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. ---------------------------------------------------------------------------- ---- E-mail: [log in to unmask] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn