On May 4th,Parkinson and Movement Disorder (PMD) Alliance presented a webinar entitled, “The Mind Body Problem: Motivation, Exercise, and Parkinson’s.”
Doctors tell those with Parkinson’s to exercise. There are countless studies that document the benefits of physical activity. However, for many, it can be hard to begin or maintain an exercise regimen. This is called the “mind body problem.”
The speaker, Sarah Ingersoll, a clinical educator with USC’s neurology department, looksat the neuroscience behind the mind body problem.
This webinar can be accessed on PMD Alliance’s YouTube Channel here.
The slides for this presentation can be accessed here.
“The Mind Body Problem: Motivation, Exercise, and Parkinson’s”
Webinar by Parkinson & Movement Disorder Alliance
May 4, 2020
Notes by Adrian Quintero, Stanford Parkinson’s Community Outreach
Dr. Indu Subramanian hosts Sarah Ingersoll, a USC Clinical Assistant Professor of Neurology. Sarah wants to encourage people to stay as active as they can. She is most interested in what makes people want to exercise. We spend a lot of time trying to decide what kind of exercise is better for us, the issue is how to get the body on board when the mind says “yes” and the body says “no.”
Sarah explains she used to not get too much exercise herself, and as she was getting older, she became more concerned about it. She called up a walking/ jogging training group that was training for an event. She had such a good time, she ended up doing the race they were all training for. This experience made her realize she really needed the group setting to be more active. In theory we can all get out of bed and be active, and most of the time, it doesn’t happen. Sarah was working at the Department of Neurology at USC, and realized there were a lot of people with PD who knew they needed to exercise but couldn’t do it. She decided to hire the same coach from the group she trained with, and get the people together to train as a team.
There are important things about working as a team:
- Teams often have a goal (i.e. race)
- On a team you can develop camaraderie over time
On the team, people who needed a walker brought the walker, and if people couldn’t do the whole race, they participated by cheering. Now in 2020 they are participating by Zoom.
The Important Question
The National Academy of Medicine:
“The challenge…is not to figure out which dose of physical activity to prescribe, but rather how to get more people to adopt the actions that researches know work”
Motivation in a group
Finding the right group is important; including the right teacher or coach, as well as other students. It doesn’t have to be people with PD, it could be other friends who also need the motivation and accountability.
Prior to COVID, Sarah’s group read around the Rose Bowl weekly. Right now people in her group are meeting virtually, twice a week. They are able to include people who normally have trouble with transportation, including someone who moved out of state. Some people do chair exercises, and some do them standing.
She would love to see more PD support groups also include exercise support and start their own team.
Sarah believes in goals to help keep oneself motivated. For her, this is entering races, where she can keep track of her times. She encourages people to sign up for a 5k. She looks for races with no time limit. When you do get a cross the finish line, you get a medal, which can be very powerful. Sarah’s group does a 5k in Los Angeles.
Of course, not everyone needs goals for the motivation. There are those of us who on their own will, for example, get up and run every morning, but she thinks that is less common.
- How hard should one push themselves?
How hard to push oneself is subjective. Sarah thinks there should be more studies around more vigorous exercise. Much of the research says to do 30 minutes of moderate exercise per day. This is good, but, Sarah says, doing more you will feel stronger and fitter.
She says most of us should do more than we think we can. Working with a coach who is sensitive to that, who can push you but not too hard, is very helpful.
- What about people with PD who may discount themselves because of their diagnosis?
Dr. Subramanian says to meet with a PT early on, get a sense of their goals for you, and then find a way to keep the trajectory going through a group. There are benefits with both motor and non-motor symptoms. Sustaining the exercise it is important.
- Are there virtual race options during shelter-in-place?
Sarah explains almost all the race directors are really hurting right now, as all the races have been canceled. Many of the races have gone virtual and they’d love for you to sign up. It is still allowable to go running outside in your neighborhood. There are many opportunities for virtual races, but Sarah and her group have not done it.
Parkinson’s foundation had a virtual race on May 9th. There is one that Disney is doing as well.
- What about if you have bad knees or hips?
Sarah had some trouble with her knees after started running, and took up Swimming. So when her knees are bothering her she goes swimming. She can swim, run if it’s not too much, and can ride a bike. So she can do triathlons. Of course currently the pools are closed.
- With all the evidence of short and long term benefit from exercise, how do you motivate loved ones to exercise?
There are benefits to both motor and non-motor issues. What brings the person joy? Is there something from their past they might find joy re-engaging in? Is there a group of friends who they can join? Couples often enjoy different levels of exercise.
- What about Rock steady and Dance with Parkinson’s?
Sarah thinks those are fabulous, and if you can afford them, they are terrific. The reason she focuses on walking/ jogging is that it is the lowest cost activity.
- What about using a treadmill while watching TV?
Any activity is better than no activity. A lot of research says exercise should be mentally engaging as well, which is part of why Rock Steady and dance are so beneficial. Walking/ jogging outside where there is a lot to see and take in keeps you mentally engaged, so that may be better than a treadmill and TV. But if it’s a choice between a treadmill with TV or not at all, go for the treadmill and TV.
- When I exercise a lot I have more tremor come out. Is this because of a lack of dopamine?
Dr. Subramanian says there are no studies to show that tremor has to do with the amount of dopamine in the brain. Tremor is probably much more reflective of the amount of adrenaline or other stimulants you have in your body. Tremors are not dangerous. When you exercise intensely, that’s when the adrenaline is going to be flowing, and that can be good for a number of non-motor issues.
Sarah says people are interested in physical activity trackers. She says she found with FitBits there is the issue of needing to recharge them and maintain them that can be difficult for people. For her group, they use a tracker from Garmin that uses a watch battery, that only needs to be replaced yearly, and it is also waterproof. It connects to the phone similar to a FitBit. This helps some people keep motivated (being able to look at or share their steps).
Along with a colleague, Sarah is also looking into about how virtual reality can benefit people as well.
Work with medical students
One of the jobs Sarah did at USC for 10 years was the medical student educator. One ways that students learn in school is with standardized patients, who are actors with symptoms. She asked people with PD to come in and tell doctors what it’s like to have PD, and the students can learn from real patients more about PD. She asked the patients to bring up the subject of exercise, if it didn’t come up on its own.
Sarah restates exercise is an important component to the well being of people with PD. Social engineering is the concept for making sure you are in a social situation that brings out the best in you. If your friends are exercising, this may encourage you to do so as well.
Dr. Subramanian says like food, water, shelter, and sleep, human connection is a basic need.