PARKINSON’S DISEASE: CURRENT TRENDS, EVIDENCE TO … · Parkinson’s Outcomes Project is the...
Transcript of PARKINSON’S DISEASE: CURRENT TRENDS, EVIDENCE TO … · Parkinson’s Outcomes Project is the...
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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PARKINSON’S DISEASE: CURRENT TRENDS, EVIDENCE TO SUPPORT
THEM
Cari Cooke, PT, Marguerite Wieler, PhD
PD as a spectrum – movement, cognition, behavioural
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Compensatory resources change
Consolidation of learning is compromised
Wu T & Hallett M et al; 2015; Gilat M. et al 2017; Ginis P et al 2018
Fox S et. Al, MDJ 2017
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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‘Exercise’ vs. Activity
Exercise refers to a specific regimen to address a specific balance, posture, endurance, flexibility, strength issue
*often supervised
Activity refers to any movement of the body that uses energy
i.e. housework, gardening, grocery shopping, “puttering”
Snider J et al. 2015
General Exercise
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Regular Exercise, Quality of Life, and Mobility in Parkinson’s Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data
Miriam R. Rafferty, Peter N. Schmidt, Sheng T. Luo , Kan Li, Connie Marras , Thomas L. Davis , Mark Guttman, Fernando Cubillos, Tanya Simuni and on behalf of all NPF‐QII Investigators
Journal of Parkinson’s Disease (2017) 193–202
Prospective NPF‐QII cohort study in 3408 PD patients ‐ Follow‐up 2 years
PD who always exercised > 2,5 hours per week
PD who started exercise at study onsetPD consistent non‐exerciser < 2,5 hours per weekPD who started exercise after study onset
Assessed association of lifelong coffee, tea, and alcohol consumption, smoking, and physical activity with progression and survival
prospective community‐based cohort (n = 360)
Physical activity associated with progression
Paul KC et al; MDJ 2019
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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CueingVisual Auditory Tactile
https://hackaday.io/project/10997/
Endurance Exercise
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Effect of high‐intensity treadmill exercise on motor symptoms in patients with De Novo Parkinson disease a phase 2 randomized clinical trial
M Schenkman, CG Moore, WM Kohrt, DA Hall, A Delitto, CL Comella, DA Josbeno, CL Christiansen, BD Berman, BM Kluger, EL Melanson, S Jain, JA Robichaud, C Poon, D Montie Corcos
In the high intensity exercise group, an increase in motor symptom severity was preventedunlike in control arms with no or low levels of exercise
p = 0.03
SchenkmanM et al; JAMA Neurol 2018
RCT ‐ 128 de novo participants
6 months treadmill walking 4x/week
When to be cautious of vigorous ex?
*more medical conditions (monitor & adapt)
*low or fluctuating O2 sat, heart rate, blood pressure
*episodes of confusion after vigorous exercise
*extreme fatigue or pain after exercise
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Neurobiology of Exercise
Early and late onset training in MPTP‐mice was equipotent
Palasz E et al, 2019; Francardo et al; 2017 Review; Petzinger et G al; 2015
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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PD Brain on Exercise
University of Southern California did study on persons with Early Stage Parkinson’s disease not yet on any medication.
‐24 sessions of treadmill training compared to persons with PD who did not exercise at all
‐ PET scans showed an 80‐90% increase in the dopamine D2 receptor binding in the treadmill exercise group
‐increased use of the neurotransmitter dopamine ‐ in synapse longer and longer signals
Fisher BE, et al. 2013
? Neuroprotection ?
Parkinson’s Outcomes Project is the
largest‐ever clinical study of Parkinson’s
disease with over 12,000 participants in
five countries
● Increasing physical activity to at least 2.5 hours a week can
slow decline in quality of life.
● Interventions providing neuroprotective benefits, such as
exercise, could change the course of the disease.
● Ongoing vigorous exercise and physical fitness should be
highly encouraged
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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The brain's ability to reorganize itself by forming new connections.
4 features of exercise that drive neuroplasticity:
intensity, specificity, difficulty and complexity
Neuroplasticity – can we drive it?
Petzinger G. 2013
MDS task force review – insufficient evidence
Movement strategy – exercise basedMovement strategy – technology based
Formalized patterned exercises
Specific
Non‐ specific
Moran.Gilat 2019
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Not better than resistance training
• Meta‐anaysis 355 subjects
o 5 RCTS – 2 studies not blind
o # of fallers measured 1‐6 months
o No tester blinding
Formalized patterned exercise
Liu H-H et al; PD 2019
Tai Chi reduces number of fallers
Fall prevention home PT
• RCT single blind in 474 fallerso PDSafe = usual care + 12 sessions in 6 monthso Control = usual care + DVD-PD
Chivers Seymour K. et al; JNNP 2019
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Chivers Seymour K. et al; JNNP 2019
Falling is not helped by home PT intervention
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Ellis T et al; 2019
M-health mediated exercise
Stepping Training
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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“Hope” in the vacuum of evidence
Forceless Spontaneous Release: A Form of Yin Tui Na ‐ “cures’ Parkinson’s disease
Yin Tui Na ‐ Chinese term for light‐touch, hands‐on medical therapy
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Cannabis on Twitter
There are a growing number of uncontrolled trials and case reports that suggest beneficial effects of cannabinoids in PD patients. However, the variety of substances investigated, the varying routes of intake, differing doses and time courses make it difficult to compare data.
Buhmann C 2019
Radon….??!!
Radon therapy (radon baths) improves joint mobility and strengthen the body's immunity.
Indications of radon therapy ‐ Parkinson's disease at an early stage
Spa Jáchymov, West Bohemia
● Tradition from 1906
● Unique radon baths with the highest level of radon
● Team of experienced physicians and physiotherapists
Radon Health Mines of Boulder‐Basin Montana
● levels of the colorless, odorless, tasteless, & highly radioactive
gas fluctuate between 700 to 2,200 picoCuries per liter of air.
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Could food made for CATTLE ease the symptoms of Parkinson's? How farmer left his profession 30 years ago to develop a 'life‐
changing' probiotic drink for humans
Front. Neurosci., 11 January 2016
Turning On Lights to Stop Neurodegeneration: The Potential of Near Infrared Light Therapy in Alzheimer's and Parkinson's Disease
PD: Current Trends, Evidence to Support Them ‐ Cooke, WIeler
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Grace Winiecki spends 40 minutes each day with a red light bucket on her head — a device she claims is making a significant difference to her life. since using red lights, she shakes a lot less, can dress herself easier, feels happier, lighter and laughs more.
Photobiomodulationred and near‐infrared lights on their heads and stomachs.