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.