The source of this article is Deseret Morning News: http://tinyurl.com/5mj5x

Parkinson's disease — Exercise can help patients cope
By Lois M. Collins
Deseret Morning News

       Noel Jensen thought he was having a "little arthritis" as he struggled
to help his youngest son move into his new home.

       His son, a recent medical-school graduate, suspected something else
entirely. "I think you have Parkinson's disease," the young man said.
       "I wanted to hit him," Jensen remembers. Instead, he asked his son to
write a letter explaining why he thought that and then he'd take it to his
doctor.
       His doctor sent him to a neurologist, an expert in movement disorders,
who confirmed the diagnosis.
       Now 70, Jensen "gets around quite well," he said. After six years with
the disease, he's convinced that "being active is the key to living with this."
       It's a message that Deborah Mraz, a computer-lab aide at Canyon View
Elementary School, says can't be overemphasized for those who have Parkinson's.
       Mraz was diagnosed in 1999 — after many false starts and theories,
since she was in her early 40s at the time, and Parkinson's typically
affects people who are older.
       Most people are diagnosed in their 60s and 70s, said Dr. Robert Miska,
a neurologist at LDS Hospital.
       The cause of Parkinson's may never be known. Miska said there seems to
be a genetic component in about 15 percent, in so far as those people have a
parent, sibling or child with the disorder. "That's far more than chance."
       On the other hand, there are probably environmental triggers, but what
they are is unknown. Parkinson's also shares traits with other
"akinetic-rigid syndromes" and there are other conditions that at least
superficially resemble it. James Parkinson, after whom it is named, called
it "the shaking palsy." But not everyone has the static tremor that is
associated with the disease. Or that may show up later.
       Mraz's first symptom, though at the time she didn't know it can be
part of Parkinson's, was depression "with no reason to be depressed." Then
she got pain, head to toe, with every joint aching. Doctors thought it was
chronic fatigue, then lupus, then an autoimmune disorder. Eventually, she
developed a tremor that sent physicians looking in the right direction.

       Parkinson's is tricky. It's a clinical diagnosis, not a lab-based one.
There's no imaging or blood test that can confirm it with certainty. Even
the symptoms are murky and varied. Experts say one clear sign is a positive
response to the medication used to treat Parkinson's.
       Mraz responded to the dopamine agonist, and they finally knew.
       By that time, she could barely walk. She used a cane. Her body hurt so
much she could hardly move, so she didn't, then her body tightened up, and
it got even harder to move. She knew she should exercise and she tried
swimming, but she was in such bad shape that someone had to help her into
her swimsuit so she could paddle around a bit, then her helper would undress
her and redress her "and drag me to my car, where I'd take a nap before I
could go home. Then I was shot for two days."
       But she persisted. Last year, she completed the Salt Lake City Marathon.
       Much of the difference, she said, is exercise.
       One reason for that, said Lee Dibble, Ph.D. and associate clinical
professor in the Division of Physical Therapy at the University of Utah, is
that Parkinson's "occurs in conjunction with normal aging. Any condition
that might increase in incident, such as osteoarthritis or coronary artery
disease, is present in people with Parkinson's, who already experience
physical challenges. Many of these respond positively to exercise. So, at
the very least, there's the benefit of preventing complications of those
diseases in conjunction with Parkinson's."
       The disease by itself induces inactivity. It's a movement disorder, a
progressive and degenerative neurological disease that occurs when certain
cells in the brain that produce the neurotransmitter dopamine malfunction or
die. Dopamine enables smooth function of muscle and movement. Take it away
and the results are tremor, slow movement, stiffness or rigidity and balance
problems, among others.

       So people with Parkinson's tend to slow down or stop moving. They get
worse and worse and do less and less, Dibble said, becoming more weak, more
tight, losing cardiovascular fitness.
       "There is some research that now suggests in animal models of
Parkinson's disease that exercise can protect the nervous system from
degenerating," Dibble said. "Those who are forced to be inactive have more
brain tissue death than animals allowed to exercise."
       So Parkinson's experts tell patients to walk as a means of maintaining
leg strength and cardiovascular condition. And to do strength and balance
exercises. "Parkinson's wreaks havoc with balance. And that leads to falls
and other injuries," Dibble said.
       Dibble, who heads an exercise clinic specifically for patients with
Parkinson's in Research Park under the auspices of the U.'s College of
Health, advocates four types of exercise: aerobic, strength training,
flexibility and balance.
       Many of those who use the exercise clinic also connect to other
resources through the U.'s American Parkinson Disease Association
information and referral center in the Department of Neurology, under the
direction of Dr. John D. Steffens.
       A movement disorder expert can usually recognize the disease in very
early stages, often before any treatment is required, Miska said. But it
should be diagnosed as soon as possible. "Prophylactic treatment, to slow or
limit its progress, such as we have, is worth using at the earliest point,"
Miska said. Treatment becomes most important when the disease is beginning
to limit a person's normal activities.

       As for exercise, Miska explains it this way. A baby, until about age
2, is hardwiring programs in his brain for normal activities. It's hard at
first, but soon walking, even running, become automatic. "With Parkinson's
disease, it's almost like all that hardwired circuitry is undercut. The one
thing that helps that is simple practice effect. Patients should be strongly
encouraged to remain active, to adopt an exercise program and include
walking in that program. It's very important. It tends to limit the
progression of the disease."
       It doesn't replace appropriate medications, he said, it complements 
them.
       With medication, "We can slow progression and treat symptoms by
augmenting the effect of the deficient neurotransmitter, dopamine. Those
work to some degree, sometimes quite dramatically, but we can't keep it from
progressing all together," Miska said.
       Jensen works out at the U. rehab clinic twice a week for about an
hour, riding an exercise bike and doing stretching exercises, along with
strength training. He works on his balance. And in the days when the
Parkinson's clinic isn't offered, he works out at home. He also goes to a
water rehabilitation program several days a week because of a knee injury
that required surgery.
       He warns that Parkinson's patients have to watch their diet. Protein
tends to compete with the medication absorption, he said. So, for that
matter, does something as simple as a cold.
       It's degenerative, but there's no blueprint of how the disease will
manifest or progress in a particular patient. It's more aggressive in some,
experts say.
       Elaine Berggren was fortunate, according to her husband, Gordon,
because her Parkinson's disease progressed slowly. After diagnosis, she was
able to travel, to play golf, to do what she wanted, although she had to be
precise in taking medications right when they were due.

       She helped organize a group of friends who would get up early in the
morning and walk the back nine of the neighborhood golf course together,
with both physical and social benefits. From the beginning, Gordon Berggren
said, her physicians — first in Texas and later in Utah — emphasized the
importance of exercise.
       She lived quite well with the disease until about three years before
her death, he said. She had a knee replacement and rehabilitated quite well
but could never quite get her medication adjusted after that. The disease
started advancing more rapidly, and she had trouble with speech (another
symptom for some), with movement, with sleeping at night.
       It was pneumonia, however, that took her life three years ago after a
serious downward spiral.
       That's the story with Parkinson's. It is not, in itself, a fatal
disease, Miska said. People live with it and they die with it, not of it.
       The other thing the experts on the disease — both patients and their
physicians — agree helps is finding a good support group, where you feel
comfortable and encouraged. A number of national and local organizations
focus on Parkinson's disease.

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