Dancing Away Disability Part 4

Exercise That Promotes Recovery

 By Irene Marie Kuch Watson

 In 2006, through our Power Over Parkinson’s1 class in Tucson, Rick and I had the extraordinary good fortune to meet Dr. Becky Farley, PHD, University of Arizona neuroscientist, physical therapist and Parkinson exercise expert, and the very person who held the keys to recovery fro Parkinson’s Disease. Meeting Becky profoundly changed our lives because she taught us how us to rescue ourselves from the forward march of both Parkinson’s Disease and my cystic fibrosis.

Albert Einstein said, “Life is like riding a bicycle—in order to keep your balance, you must keep moving.” From Becky, as she is affectionately called by many, we learned the profound implications of Albert Einstein’s witty quip.

Dr. Becky Farley

When we met her in 2006, Becky was researching the use of exercise to get better from PD and was looking for research subjects with early stage PD. Rick and I volunteered and from 2006 to 2009 we performed various kinds of movements under her direction while computers collected data from the many sensors both on our bodies and on the surfaces that we touched. From this and other data Becky was able to determine what type of exercise can induce changes in the brain that promote recovery from PD.

In 2009 Becky wrote of the “enormous capacity of the PD brain to reshape itself in response to self-produced activity . . . Patients without specific contraindications should be encouraged to begin exercise training programs that focus on achieving a higher training intensity, beyond what they may self-select . . . We have a tremendous opportunity and a duty to help educate our PD patients on the benefits of exercise . . . A period of inactivity or stress may reverse the protection and behavioral benefits of exercise . . . inactivity is not only a symptom of PD, but a catalyst in the degenerative process . . . The scientific bases for exercise prescription in PD should be taught at medical and physiotherapy schools and residency programs.” 2  These are profound words!

In 2010, Becky founded Parkinson Wellness Recovery 3 whose website www.pwr4life.org contains the statement:
"We believe that people with Parkinson's Disease can GET BETER and STAY BETTER with Exercise."

Rick and I were still Becky’s research subjects in 2009 when she created the model for a community gym (which she later branded as PWR!Gym®) where people with PD can practice exercise as medicine. We joined the gym and trained with her there in 2009 and 2010.

Each year during the hottest summer months Rick and I returned to our Monterey area home to escape the heat in Tucson. While in California in 2009 my lungs became infected with the deadly multi-drug-resistant mucoid Pseudomonas aeruginosa bacteria and during the summer of 2010 the pneumonia from this bacteria became so serious that my survival was seriously doubted. Overwhelmed with the care of two homes, we decided to remain permanently in California where we are nearer to our sons. But this choice meant the loss of our Parkinson’s exercise program at Becky’s gym in Tucson, a very big loss indeed.

Fortunately I was referred to National Jewish Health in Denver in the fall of 2010, where my Nonclassic Cystic Fibrosis was diagnosed and my deadly pneumonia was successfully treated, which saved my life. I returned home from Denver very weak and debilitated. My Parkinson’s tremor had also returned and it interfered with my ability to rest and sleep. Then in the midst of this difficult time Rick and I had the good fortune meet Cathy Rivera, a wonderful Monterey neurological music therapist, who came to our home and worked with both of us. She is the one who recommended the metronome to Rick so he could get out of his closet. I was so weak then that I would fall asleep while she led us in an hour-long music-based program of exercise and yoga to combat our Parkinson’s and to help me rebuild my strength and endurance.

As I got stronger Rick and I both received physical therapy from Dr. Jeanine Yip, a PhD in physical therapy who is currently a neurological physical therapy clinician and clinical instructor at CHOMP (Community Hospital of the Monterey Peninsula) as well as an assistant professor of research physical therapy at the University of Southern California.

Rick and I kept in touch with Becky in Tucson and when in May of 2011 Becky offered her first PWR!Retreat, a weeklong intensive residential PD exercise boot camp,⁴ Rick and I were thrilled to be able to attend. 

PWR!Retreat with Becky, May 2011 at Wickenburg AZ

All of us participants were tested at both the beginning and the end of the week to assess the nature and degree of our movement deficits. During the week we all participated in exercises designed specifically to target these deficits and the improvements we all experienced were truly impressive. A number of experts in the field of PD and recovery also gave presentations to help us grasp the essentials of how exercise promotes recovery.

One of these experts was Dr. Giselle Petzinger, MD and an assistant professor of research neurology at the University of Southern California. In 2009 Giselle Petzinger had written, “There is compelling scientific evidence . . . that intensive exercise can alter the way the brain works and promote recovery.” 5 Her very interesting lecture was just before lunch one day and I snagged her just after her talk and got the opportunity to ask her my 40 questions as we lunched together.

Giselle Petzinger, Becky Farley and Jeanine Yip collaborate in Parkinson’s neuroscience research involving the use of exercise and all three are focused on how to translate research findings into clinical care for individuals with PD. Rick and I are thrilled to have been able to work with each of them, as well as with neurological music therapist, Cathy Rivera, who helped me build my strength and endurance through yoga following my 2010 CF diagnosis at NJH. I have learned a great deal from each of them about the use of exercise to recover from PD.

In the fall of 2011 at a Davis Phinney Foundation Victory Summit event for people with PD Becky presented her research findings beginning with the announcement,

“HOW YOU EXERCISE MATTERS!”

Exercise must be of a certain complexity, intensity, frequency and duration. When those conditions are met, exercise causes our neuroplastic brains to reorganize in a way that brings recovery. However, she cautioned that “These brain changes augment the effects of medications and together they restore function.” So don’t stop taking your meds.  During her presentation, Becky went on to describe what she later branded as the PWR! Exercise4BrainChange® principles, namely the type of exercise that promotes brain changes leading to recovery: 6

• It is aerobic—Aerobic exercise metabolically prepares neural substrates to learn (neural priming)
• It involves learning new skills—Learning new skills creates new or restores old neural communications in the brain, which underlies long term behavioral recovery
• It is physically intense—The exercise must require you to push beyond your self-selected energy expenditure
• It is increasingly complex—The exercise must be progressively challenging and require a constant high level of focused attention
• It specifically targets your deficits—The exercise must involve movement that is or has become difficult for you through aging or disease, such as taking big steps, rotating the spine, shifting the weight from foot to foot, turning while walking or otherwise moving forward, moving to a changing tempo, and maintaining an upright posture
• It is emotionally engaging—Exercise that is fun reduces stress and ensures that you will continue; exercise that involves achieving a satisfying goal empowers you
• It must be repeated and repeated and repeated— so that acquisition of the new skills and the new neural pathways are achieved
• It is practiced at least 30 minutes most days of the week

In May of 2013 Rick and I visited Becky at her PWR!Gym® in Tucson and she excitedly told us that Giselle Petzinger, Jeanine Yip and other researchers at USC had just completed a study in which the researchers amazingly captured images (pictures) of neuroplastic changes in dopaminergic signaling in the basal ganglia of the study participants’ brains, changes that took place during a program of exercise that brought about improvements in motor function. The images were obtained using PET scan technology (Positron Emission Technology, a nuclear medical imaging technique). 7 So there it was, visual proof of the brain changes associated with motor-function-improving-exercise.

Other scientific research has shown the amazing benefits of exercise to promote recovery from a wide number of ailments. I’ve listed comments from a few of these:

 According to Harvard University School of Public Health, “Regular exercise or physical activity helps many of the body’s systems function better.” 8 Exercise is an unparalleled protector of health and a remedy for many, perhaps most, diseases.

Aerobic exercise provides a certain amount of airway clearance and airway hydration, two functions that are critical to reduce the chronic inflammation and infection that cause CF’s severe morbidity and mortality. 9 

According to a July 2012 Expert Review of Respiratory Medicine, “exercise is safe, beneficial, and has the potential to have a significant effect on outcome for individuals with CF. However, the current practice of exercise testing and exercise prescription in CF centers is highly variable. In order for exercise to become an integral part of the therapeutic clinical management of individuals with CF, it is important that all those involved in CF care view exercise as a ‘medicine’ for CF.” 10

 Numerous other studies have shown the profound benefits of aerobic exercise. 11-17

There is a significant body of scientific research that demonstrates that ballroom dance lessons are an excellent if not superior therapy for chronic disease, especially for Parkinson’s Disease. 18-25 Here are two more reports:

• Pamela Quinn, PD patient, professional dancer and movement therapist states, “Dance is an ideal tool for retrieving many of the functions PD takes away. In combination with music, dance uses auditory cuing to both initiate and organize movement and to propel you through space. Dance also uses visual cuing and touch to initiate movement. In addition to these cuing systems, dance teaches the mechanics of posture and balance, requires the repetition and memorization of sequences, and uses imagery to elicit a range of movement. Perhaps most important of all, dance involves the practice of conscious movement every day. A dancer is constantly directing the body, talking to it…[which over time] supply a host of skills and a nervous system supplied with useful detours already in place.”26-27
• The NYU School of Medicine states, “Not only has Argentine tango proven to be beneficial for the motor function of patients with PD, it has also demonstrated superiority to exercise and American ballroom dance. The Argentine tango demands postural control, movement initiation, turning, and moving in close proximity to another individual. These fundamentals of Argentine dance can improve balance, difficulties in movement initiation, directional changes, and overall functional motor control . . . If research continues in this direction, it may not be long before we see Parkinson’s patients practicing the Argentine tango up and down the halls of Neurology Clinic.” 28

During the 10-month, period from November 2010 to September 2010, my working with Cathy, Jeanine, and Becky in various forms of exercise, in combination with the medications prescribed me at National Jewish, brought me transformational benefits:

• A phenomenal 43% improvement in my lung function from 42% of normal to 60% of normal, as measured by FEV1 (Forced Expiratory Volume in 1 second). FEV1, which measures the maximum volume of air one can forcefully exhale in one second as a percent of normal, is the single most important measure of a person’s vitality regardless of his/her health status
• A significant decrease in my Parkinson’s tremor, reduction in my stooped posture, and improvement in my balance

I realized that if I wished to continue to improve, an ongoing program of exercise was essential. Becky’s gym was no longer available to me now that we lived in California full time. I made a valiant effort to try to bring Becky’s gym concept to Monterey, but failed in that effort. Then one day during the fall of 2011 I found the answer. Overhearing the strains of music coming from a ballroom dance studio, I was enticed to go in. Inside I found another set of keys, keys that opened the doors to joyful youth-instilling exercise in the form of ballroom dance.

(The story is continued in Part 5, Dancing And My Amazing Reversals of Disease. See Part 7 for all references.)

© 2014 Irene Marie Kuch Watson