Each week Rory Cellan-Jones guides us between the laughs and moans in the pub. Here is Rory's summary of this week's episode.
This week’s edition of Movers and Shakers is all about exercise, the one treatment for Parkinson’s everybody seems to agree is effective.
Our guest this week, Jerry Collier, is uniquely qualified to talk about this subject - he’s a consultant surgeon, he has Parkinson’s and he’s an absolute exercise fiend. Jerry explains why getting moving is so important:
"Exercise improves outcomes because it's one of the few things that induces neuroplasticity and reduces neuro degeneration," he says, explaining that neuroplasticity is the creation of new synapses - new connections in the brain. He asks us to imagine that our Parkinson’s-addled brains are like a road system where accidents are clogging up the motorways:
"What neuroplasticity is doing is forcing your brain to take the backroads that it wouldn't normally take. So it is opening up existing connections, which you're not using and which are redundant. We all have a large amount of redundant tissue that we're not using. It's a question of utilising the tissue that works, rather than the tissue that doesn't."
We learn some surprising things when we discuss our current exercise regimes. Judge Nick Mostyn appears to be rehearsing for the modern pentathlon, telling us he skis, plays golf, goes horse-riding and works out in the gym at the Royal Courts of Justice.
Gillian Lacey-Solymar has also been skiing - a sport I’m giving up because I decided I could no longer turn effectively - and marvels at the fact that she can still get down the mountain when she often finds walking across a room a challenge: "I just can't walk but I put the skis on and I can ski."
After first saying he has "done nothing at all" Jeremy Paxman suddenly reveals he is seeing a personal trainer five times a week - to the dismay of Paul Mayhew-Archer who admits he has somehow missed his exercise and dance classes this week: "I forgot to do everything and I'm just feeling very guilty and miserable, and you're just making me feel worse." Mark Mardell says his problem is that he has always detested exercise but he is now trying out Tai Chi and boxing and hoping to find something that works for him.
My exercise regime is focused on the weekend. On Saturday I do a Pilates class and then have a piano lesson, which I count as exercise because it keeps the fingers of my now very weak right hand working. Then on Sunday I head to the towpath of the Grand Union Canal to meet Wendy, the trainer who has been working with me for many years, long before my Parkinson’s diagnosis. Her main technique is ritual humiliation, forcing me to wear pink boxing gloves and shouting "Muppet!" as I struggle to land a punch on her.
So what sort of exercise works for Jerry Collier? He recommends e-biking and an intensive course developed in Australia called PD Warrior - "boot camp for Parkinson’s." It sounds horrific but he says it has been transformative:
"It's given me a level of fitness back that I haven't had probably for three to four years. It made me a lot better on the bike. And because I'm a lot fitter on the bike and doing more e-biking, I'm doing more exercise, which means I'm feeling much better."
None of us - except perhaps the judge - looks that enthusiastic about taking up such a demanding exercise regime. But Jerry stresses that there is no one magic bullet for such a variable condition as Parkinson’s:
"What I'm saying is that some exercise will benefit everybody. But the exercise that benefits you is going to be tailored to your particular need."
We end our conversation in the pub both convinced that we need to do more exercise and uncertain what form it should take. Large sums of money are now being spent in the hunt for new drugs to treat or even cure Parkinson’s and we welcome that, even if it seems a dreadfully slow and bureaucratic business. But maybe there should be more funding for research into the effects of exercise - one "medication" that is available here and now.
Guest Biography
Luis Diaz
As a graduate in sports science working as a fitness consultant for over 15 years, I specialize in injury recovery and performance improvement, bringing a holistic approach to health.
I believe in Sport and physical activity as means to improve our health and quality of life. I adapt all training programmes to my clients needs and most importantly their capacities to ensure they reach their goals in a correct, safe and healthy way.
Click here to find out more about Luis.
Mark's Musings…
Parkinson forces us into many accommodations. For me that means embracing a personal demon. As long as I can remember I’ve loathed sport, barely tolerating friends talking about their passion for running around chasing various types of balls. The mere thought of actually joining in myself gave me the vapours. That has had to change. One Professor, probably the country’s top neurologist was blunt on our podcast : ‘exercise is not a recommendation - it’s a prescription.” I seem to take dozens of pills every day but this was the bitterest to swallow.
I blame my eyesight. And my schools. I’ve long disliked organised exercise with a passion that goes well beyond mere laziness. Here’s an early memory. Being part of a circle of schoolboys practicing catch on a wide green lawn, in the sunshine, near the shade of an oak tree. It should have been idyllic. It wasn’t. The misery seemed never ending as I failed again and again, time after time, to catch the cricket ball hurled in my direction. But end it did. Although I failed to catch the ball, the ball caught me. The master in the middle wasn’t unusually sadistic for the late 60s but he was a very good shot. Clunk ! Ouch ! Gulp ! The soft, fuzzy tennis balls I’d played with at home bounced on contact with flesh, this hard red shelled thing didn’t. It dazed and bred resentment.
Cricket at least was played in the summer, fully clothed. Football was played in the even colder months paradoxically required bare legs, liberally splashed with mud and boot marks. My unacknowledged need to wear glasses wasn’t entirely to blame. But it didn’t help.
Like Molesworth in the "Down with skool" books I tended to play right back – right back as far from the ball as possible. Hanging out with my friend, the equally indolent and chatty goalkeeper. We talked about everything under the pale watery sun. We discussed the mystery that was girls, books, girls, war, girls, music, girls ( the mystery that was). Never sport or where the ball was on the pitch. It always came as a great surprise when it loomed in our direction. I like to think we were a spur to success and excellence for Blue Team’s forwards because they knew the last line of defence wilted at the first glimpse of spherical threat.
To me the beautiful game was an ugly aberration. PE, although warmer, was little more than ritual humiliation. The gym teacher yelled contempt as he urged me to vault unfeasibly high objects. We'll call him Hobbes because he was nasty, brutish, and short.
“Mardell, you look like a camel” still stings. True, I loved fencing and at least rugby taught me important life skills. Sharp shoulders and grim determination proved invaluable in punk era mosh pits and later, as a reporter, covering riots. While I rather relished the idea of contained thugishness, the odd shape couldn’t disguise the fact a ball was involved, or hide the fact running around in the muddy cold was required (without my newly acquired glasses).
Perhaps that all goes some way to explain my lifelong indifference to ballgames. Actually, indifference is something I managed to cultivate as I grew older. The original emotion squeamish dislike translated in adolescence to militant scorn. It has served me ill.
I feel a profound sympathy for those like my fellow “Movers and Shaker” Sir Nick Mostyn who has had to give up his beloved wind surfing, and all the other Parkys who’ve had their favourite pastime torn from them. But spare a though too, for those of us thrust blinking into the harsh sunlight of an unfamiliar world of exercise.
Well before the Professor’s alarming announcement the internet had made me aware of the need to change my ways. But there’s a problem here: a lack of ready-made advice. On the day of my diagnosis, I asked my neurologist what might be best for me. "I don't know. Ask the Parkinson's nurse". Many consultants see pills not push-up as their proper realm. Several months later when I eventually got my appointment with said nurse she suggested PD Warriors. No, she didn’t know about any local groups, and told me details could be found online.
It clearly wasn't going to be provided on the NHS. Poking around the internet didn’t really tell me what the course might be like, apart from expensive. What there was suggested it might involve being shouted at an Australian version of Mr Hobbes.
I was further put off by one of our podcast guests, who had become a self-confessed fitness fanatic in the wake of his diagnosis. He’d even given up his job as a surgeon, not because of tremors, but so he could exercise more. He gushed about a weeklong PD Warriors course, celebrating its toughness, warning it was transformative, but really arduous, challenging even for him. He is a delightful man, and his symptoms seem to have been stopped in their tracks. But I was seeking solace not suffering.
At least three of my fellow Movers & Shakers have a personal trainer – a bit pricey I recon and I’m not willing to pay good money for my own personal Mr Hobbes.
So what happened ?
Parkinson's alters not just your body and brain but also your attitude and focus. For me, it underscores one's mortality, emphasises the decline inherent in ageing and puts a big marker pen on the word ‘death’, the eventual destination not just us Parkies, but for every single human being. Depressing ? No, realistic. Like ice on the vine, it concentrates the sweetness of what we have left. Call me shallow, but for me that means focusing on fun.
So exercise has to be enjoyable. And again personally this is not only a driving philosophy but very practical – it’ll be just a one day wonder unless I like doing it. I was walking more, going to the gym a bit but had failed to find focus. Until a group of experts came to the rescue. The real experts. Other people with Parkinson’s. There is so much wisdom, so much experience, so much advice out there. Not surprisingly I leant on the Movers and Shakers Facebook page. The aptly named Mr Lazarus rose up and told how he did some very simple stretching exercises as soon as he got up. Punching up and down, left and right. You know what ? It felt almost as good as the first sip of coffee.
That got me started. After a brief dalliance with Canadian Airforce exercises which didn’t do it for me, I struck gold. The Parkinson’s nurse knew of no local group, following a trail on the Parkinson’s UK website suggested it was defunct. A friend of my wife’s knew different. She put me in touch with their leader, the steady, solid comfort that is Arthur Hookway, who was part of a nearby Tai Chi class. I joined. It stretches my body and mind, makes me smile and calms me down. I am quite the worst in the class, and it doesn’t matter. The teacher, Vicky Ahern-Hardiman, is remarkable for her efficient compassion and quiet passion for this Chinese art, a reassuring guide into an unfamiliar world.
Next Arthur helped me join Caroline’s PD Warrior zoom class. Not tough, not pricey. Enough to raise the heart rate, but not so much as to dominate the day. And there are regular video’s too. That’s Monday and Thursday sorted. Then one of the other Movers & Shakers told me about a Joe Wick’s video on YouTube for Parkys. I interviewed him once for my Radio Four programme and he struck me as a really decent guy. So I was pleased that it packs quite a punch in its twenty minutes. Along with regular trots around the park, a bit of yoga , Tai Chi practice and Caroline’s videos that’s the week sorted. Do I miss days? Too often. Backslide? Of course. Is it enough? Almost certainly not. But I’m doing more exercise than I ever have in my life before. And feel better for it.
And I’m still looking for new stuff : I was invited to join in the wonderful “Song Surgery” project
Which allowed me to ‘dance’ (wave my arms in time to music) with the former principle dancer of the Royal Ballet. I’ve written about that elsewhere.
There aren't many good things you can say about Parkinson's – but you can wrangle advantage out of it. It gives you license. Not to kill, like OO7, but to live without the burden of presumptions. A license to fail. In the past being a klutz in the gym, useless at yoga, a dromedary on the dance floor felt not only humiliating, but like a personal moral failure. Now Parkinson's gives me permission to do something and be rubbish at it. No one expects anything else.
When I started this piece, I had no intention of sending a message but I can't help it. There is a clear moral here: it would be great if we could rely on the professionals and the big organisations, but the best and biggest resources is ourselves, whether that means podcasts like Movers & Shakers, a centre like this one or local groups. Only connect. Just not with a ball.
The ‘PD Warrior’ exercise program improves motor outcomes and quality of life in patients with early Parkinson’s disease: results of a pilot study
By Claire Tucak, HuiJun Chih, Frank Mastaglia and Julian Rodrigues
Parkinson’s Disease (PD) is estimated to affect around 100 000 Australians1 and over six million people worldwide, and its prevalence is increasing.2,3 The treatment of PD involves both pharmacological and nonpharmacological interventions, with a combination of these typically resulting in better health outcomes and reduced disability. Exercise in various forms is accepted as one of the mainstays of treatment, and in recent years the importance of exercise in reducing PD symptoms, and even possibly slowing disease progression, has become increasingly appreciated.4–7 Many different types of exercises have been investigated, including aerobic exercises like walking and treadmill exercise, strength interventions, balance and gait interventions, hydrotherapy, Pilates, dance, boxing, tai chi and other multimodal exercise combinations. Systematic reviews have confirmed the relative benefits of different types of exercise on subjective quality of life (QoL). Confl 8,9 Motor benefits have also been found9–13 and attributed to enhanced cortico-striatal plasticity and dopamine release and transporter function in the caudate nucleus.6,14 One treatment program originating in Australia is the ‘PD Warrior’ (PDW) program, which was developed in 2012 and has since been widely taken up for the outpatient management of PD. This program involves a combination of intensive physical and mental exercises designed to enhance brain plasticity and facilitate functional movement.15 It is now available in licensed facilities in numerous countries and has been translated into four languages. However, while the subjective and objective benefits of the program have been observed anecdotally in clinical practice, there are as yet no published reports of outcomes in systematic studies. Due to the rapid growth and increasing popularity of the PDW program, there is a need for published data to support the proposed benefits, as well as studies of the physiological changes in brain plasticity and motor function following the intervention. Such data will also provide a stronger evidence base defining the benefits and outcomes of the PDW program to allow patients and their carers to make an informed decision about participating in the program. The aims of this study were to evaluate the objective outcomes in a group of participants in the PDW 10-week challenge program using a comprehensive battery of tests of motor function, balance and mobility, as well as the Parkinson’s KinetiGraph (PKG), to analyse diurnal changes in PD symptoms. In addition, changes in QoL were evaluated using the PDQ-39 scale.
If you would like to read more from this academic paper please click here.
Why high intensity exercise matters when you have Parkinson's
Different types of physical activity and sport are beneficial for people with Parkinson’s. But more recently research has shown that moderate to high intensity exercise is particularly good for you.
High intensity exercise has a positive impact on the health and development of neurons in your brain. Neurons are nerve cells that send messages to different parts of your body to allow you to do things such as breathing, moving, talking and thinking.
It can also help your neurons to work better. This is important in Parkinson’s because as dopamine-producing nerve cells die, parts of the brain stop working normally and cause Parkinson's symptoms to appear.
Click here to read the full article.
Watch Sir Nicholas "the Judge" Mostyn doing the plank
Poetry Corner - Gillian Lacey-Solymar
LIFE SENTENCE
“Squeeze and stretch”
So says the wretched trainer on TV
Look at me, just look at me
He clenches muscles silently
Easily breezily.
Smiling.
I watch
First languidly
Then angrily
First curiously
Then furiously
Never have I ever seen
On the large or little screen
A smugger bugger.
Could it be, Judge please tell me
Precisely, categorically
Could there be a good disclaimer
Murdering a personal trainer
Especially one who may be A TV personality?
Some useful links
Comments