Neuroplasticity, Exercise, and Parkinson's

[Music] hi everybody my name is melanie diesen i'm the director of education at the davis spinney foundation and today i am here with mike studer and i'm so excited to have you here mike thanks for being here uh it's my pleasure thanks so much yeah mike did a lot of work with us um over the years it's been a while since we've had him on and we've been trying to wrangle his schedule so i'm excited to finally get an hour with you mike why don't you tell our community who you are and what you do sure so i've been a physical therapist for a little over 31 years primarily focused in neurology and geriatrics i have been a private practice owner for 18 years have lectured nationally internationally and just a really an enthusiast and a neuro nerd i treat persons with parkinson disease stroke neuropathy imbalance vestibular conditions and really those persons with parkinson disease hold a special place in my heart because there's so much untapped potential awesome well then you're in the right place i'm excited about that so today we're going to be talking about neuroplasticity and uh but before we get started i'd love to kind of just get some foundational information on some of the terms so what is neuroplasticity well that's a great question and a perfect one to start off with because a lot of people think that neuroplasticity is forming new neurons uh when in fact it's actually just the process of learning so it's connecting neurons that are already there and so we talk about making more synapses and synapses means nothing other than just the junction between neurons so that we can learn how to integrate and synthesize information that we've learned whether that's fact-based information or even movement-based information and i should also include sensory information so to summarize neuroplasticity is just the process by which we form new connections we call those synapses in learning okay so it's not one of those things where you hear oh you have no more brain cells left your your and you now you now i have to recreate all these new ones no you're just creating the the new uh synapses between them that are there okay yeah you know a nice analogy for it uh melanie is really the process of road construction and it doesn't matter what the injury is to the roadway system whether it be a concussion that basically is like an earthquake that shakes the connections but leaves everything relatively intact a stroke that kind of washes out the roadway or a degenerative condition that basically crumbles the roadway away and erodes it away slowly in all of these processes we're looking for basically an alternative route and that's neuroplasticity connecting pathways or roadways in the analogy that formerly had been connected getting them connected again okay great all right so i've heard the dif there's a difference between structural and functional neuroplasticity can you talk a little bit about that yeah so structural neuroplasticity means uh the underpinning underlying uh connectivity that happens certainly uh as we develop and as we grow as we age and have we as we have new experiences okay so structural connectivity is really how many connections do we have are we making new connections physically are we growing and attracting one neuron over here to try to make another connection functional connectivity really is the process by how we use those the synthesis the integration the proficiency the expedience so really is how well the machine is running functional connectivity how big the machine is structural connectivity okay that is great um [Music] when i think of the idea so of neuroplasticity and i think of our community of people with parkinson's um i'll often get well what's the point uh you know i already have parkinson's it's already degenerative like not really is anything really going to be able to happen so what do you what is somebody who believes in neuroplasticity what are they really believing in um and then what do these people do that people who don't tend to not do yeah so that's that is such a lovely question and i'll make certain that i don't go on a long diatribe here so really neuroplasticity is important for a person with parkinson disease so that they can slow the disease process preserve what they have and make connections that were actually left off the table because of learn non-use so imagine once you have the diagnosis of parkinson's disease there may be some self-fulfilling prophecies things that you stop doing because you think these things are unsafe or not expected or incapable because now i've labeled myself as a person with parkinson's disease so melanie what's left on the table is learn non-use because you stop taking 5 000 steps per day stop trying to climb the stairs stop trying to balance without relying on a walker now all those things may be necessary for you to stay safe but if you don't challenge those facets and in constant or actually in order i just mentioned endurance 5 000 steps a day strength trying to ascend stairs and balance keeping your faculties negotiated if you now become a person that stays inactive because you have the label you've left neuroplasticity on the table for me to still as a healthcare professional tap into so that's why neuroplasticity is important for those three reasons slow disease process maintain what you've got and actually tap into things that you left off the table that you didn't even know you had the potential to access those three okay so now i i picture it um let's say i've been recently diagnosed i uh with parkinson's i am i've been active you know i have been relatively good health and i think huh like i'm fine i don't need to see a doctor i definitely don't need to see a physical therapist i'm still moving around um what would you say to that person why is it important for them to see a physical therapist in terms of this whole thing you were just talking about okay so now i'm going to back up and give you two analogies that are going to lead me to that answer first analogy high-level gymnast who has been active in gymnastics since she was age six and all the way through her olympic career at age let's say 26. how proficient is that person's balance going to be when she turns 56 do you think that person's balance is going to be better than someone else who didn't have a high level athletic career that depended on balance who's also 56 maybe her twin sister that didn't do all those things and they have the same genetics all right if you believe that then you know that you can build what's called a redundancy right so you can build a reserve so that if any process in this example i'm talking about aging but in any process including a stroke takes something away from you you have neuropathy you have parkinson's disease the higher level that you start your water table the longer it takes before you get to drought all right so that's the gymnast now i'm going to make it even more specific and get toward parkinson's disease think about alzheimer's disease a very related condition with regard to degeneration plaque development amyloid etc what if i was a harvard professor for 51 years from age 31 to age 82 and i suddenly began to have some mild cognitive impairment and was later diagnosed with alzheimer's disease if i was well educated maybe even multi-lingual professor instructor for 31 years again my level of redundancy if i'm going to erode down with a condition such as alzheimer's it's actually going to be a higher level harder to detect later detected in life and it's probably not going to impair my function because i had so much of a redundancy now you already see the analogy of where i'm going with parkinson disease right you want to go to see a physical therapist so that even though you're high level right now you want to invest you think about the bank account is it going to be easier for me to invest in strength training right now when i'm 72 and i don't have many symptoms of parkinson disease so that i have redundancy reserve in the bank so strength training which is different than power training which is different than high speed reaction training which is different than dual task training which is different than high speed walking so you could work on those five facets of fitness now and actually benefit from the return on investment easier than investing just before you get to withdraw some of those things i need them from the bank so hopefully the gymnastics analogy harvard analogy banking analogy all those help to meet one of our listeners today to make that an impactful consideration yeah and you know it's interesting because right falls are one of the biggest issues right people with parkinson's they they have postural instability they have balance problems they have all of those things and i remember talking to somebody once and i was like well how much you know how much weight training do you do and and i was talking about falls and it's like you don't really think about it but you can catch yourself if you have right if you have some muscle you you're able to catch yourself in a different way and for some reason you know it's one of those things that you hear things a million times and for some reason it clicks and that person was like oh my gosh i yes like of course it makes sense and i think the analogy of investment you're putting it in the bank um you're gonna get the return it's not you are not doing this for nothing you are not just going to the pt for nothing and getting out and getting outside for nothing this is going to pay off yeah i love the fact that you tied that in today today with that analogy of the investment because you know you're making a quick withdrawal of a decent amount of money or resources or reaction speed or power from the bank and if you never deposited that in when you need to sidestep and put a right leg out really fast to stop yourself from falling you better have the reaction speed the cognitive processing ability right the flexibility to get out there the pain-free range of motion to get there the strength to generate enough force to stop your body's momentum and then what we call power so generating force fast is different than just the ability to generate force so yeah you're exactly right on points to draw those two stories together and then one of the things that i tell people is you know especially people that struggle that say like oh gosh i don't want to work out i don't feel like it i'm tired what's the point um i will if you ever heard of the 10 10 10 rule where yeah right so i always say like okay well if you say no to this how will you feel in 10 minutes and they're like pretty good yeah you're gonna feel great you can get on the couch you can watch your favorite show how are you gonna feel about this in 10 months yeah uh yeah i hope i did it how are you going to feel about in 10 years well you could be really strong right yeah and i think sometimes we just have to frame things in in different in different ways um okay so let's talk a little about learning you talked about learn non-use um all learning is not created equal right when we're thinking about neuroplasticity so what types of learning actually allows people to take advantage of neuroplasticity yeah that's great so we try to make this very person specific and very presentation specific so we understand that it's inarguable that there's at least two different subtypes or phenotypes of parkinson disease right some would argue that there's three types we would say there's tremor dominant postural impairment gait dysfunction and then also some would consider really a person with young onset parkinson disease who's more likely to have some dystonian dyskinesia maybe to be a third subtype so we try to actually make our dosage very person specific and condition specific what type of learning do you need and what we've become more proficient at learning uh is in these categories or columns of the different phenotypes is that there are some associated losses so that a person with tremor dominant has a greater amount of dopaminergic connections and pathways lost which actually means they tend to be less capable in dual tasking and attention so we look at the movement condition the presentation and we say we probably need to get some learning done that loads this individual up exposes them to some dual tasking so we can help those associated pathways now we move over into postural impairment gait dysfunction pig d a difference phenotype of parkinson disease and we understand that these individuals have a little bit more difficulties in kind of the cholinergic pathways yes they're missing dopamine yes the substantia is impaired but they lose more in the cholinergic pathways which means their executive functions impulse control decision making those types of things and visuospatial perception so if i have a blanket everyone with parkinson's disease gets this then i maybe only make it correct forty percent of the time for these people that have tremor dominant forty to fifty percent of the time for these people that have the pig d and then maybe i missed completely the persons with dyskinesia who need a little bit more of a management and learning that is repetition based that is core strength based that is try to deal with this perturbation and that perturbation so they we do our learning with them more in blocked training in high repetitions and in motor based learning in the middle group maybe we do a little bit more of the visual spatial perceptual and then remember in that first group of tremor dominant we try to do a little bit more of the attention-based efforts everyone with parkinson disease asterisk nearly everyone right because there are individuals out there we see they benefit from that higher volume procedural memory learning give me something to do that has ultimate relationship to functional tasks give me an opportunity to expose to it repeatedly repetitions and give me some intensity as much as my personality is willing to endure all right love it i love it i think everybody in our community can say light bulb yeah that might be i might be learning things that are not specific to my type right uh how does neuroplasticity change over time and is it something that you know as you as your people with parkinson's age their ability to do it lessens as they get older or is it is it lessening because their parkinson's is progressing yeah that's a good question so we we don't believe at this point that there are any limitations temporally based to a person's ability to learn so we have the ability to learn throughout our lifetimes now we talked early on that uh you know really persons that are before or earlier younger than the age nine they're still developing a lot of new neurons neurogenesis we don't know for sure exactly at what age and there's some variability in there across genders and persons we don't know what age people stop developing new neurons massively but remember neuroplasticity or learning does not depend on new neurons that should be time resistant so you should have the ability to continue to make new connections no matter whether you've had three strokes or parkinson disease for 22 years it's not age dependent on that okay great what are some of the most common let's say somebody is new they're going to go into their pt they're going to go through some assessments they've got this benchmark and they've got a plan going forward and maybe they you know they didn't do this beforehand so they're really kind of getting on a new plan what are some of the types of changes that they might see as a result of neuroplasticity number one i would say is response time which is involved with kind of cognitive processing and reaction speed so number one is response time how quickly did i identify that i'm losing my balance and effect a change create a strategy to do something about it so number one i'll say response time number two i'm going to say power the ability to generate force quickly and that's something that can be easily measured and what we like to talk about is gamified both of those things because i can measure balance now using technology better than i ever could in the history of rehabilitation and i can measure power better so those would be my top two that i would expect anyone with any subtype of parkinson's disease to be able to gamify measure and expect change to be effected okay so give can you give me a few examples of somebody in their 60s with parkinson's that are that's going to increase power like where are they seeing this in their life yeah so your ability to actually stand up quickly from a seated surface is is power so if i look at and this is a really nice thing to contrast what's the lowest chair height that i can get up from without using my hands without time being a factor that's strength i can get up from a 15 inch chair and i don't have to push up or have somebody pull me up that's strength my ability to stand up and sit back down rapidly as many times as i can from a reasonable heighted surface not a very low surface in 15 seconds how many can i do that's power okay so now power is what helps me quickly put uh a stop to my loss of balance i have enough power in my arms or enough power in my hips trunk legs right so that's where it functionally plays out but if i wanted to test power i'd say okay i'm going to start a stopwatch i want you to stand up and sit down as fast as you can as many times you can in 15 seconds go that'd be a crazy test for anybody to actually conduct professionally in a clinic or at home yeah we uh that's good we just for parkinson's awareness day we just did the sit to stand challenge the minute sit to stand challenge right that's something you can do on your own every month you could give yourself a little test right you can just measure it over time that's great uh let's see what are some of the ways that a parkinson's brain can benefit from adaptation oh this is a pretty long list it's really exciting though so you think about adaptation that means okay i know i have a condition and i still want to function optimally right so some of the easiest low-hanging fruit would be okay i'm going to use an assistive device and still keep my long walks going so rather than stopping walking because i don't think it's safe for me to walk a mile i'm going to use an assistive device alright so that would be one i can modify how i approach a task number two could be adapt the environment that you function in all right so i get some hesitation and walking as i walk through the open door okay and i begin to get freezing of gate so adaptation would be all right i'm going to change how i approach this task and rather than being allowing myself to look at the doorway i'm going to stare at something through that room and identify that as my destination so that i don't get visually or cognitively distracted into freezing of gait a third way for adaptation is another way of modifying the environment that means maybe my caregivers think about the cues that they give me okay take a big step all right or count out your steps as you turn or i change what's happening in my environment and i might actually even place lines that are perpendicular to the direction of my pathway so i can step over something visually maybe i even change the carpeting in my home from an ornate busy carpet pattern to something that has more geometry so that's adaptation too now all of those things involved adaptation that caused me to change how i maneuver in the environment or what i'm doing potentially even using an assistive device however adaptation might actually be in a positive spin where i say okay i'm retired i uh enjoy a relatively sedentary life of retirement uh-oh my physician thinks i have parkinson disease my neurologist has now confirmed it adaptation i'm going to become active i'm going to change my lifestyle i'm going to adapt to the condition i've been told i have so that i can manage the condition best similar to a person with diabetes who's told exercise is a must for you now i'm going to adapt to my medical information and change my life for the positive so adaptation doesn't always have to be a take away right okay that's great so for those initial ones that you talked about it made me go back to what you said earlier around learned non-use so in what scenario is an adaptation actually triggering learn non-use that actually can be a problem so what is that first of all okay yeah so then we start talking about a compensation so it is similar to an adaptation but now it's i'm compensating now in a compensatory compensatory manner i might actually cause myself learn non-use per your question meaning if i uh every time i need to stand up i say honey honey come over here and help me lift up right rather than making me attempt myself now i am changing my entire approach to the task and i'm compensating and i'm having somebody pull me up to standing and now i'm using my arms and my trunk as my stand up muscles and my wife or husband's assistance and i'm not using my leg so over time i'm going to experience learn non-use from a body standpoint not engaging those legs powerfully from a neuronal standpoint not actually sending a message down to the legs to be a part of the motor program so that'd be one example for what you're talking about okay i would say that's got to have very big implications for care partners because you know there's that balance between i want to be helpful uh but maybe learning about what this is and actually that it's it's physiological yes what's happening to that person when you help um and and getting a sense of like oh this is where i can and this is where i might push you a little bit i might there's a balance there right there is a fine balance because you can say honey i recognize during some times of the day evening or sometimes of your dopamine replacement therapy cycle off cycle you might need my help okay but we know it's not all the time so let's make certain i'm only helping you during the times you need me and every time i come over i'm going to help you if you need it but let's always give you the opportunity to try to make it up one or two times on your own because that'll be healthy for us to both know that you're doing as much as you can for yourself every time because there's variability yeah and also a lot of times you know our people with parkinson's day people in our community will get up and they'll take a couple of hours and then they'll they're feeling great they go exercise right they could go on a four-hour bike ride or whatever they're gonna do right but then come later in the day they they they have trouble getting up from the chair and you wanna say uh i know that you are doing so many things and now you're just pooped out right you're beat i can help you right i i know you actually did the work and now it's just taking a toll so there's no reason for me to have you do that right now yeah that's a nice positive spin on that too let's logically rationalize when you do need help and get it then rather than feeling like it's a loss or a failure or that you need it all the time right right great uh let's see um a lot a lot of talk on bdnf what is bdnf and what role does it play in people with parkinson's yeah so brain derived neurotrophic factor i'm going to say that one more time brain derived it comes from the brain neurotrophic means it actually feeds the brain feeds neuro remember when we have the word atrophy it means without stimulus or without being fed a is the prefix meaning without okay but when we have neuro trophy we actually have brain being fed factor means it's a catalyst it's an essential part of a process so bdnf just means it's a protein substrate that's absolutely necessary you can think of that as a fertilizer for the brain that your grass will still grow to some extent without fertilizer but if you don't have good soil enough rain it will steadily decay well bdnf helps to enrich the soil and if you still have experiences that are neurologically stimulating then your grass i.e your brain will be fed and be more likely to grow people have different amounts of bdnf available to them and that's on a personal level that is more genetically based and is not parkinson disease based so not everybody has a ton of bdnf viable however we maximize our bdnf viability through high intensity exercise so you can actually fill your tank up more rapidly with high intensity exercise and we can maximize your capacity for learning i.e neuroplasticity therein okay great so let's move on to high intensity exercise so very important for people everybody not just people with parkinson's but no matter how much we talk about it we always get the question how intense is intense enough let's start there i have a million questions about this but how intense is it yeah so typically the research tells us something in the neighborhood of 70 to 80 percent of your maximum and we can talk about that in terms of heart rate okay my age prediction maximum of heart rate is something in the neighborhood of 220 subtract away my age i'm 70 years old it's 150 multiply that by 70 or 80 percent and now you're basically talking about 120 beats per minute for 80 percent of an individual's age predicted maximum heart rate if you're 70 years old 120 beats per minute to give you some hard facts in all right that means i count on my wrist or someone else counts for me my heart rate for 30 seconds and they count it to be 60. that means for a minute it's 120 i'm there so that's one way to do it and that means i wrote and i'm actually on a stationary bike right now right so i rode the bike and i'm pedaling it away and i'm 70 years old and i made it to 120 and there's your answer but additionally we can also use 70 to 80 percent as our indicator of intensity when we're talking about strength and power okay i'm able to lift a 20 pound barbell with both of my arms and i can only do that one repetition that's my one repetition maximum well 70 to 80 percent means i want to be able to exercise and actually conduct something that is of sufficient intensity so i'm going to do 15 pounds we all know that 75 of 20 pounds and i'm going to actually see if i can use that uh weight for 8 to 12 repetitions i'm operating at 75 percent of my maximum therefore i've hit intensity again now i'm going to give you one more way and and hopefully those will kind of fulfill the questions that are out there all right what if that lowest surface that i can get up from is 20 inches and lower than 20 inches i have to use my hands or i have to get physical help now what is this is going to be a tricky math question for you you ready what is my h well what's my predicted 75 percent if 20 inches is as low as i can possibly go what height should i operate at so that i'm at about 80 will you say wait a second you just gave us this because you did 20 pounds so it'd be 15 inches right no you got to go the reverse because if 20 inches is as low as i can go i need to be a little bit higher to actually make it a little bit easier so let's do the simple math yeah if 10 of uh 20 inches is 2 inches then it's at 90 percent if i'm operating right uh at 22 inches so another 10 at 24 inches puts me at 80 because that's 20 percent easier than 20 inches so now do a collection of sit-to-stands from 20 easier than your maximum height and you hit it again i love that i have never heard that that is great i love it um i want to talk a little bit more about this first of all what about so very common uh we we talk to somebody we give them that recommendation and maybe they have never exercised and a they either can't get to that point like if they do the math right it's just like i can't get there or b they get there and it's scary because they they're really not somebody who's pushed themselves ever physically that's just not their thing yeah how do you work with that okay so i love that so much that's that hits a wheelhouse for me i like to actually take each person for what their preferences are their personality is and some people are very competitive and some people uh completely uh resist any type of stress challenge competition etc so the things that we have to think about is when we take each person at who they are a lot of times we have to think about how we're going to frame their expression of wellness so i actually have to resist using the term exercise for some people and i'll talk about it in terms of physical activity because exercise especially for the generation of people that for uh currently have been diagnosed or are living with parkinson disease exercise can seem like a little bit of a misuse of time so of for that generation an absolutely exceptional generation the baby boomers and some of that greatest generation that are still alive right before them they think well if i'm going to be moving i need to do something that's purposeful exercise is a waste of time so i need to actually change my mindset rather than trying to change their mindset so that means okay i want to actually consider how to frame your physical activity and wellness around what you like to do all right well i like to walk with friends all right we'll get your endurance exercise there i need to walk my dog we'll do some of your high speed interval walking there i play pickleball with friends we'll get your reaction speeds and your balance there i love my grandchildren we're gonna get your weight lifting there okay and i love to garden okay we're gonna get your flexibility and your ability to get up from the ground there so i'm gonna frame what types of fitness attributes i need to get for you around your preferences rather than around my preferences great i love it now let's say we have a gardener yeah and they gardening is hard work it's you're you're up and down you're on your knees you're pulling you're doing all of this kind of stuff but are you getting to that level of intensity that's actually going to create more bdnf that's going to help you with your parkinson's and that kind of thing absolutely all right so let's think about this so we know that several different authorities including the world health organization including the american college of sports medicine including the centers for disease control all are in agreement that a weekly total of physical activity should be something along the lines of 150 minutes per week of moderate intensity exercise or 75 minutes per week of high intensity exercise and we know that that works very well within the realms of persons with parkinson disease now i'm talking seven and a half minutes per day 75 minutes per week okay well actually i should say 10 minutes per day right 10 minutes per day of something that is of high intensity here's the nice thing so when i grew up see everett coop was the surgeon general and we thought okay that people need 30 minutes of endurance exercise and we used to think it had to be done all at once but now what we know going back to the gardener your question is that there is an effect of accumulation or an accumulation of activity that is just as proficient as if we did it all at once so now i'm going to take that gardener and i'm going to say okay what i want you to do is have these bags of soil that are 30 pound bags okay that you know are too heavy for you to lift let's say 10 times in a row but you've got them stacked up so that they're not all the way down at the ground and i want you to go to your uh let's say your wood shed your workshop your gardening shed out in your yard and i want you to uh three times per week pick up that 30 pound bag and bring it to your chest and set it back down and just do five repetitions that's going to be intensity and then what i want you to do is when you get down you've done some weeding every 20 minutes i want you to get up from the ground and go back down just five times that's going to accumulate and then what i want you to do is take your shovel and i want you to dig into your pile of bark dust and move it into a wheelball and give me one half of a wheelbarrow full and i want you to do that three times a week that's going to add up and we're going to get some intensity and we're going to do it and frame it around your gardening and we never called it exercise we made it purposeful oh i think that you probably just made people so happy because a lot of people that start i haven't exercised now you want me to do it every day and you want me to go get on a bike and go crazy and it's like you made it accessible yeah so the thing is melanie you said it exactly right there if we don't make it accessible for the person they won't do it if we don't make it something that they enjoy they won't be as intense with it so why not couple both of those something that's practical something you enjoy your intensity is going to be up your compliance or frequency is going to be up and it's going to be a win-win great okay so how can people track it what are some of the best ways that people that are watching this right now can kind of come up with a plan and then track their product progress and then what sort of time frame let's say there's somebody that you know doesn't really do much and now they implement a plan and they're tracking it how soon might they start to feel the benefits sort of maybe cognitively balance wise power wise all right i am going to challenge myself to give you several different ways to measure it maybe i'll come up with six or so and i'm going to try to answer all of those questions that you outlined there all right so now one let's say how much time does it take for me to walk around the block all right i can gamify that all right we made it 19 minutes and 38 seconds today honey gamify that that's a measure it okay let's go back to the sit-to-stand example that we talked about make it palatable and just do 30 seconds from a very high surface oh this low surface hurts my knees go to your bed or your guest bedroom that has a high bed and time it from something that's going to be palatable and easy and like you and i talked about you suggested it measure yourself once every two weeks or four weeks and do a 30 second sit to stand and put a clock to it that's another measure okay here comes number three how many steps does it take for you to get down your hallway when you're just walking naturally all right it's a 30-foot hallway today i just tried to do it as i normally would walk and it took me 35 steps alright how few steps can you take to get that done oh my gosh the same hallway i was able to do it in 28 steps re-gamify that measure that and occasionally when you walk through there go ahead and do it again all right now let's see can you do a sit-to-stand with your eyes closed can you gamify that no gosh i've gotta i've gotta actually put my hands on the chair or i needed help or i staggered can you gamify your ability to move with your eyes closed now let's take a look at your ability to actually uh let's let's time you going up the stairs all right that'll only take me 10 seconds but i put a watch to it my grandson is there with me he enjoys interacting with me okay grandpa let's see what your record is today you made it up in you know 9.87 seconds i don't care whether you use a handrail or not you just did intensity all right that's number five let's give you one more and let's say okay let's see how many steps you can take in a row trying to walk with your feet lined up maybe you can't even stand like that for now and maybe you get to the point in three weeks from now where you can stand put your left foot in front of your right and then you got your right foot in front of your left you made three you can measure that and now pretty soon you can walk 10 feet so i've given you six there but then you asked another question inside that how long does it take for someone to make changes i'm going to back up into exercise and i'm going to get right back at you when somebody goes to a gym for the first time in a long time and they lay down and they want to work on bench press and oh my gosh the most i can lift is 40 pounds but then next week they come back and they can do 45 pounds and pretty soon after that they can do 50. well why do people make such fast strength gains like that and when you talk about percentage you go from 40 all the way to 50 you improve by 20 right there actually 25 10 pounds out of 40. well you make gains quickly by using several different facets strength gains neuromuscular recruitment gains coordination gains motor control gains so gains that come with something that you're doing that's novel come very quickly if it's something brand new for you because you have all these different facets to tap into and now here's the last part of the answer to your question the effect of feeling dopamine and positive wellness influenced chemicals neuromodulators and neurotransmitters such as right the dopamine the endorphins the serotonin and additionally oxytocin depending on whether we're exercising with somebody else all of those things actually uh can contribute to a relatively immediate sense of wellness so now your the answer to your question is the neurochemical benefits are nearly immediate the physiologic and motor control benefits follow right after that it takes 10 minutes to make neuroplasticity work 10 minutes yeah so that's a very long answer but hopefully we've covered things comprehensively yeah no that's great and it i think it gives people hope that it's not something that has to you don't have to wait months for the impact like and the faster they start to feel it the more they all feel like i have to do this i have to do this this feels so great right yeah you get addicted to it then yeah okay can we talk a little bit about sleep it is super important for everybody especially people with parkinson's have a lot of trouble sleeping so what does it have to do with learning and how does it have to do with like helping them uh consolidate their all of the exercise that they might be doing or physical activity yeah gosh sleep maybe in the next couple of years we're going to talk about that as the eighth vital sign right we keep adding vital signs and i'll tell you the sleep science is not something that i'm trained in to be an expert in but because i am considered to be an expert in motor control and thereby motor learning and neuroplasticity i will tell you that i'm fascinated by quality of sleep because we understand that sleep is a time that we do basically three things that are important for us first and very much specific to what we're talking about today learning becomes consolidated or actually settles as wet cement becomes hard cement becomes permanent during sleep so your experiences during the day today will be things that you can hold on to but only if you get quality sleep will they be solidified as what we call episodic memories that you will hold on to in the future if you get good sleep tonight in your procedural memories the movements that you taught yourself how to do today or you learned today in your golf lesson will be consolidated also in sleep so there's one consolidation sleep also seems to have an as yet poorly defined role for clearing away some of the negative accumulations of alpha synuclein plaques beta amyloid as we sleep you think about your cerebral spinal fluid coming in as a dishwasher and basically cleaning out these negative plaques that would build up in degenerative conditions so our likelihood of developing lewy bodies would actually be reduced with quality of sleep and then the third thing is growth hormone is released during deep rem sleep growth hormone helps me take advantage of the physical stimulus that i uh subjected my body to today so i can turn it into more strength tomorrow so i'm going to stop with those three attributes of strength and again qualify i'm not pretending to be an expert in sleep but gosh as a consumer of the literature and practitioner i can tell you for certain those three attributes are solid yeah and i would bet that as a clinician you see a lot of people and when they're not sleeping you know it yeah yeah absolutely because you know that's going to throw out how efficacious uh your dopamine replacement is whether your deep brain stimulator is working to the level you normally expect it to be your relative attention to participate with me in task and then your intensity that you can conduct with me or at home are all going to be influenced by sleep right well i appreciate you being here so much mike there's so much practical advice and ideas and suggestions and i think it's going to be really helpful for our community we're going to write them all down and give people a handout so they can follow all of the tips that you gave us so i appreciate it so much thank you for being here [Music] you

Channel: Davis Phinney Foundation for Parkinson's

Views: 7,505

Keywords: Davis Phinney Foundation, Parkinson's Disease, Living Well with Parkinson's

Id: jkLAf745ksQ

Length: 49min 33sec (2973 seconds)

Published: Fri May 20 2022