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Table tennis offers Parkinson’s patients physical, mental challenge

Stiff-limbed from Parkinson’s disease, Jim Brougher gets help taking off his coat from his wife, Jan, as the couple prepare to play pingpong with fellow patients at the Boys & Girls Club of Bend gym.

A former windsurfer, kayaker, swimmer and runner, the 83-year-old’s athletic nature still shows. He’s notorious in the Parkinson’s group for a quick, low-flying serve that’s difficult to return. While the Parkinson’s patients aren’t as nimble as the rest of the Bend Table Tennis Club players who fill out the gym on Monday nights, they say they benefit from the sport, which is popular because it requires physical and mental agility.

When the Broughers joined the group last year, Jim needed to use the elevator to reach the second-floor gym. Now he’s taking the stairs. While the reversal of his physical ability is unusual, a growing body of research suggests exercise can at least help Parkinson’s patients manage the progressive physical and cognitive decline associated with the disease.

“People are working very hard at keeping themselves as capable as they can for as long as they can,” said Margie Lussier, a Bend patient who started the twice-monthly pingpong night a year ago. “It seems to work.”

Parkinson’s affects about 1 million Americans, and it’s the second-most common neurodegenerative disease, behind Alzheimer’s, according to the Parkinson Foundation. While patients and their advocates widely believe that exercise counters the physical and cognitive effects of the disease, whether it actually delays the progression remains unproven. Parkinson’s patients are sometimes ahead of the medical community in seeking out new ways to stimulate their bodies and minds, and that’s true in Central Oregon. Pingpong is one of several activities that Lussier and other patients have worked to make available over the last few years.

The lineup of specially tailored classes now includes tai chi, dance and Pilates. Starting in March, a speech-language pathologist will offer a group communication skills class for people who want to keep up their speech therapy work. Parkinson’s affects the muscles of the throat, so patients often experience a softening of their voices and trouble swallowing.

A personal trainer will offer high-intensity group exercise for patients who aren’t severely affected by the disease. Both of the new classes are sponsored by Parkinson’s Resources of Oregon in Portland, which has helped local instructors get certification.

Lussier said starting pingpong was simply a matter of reaching out to table tennis club president Don Borne, who embraced the idea and reserves two tables every other Monday for the Parkinson’s group.

Pingpong is one of the rare activities that patients and their families can do together, said Lussier’s husband, Jim Lussier. He and other spouses and relatives join in for rounds of doubles.

The social element is important because depression is a common symptom of the disease, which causes a loss of dopamine-producing brain cells, Margie Lussier said.

Jan Brougher said all physical activity seems to be helping her husband. The Broughers moved to Bend last year from California to be near their daughter, and they’re enjoying pingpong because it’s also a chance to socialize, Jan said. “Being new to the community and not knowing a whole lot of people, it’s wonderful to be with them,” she said.

Recent research has tried to measure the benefits of specific activities, including tai chi, yoga, dance, resistance training and even boxing-style training. The idea behind all of it is to encourage neuroplasticity, which means the brain creates new connections between neurons to compensate for deficits elsewhere.

It’s unclear whether the benefits of exercise are lasting or temporary. A literature review published in the journal Neurology in 2011 concluded that data published so far failed to “prove that exercise slows Parkinson’s disease progression, but a neuroprotective effect is certainly plausible if not compelling.” The study’s author, Mayo Clinic neurologist J. Eric Ahlskog, said doctors should encourage ongoing, vigorous exercise, defined as anything sufficient to raise heart rate and oxygen needs for 20 to 30 minutes at a time, and make sure it’s incorporated into physical therapy plans. He also urged doctors to use medication to maximize their patients’ capacity for exercise.

Anecdotally, patients know they feel better if they stay active, said Holly Chaimov, executive director of Parkinson’s Resources of Oregon. It’s been difficult for doctors to recommend a specific course of activity because until about six years ago, scientific evidence was limited, she said.

The American Academy of Neurology updated its guidelines on alternative therapy for Parkinson’s in 2013 to reaffirm that “no treatment has been shown to be neuroprotective,” and “exercise may be helpful in improving motor function.”

The academy also said rigorous studies are needed in this area.

In practice, Bend Memorial Clinic neurologist Steve Goins said he’s telling Parkinson’s patients they need to get 2½ hours of exercise a week on a regular, consistent basis. “We know that it improves balance, decreases falls and wards off depression,” he said.

Medicine has taken a similar turn on Parkinson’s support groups, Chaimov said. Doctors used to think witnessing later stages of the disease would depress patients, but that’s no longer the case, she said.

Central Oregon has seen the number of local support groups grow from one to three, including one just for Parkinson’s caregivers. As with the exercise classes, the growth in support groups is the result of advocacy by the Central Oregon Parkinson’s Council, Chaimov said.

Parkinson’s Resources helped pay for local dance instructor Julie Carda to travel to New York City last year for training in Dance for PD, a program developed in collaboration with the Mark Morris Dance Group. The class uses various choreography styles and is adapted to accommodate people at any level of physical ability, from walking to wheelchair, she said.

Carda said the class, held at First Presbyterian Church in Bend, has been a hit because it goes beyond exercise. There’s imagery, awareness of the body in time and space, rhythm and joy, Carda said. Those things help people forget about the fact they need to keep moving, which is hard enough when you’re not dealing with a loss of motor function, balance or tremors, she said.

“We want them to show up for dance class because it’s exciting. Their brain is going to get stimulated, and their best friend is there, and they’re going to see them today.”

Parkinson’s is a fairly recent diagnosis for George Lee, a retired police officer from Seattle. Hearing the news from a Bend neurologist last April, the 64-year-old was at first relieved to have an answer for the depression, anxiety, muscle soreness, tremor and memory problems that bothered him over the last two years. At the same time he’s facing a long-term progressively degenerative disease. Activities with other Parkinson’s patients have helped him come to terms with it. He goes to tai chi, and he dived into pingpong, which he played during his 24 years in the Army. “I thought I was good,” he said, but he found out, “I wasn’t as good as I thought I was.”

Lee plays both with Parkinson’s patients and with the table tennis club members. He’s even taken some lessons from Borne, the club president. A friend of his is also in the table tennis club, so they play when they get together.

“It’s really helped me to sort of get back into society,” Lee said.
http://www.bendbulletin.com/home/4039710-151/table-tennis-offers-parkinsons-patients-physical-mental-challenge#

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