Dr. Giselle Petzinger’s recommendations on the best exercise approach for Parkinson’s disease
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People with Parkinson's disease can benefit from engaging in an intense exercise program that incorporates both a skilled and an aerobic component. Activities that involve gait and balance training are particularly useful. Having someone to provide feedback is important to help the person progress and stay engaged. In this clip, Dr. Giselle Petzinger describes her recommended components for an exercise program for people with Parkinson's disease.
[Rhonda]: Do people with Parkinson's disease have a higher, like, for example, higher levels of plasma circulating inflammatory cytokines in their plasma?
[Giselle]: Yeah. So there's some data, I mean, interestingly, you know, there hints here and there. It's, again, not as well worked out is, you know, MS, for example, but yeah, the idea that there is, you know, TNF-alpha, IL-6, so the idea that there may be higher proinflammatory cytokines, and that's something that we're going to try to explore in some of the work that we're doing right now. So we, you know, people do believe that, you know, again, it may not be the cause of Parkinson's, but maybe something it's adding to the progression, which is things like inflammation, what role diet and the microbiome. I mean, they all sort of tied in together there. That may play as a mechanism is going to be important and something that definitely needs to be investigated further. So, again, another place where we may be able to modulate the disorder.
[Rhonda]: Yeah. But right now it seems as though the thing that's pretty repeatable is the exercise, and that's... Do you tell them three times a week? Do you...
[Giselle]: Yeah. I mean, most of the studies are about three times a week. So I would say about three times a week, minimally 30 minutes, three times a week, and trying to make it as, you know, intense as possible.
[Rhonda]: Intense as possible.
[Giselle]: Yeah. And then we add that... You know, as part of that, that should also have some skill component, particularly involving gait and balance-related tasks. And there's a lot of things that do that. So I don't pick out anyone in particular. I don't, you know, whether that's tai chi, yoga, surfing, whatever they like to do. I think that's important as well. And I think as you pointed out before, having someone to give you the feedback so that you're accurate and challenging yourself is actually quite important. So I think having that one-on-one, particularly in Parkinson's is a smart thing. And we do try to get people into some one-on-one therapy. I usually do at least two times a year. And actually, I start right away. And there isn't anybody that I don't send because we can always make it challenging for you.
[Rhonda]: Absolutely. That's really key. I think that having, you know, having someone there that's going to really help push you past your comfort zone, give you that feedback, I just, you know, it's really important for people, particularly people that are less prone to push themselves. Like I'm one of those people that I'm pushing myself. I want to be the hardest working girl in my spin class. Like I'm like, you know, that's.. But, but you know, I don't have these neurological problems and apathy and all this other stuff, you know, that comes along with Parkinson's disease and I've been younger and this is sort of my personality. So getting someone to do that, to push themselves, it's so key. Oftentimes, you know, I might say to someone, you know, "Exercise is really important." And they're like, "Well, I walk my dog." And it's like...
[Giselle]: Yes. I hear that a lot around here.
[Rhonda]: You know, "I walk my dog." Well, that's good, but are you red in the face and sweating? Are you pushing yourself? And you know, are you running with your dog? So I mean, I just...
[Giselle]: Right. Exactly. Yeah. Yeah. You got to be tough. You got to be a little tough. And anyway, I try to be pretty tough, but also, like I said, there isn't anybody... I don't care if they're even, you know, been in a wheelchair, I'll try to get them up. We'll see what we can do. You know, we do everything safely, but I think I'm so passionate about that because, you know, when I was in field, you know, it's been a while obviously, but, you know, I was in the field of time...exercise was not thought like that. In fact, it was pretty much thought it couldn't do anything. And so, patients with Parkinson's disease, we may give him a wheelchair or a walker, but there was no plan to make it hard. And I think that's the thing in general, I think people kind of feel like, "Oh, you know, as you're getting older, you know, just chill and like don't do anything." And it's like, yeah, no. No, no, no, no.
[Rhonda]: People are afraid of falling. They're afraid...
[Giselle]: No. I think it's this idea that somehow you can't gain something or you can't do it. I'm not sure. But, yeah. So forget that. Yeah. No. Everyone is...
[Rhonda]: Do you see improvements like with your people that have more severe...they're more...
[Giselle]: Everybody gets better. I mean, we see improvement in everybody. You know, I think that's the thing, you know. And even small gains are good gains. I mean, so, yeah. And I like them to mix it up by, you know, tell them to play instruments even to get more hand skill going. And I mean, yeah. I mean, I think that's the thing. In a way we're too easy on each other. And as people get older, it's like, yeah, get out there and learn something. Go out there and learn a new skill. Take up racquetball. I mean...
[Rhonda]: Like is this a common for clinicians in the Parkinson's field? Are they commonly emphasizing exercise? Do you know, is this like something that's been more embraced or do we have to push it more?
[Giselle]: In general, it's been more embraced, but I have to say, in general, I mean, I'm very, you know. I'm harsh.
[Rhonda]: You do research on it. You know, you've got the data.
[Giselle]: I don't let anybody get away with not talking to patients about lifestyle. And I think the data is pretty clear. And this is not just Parkinson's, it's 50 percent of any neurological disorders lifestyle. And I'm very on it, I tell everybody, I tell all my residents whenever I'm educating people or whatever going around with rounds, 50 percent of any discussion of treatment has to be lifestyle. If you're not doing that, you're not giving a fair balance of what we really know. And so, yeah, I think that message, loud and clear and there's no excuse anymore.
[Rhonda]: And it's never too late. It's never too late.
[Giselle]: Never too late.
A broad category of small proteins (~5-20 kDa) that are important in cell signaling. Cytokines are short-lived proteins that are released by cells to regulate the function of other cells. Sources of cytokines include macrophages, B lymphocytes, mast cells, endothelial cells, fibroblasts, and various stromal cells. Types of cytokines include chemokines, interferons, interleukins, lymphokines, and tumor necrosis factor.
Important for the endocrine enhancing properties of exercise. Exerkines are exercise-induced hormonal-like factors which mediate the systemic benefits of exercise through autocrine, paracrine, and/or endocrine properties.[1]
- ^ Helge, Jørn Wulff; Moritz, Thomas; Morville, Thomas; Clemmensen, Christoffer; Dela, Flemming (2020). Plasma Metabolome Profiling Of Resistance Exercise And Endurance Exercise In Humans Cell Reports 33, 13.
A critical element of the body’s immune response. Inflammation occurs when the body is exposed to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective response that involves immune cells, cell-signaling proteins, and pro-inflammatory factors. Acute inflammation occurs after minor injuries or infections and is characterized by local redness, swelling, or fever. Chronic inflammation occurs on the cellular level in response to toxins or other stressors and is often “invisible.” It plays a key role in the development of many chronic diseases, including cancer, cardiovascular disease, and diabetes.
An essential mineral present in many foods. Iron participates in many physiological functions and is a critical component of hemoglobin. Iron deficiency can cause anemia, fatigue, shortness of breath, and heart arrhythmias.
The collection of genomes of the microorganisms in a given niche. The human microbiome plays key roles in development, immunity, and nutrition. Microbiome dysfunction is associated with the pathology of several conditions, including obesity, depression, and autoimmune disorders such as type 1 diabetes, rheumatoid arthritis, muscular dystrophy, multiple sclerosis, and fibromyalgia.
A chemical that causes Parkinson's disease-like symptoms. MPTP undergoes enzymatic modification in the brain to form MPP+, a neurotoxic compound that interrupts the electron transport system of dopaminergic neurons. MPTP is chemically related to rotenone and paraquat, pesticides that can produce parkinsonian features in animals.
A neurodegenerative disorder that affects the central nervous system. Parkinson’s disease is caused by destruction of nerve cells in the part of the brain called the substantia nigra. It typically manifests later in life and is characterized by tremors and a shuffling gait.
An antibody that plays key roles in immunity. Secretory IgA is the most abundant antibody in the mucosal immune system, accounting for nearly 20 percent of serum immunoglobulin. It is crucial in protecting the intestinal epithelium from toxins and pathogenic microorganisms.
The highest level of intake of a given nutrient likely to pose no adverse health effects for nearly all healthy people. As intake increases above the upper intake level, the risk of adverse effects increases.
A proinflammatory cytokine. TNF-alpha is produced by a wide range of cells, including macrophages, lymphocytes, glial cells, and others. TNF-alpha signaling inhibits tumorigenesis, prevents viral replication, and induces fever and apoptosis. Dysregulation of the TNF-alpha signaling pathway has been implicated in a variety of disorders including cancer, autoimmune diseases, Alzheimer’s disease, and depression.
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