Exercise to Fight Stress and Parkinson's Disease

 

Guest Author Rebecca Daniels

In healthy cells, there is a balance between the production of free radicals called reactive oxygen species (ROS) and the antioxidants that neutralize them. Oxidative stress occurs when there is an increase in the number of ROS compared to antioxidants. Psychological stress can contribute to these imbalances. Even acute bouts of high stress can negatively affect brain health, as the resulting increase in oxidative stress causes a host of inflammatory processes within neurons (1).

These changes are similar to some of the issues that already occur with Parkinson’s disease, where there is an increase in oxidative stress in neurons that produce dopamine in the substantia nigra. Additionally, damaged mitochondria within these neurons don’t get tagged correctly to be discarded, leading to further increases in oxidative stress, inflammation and damage. Compounding the effects of stress with the processes of Parkinson’s disease can lead to a toxic environment and degeneration within key parts of the brain (2).

This all sounds very bad, but the good news is we have evidence there is something you can do about it. Exercise is a treatment that reverses many of these negative side effects and can be protective in its own right. In animal models of PD, aerobic exercise increases antioxidant production within brain cells, decreases ROS, and increases cell turnover, which decreases inflammation and oxidative stress (3,4). Additionally, exercise encourages the release of brain-derived neurotrophic factor (BDNF). In animal models of PD, BDNF production due to aerobic exercise was shown to preserve dopamine-producing neurons in the basal ganglia and even induce neuroregeneration, which resulted in improved motor performance (3, 4).

So now that we know another reason why exercise is good for you, you might be wondering what type and duration of exercise will get you the benefits. An animal model of PD found that 30 minutes of treadmill exercise daily for two weeks was an effective treatment to reduce oxidative stress (4). Additionally in humans, researchers found that eight weeks of resistance training twice per week (3 sets of 5-8 repetitions on the leg press, seated leg curl and calf press) resulted in a ~15% decrease in blood biomarkers of oxidative stress in people with mild to moderate PD compared to a 14% increase seen in the control group (5). Another study found that eight weeks of 40 minutes of moderate-intensity interval cycling three times per week resulted in an increase in blood levels of BDNF in people with mild to moderate PD and improved scores in the Unified Parkinson’s Disease Rating Scale compared to pre-training (6). How can you act on this information? First and foremost, find an accessible form of exercise that you enjoy, and is sustainable for you. This could also be as simple as going for a walk when you feel stressed. Try to find a type of exercise you can perform for 30-40 minutes with a 5-10 minute warm up and cool down three times per week (7).

Now more than ever is a time to prioritize your self-care. Life is stressful, especially while also managing difficult disease. One of the best ways we can support our body in times of stress is engaging in regular movement. Happy exercising!

References

1.       Gerecke KM, Kolobova A, Allen S, Fawer JL. Exercise protects against chronic restraint stress-induced oxidative stress in the cortex and hippocampus. Brain Res. 2013; 1509:66-78. https://pubmed.ncbi.nlm.nih.gov/23499928/

2.       Dias V, Junn E, Mouradian MM. The role of oxidative stress in Parkinson’s disease. J Parkinsons Dis. 2013; 3(4):461-91. https://www.mdpi.com/2076-3921/9/7/597

3.       Palasz E, Wysocka A, Gasiorowska A, Chalimoniuk M, Niewiadomski W, Niewiadomska G. BDNF as a promising therapeutic agent in Parkinson’s disease. Int J Mol Sci. 2020; 21(2):1170. https://pubmed.ncbi.nlm.nih.gov/32050617/

4.       Oliveira da Costa R, Gadelja-Filho CVJ, Moura da Costa AE et al. The treadmill exercise protects against dopaminergic neuron loss and brain oxidative stress in Parkinsonian rats. Oxid Med Cell Longev. 2017; 2138169. https://pubmed.ncbi.nlm.nih.gov/28713483/

5.       Bloomer RJ, Schilling BK, Karlage RE, Ledoux MS, Pfeiffer RF, Callegari J. Effect of resistance training on blood oxidative stress in Parkinson disease. Med. Sci. Sports Exerc. 2008; 40(8): 1385–1389. https://pubmed.ncbi.nlm.nih.gov/18614956/

6.       Zoladz JA, Majerczak J, Zeligowska E, Mencel J, Jaskolski A, Jaskolska A, Marusiak J. Moderate-intesity interval training increases serum brain-derived neurotrophic factor level and decreases inflammation in Parkinson’s disease patients. J Physiol Pharmacol. 2014; 65(3):441-8. https://pubmed.ncbi.nlm.nih.gov/24930517/

7.       Alberts JL, Rosenfeldt AB. The universal prescription for Parkinson’s disease: Exercise. J Parkinsons Dis. 2020; 10(s1):S21-S27. https://pubmed.ncbi.nlm.nih.gov/32925109/

Inspirations

We all have different challenges to overcome when we try to improve our mobility and quality of life.  Overcoming these challenges is especially hard when motivation is low.  I am going to use this post to assemble some inspirational materials that I have found appealing.  I hope that these materials help your progress.  Exercise will only work if you do it.

Health is the complete state of mental, physical and social well-being and not merely the absence of disease or infirmity.  W.H.O. definition of health.

Be well.
--ck

Sleep, Learning, Brain Waste and PD

Sleep matters whether or not you have Parkinson's Disease.

ONE:  If you were to practice a complex motor skill like a golf swing (Scott D!), your ability to learn and retain that skill is enhanced considerably by sleep.  That is known.  And the research not only supports the right amount of sleep but also the importance of sleep quality (time in key stages).  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527676/).  Further, the importance of sleep for making a new skill relatively permanent is also true for non-motor tasks (for example: https://www.ncbi.nlm.nih.gov/pubmed/15979164). 

TWO:  The knowledge and theories about sleep are fascinating but outside my area of expertise.  I want you to watch this TED talk and consider for yourself how this understanding of sleep relates to helping your brain while it struggles with Parkinson's disease.  Sleep is critical for brain health and this does not change with PD. TED Talk: Jeff Iliff: One more reason to get a good night's sleep.

Have a restful night.  --ck

PaddleBoard & Balance Training

This isn't a scientific post.  I just like this story from SUPM (Stand Up Paddle Mag - UK) about Stan W., who found ways to keep doing the things he enjoys despite having Parkinson's disease.  Perseverance and balance training are visible in this story.  Not all of your exercise needs to be done in the Gym!  See the full story at this link and read the material below to learn more about the progressive overload principle in balance training.



Progressive Overload is a training principle in which you progressively increase the challenges to your body over time.  Doing the same exercise routine every day is good for maintenance but not effective for improvement.

Progressive overload in strength training easy to understand.  To increase the demands on your nervous system and muscles, you lift heavier weights.  What about Balance Training?  To overload the system you would do exercises that are progressively less stable (harder to balance).  For example, once you can sand on one leg for a good amount of time, try doing your upper body exercises (like arm curls) while standing on one leg.  Start with lighter weights.  Or try bouncing a tennis ball against a wall and catching it while standing on one leg.  The idea is that to improve your balance, you need to do increasingly complex activities.

Another training principle is Individual Differences.  Not all of you will be able to do these exercises.  Some might even look fairly advanced for people with Parkinson's disease but this is not always the case.  In our research program, we work with several people who could perform some of these advanced exercises or progressively train their bodies for these new abilities.  They are within reach for many people but you have to know yourself, your limitations and a safe starting point.

Look at some of the exercises below and see different levels of challenge.

This picture shows a progression of seated exercises.  This will strengthen leg muscles and improve postural control and balance.

Here is the Tennis Ball example.

Now the ball is being thrown to the side (laterally) and the ball is a weighted medicine ball.  The increased weight makes the task more challenging.

Next Step: Standing on an unstable surface.  This device is called a Bosu Balance Trainer or Bosu Ball.  There are other brands but Bosu is probably the most widely known.

This is the "I wish" picture.  Maybe you can do this.  I cannot...  Yet.

Good luck with your training!

PhillyRabbitRun:4.15.17

Philly Rabbit Run: 5K and 1 Mile Walk

April 15, 2017

Join Our Team: BlueHen-SpeedGeezer

First, I wish to disclose a conflict of interest in promoting this event.  Shake It Off, Inc. has been a generous supporter of our research program in the College of Health Sciences at the University of Delaware.  With your support and their support, we have been able to grow our research program on the topic of exercise prescription for people with Parkinson’s disease.  Your donations support personnel for our experimental exercise programs, laboratory equipment, and student travel to conferences where we present our work.  We have published two studies on the benefits of our ‘SpeedGeezer’ program in which we use high speed bicycling intervals to re-train the brain for faster physical function. The first study supports the safety of the exercise program and we found that just one session of exercise can improve two measures of mobility.  The second study (accepted and In press) demonstrated that the six-week SpeedGeezer program can improve many measures of mobility by about 15%.

Help us do more!  We typically have eight people participating in our exercise programs at any time and we want to be able to do more.  We want to be able to train more people and test more symptoms. So, I would love the amazing people at Shake It Off, Inc. to see a strong UD presence at the Philly Rabbit Run as racers, walkers, volunteers and donors.  I have created a team called: BlueHens-SpeedGeezer.  Please race or donate with us!

The Race Website is here:  http://www.phillyrabbitrun.com/ and you will be able to find all the necessary information about registering to run or walk (Join our team: BlueHens-SpeedGeezer) and/or how to donate to the cause.   Here is a shortcut directly to team BlueHens-SpeedGeezer for donation: https://runsignup.com/Race/40441/Donate/aAstckGjAZq2MvDx

Dave Mills, The Optimal Balance

I am happy to have a guest post to Exercise Neuroscience @ UD.  Megan Gilmore is a Senior Exercise Science major at the University of Delaware and the type of student who makes my job more meaningful.  Enjoy.

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This is Dave. Dave was diagnosed with Multiple Sclerosis (MS) in 1973 at just 24 years old. After years of questioning his diagnosis, Dave saw another doctor who concluded that Dave actually has Spinocerebellar Ataxia in 1992. As his condition has progressed since then, he has become 98% dependent on his wheelchair. This hasn’t stopped Dave from getting to the YMCA to swim 3-6 times weekly, covering 1-1.5 miles each session. In order to maintain his physical fitness, Dave needs to display strong aspects of social and mental fitness, while arranging rides through his transportation service and keeping a positive attitude to continue exercising, despite the effort it may take to get there. The majority of us are perfectly capable of walking to a local gym, using the exercise equipment of choice, and getting back to our lives within an hour, yet we choose to let our physical fitness take the back burner. Does it take a debilitating event or disease to appreciate the bodies we are given?

Spinocerebellar Ataxia (SCA) is a condition characterized by progressive problems with movement. People with this condition initially experience problems with coordination and balance (ataxia). People with SCA typically survive 10 to 20 years after symptoms first appear. Today in 2015, Dave has been diagnosed with a condition degenerating his ability to move for over 40 years. Watching Dave swim 54 laps in the pool before 10 am on a Saturday morning was moving to say the least. He refuses to receive help from any person or device to get into or out of the pool and moves from one end to the other using mainly his left arm. After getting out of the pool, he said to me, “My right arm doesn’t move too well does it? But it works enough. Everything has its role.” Dave doesn’t take anything for granted and feels fortunate to have any ability in the arm that is lacking the mobility it once had. Comprehensive fitness can certainly be brought back to Dave’s quote. Social, mental, and physical fitness have to work together, each playing  a role, for a person to embody an overall high level of fitness. He utilizes his body as a unit, where everything has a part to play, big or small.

Dave was hospitalized on two separate occasions this May and June for a serious case of pneumonia, adding up to a total of six weeks in the hospital. In neither of these hospital visits did Dave receive a shower. He watched as his able-bodied roommates got up to take showers daily, but this simple daily function would be considered more of a luxury or a treatment for Dave, as the nurses or aides would have to step in and initiate the process. Dave explained that the staff appeared to be too busy to give him a shower, as they were dealing with more “critical” events with other patients.

It shouldn’t take losing mobility for people to realize that there needs to be change. It is education and awareness that can facilitate change in the attitudes people have towards people with limited mobility. Rather than asking himself, “why me,” Dave maintains a positive attitude as he realizes that his disability is a reality that people face. Hopefully this makes you think. As a 22 year old, I know that I am not guaranteed my health. Maintaining comprehensive fitness is the strongest protective measure to combat challenges and ensure resilience. Any day my body could fail me, and I hope I would choose to live like Dave.

REFERENCE:
“SCA1.” Genetics Home Reference. 30 Nov. 2015.   Web. 1 Dec. 2015.

Q. Why does exercise help Bob's PD?

Because he does it!  The video below shows Bob's legs during one of the high speed bicycling intervals in our SpeedGeezer exercise program. SpeedGeezer is described in this post with training worksheets that you can download, print and use.  Bob overcomes his challenges with PD and does this 30 minute workout 2 times per week.  Listen - when he says '51' he has hit 151 revolutions per minute (RPM).

(See this post about Bob's Comeback.)

An exercise habit or physically active lifestyle is hard to develop and maintain, even for people who do not have the added challenges of Parkinson's disease.  In my research program, we seek the best exercise prescriptions for your health and performance.  But there is a more important issue that often gets in the way of this information becoming useful.  Motivation!

You have to want the benefits of exercise enough to overcome anything that you identify as a reason not to exercise.  And this is a hard thing for me to suggest because I don't have Parkinson's disease and couldn't possibly understand how hard this is.  My perspective might also be different from yours in another meaningful way.  I grew up as a high active and love the feeling I get during and after a good workout.  In fact, when two days pass without a good dose of physical activity, I easily recognize the consequences; physically, mentally and sometimes socially (the three overlapping domains of health).

Below are three links to resources that might help you to get started.  Starting a new exercise program requires more than knowing what exercises to do - it requires you to train your motivation as well.

• Parkinsons Exercise Essentials: Getting Started, Staying Motivated, Seeing Results (DVD).  This is a 1min 57s trailer for a DVD you can request from the Phinney Foundation HERE.
• Parkinson'sExerciseEssentials: Wendy.  Listen to Wendy's story (4 min 53 s).
• ACSM Finding your motivation for exercise.  This is a pdf brochure that you can download.

Exercise only works if you do it so take action now.  Like Wendy above, list reasons why you want to exercise - or why you want to improve your mobility and health.  Then set one really easy goal. Achieve that goal.  Elevate your goal and repeat.  Little by little, grow an exercise habit into your life.  We don't have to re-invent ourselves all at once to make this work.  We just have to keep nudging things in the right direction.  One thing at a time.

Be well.   --ck

Wii Speed Slice: Samurai with PD

The Active Video Game Market has provided many awesome tools for improving your function and fitness. Several games are ideal for fighting Parkinson's disease or age-related slowing (if your partner is a geezer).

I cannot recommend the best game for you without knowing more about you, your symptoms, fitness status and goals but I can explain the features of some of my favorite game options.  Here, I am reviewing a game in the Wii Sports Resort called Speed Slice.

Speed Slice Video: This video shows how to get to the game in Wii and what it looks like.

Precautions:

Fall Risk & Balance Training:  Especially if you have balance impairments, you should make sure that you have created a safe exercise environment.  Remove all tripping hazards from your exercise space and place a stable chair or other piece of furniture nearby so that you can grasp it when needed. You might also consider whether it is best for you to play this game while seated or standing -- or maybe while standing on one leg if you seek Samurai status. Challenging your stability is the way to improve your balance but you need to do so safely.

Shoulder Stability and Getting Carried Away:  I learned this the hard way.  This game is fun and sometimes I get competitive.  The day after I explored this game I had really sore shoulders.  Ease into this game to prevent soreness and injury.

You don't have to walk towards the TV screen to do well:  Some people get so involved that they approach the screen without knowing it.  There are legitimate reasons to attack your television with a sword but this is not one of them.

Why do I recommend this game?  

1. It is speed based:  This game directly attacks some of the symptoms of Parkinson's disease and age-related slowing.  It is a tool to improve your a) ability to make fast decisions, b) reaction time, c) movement speed.  These abilities are important in driving a car safely, among other things.
2. It trains your balance:  You can enjoy this game while sitting or standing and you can creatively modify it to challenge your balance.  The slicing movement requires a coordianteed movement  of your arms and trunk and your whole body needs to be prepared for these fast movements to prevent a fall.  Other ways to train these higher level abilities include boxing, partner dancing, throwing/catching, and exercise with battle ropes and other training aids.

Tips:

1. Ease into this game slowly.  Try it briefly on day one and then increase your vigor as long as you don't experience pain or soreness.
2. Keep track of your scores using the Wii game system or a notebook and pencil.  Keep it simple.
3. Study the ways of the Samurai and pursue perfection.  Pay attention to a stable foundation and maintain your best posture.  Work on two- handed slices.  Use the abdominal breathing that you learned in Tai Chi classes.
4. Put Speed Slice on your calendar with recovery days in between at first.  Consider using the game in the morning and see if it awakens your nervous system.
5. Don't get discouraged - If this game is too challenging for you, continue to seek ideas from your health care providers and fitness professionals.

Find the Scientific Support Here:  Link to PubMed Search

Side Effects of Exercise for the Nervous System

My blog is called Exercise Neuroscience @ UD and it is about how older adults and people with Parkinson's disease can use exercise to jumpstart their nervous system and improve their mobility. Even though the exercises I recommend are designed to improve nervous system function, there are meaningful side effects that affect other parts of the body. Fortunately they are good side effects.  And 30 minutes can do a lot of good. My mom endorses this video. 

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.

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! 

High Intensity Interval Training - Not so fast.

If you follow this blog, you know that we use high speed exercise training  (see SpeedGeezer) to 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: https://www.acsm.org/docs/brochures/high-intensity-interval-training.pdf 

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.

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.

OVERVIEW OF THE TRAINING PLAN


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.

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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. 

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

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. 

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 lab.  The 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 SpeedGeezer.  Always 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 week.  Speed 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.