Thursday, December 17, 2015

Purposeful Fitness

These are the heart rate data from my 5K (3.2 miles) on the treadmill this evening.  It was a 35 minute experience.  It wasn't my typical 5K run.  It was a run-walk-run 5K with a specific purpose.  And the goal of this post is to model the habit of attaching fitness to a purpose.

The purpose of tonight's training was to support personal fitness and family fitness.  In about 12 days my family from Delaware (flat) will be visiting the White Mountains in New Hampshire (not flat). Not too long ago we decided that one of our family goals is to climb all the 4000 footers in the Whites.

Tonight's fitness strategy is informed by experience from last year (Jan. 2015), when the premier hike took us to the summit of Mt. Pierce with a temperature at the summit well below 0.  We have been visiting the Whites for 2-3 days at a time in the summers and winters.  During each visit, our first hike is an easier 'shake-down' hike in which the purpose is to become reacquainted with the temperatures, the terrain, our gear and fitness.

Last year was our first attempt at a Winter 4000 footer.  If you believe in comprehensive fitness, you believe in planning and being prepared.  This list of recommended equipment from the Appalachian Mountain Club will fill a backpack and I haven't hiked with a  full pack in years.  Our shakedown hike was a beautiful hike up Mt. Pemigewasset.  Unfortunately, I wasn't fit for the task and it made me very tired and very sore.  Embarrassingly so.  I bounced back well enough for the larger hikes on the following days but I have absolutely no interest in being unfit again at the wrong time this year, especially with family-welfare at stake.

So this evening's treadmill workout went like this:
  • Run a 9-minute mile.
  • Walk 1.2 miles at 4 mph with the incline set at 14.  
  • Run a 9 minute mile.
This workout was hard for me and it accomplished exactly what I hoped.  It gave me a mild sensation of low-back strain and my tibialis anterior muscles were working very hard.  Both sets of muscles will likely be sore within 24-36 hours (delayed onset muscle soreness).  I will periodically get out of my chair and walk around at work tomorrow. These muscles will recover and if I have a few more workouts like this I will not be sore in New Hampshire due to a task-specific increase in fitness. I'll be better prepared and this elevates the family safety factor - comprehensive fitness.

And yes, my heart rate data probably look weird for someone who knows what they are looking at.  I happen to have a cardiac pacemaker.*  It keeps my heart rate above 55 beats per minute (bpm) and increases it as needed for exercise - as well as modern technology can.  The point of showing you the heart rate data is to demonstrate how much you can increase your cardiovascular demand by walking. Walking can be used sensibly to reduce the impacts that would otherwise occur with running - while still getting great fitness benefits.  Some of my favorite Kinesiology experiments from the 1970s are Scandinavian studies that show substantial increases in VO2 max (the ability to use oxygen for work) due to a program of inclined treadmill walking with ski poles.  Very specific - very purposeful.
During my first 9 minute mile of running my HR was around 140 bpm.  When running or cycling, I rarely see my HR at the pacemaker's maximum setting of 160 bpm.  But after the first blue line on the graph, look at how the heart rate goes up with walking at 4 mph on a 14% incline.  It quickly went up to 160 bpm and stayed there as constantly as a machine would (straight lines in natural heart rate data are rare).  And wow, I learned something new about myself.  Once I got my heart rate up to 160 bpm by power walking - it stayed there even after I switched back to the easier 9-minute mile run on the level treadmill.

Bottom line - I am better staying fit when I attach it to a purpose and when the purpose relates to more people than just me.  I hope you can find the higher purpose in your fitness too.

*  The big dips in the HR data are where the monitor strap lost contact with my chest.

Thursday, October 15, 2015

Beetroot Juice Revisited...

Mazzo sets school record in Steeplechase.
This is a guest contribution from a former member of my research team named Melissa Mazzo.  She is smart and fast and currently pursuing Graduate Training in Integrative Physiology at the University of Colorado at Boulder.  Melissa is a high active who adheres to a healthy diet and lifestyle.  To me, that makes her delivery of related scientific information even more credible. - ck

What’s with all the fuss about beetroot juice?

You may have heard about it on the radio, read it in a magazine article, or seen an advertisement for the dark red drink marketed as the next popular “superfood.” But why did a simple root vegetable get so much hype?

With the spreading understanding that cardiovascular disease is the largest single contributor to global mortality, researchers are attempting to learn as much as possible about what factors contribute to heart disease and how cardiovascular health is affected throughout aging. A simple compound called nitric oxide has been found to play a large role in circulatory health, and has been the focus of recent scientific studies in labs around the world. This tiny substance—made up of just one molecule of oxygen and one of nitrogen— is what has the health industry humming about beetroots.

Beets are a plentiful source of nitrate, another small compound that, once ingested, is broken down into nitric oxide. Nitric oxide is then absorbed and circulated in your bloodstream, which is where the potential health benefits of beetroot juice may occur.

Nitric oxide is a substance that is normally produced by healthy, functioning blood vessels. It signals the muscle that surrounds the blood vessels to relax and dilate, which allows for increased blood flow and reduced blood pressure. In populations with hypertension, cardiovascular disease, peripheral arterial disease, and other circulatory health conditions, the blood vessels have become damaged and are unable to produce adequate amounts of nitric oxide.

By consuming foods that are rich in nitrate, the amount of nitric oxide available in the bloodstream can be increased, supplementing the amount of nitric oxide that the blood vessels can produce naturally. Researchers have shown that incorporating high-nitrate foods improves blood vessel dilation (vasodilation) and decreases blood pressure. In these studies, beetroot juice is often the dietary supplement of choice, and does indeed help to increase dilation of the blood vessels. However, beetroot juice is not the only source of nitrate that can help to improve blood vessel health through circulation of nitric oxide.

Beetroot juice is an easily accessible and practical source of nitrate, but many other fruits and vegetables contain substantial amounts of nitrate as well. Dark, leafy greens are excellent sources, and the greens of the beetroot plant even contain a higher concentration of Nitrate than the signature, red bulbous root. Another plant with a red-colored stem, the rhubarb plant, also has high concentrations of nitrate. Arugula, collard greens, spinach, mustard greens, and butter lettuce are all plentiful sources as well.

For anyone who isn’t a fan of drinking earthy-tasting beetroot juice, don’t give up on increased nitrate in your diet just yet—researchers have examined the effects of a simple DASH diet on nitrate intake and nitric oxide concentration in the blood. For those not familiar with the “Dietary Approaches to Stop Hypertension” (DASH) diet, it is a nutritional approach to lowering blood pressure and increasing cardiovascular health without medication.

It’s not a complex diet full of exclusions and banned foods, but instead emphasizes meals rich in fruits and vegetables (especially leafy greens), low-fat or non-fat dairy, lean sources of protein, and a moderate amount of grain products (preferably whole grain). This simple, balanced dietary recommendation has been shown to both increase nitrate consumption and levels of nitric oxide in the blood, showing that you don’t have to supplement with beetroot juice to experience the benefits of nitric oxide.

Even for those without high blood pressure, arterial disease or heart disease, increasing dietary intake of nitrate-rich foods will help to preserve the function of your blood vessels and entire circulatory system. When your circulatory system is healthy and functioning, the rest of the organs, tissues and cells in your body will be healthier as well. Blood vessels are like the lifeline of every cell, providing oxygenated blood and removing metabolic wastes like carbon dioxide from every cell in order to keep them functioning optimally.

Researchers have explored this effect and found that a diet higher in nitrate does indeed have a large impact on improving blood flow in the brain.

Chronic decreased blood flow in the brain tends to occur more naturally as we age, and has been linked to cognitive decline, dementia, and the degradation of brain cells. In contrast, preserving ample blood flow through proper blood vessel dilation helps to ensure the health of brain tissue and to preserve cognitive functioning. Increasing dietary nitrate consumption to increase blood flow allows more oxygen to be transported in the blood and delivered to brain cells to prevent damage that accumulates with age.

This increased availability of oxygen is vitally important in other tissues as well. Increased nitric oxide in the blood has been shown to improve exercise capacity in large part due to the increase in oxygenated blood flow to skeletal muscle. However, increases in exercise capability aren’t quite that simple; nitrate isn’t a “magical” supplement that will cut a minute off your 5k time or allow you to instantly ride for twice as long on your road bicycle. The effect of nitric oxide on exercise performance is seen primarily in populations with sub-optimally functioning blood vessels, like those with heart disease, atherosclerosis, or even anyone leading an exceedingly sedentary life.

In other words, supplementing with nitrate to increase blood-nitric oxide will only improve vasodilation (and therefore blood flow and exercise capacity) in anyone whose blood vessels cannot individually produce enough nitric oxide to suitably vasodilate the blood vessels.

This selective benefit of additional nitric oxide makes sense, as researchers have also studied the correlation between increased fitness and improved ability of blood vessels to produce nitric oxide. Their findings indicate that changes in diet (emphasizing fruits and vegetables high in nitrate; beetroot juice supplementation) are not the only ways to increase blood vessel dilation ability via nitric oxide. As you may now have realized, exercise helps to improve the health and function of blood vessels as well, stimulating the cells in your blood vessels to produce more nitric oxide naturally. Exercise, in addition to improved diet, is another guaranteed way to reduce hypertension and risk of heart disease.

Don’t forget, cardiovascular health is cumulative; the slow-but-steady breakdown of your circulatory system is occurring constantly, so you shouldn’t wait until your arteries are showing signs of damage to start changing your health habits. The earlier a healthy, balanced diet and regular exercise become habitual in your life, the more optimally your circulatory system will function throughout aging, keeping the rest of the organs and tissues in your body in good health as well.

Important points to take away:

Beetroot juice contains a high amount of Nitrate, which can also be found in fruits and vegetables, especially dark leafy greens.

Nitrate breaks down into Nitric Oxide in your body, which your blood vessels naturally produce when they’re healthy.

Increasing the amount of Nitric Oxide circulating in your bloodstream (by eating foods high in Nitrate) can help to…
  • Improve vasodilation and lower blood pressure
  • Improve blood flow to the brain and improve cognitive health
  • Increase exercise tolerance

Exercise improves the ability of your blood vessels to secrete Nitric Oxide themselves, relying less on dietary consumption of Nitrate

 A healthy, balanced diet and habitual physical activity can help to improve and preserve your cardiovascular health, leading to a healthier you all around!

Share your new knowledge with friends and family! 

Tuesday, September 15, 2015

High Intensity Interval Training - Not so fast.

If you follow this blog, you know that we use high speed exercise training  (see SpeedGeezerto jumpstart the nervous system in people who are suffering from slowness (people with Parkinson's Disease and older adults).  This post is to clarify the difference between our speedwork approach and something called High Intensity Interval Training (HIIT), which is quite popular right now in the fitness industry and receiving much attention in physiological research.  I will first provide you with some information about HIIT and then return to the focus of our speed-based exercise strategy.

The American College of Sports Medicine (ACSM) provides a public brochure about HIIT here: 

The following two bullets are taken directly from the brochure:
  • Definition: High intensity interval training sessions are commonly called HIIT workouts. This type of training involves repeated bouts of high intensity effort followed by varied recovery times.  The intense work periods may range from 5 seconds to 8 minutes long, and are performed at 80% to 95% of a person’s estimated maximal heart rate, the maximum number of times your heart will beat in a minute without overexerting yourself. The recovery periods may last equally as long as the work periods and are usually performed at 40% to 50% of a person’s estimated maximal heart rate. The workout continues with the alternating work and relief periods totaling 20 to 60 minutes.
  • What are the Safety Concerns with HIIT Training?  Persons who have been living rather sedentary lifestyles or periods of physical inactivity may have an increased coronary disease risk to high intensity exercise. Family history, cigarette smoking, hypertension, diabetes (or pre-diabetes), abnormal cholesterol levels and obesity will increase this risk. Medical clearance from a physician may be an appropriate safety measure for anyone with these conditions before staring HIIT or any exercise training. Prior to beginning HIIT training a person is encouraged to establish a foundational level of fitness. This foundation is sometimes referred to as a “base fitness level”. A base fitness level is consistent aerobic training (3 to 5 times a week for 20 to 60 min per session at a somewhat hard intensity) for several weeks that produces muscular adaptations, which improve oxygen transport to the muscles. Establishing appropriate exercise form and muscle strength are important before engaging in regular HIIT to reduce the risk of musculoskeletal injury. 
The members of our research team in the College of Health Sciences would love to see your functional abilities and cardiovascular health improve to the level at which you can safely practice HIIT, but high intensity exercise comes with risk factors that should be considered carefully. Our speedwork program is designed such that high speed movements are are paired with low resistance.  This means low force, light weights and low effort settings on bicycles and other equipment.  We typically set the bicycles on effort levels of "0" or "1".  We use 20-second intervals at high speeds but we watch your heart rate and blood pressure so that we can adjust the recovery time to keep your intensity in a moderate range.  If you wish to someday practice HIIT, a program like SpeedGeezer might be a sensible first step to get the nervous system going.  See the section in the ACSM brochure on HIIT called "The First Step" for more guidance.

Monday, July 6, 2015

PD: Bob's Comeback

In this post, we share Bob's success with an individualized training program.  Every person has a unique exercise history and is affected by Parkinson's disease (PD) differently, with a different set of risk factors and exercise preferences.  This is why individual exercise prescription is so important.

In a recent post, I stated that the typical recommendation 'You should exercise.' is not enough. It lacks the guidance that enables new exercise behaviors.  In this post we use Bob's program as an example of an individualized training program and provide the rationale for its design.  In an upcoming post, we will explain the basic principles of designing a training program: specificity, overload, and individual differences. They are applied here.

We hope that you can use information like this to design an exercise program for yourself, your client or your patient.  You might want to talk with your doctor before beginning a new exercise program and you can see this ACSM Comment on the relevant considerations. You should also know that we did not 'fix Bob' all by ourselves.  Bob has a team that he really values including a movement disorders specialist at UPENN and a Physical Therapist who specializes in PD.  

Who is Bob?  Bob is a 75 year old man.  He was diagnosed with PD about 5 years ago.  Around Thanksgiving (it is now June) he was falling all the time and experiencing a downward spiral.  We know Bob from the PD support groups in our community and my colleagues at the Parkinson's Clinic told us that he didn't look so good.  So we invited him to the lab to see if we could help.

Q. Bob, why did you come to our lab?

Q. PD has several symptoms which affect people differently.  What symptom affects you the most?

Lab Notes: When Bob arrived at the lab, we walked in from the parking lot together.  His difficulty was obvious.  He was freezing in place, especially at doorways and if you stood too close to him. He looked like he might tip backwards and fall at any moment.  He had bruises and cuts on his arms and head from recent falls and his speech and/or cognition were not as fluid compared to what I remembered. After discussing his health history, we identified a set of priorities to address.
  1. Falling that seemed mostly related to his symptom of freezing in place
  2. Poor balance - not even good enough to begin balance exercises
  3. Poor upper body strength would not allow him to get up after a fall
  4. Low confidence in his abilities and behavioral withdrawal from activities of daily living.  He would carry his phone into the basement so that he could call someone upstairs if he fell. 
  5. We also noted that he had received treatment for an orthopedic issue with his shoulder and we would be very careful with this in any related exercises.


First Speedwork: Use high speed bicycling to speed up his nervous system and see if the SpeedGeezer program could disrupt his pattern of freezing in place.  See our companion post on SpeedGeezer Training including downloadable training sheets at the bottom.

Then Functional Conditioning: Using a suspension training system, medicine balls, a homemade T-bar weight, table pushups and creativity, we sought to design a program based on twice-weekly 45-minute workouts that would improve his strength, balance and muscular endurance.


SpeedGeezer:  Bob began with this high-speed interval cycling program because he wasn't in good enough condition to begin the functional strength and conditioning exercises. His fall risk was high. Bob did about 6 weeks of twice-weekly SpeedGeezer sessions (30 minutes each).

Right: Bob and the lab team multitasking: Graduate and undergraduate students supervised Bob's workout while we all watched a podcast about exercise from the Michael J. Fox Foundation (Link Here).  The students are gaining first hand experience working with people who have Parkinson's disease.  Many of our students are aspiring health care professionals and researchers so they value these opportunities very highly.  Thanks for teaching our students, Bob!

After six weeks of high speed cycling, Bob's freezing was almost entirely gone and he was considered ready for the next phase of training.  The really fun part. 

"Around Thanksgiving, I was falling all the time and on Saint Patrick's Day I walked a 5K." Bob Klopfenstein

Functional Conditioning Exercises:  Bob worked directly with an experienced personal trainer during two 45-minute sessions each week for six weeks.  His adherence to the program was perfect and the only challenging day he had was one on which he did not have a good breakfast. Each session began with a few minutes of warm-up on the bicycle followed by two sets of about 6 different exercises.  The training space is free of tripping hazards and all extraneous equipment is stored in cabinets to prevent a cluttered environment from stimulating episodes of freezing.  Bob listens to his favorite station on Pandora while exercising. 

Q. Can you tell us about some of the equipment you used and the exercises?


Return to this blog again for a list of specific exercises and equipment used .

Q.  Applying overload principle, we tried to improve your balance by increasing the complexity of the exercises.  Did this seem effective to you?  

Lab Notes: In Bob's program, the early weeks required him to learn several new and relatively complex exercises. All exercises required Bob to activate the core muscles in his trunk and also involved postural control.  Simply lifting a weighted yellow ball to eye level requires several postural muscles to be activated first, or he would fall forward.  This is coordination. Not only were the exercises complex but we also began to complicate their sequence.  At first he would do 2 sets of an exercise and then move on to another exercise, with plenty of rest in between.  By the end of the program, these 'straight sets' became 'super sets' in which he would quickly alternate between two different exercises and the rest periods were minimal. Bob had to remember how to do the exercises and switch between them frequently, not only overloading the physical and cognitive complexity, but also overloading the muscles to increase endurance.

Assessment and Self-Efficacy Best practices in training include periodic assessment of a person's function.  This is an effective tool for motivation and program revisions.  A person's belief in their own abilities is just as important as the abilities themselves.  We can improve Bob's balance, but he won't try to cut his lawn again unless he also has confidence in his balance.

All of Bob's measures improved, especially balance and muscle endurance.  This video is part of a meeting in which Bob and I had discussed some results.  We enable our participants by teaching them the purpose of the exercises and the meaning of the measures.  In addition to discussing functional tests, we also summarize their attendance record and show how much work they have done.  For a 75 year old person with Parkinson's disease, preventing further decline is meaningful.  Achieving improvements is fantastic!

Q.  Bob, our ability to try this new equipment and test new training strategies was possible due to generous support from Shake It Off, Inc. and their friends.  Do you have anything you would like to say to them? 

Monday, June 1, 2015

What kind of bike?

Some of our research participants have asked us questions about buying an exercise bike for their home.  Perhaps you are looking for a recumbent bike like the ones used in our SpeedGeezer Training.  Before I share the details about the bikes we use, I'd like you to be aware of a few things.

The benefits of speed-work are not necessarily limited to a bicycle training.  Boxing, pool-based 'aerobic' classes and dance can all have speed-work in them.  An upright bicycle will work just as well as a recumbent bicycle if that is your preference. Also consider that there may be delivery charges and assembly charges when you get your bike. See also: Consumer Reports Exercise Bike Buyer's Guide.

Our Exercise Intervention Lab at the STAR campus has two types of bikes:

Semi-Commercial Grade:  Compared to home use, these are stronger, have better padding, and are generally heavier.  Ours were purchased from Leisure Fitness.  This purchase goes back to 2012 and we bought two SPIRIT XBR95 bikes, with rubber mats to protect the bike and the flooring.  The bikes have held up very well and our exercise participants seem to be comfortable using them. We did not consider Full-Commercial Grade at that time because we do not have the heavy flow of exercisers.

Home Fitness Grade:  One bike was bought from Dick's Sporting Goods at considerably less cost.  This was also around 2012 and we bought the PRO-FORM 315 CSX.  This bike has held up well but it shakes just a little more than the others during intervals of low resistance speed-work.  Ideally, the shaking should be minimized as the rider learns to make their pedaling more smooth.  If you think you will need to move the bike around frequently in your home (out of the way), these are generally lighter.

Our considerations:

1.  RPM display:  We like to use revolutions per minute (RPM) as feedback to the person exercising.  Most bikes will display this on the computer console.  If the bike also displays power in Watts, this is a bonus.  Keep in mind that we are keeping records of these values for scientific purposes - you might not need them.

2.  Step-through not over: Sit on the different bikes and try them.  Is the bike easy to mount?  Look for a wide open step-through area between the seat and the front console.  Compared to the bike at the top of this page, the bike to the right has no step-through area.  With elevated fall risk, we do not want our exercisers to have to step over a big piece of the bike to sit on it.   

3.  Big feet and heel contact: Some of our participants with larger feet have difficulty keeping their heels from hitting the central housing near the pedals and cranks.  You might try pedaling slow and fast on a bike to see if this will be a problem for you.  Ideally, you would want your feet to be aligned straighter so this does not happen.  This problem almost always went away after a few exercise sessions.

4.  Good toe straps: Sometimes with Parkinson's disease, the pedaling motion isn't as smooth as it could be and some people have had trouble keeping their feet on the pedals, even with the straps.  On one bike we replaced the factory pedals with bike shop pedals and toe straps.  We have even taped the feet in place on the pedals before.  Anything to make the exercise possible.

For our exercise participants who are older adults and people with Parkinson's disease, we like the recumbent exercise bicycle.  There is lower fall risk compared to the upright bicycle.  Don't buy a bike you won't use.  If you really want prove that you value your health, replace the couch in your living room with a piece of exercise equipment. 

Monday, May 4, 2015

SpeedGeezer Training

“SpeedGeezer” is a bicycle based exercise strategy designed to improve physical and mental speed in people who are slowing down like people with Parkinson’s disease (PD) and many older adults.  It is based on both published and ongoing scientific experiments from our labThe information that follows is part evidence-based (SpeedGeezer1, SpeedGeezer2) and part expert opinion.  SpeedGeezer may not be suitable for everyone and you don't have to be a Geezer to do SpeedGeezerAlways take your risk assessment and management seriously when beginning a new exercise program.

What is SpeedGeezer?
  • An exercise program to jumpstart the nervous system!
  • One SpeedGeezer session is 30-minutes long.
  • We use a stationary recumbent bicycle but other modes of exercise may work too. 
  • Warm up: You begin by pedaling at a preferred cadence (RPM) against the bike’s lowest resistance setting.  YES(!), this means setting 1 even though it might feel annoying and unproductive to some of you.  Work on pedaling smoothly.  Improve your coordination.
  • Add intervals: After a 5 minute warm-up at your preferred pedaling cadence (PPC), you will begin to do 15-second intervals of pedaling at a fast cadence (Fast Pedaling Cadence = FPC).  Do 20 intervals.  You decide what “fast” is.  Between each 15-second interval you pedal at your PPC for 45-seconds (recovery).  
  • Cool Down: The final (20th) FPC interval is followed by 5 minutes of cool-down at PPC. 
  • You can modify these parameters for your level of conditioning or risk.

Why do this? Every system in the body benefits from exercise.  In both older adults and people with PD, early results show improvements in walking speed and agility. And even though the bicycle exercise involves the legs, we see improvements in the speed of the arms and even in the 9-hole peg test of hand dexterity.  This suggests that the exercise is improving the brain.  And that is great!

Why speed?  
  1. Reducing fall risk: When you slip or trip, you need your nervous system to respond very quickly.  It needs to turn your muscles ON and OFF in the right sequence to restore your balance. 
  2. Anti-Bradykinesia: This symptom of PD involves slowing of movement.  Like any athlete who wants to get faster - you have to train faster.

Why low resistance?
  1. High neural activation: The high speeds allowed by low resistance are the perfect way to cause high neural activation in the brain and spinal cord.
  2.  Risk management: You are beginning a new exercise program or you are adding speedwork to an existing program. Low resistance reduces the strain on the heart, muscles and joints.  We want you to be safe and we don’t want soreness to keep you from exercising.
Why a recumbent bike?  More risk management here.  Recumbent bikes are easier to get on and off of, especially if they have a big open step-through area in front of the seat.  Knock on wood - nobody has fallen off of our recumbent bikes.  The back support also helps if people struggle with their posture.  These bikes are also relatively comfortable to sit on.

What should my FPC and PPC be?  Some people enter our study pedaling at PPC/FPC of 20/30 RPMs.  They typically finish the 12 sessions with a substantial improvement.  Others enter with PPC/FPC of 50/70 or even higher 60/110.  There is a lot of variability here but most people do improve their mobility whether they enter the study fast or slow. You will need to monitor your speed on the bike using whatever information it provides.  Monitoring revolutions per minute (RPM) is most convenient but you can also use speed in miles per hour (mph).  Just keep the resistance low! 

Individualize your session.  During our supervised training sessions we monitor blood pressure and heart rate.  If cardiovascular strain gets too high, we reduce the fast pedaling cadence or increase the recovery between intervals.  See this link on monitoring your heart rate. Early in the 12-session program some SpeedGeezer sessions are shorter (15 rather than 30 minutes) and the participant might only do a few intervals.  On the higher end, someone might graduate from the lower resistance to a higher one - as long as they can still pedal fast.  Some former research volunteers have taken their new knowledge home and created a treadmill version of SpeedGeezer.  Awesome!

When will it start working? Based on participant feedback, the noticeable benefits seem to begin after about four sessions.  Functional tests show improved mobility after 12 sessions (3X/week for 4 weeks or 2X/week for 6 weeks). There are some people who do not notice or report improvements.  It is also possible that exercise might be slowing the disease progression.

How often should I do it? The answer to this is also a matter of priorities and life balance.  Some former research subjects do an abbreviated SG workout almost every day when possible.  It helps to gets them going.  As mentioned above, we are observing good results with 2X per week and 3X per weekSpeed might not be the only domain of fitness you are working on so we want this speedwork to fit in with your other exercise rather than replace it

What if I can't pedal fast?  SpeedGeezer is designed for people who are in the early stages of PD or have moderate symptoms.  In more advanced PD you may have real difficulty pedaling a bike voluntarily.  This is why some people consider using a bike that provides mechanical assistance (like the Theracycle). 

Our research on Exercise for people with Parkinson’s disease is made possible by generous support, from Shake It Off, Inc. See this UDaily Article about our Partnership.I will periodically revise my posts based on on community comments so please check back again.  What do you want to know?  How do you get your speedwork?

Training Sheets are available at the SpeedGeezer Resources Page.

Wednesday, April 1, 2015

'You should exercise' is NOT enough...

Dr. Hans Kraus (1905-1995) is recognized by some as the father of Sports Medicine in the US and by others as a world class rock climber.  His highly active and adventurous life informed his approach to medicine in a way that set him apart from other physicians. He used exercise as a therapeutic modality.  He believed immobilization was over-used and he avoided surgery at all costs.  He got people moving!  He used a sliding fee scale to care for people without means as well as many celebrities including Katherine Hepburn.  He was President John F. Kennedy's secret doctor - a position that he did not seek but accepted as a service to his country.

Today you might find the phrase 'Exercise is Medicine' in discussions of diabetes, high blood pressure, neurodegenerative diseases, chronic kidney disease, stroke and many other conditions.  But what is the prescription?  In his biography Into the Unknown by Susan E.B. Schwartz, this is what Dr. Kraus had to say about prescribing exercise. 

"Prescribing therapeutic exercise is an art, and exercises are like medicine.  You wouldn't go to a drugstore with a prescription that simply read 'medicine'.  You'd of course expect your prescription to be fully described and specific about what you're going to take, how much, and when.  It's the same with therapeutic exercise... I wouldn't give everyone the same exercises any more than another doctor would give all his patients the same medicine, whether their problem was a cold, broken leg, or heart condition."  - Dr. Hans Kraus

This quote from Dr. Kraus is related to our mission in the Exercise Neuroscience Lab at UD.  Whether you have Parkinson's disease or find yourself slowing down with age, you are probably aware that you should exercise. We are working to understand and to help you receive the best exercise prescriptions, whether they are for increased speed, balance, strength or a better mood.  We want to help you get started with exercise, to enhance your current exercise strategies, and equip you with knowledge and tools to continue on your own.  Borrowing from rock climbing vernacular, Dr. Hans Kraus established a route for us and we are following his lead.

Follow this blog to find more information about exercise strategies for Parkinson's disease and be sure to friend our community partner, Shake It Off 4 PD on Facebook.

A sample prescription involving a practical program for speedwork is described here.
Parkinson's Exercise Essentials Video from the Davis Phinney Foundation here.

Be well.