Bicycling and other exercise may help people with Parkinson’s curb their symptoms
By Alice Reid,
Well before sunup, Chuck Linderman launches his daily workout at the Alexandria boat house: 30 minutes pulling hard on a Concept 2 rowing machine, an equal stint lifting free weights and 30 minutes pedaling a stationary bike. He drives himself to sweaty, breathless exhaustion, for Linderman is training for the race of his life — a race against Parkinson’s disease.
Linderman is one of a million Americans afflicted by this neurodegenerative disease that kills off the brain cells responsible for the body’s ability to move. His diagnosis came six years ago, when his wife noticed that his right arm was moving weirdly and that he was having trouble fastening the top button on his dress shirts. His doctor recommended seeing a neurologist.
“It took the guy less than 15 minutes to make the diagnosis,” said Linderman, 64.
Rowing already played a role in his life. For nearly a decade, he had been active in Alexandria Community Rowing’s masters program. So his response to Parkinson’s was immediate. Fight back with what he knew best: strenuous exercise.
“What is the alternative? A descent into invalidism?” said Linderman, who retired two years ago from his job as director of a power company association.
Exercise of any sort has long been known to be helpful for Parkinson’s. Before the development of effective drug therapy in the ’60s, patients often improved with any exercise, even the act of folding laundry, according to Michael Okun, national medical director of the National Parkinson Foundation, which emphasizes exercise as an important tool to fight the disease.
While today’s pharmacopeia offers patients effective means to allay the disease early on, most of the drugs have serious side effects, which can range from nausea to involuntary movements and memory problems. Many of these medications can lose effectiveness over time.
Much of Linderman’s regimen — daily cycling and hard rowing, plus weight training twice a week with a personal trainer — is just the sort of workout that is intriguing researchers. There is evidence that challenging the muscles through repetitive resistance motion far beyond one’s comfort zone can diminish some symptoms.
Preliminary studies show that after eight weeks of cycling three times a week at a pace high enough to break a sweat and raise the heart rate, some patients can recoup much of their mobility for nearly four weeks. After that, gains disappear unless the patient resumes exercising. While it cannot cure Parkinson’s, heavy-duty exercise shows promise for countering, even delaying, the inability to move that the disease causes.
The Michael J. Fox Foundation for Parkinson’s Research has funded close to $3 million in exercise research. And Okun of the National Parkinson Foundation said the focus is on finding the most effective exercise.
“We know you need to sweat,” said Okun. “But we don’t know exactly what kind of exercise is most effective, its optimum frequency or what the long-term benefits are.”
An accidental discovery
Jay L. Alberts, a Parkinson’s researcher at the Cleveland Clinic, discovered how good intense cycling could be quite by accident eight years ago, as he rode a tandem bike across Iowa with a friend who has the disease.
“The purpose of the trip was simply to show that with Parkinson’s you can live an active life,” said Alberts.
But something surprising happened. Although the disease had already robbed his friend of her ability to write legibly, she could suddenly write her name clearly after the first day of strenuous cycling.
The following winter, Alberts rode with patients in Tucson and elsewhere, “and I heard the same kind of thing. I knew we needed to follow this up.”
For five years Alberts has been researching the effects of strenuous cycling on patients. With $1.5 million in grants from the National Institutes of Health and the Department of Veterans Affairs, he has finished a 60-person study and has just launched another for 100 patients. Although no final answers are in, Alberts’ work has sparked interest in the Parkinson’s world. Indoor cycling programs have sprung up at YMCAs in Seattle, Cleveland and Sarasota, Fla., with another in the planning stages in Los Angeles. A nonprofit called Pedaling for Parkinson’s is affiliated with the YMCA .
For Alberts’s just-completed study, patients rode indoor bikes. First he tested them to determine the pace at which they were comfortable, which was about 60 pedal revolutions per minute. Then they were required to pedal 35 percent faster.
After three-times-a-week sessions, nearly all patients showed improvement in mobility and small motor skills, and not one dropped out of the rigorous program. And although cycling involves the legs, mobility improved elsewhere as well — “in manipulation — the ability to open a jar, for instance. Something global was happening in the brain,” Alberts said.
When Alberts did brain scans on his research subjects they showed that exercise sparked blood flow and brain activity as effectively as the medications routinely prescribed for Parkinson’s.
“One of our goals is, can we delay the onset of symptoms. This is a neurodegenerative disease,” Alberts said. “If we can alter the slope of that progression, there is tremendous value here.”
Firing up the neurons
To discover exactly what is happening in the brain, Alberts, who is a kinesiologist and not a brain chemist, depends on others, including University of Pittsburgh Medical Center neurologist Michael J. Zigmond, who is studying how exercise affects the brain chemistry of animals that have a version of Parkinson’s.
Parkinson’s disease kills off the brain cells that produce dopamine, a chemical that enables the brain cells, or neurons, that control muscles to communicate with those muscles. The result can be the patient’s loss of small and large motor skills such as walking or writing, swinging a bat or tying one’s shoes.
Research has shown that when lab animals hop on treadmills or wheels, their brains produce increased blood flow and more synapses, or message paths, between brain cells. Their neurons fire with more energy.
Zigmond is testing a hypothesis that might explain what’s happening with Alberts’s patients and why Chuck Linderman is doing so well.
“One thing Parkinson’s does is it decreases the amount of compounds in the brain called neurotrophic factors,” Zigmond said in a recent interview. “Our hypothesis is that exercise increases neurotrophic factors, and they in turn protect the neurons that produce dopamine.”
In such a scenario, more exercise means survival for more dopamine-producing cells, which can slow the loss of mobility.
Setting a fast pace
Alberts has shown that the pace of the exercise is important. “You want to make sure the person is really doing something. They must actively participate,” he said. By cycling intensely, Alberts speculated, “you have information about a [muscle] movement going back to the brain. So if you can increase the quality and the quantity of that information, it may trigger biochemical changes in the brain.”
Linderman’s personal trainer, Rob Kreider, bases much of his weight training program on a similar theory. Kreider has Linderman lift quickly and repetitively. He calls it power lifting rather than strength training.
“When you do a curl or a squat, your brain is sending messages to your muscles,” Kreider said. So, he reasons, the more repetitions, the more messages to help the Parkinson’s sufferer.
Kreider says Linderman is incredibly motivated and determined.
And for those qualities, Linderman credits the time he spent as a rower before his diagnosis.
“Rowing provides the discipline, the ability to get up and do it every day,” he said. “It would be very easy to drift off into Parkinson’s.”
He no longer rows with the Alexandria program, although a lifetime membership allows him to use the club’s gym. Club leaders stopped his rowing after he exited a shell one morning two years ago, lost his balance and fell backward into the boat. Linderman said he was sorry to quit, but he understood the safety concern.
“Balance is an issue with Parkinson’s,” he said.
Now he rows with a program for people with disabilities that is run out of a boathouse on the Anacostia. He has won gold and silver medals at so-called “adaptive rowing” regattas in a double and in a four. The double, a tippy boat under normal circumstances, comes equipped with pontoons on the riggers that keep it upright no matter what.
Alberts said he has never put any patients in a rowing shell or a rowing machine. But, he agreed, either of those devices could convey the advantages of the bike, and he said he has received one query from a rowing club about his research.
Another researcher, University of Florida neuroscientist David E. Vaillancourt, has been comparing how patients do on two exercise programs, the National Parkinson Foundation’s “Fitness Counts” and Progressive Resistance Exercise, which is directed at lifting increasingly heavy weights.
“My colleagues and I believe that pushing the patients to work out hard is the key to exercise training in Parkinson’s disease,” he said. Told of Linderman’s workouts, he added, “It sounds to me that Mr. Linderman has figured this out on his own.”
Linderman, for his part, said fighting Parkinson’s with exercise has many benefits. “And it beats taking a whole lot more pills,” he added.
Reid is a retired Washington Post editor and writer.