boxing uses a non-contact boxing-based fitness curriculum to help slow Parkinson’s progression and enable patients to better manage disease symptoms.

“As a care-based company, we understand firsthand how important it is to stay current with the skills and techniques that help our clients,” Mari Baxter, senior vice president of operations for Senior Helpers, said a press release.

“Rock Steady Boxing has been one of our most valued partners the past several years and the organization’s commitment to helping improve the lives of Parkinson’s patients is an exemplary example of humanitarianism,” Baxter added. “It’s our honor to help these coaches advance their skillsets and enhance their instruction.”

In general, research shows that exercise helps Parkinson’s patients maintain the abilities needed for a degree of independence in everyday life. In particular, exercises that stress gross motor movement, core strength, balance, and rhythm can positively affect patients’ range of motion, gait, posture, and flexibility.

The Senior Helpers-sponsored coaches are Mike Wilson, co-founder of Rock Steady Boxing of Wilmington and a former Jiu-Jitsu instructor; martial artist Val Wilson, who co-founded Rock Steady Boxing of Wilmington; Christy Gillenwater, a fitness studio owner who is certified as both a personal trainer and medical fitness specialist; multi-sport athlete Ryan Gillespie, a health and wellness veteran; Sheryl Johnson, a former police officer who was diagnosed with Parkinson’s in 2013; and Jim Cosper, a U.S. Navy veteran and Parkinson’s patient.

“Parkinson’s disease hits close to home for so many people, myself included,” Baxter said. “My husband Bill was recently diagnosed with Parkinson’s disease and has found Rock Steady to be an immense help in his overall wellbeing and day-to-day health. He was so resistant after his diagnosis, but now he’s their biggest convert.”

Founded in 2006 as the nation’s first boxing program of its kind, RSB is specifically designed to help patients at all stages of Parkinson’s. Visit this site to find a local class.

With more than 300 franchised businesses, Senior Helpers was founded in 2001 to help senior citizens with age-related illnesses and mobility challenges remain in their home.

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Grants Will Establish Exercise Program for Parkinson’s Patients in Arkansas

exercise program

Grants totaling nearly $29,000 will enable the University of Arkansas for Medical Sciences (UAMS)  to establish a free exercise program for patients with Parkinson’s disease and Parkinson’s-like symptoms.

Some $13,924 from the Parkinson’s Foundation will go toward program staffing, training and other support. A $15,000 grant from the Philip R. Jonsson Foundation will pay for equipment. Classes start Aug. 20.

Designed to enhance patients’ overall quality of life, the program’s regimen will emphasize strength maintenance, balance improvement, and cognitive and social engagement.

“Treating Parkinson’s disease involves treating the whole person, and that means going beyond what we can accomplish during a clinical visit,” Rohit Dhall, MD, said in a press release. Dhall is director of neurodegenerative disorders in the UAMS department of neurology. “I am so happy that the central Arkansas Parkinson’s community will be able to benefit from this evidence-based, high-quality exercise program — all free of charge.”

Fitness instructors will receive Parkinson Wellness Recovery (PWR!) certification in PWR!Moves group and circuit class formats. The funding also will enable a physical therapist specializing in Parkinson’s disease to receive certification in research-based exercise approaches and task-specific training routines.

PWR!Moves is a Parkinson’s-specific skill-training program aimed at maintaining or restoring skills that deteriorate and interfere with everyday movements. Specifically, the program targets antigravity extension, weight shifting, axial mobility and transitions. The regimen aims to counteract Parkinson’s symptoms such as rigidity, bradykinesia (slowness of movement), lack of coordination, and loss of motor automaticity.

In the group class, patients will learn how to offset Parkinson’s symptoms and move “bigger and faster” during daily life. The course is designed to be fun and supportive, but physically and cognitively challenging.

The circuit will incorporate PWR!Moves into athletics, fitness and conventional gym activities such as coordination, strength, balance, agility, and flexibility training. Using different exercise stations — each with a specific focus — patients will work alone or with partners.

While each participant will receive personalized input regarding needs and goals, the program is crafted to benefit patients regardless of fitness and symptom levels. For instance, a new Solo-Step overhead track and harness system — in which a torso harness attaches to a room-length ceiling track — allows patients with concerns about balance or strength to exercise safely. Other grant-funded equipment will help participants with functions such as walking on uneven surfaces.

“Our approach combines the best of an individualized exercise experience with the social nature of group exercise,” said Chris Oholendt, program manager for UAMS outpatient physical therapy/occupational therapy. “We are thrilled to provide people with Parkinson’s and their care partners this unique program that will change the way they live with PD for the better.”

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Resistance Training Reduces Depressive Symptoms in Older PD Patients, Trial Shows

Resistance training

Twenty weeks of resistance training significantly decreases depression symptoms and improves quality of life in older people with Parkinson’s disease (PD), a study has found.

The training, consisting of exercises involving the arms and legs and simulating daily activity movements, also improved patients’ flexibility, endurance, and walking performance.

Based on the promising results, researchers are calling for resistance training to be included in exercise programs for patients with Parkinson’s disease.

Their study, “Resistance training reduces depressive symptoms in elderly people with parkinson disease: A controlled randomized study,” was published in the Scandinavian Journal of Medicine and Science in Sports.

Loss of muscle strength and function predisposes Parkinson’s patients to sedentary behavior and social isolation, with consequent increase in depressive symptoms, affecting up to 40% of patients.

But studies suggest that those who have a more active lifestyle and exercise are less prone to depression.

Some researchers contend that exercise works at least as well as antidepressants. The effect of exercise as natural antidepressant is thought to be mediated either by stimulating the growth of new nerve cells — as antidepressant medications might — or releasing substances from muscles and fat cells (adipocytes) that can travel to the brain and work as antidepressants.

Up to now, known effective physical therapies against depression in Parkinson’s are based mostly on  aerobic exercises.

Here, Brazilian researchers conducted a trial to evaluate the benefits of another exercise modality — resistance training — in reducing depression and improving quality of life in elderly patients with PD.

Considering its potential physical benefits, researchers investigated how much this type of training improved patients’ movement and resistance capacity as well. The trial was sponsored by Pará State University, in Brazil.

Resistance training is a form of exercise designed to improve muscular fitness by exercising a muscle or a group of muscles against any object that poses an external resistance. This causes muscles to contract, which can help improve strength, power, muscle growth, and endurance.

The trial involved 33 patients, age 60 or older, who were randomly assigned to resistance training (17 patients) or a control group (16 patients) for 20 weeks. All were on stable medication and had Parkinson’s stage 1-3 on the Hoehn and Yahr scale.

Those in the resistance training group spent the first two weeks getting used to the exercises, under supervision. After that, they started having training sessions twice a week, on non-consecutive days.

Each session (30–40 minutes each) consisted of two series of of 8–12 repetitions of these exercises: bench press, deadlift, unilateral rowing, standing calf raise and abdominal reverse crunch. Such exercises involve the major muscle groups in the arms and legs and mimic the basic movements of daily activities.

Training loads were increased when the patient had a high performance, with full range of motion.

Unlike the control group, at the end of the 20 weeks, patients performing resistance training had fewer depressive symptoms. Clinician-rated HAM-D17 scores dropped from 17.9 to 10.3.

Patients in this group also reported improvements in their quality of life (as measured by the Parkinson’s disease Questionnaire, PDQ-39) and had better UPDRS scores, which rate Parkinson’s motor and non-motor symptoms.

Concerning motor capacity, resistance training also improved patients’ physical performance as seen in several tests — Timed Up and Go (pre-training, 33.2 seconds versus post training, 26.4 seconds), flexibility on the sit and reach test (pre, 20.7 cm versus post, 28.8 cm), aerobic endurance measured by the two-minute step test (pre, 79.2 steps versus post, 99.1 steps) and maximum walking speed (pre, 1 meter per second versus post, 1.3 meters per second).

In contrast, no significant changes were seen in the control group, either regarding depressive symptoms, quality of life, or motor skills.

“In addition to improving functional capacity and quality of life, resistance training reduces depressive symptoms of elderly with Parkinson’s disease,” the researchers said.

“To our knowledge, the present study is the first to show that 20 weeks of isolated resistance training reduced depressive symptoms in elderly people presenting PD. We suggest that resistance training should be a central component of exercise programs for patients with Parkinson’s disease,” they concluded.

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Exercising with Parkinson’s Disease: Try It and See the Benefits

panic attacks

I began taking Rock Steady Boxing classes about nine months ago. The exercise program is tailored for those with Parkinson’s disease, and if you’re like me, you’ve dragged your feet and refused to go for any number of reasons or excuses. Maybe there isn’t a class near you. Or perhaps you feel too tired and don’t think you’ll have enough energy to do what’s required. Maybe money or time is the issue.

Do me a favor. 

Just consider it

I was reluctant to go. Mostly because I’m an introvert — yes, I really am. I have to push myself to get out there. And so I did. I forced myself to check it out almost nine months ago, and I am still going. 

I recently read a discussion in a Parkinson’s Facebook group I belong to. Someone asked what decision others had made in their lives since their diagnosis that had made the most positive difference to their health. I was surprised by the number of answers about exercise. It seems logical to me now, but before attending boxing classes, I may have had a different response, such as increasing my chocolate intake.

We are meant to be active

A 2018 study looked at the reduction of movement in neurological diseases. Commenting on the research, one of its authors, Dr. Raffaella Adami, told the journal Frontiers that we are meant to “walk, run, crouch to sit, and use our leg muscles to lift things.”

According to the article, “Cutting back on exercise makes it difficult for the body to produce new nerve cells — some of the very building blocks that allow us to handle stress and adapt to challenge in our lives.”

When I joined my boxing class, I was surprised by the number and variety of exercises we had to do. I had figured that activities would be specifically related to boxing. We spend the first half of the class on exercises such as jumping jacks, squats, leg raises, jump-rope, stair steps, balance beam, ladder steps, box steps, pushups, lunges, planks, and various activities using punching bags, jelly bags, and speed bags. Then we practice punches with our coaches. We close out our session with a game or competition — my favorite part.

Many participants in the Facebook group discussion agreed that their decision to join a Rock Steady Boxing class had been beneficial. The next two most popular activities were walking and yoga. I don’t think that it matters which form of exercise you choose as long as you are doing something.

See the benefits

May I encourage you to start an exercise routine if you haven’t already. You’ll soon realize that you can do more than you could before, and you may find that your overall well-being has improved.


Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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By Learning to Shift Perspective, We Can Change What’s Possible

Dr. C

I hate exercise! Both my pain and fatigue increase when I exercise. These are disabling Parkinson’s disease symptoms, and both trigger the fight-or-flight response that often manifests as “the grouch.” I have not found an easy way of exercising with Parkinson’s pain and fatigue, but I have found ways to shift my perspective. Shifting perspective opens up the possibility of experiencing enjoyment from exercise.

One of the most important parts of a Parkinson’s wellness map is exercise. But here’s the catch: It’s difficult to do with regularity. We know it works! Yet, knowing what is good for wellness is not the same as doing it. The doing part of exercise — showing up three to four times a week — is difficult with all the chronic disease barriers. It’s easy to feel defeated before even starting.

The way around this apparent Catch-22 is to shift one’s perspective on exercise. I mentioned the idea of shifting perspective in connection to wellness in a column about moments of well-being. The shift I need with regard to exercise is one that will get me off the sofa and into exercising. I am not getting off the sofa to do something I hate, but rather to do an enjoyable, creative project that involves exercise: landscaping to produce gardens. It’s a good exercise to keep the trunk strong, which helps prevent falls.

It takes a bit of perseverance to get into my work clothes, strap on the heavy work boots, find the hat and sunglasses, and then head out the door. Surveying the work ahead — which is sometimes a bit daunting — I start with light work to warm up. Walk, then shovel, and maybe rake, before getting behind the wheelbarrow to move gravel or dirt from one location to another. Pause to hear the birds sing, marvel at the variety of flower blooms and fragrances. Pretty quickly, the world slips away, replaced by the Zen of gardening.

My Fitbit reminds me when a time for medication is coming up and keeps track of my heart rate. I take lots of water breaks! By the time two hours have passed, my work shirt is drenched with sweat — as much as, if not more than, the amount of water I’ve consumed. In the Zen garden moments, the mind is free of the worries of Parkinson’s and vision problems. That feeling remains with me, not as a false euphoria, but as a deep-rooted sense of well-being.

There are many ways that shifting perspective can open wellness possibilities. A nurse shared a wonderful example. She was a smoker from her early teen years, and now in her 30s, she decided to quit. Six months without a smoke and she says, “I had this memory of how much I enjoyed smoking.” So, she bummed a cigarette and immediately got sick from smoking it. Recounting the event, she says, “I can remember the horrid feeling as clear today as if it just happened. I never had the urge to smoke again after that.” She shifted her perspective from enjoying smoking to thinking of it as a horrid, sickening experience. Shifting perspective opened up the possibility of wellness.

There is research supporting the practice of shifting perspective in a way that promotes well-being. The placebo effect is a mind/body interaction where the patient is convinced of treatment efficacy, which is a shift in perspective. Also, in many cases of “miracle” disease remission, a common theme is the patient’s ability to shift perspective. Reframing a problem can provide a new perspective and lead to new solutions.

The ability to shift perspective may also improve our ability to adapt to stressful times and to become more resilient, and therefore more open to new possibilities. The shifting of perspective causes us to shift our focus to a new intention, a new possibility. I hated exercise, and my intention was to avoid it. The shift in perspective offered the new intention of enjoyment and the possibility of a beautiful garden, along with a healthier body, in spite of the chronic disease limitations.

How has the ability to shift your perspective helped you? Please share your story in the comments below.


Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Progressive ‘PD Summer School’ Gearing Up at Bastyr University

PD Summer School

A top progressive researcher at Bastyr University in Washington will lead a unique event — a five-day medical-educational retreat called PD Summer School — aimed at improving the lives of people with Parkinson’s disease.

Touted as the world’s only event of its kind for those living with Parkinson’s, the August 18-23 “school” will be led by Laurie Mischley, ND, MPH, PhD, associate clinical investigator at the university’s Research Institute. Mischley, author of “Natural Therapies for Parkinson’s Disease,” is conducting the ongoing Complementary & Alternative Medicine (CAM) Care in Parkinson’s Disease study at the university. She also developed an outcome measure to assess PD severity.

The PD Summer School, held in collaboration with Bastyr, will include 20 hours of classroom instruction, and individual and group activities, such as meditation, cooking demonstrations, chair massages, and yoga. There will be a field trip to a cannabis dispensary. Participants also will receive “recommendations catered to their unique symptoms, situation and priorities,” based on the results from required lab tests completed prior to the start of classes. Go here for the complete agenda.

Strategies presented will be data driven and supported by peer-reviewed literature. Attendees also can expect information on clinical trial participation, real-world solutions, and patient-centered recommendations.

“The therapies we teach are evidence based, supported by published, peer-reviewed literature,” Mischley said a press release. “They’ll also have a lot of fun, enjoying delicious and nutritious foods, receiving massages and participating in meditation and exercise classes in between lectures and appointments.”

Customized recommendations will be given to all participants based on their individual symptoms, priorities, and lifestyles. Following the program, these suggestions, complete with strategy details and explanations, will be sent to each patient’s physicians.

Participants will get up-to-date information on therapies, environmental toxins, nutrition and diet, and exercise from Parkinson’s experts, including movement disorder specialists, naturopathic physicians, and physical therapists.

Instructors will include John Duda, MD, director of the Parkinson’s Disease Research, Education and Clinical Center; Samantha Evans, naturopathic doctor with a practice in Seattle; physical therapist and PD specialist Nate Coomer; Matthew Brodsky, MD, Oregon Health & Science University; Kimball Magoni, PhD, psychologist; naturopathic doctor Russell B. Mars; naturopathic physician Jade Stefano, a cannabis farmer and processor; and naturopathic doctor Michelle Sexton.

Mischley believes that, much like Alzheimer’s patients in a 2014 study, people with Parkinson’s can benefit from a comprehensive, personalized therapeutic program.

“I don’t think neurodegenerative diseases are nearly as progressive as most people think they are,” she said. “People just need to stop doing the things that are causing the degeneration.”

The last day to register for the program is June 24. For more information, go here. The $4,500 per-patient fee, which does not include lodging, may be partially reimbursed through insurance. Partners or caregivers may attend at a cost of $1,000 per person, not including lodging.

Based in Kenmore, Wash., Bastyr University is a nonprofit private school offering undergraduate, graduate, and doctoral degrees, with a multidisciplinary curriculum in science-based natural medicine.

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Cleveland Clinic Researcher Gets $3M NIH Grant to Study Impact of Exercise on Parkinson’s Disease

impacts of exercise

A Cleveland Clinic researcher is getting a $3 million grant from the National Institutes of Health (NIH) to study the long-term impact of high-intensity aerobic exercise on Parkinson’s disease progression.

The five-year award goes to Jay Alberts, PhD, a staff member in the department of biomedical engineering and the director of the Cleveland Clinic Concussion Center, and vice chairman of health enabling technology and innovations. His research focuses on the central nervous system and upper extremity motor performance in PD patients, and the effect of behavioral and surgical interventions.

He was also the lead researcher for a clinical trial called CYCLE (NCT01636297), aimed at determining the effects of forced cycling on motor and non-motor performance, compared with voluntary cycling and a non-exercise control group. Begun in 2012, the randomized study, which included 100 participants, also assessed whether exercise improves brain activity.

Recently completed, the study showed that an eight-week high-intensity aerobic exercise program markedly enhances overall motor function, certain aspects of walking, and cognitive function in Parkinson’s patients.

The new study, touted as the first of its kind, will measure the effectiveness of a long-term CYCLE protocol in a home-based setting.

”Our previous work clearly indicates that aerobic exercise, such as cycling, in a controlled environment improves motor function over the course of eight weeks,” Alberts said in a press release. “This project is important in understanding how exercise can slow disease progression, and the translation of a laboratory-based protocol to the home of the patient. To bring an effective intervention from the Cleveland Clinic to the home of a patient outside of our zip code is an exciting next step in the treatment of Parkinson’s.”

Along with the University of Utah, the clinic will recruit 250 Parkinson’s patients who will be randomized to either a high-intensity home exercise or usual and customary care (UCC) group. Using stationery indoor bikes, the exercise group must exercise three times weekly for a year, while UCC participants will go about their daily lives. All participants will be evaluated for motor and non-motor function upon enrollment and at six and 12 months.

The volunteers will wear devices that will track overall activity levels. Exercise performance data will be used to determine whether a certain level of exercise can slow Parkinson’s progression. A positive determination would enable clinicians to make specific exercise recommendations to patients, and empower patients to play a more active role in disease treatment and management.

In general, researchers have determined that exercise is essential to helping Parkinson’s patients maintain balance, mobility, and the ability to perform daily routines.

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Endurance Exercise May Help Manage Cortisol Levels in Parkinson’s Patients, Study Suggests

cortisol exercise PD

Doing high-intensity endurance exercise reduces morning cortisol levels in patients with Parkinson’s disease, which may have an impact on the progression of non-motor signs and symptoms, a pilot study suggests.

While other studies are needed to confirm if lowering cortisol with physical exercise works for delaying disease worsening, this data supports the further exploration of the role played by the hormone in non-motor symptoms of Parkinson’s.

The study, “Endurance Exercise Reduces Cortisol in Parkinson’s Disease With Mild Cognitive Impairment,” was published in the journal Movement Disorders.

Parkinson’s disease is a complex disorder associated with both motor and non-motor symptoms including sleep problems, depression, and cognitive impairment.

There is evidence that a malfunction of the hypothalamic-pituitary-adrenal axis (HPA) is involved in the progression of non-motor symptoms of Parkinson’s due to an overproduction of the hormone cortisol.

HPA is a system in the body crucial for stress management. It involves a set of complex interactions between two parts of the brain — the hypothalamus and the pituitary glands — and the adrenal glands located at the top of each kidney, which are regulated by different hormones.

After a stressful or threatening event, the HPA axis is activated and several “stress hormones,” primarily cortisol and adrenaline, are released by the adrenal glands into the bloodstream. As the blood levels of cortisol rise, they start to block the release of other hormones from the hypothalamus and the pituitary that, in turn, will induce a drop in cortisol levels.

This type of negative feedback loop is one mechanism by which HPA regulates itself to avoid excessive and sustained production of cortisol.

Beside this natural stress management process, cortisol is also important for a wide range of vital processes, including metabolism and the immune response. There has been a long-standing association between raised or impaired regulation of cortisol levels and a number of psychiatric conditions such as anxiety and depression, even though this is not yet fully understood.

Elevated morning cortisol levels have been reported in Parkinson’s patients. Accordingly, there is evidence that elevated cortisol in Parkinson’s patients is linked to symptoms such as depression and risk behavior.

Physical exercise is associated with a lower production of cortisol in healthy individuals, and there is evidence that it may also reduce the risk and rate of Parkinson’s progression.

Based on this data, the researchers reasoned that doing exercise could lower daytime production of cortisol in Parkinson’s patients, with possible implications for delaying the progression of their non-motor symptoms.

To test this theory, they conducted a small study in which they measured the levels of cortisol in saliva samples collected from eight Parkinson’s patients with mild cognitive impairment (ages 53 to 79). Over six months, participants were asked to perform high-intensity treadmill endurance exercise.

The exercise program included five to 10 minutes of warm-up, 30 minutes of exercise at 80-85% maximum heart rate, followed by five to 10 minutes of cool-down. Participants exercised an average of 2.5 days per week, and over the first eight weeks of training, exercise duration and intensity were gradually increased to target levels.

Saliva samples were collected before and after completing the program, and at specific times immediately after waking up (0, 0.25, 0.50, and 0.75 hours after awakening) and at periods throughout the day (three, six, nine, and 12 hours after awakening).

Overall, cortisol secretion of Parkinson’s patients more closely resembled that of healthy people after they had completed the training program.

Results showed there was an average 19% reduction in cortisol secretion, compared with the pre-training period. In addition, while cortisol reduction was significant during the times immediately after waking up, it was not in the periods later in the day.

“These data support the need for further exploration of HPA axis dysregulation in Parkinson’s disease,” the researchers wrote. “To understand not only its potential role in the mechanisms underlying non-motor symptoms of Parkinson’s, but also its responsiveness to intervention studies such as physical exercise that can improve non-motor symptoms.”

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