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To Mark Hirsch
 
Here are a few thoughts re a subject you raised - Excercise and PD
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I believe there is a definite relationship between certain effects of exercise
and PD. The primary benefits are not in the area of retraining or mental well
being but are direct therapeutic consequences of adrenaline mediated activity.
Thus, I would speculate that the most impacting activity would be sustained
vigorous (aerobic) excercise or situations which result in sustained anxiety.
These effects are mediated by the autonomic nervous system which is commonly
divided into two modes; 1. the lie down and be loved mode and 2. the fight or
flight mode. The benefits of the aforementioned activities seem to be a
consequence of exhausting the latter mode, (depletion of norepinephrine?
transient unresponsiveness of norepi receptors? , effects of endorphins? or
direct influence on the dopamine system). In the presence of dopamine the
exagerated response to the ANS fight or flight mode results in increased tone in
the muscles and clinicaly as dyskinesia, in the absence of dopamine it
increases the severety of akinesia. Here's an analogy; imagine a motorized
articulated machine, in the presence of dopamine the articulations are rusty so
the movement is non fluid, herky jerky - oiling thse joints (blue filter or
visual cues) results in more normal function. in the absence of dopamine, the
gas pedal is depressed but the brakes are also engaged, dopamine or visual cues
releases the brakes. I have observed that frequently as long as 24hours after
vigorous excercise or a prolonged period of anxiety rich activity I will get an
increase in the duration and degree of dyskinesia. This is a positive sign
indicating that what is ordinarily the appropriate dose of L-Dopa is now
excessive. If one is conscious of this response and reduces the dose there is a
qualitative and quantitative response - sometimes dyskinesia can be completely
suppressed for 6 to 8 hours. In fact I sometimes think of dyskinesia as a body
that is fighting but without cognitive control - instead of a coordinated
controlled explosion of muscle activity e.g. a punch, one gets uncontrolled
flailing of muscle activity i.e. dyskinetic motion. An interesting study would
be to test my belief that it is possible to temporarily but immediately
rationalize this irrational muscle activity by consciously applying cognitive
control - choreographed aerobic exercise, shadow boxing, running.
The blue filter phenomenon is useful because it tends to facilitate the
suppression of the fight or flight mode and augment the lie down and be loved
mode. I don't see how wearing them while excercising could augment the
therapeutic benefits of excercise, however, it is possible that their anti
dyskinetic effect could be augmented if they were used after excercise.
An important study would be to test whether sustained suppression of dyskinesia
(via visual cues) extends the duration of action of a dose of l-dopa
 
Finally, you made a comment about how voice training can affect gait. In my
experience it is just the opposite, gait enablement can imnpact on voice.
best wishes,
tom riess