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The New Prescription for Parkinson’s: Puttering

The press has declared sitting the new smoking as research pours in on the negative health effects of a sedentary lifestyle. And exercise may not be answer enough — even marathon runners who sit at a desk all day may be hurting their health.
People with Parkinson’s are no exception. A recent paper from The University of Michigan shows that more everyday physical activity, perhaps more so than vigorous exercise, is associated with less severe motor symptoms. The Michael J. Fox Foundation supported the study.

Motor difficulties are a trademark of Parkinson’s disease (PD), but many people assume the deterioration seen in advanced stages is solely from dopamine loss.

“It is also plausible that lack of physical activity worsens motor symptom severity in PD independent of the degree of nigrostriatal [brain] degeneration,” the authors wrote. Their study investigated that relationship.

The study team enrolled 48 people with PD, most with moderate severity of disease. Each had an imaging scan to measure brain dopamine change and completed a survey that asked about time spent doing various physical activities — both exercise and other actions such as housework and visiting local events.

They found that increased motor severity (measured by the Unified Parkinson’s Disease Rating Scale) was associated with decreased duration of non-exercise physical activity even when accounting for brain dopamine change, levodopa medication dose, age and duration of disease. Translation: those people who did more puttering and low-impact activity had less severe motor symptoms. Further analysis showed the biggest impact on slowness, gait and balance, more so than rigidity and tremor.

“The study indicates that disability of Parkinson’s is not just from the brain disease itself but also a consequence of a sedentary lifestyle. Non-exercise physical activity has an independent outcome on patients’ motor impairments,” says lead researcher Nicolaas Bohnen, MD, PhD.

Interestingly, they did not find the same association between motor severity and duration of exercise activity. More time spent exercising did not mean less severe motor symptoms in this study. Dr. Bohnen’s paper suggests this may be because exercise uses a different brain region than is used for daily movement. Non-exercise physical activity also may contribute to habit formation, where the brain knows how to build motor routines to better meet the demands of daily life.

While beneficial, building in more activity is easier said than done. Poor peer support, lack of motivation, fear of social stigma and barriers to activity (geographic location, for example) make it difficult to get up and go. That inactivity breeds more of the same, though, as people have decreased muscle strength, deconditioned reflexes and fear of falling, the researchers write.
“A vicious cycle of worsening parkinsonism and increasingly sedentary behavior may explain decreasing physical activity in advanced PD,” they said.

Starting small — tracking your steps with a pedometer and setting incremental goals or working with a physical therapist to gain strength — can help increase activity.

“A person with Parkinson disease will be best off when medical management, such as taking medications, will be combined with behavioral interventions that reduce a sedentary lifestyle. The good news here is that this does not require intense or vigorous exercise efforts but can be done right at home while cooking, doing this dishes, cleaning the house, working in the garden or walking the dog,” says Dr. Bohnen.

He found many participants for this study through the MJFF online tool Fox Trial Finder. Register today to be matched with Parkinson’s studies in your area looking for volunteers like you. People with or without PD can register.

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