“Exercise for Lewy Body Disorders”- Webinar notes

“Exercise for Lewy Body Disorders”- Webinar notes

On February 11th, Columbia’s Taub Institute hosted Dr. Lori Quinn, Associate Professor of Movement Science and Kinesiology at Teachers College at Columbia University to speak on exercise for Lewy Body disorders. Dr. Quinn explained why exercise is important for those with Lewy Body Disorders. When the speaker refers to Lewy Body disorders, she means Lewy Body dementias, including Parkinson’s Disease dementia. Exercise helps improve brain function and has a neuroprotective effect.

Dr. Quinn spoke about different exercises that are helpful, for example aerobic, strength, and stretching exercises. She recommended  exercising a minimum of 3 times a week, and detailed possible exercise options that a person can do depending on their own mobility. 

This webinar is part of the “Living With Lewy Body Disorders” spring seminar series presented by the Taub Institute. To register to attend the next sessions, email Katherine Smith from Columbia University.

For more information on the benefits of exercise see this Stanford Parkinson’s Community Outreach page.

For some Parkinson’s Disease exercise videos, see this Stanford Parkinson’s Community Outreach page

The webinar recording can be viewed here.

Please see below for notes on the February 11th webinar.

Regards, 

– Joëlle Kuehn


“Exercise for Lewy Body Disorders”

Speaker: Lori Quinn, PT, EdU, Associate Professor of Movement Science and Kinesiology at Teachers College at Columbia University

Webinar Host: Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University

Webinar Date: February 11, 2021 

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

Why should people exercise regardless of diseases/disorders?

  • Maintain a healthy weight
  • Manage stress
  • Improves sleep
  • Decreases risk for many diseases and disorders
    • Prevents many types of cancers 
    • Decrease risk for heart attack or stroke
  • Important for brain health, if your brain is healthy you can pay attention better, solve problems, communicate and maintain blood flow required for peak performance
  • Exercise has a neuroprotective effect – it is important for prevention and delaying symptoms of neurological diseases
    • Parkinson’s disease
    • Alzheimer’s disease and other dementias

Ideally we want to prevent someone from having a disease, but if someone is at risk, or at the early stages, we want to slow the progression of the disease.

Lifestyle has a large impact on your brain health:

  • Physical exercise
  • Food & nutrition – there is a correlation between gut health and brain health
  • Medical health
  • Sleep and relaxation
  • Mental fitness – helps with neuroplasticity 
  • Social interaction

“If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation” – Robert Butler, Former Director of the National Institute of Aging

How does exercise affect the brain?

  • Tested on animals such as rats
  • Those forced to exercise performed better on cognitive tasks than sedentary animals
  • Long term running exercise causes:
    • Increased growth of neurons in the hippocampus (crucial to memory)
    • Increased release of the brain factors that build new connections (synapses), increased release of synapse-forming proteins, the protein helps to compensate for areas that are damaged from disease or disorder like dementia

Exercise improves brain function in many ways:

  • Improved heart & lung function which improved motor function, attention and cognitive speed
  • Improves attention, executive function, and memory in healthy older adults
  • Improves memory, executive function, and balance in people with Alzheimer’s Disease
  • Improves working memory, processing speed and visual learning in people with depression

Exercise can be neuroprotective:

Due to the brain-derived neurotrophic factor (BDNF)

  • Supports health of existing neurons
  • Encourages growth of new neurons to be developed (called neuroplasticity)
  • If you have a disease or disorder in the brain but you can have growth of new, healthy neurons, it can help compensate for areas of the brain that are being damaged
  • BDMF is a critical factor because exercise increases the BDNF levels

Why exercise Lewy Bodies Disorders specifically?

  • Brain health and neuroprotection – to improve or maintain cognition (problem solving, cognition, speed etc)
  • Promote independence and mobility
  • To improve sleep
  • Minimize the risk of falls and prolonged periods of bed-rest and sedentary time
    • It counteracts negative components of being sedentary

What is the best exercise to do – the one you will actually do! – moving more, and sitting less

Every day: 

  • Get a dog and walk it
  • Take the stairs instead of elevator
  • Park car further away from the shop
  • 10,000 steps a day
  • Minimize time sitting 
  • Keep moving as much as possible – get up and go to the kitchen and walk back

3-5 times/week

  • Doing enjoyable recreational sports: tennis, badminton, football, dance, boxing etc
  • Do aerobic activities: fast paced walking, treadmill or elliptical, cycling, swimming

2-3 times/week

  • Enjoy leisure activities: golf, gardening, bowling, tennis
  • Stretch/Strengthen.  Start a regular exercise programme

Overall goal: sit sparingly, move more

Aerobic exercise: 

  • Total of 150 minutes per week (seems like a lot but it is 30 min a day, 5 days a week)
    • Get your heart rate elevated
    • Sweating
    • Enough to feel fatigued but not exhausted or in pain
    • Still want to be able to talk – don’t want to be heaving for breath
    • If you are starting from 0, start with 10 minutes and start with small steps and small changes
    • Do not do too much too quickly, it makes it difficult to do your goals
  • Some recommendations: 
    • Stationary cycling (such as a recumbent bike which is easy to get in and out of)
    • If you don’t have the space, a good solution is pedals you attach to a chair
    • Walking
    • Lots of gym equipment (treadmills, elliptical, rowing machines) can be difficult with people with movement disorders because it is difficult to coordinate those

What is intensity?: 

Intensity can be measured by the BORG rating of perceived exertion:

1: very light activity (sitting up, watching TV or riding in a car)

2-3: light activity (can maintain for hours, easy to breath and talk)

4-6: moderate activity (feels like you can exercise for hours, breathing heavily, can hold a short conversation)

7-8: vigorous activity (on the verge of becoming uncomfortable, short of breath, can speak a sentence), don’t want to stay in this stage very long, but spurts are good

9: very hard activity (very difficult to maintain exercise intensity, can barely breathe and speak a single word)

10: max effort activity: feels almost impossible to keep going, completely out of breath, unable to talk 

*We want to be between a 4 and a 8*

Another way is to measure your heart rate (FitBit, Apple Watch, some machines can measure it on the handle bars).  The intensity you want to get at is 75% of your maximum heart rate (ex – if 75 years old it is 108 beats per minute).

Balance exercises: 

Can help prevent mobility disorders and falls.  Recommendations:

  • Tai Chi
  • Dancing
  • Balance-challenging exercises 
    • Standing on one leg
    • Challenging your balance is one of the best ways to improve it 

Strengthening exercises:

Seated on a chair or holding onto a chair.  Recommendations: 

  • Use cans of food, hand weights, or stretchy bands to provide some resistance
  • Doing daily activities can be exercise
    • Sit to stand.  Try to get up from the chair without holding on
    • Coming up from the floor
    • Vacuuming

Stretching exercises:

Stretch upper body:

  • Arms over head
  • Extensions
  • Rotations – turn around

Lower body

  • Marching
  • Hamstrings – if you are sedentary, hamstrings are one of the first muscles to get tight 
  • Ankle stretches – ankle circles – can help with circulation

Important considerations for LBD:

  • Start as early in the disease process as possible (try as soon as you are diagnosed).  Helps create habits that you will have throughout the disease
  • Safety is very important.  An example of something that can happen is postural hypotension – low blood pressure from moving from one position to another
  • Having a partner to monitor your activity
  • Get an activity monitor – fitbit, apple watch
    • See how much you are moving, steps take etc.
    • Carrying a smartphone can help count steps too
  • Consult a physical therapist first
  • Pick something you will enjoy doing
  • There is a good connection between movement and music, try using music as a motivator 

Question & Answer: 

Question: In general, does neuroplasticity decline with age?

Answer: Yes, we know it’s at its highest when you’re young. But people can learn and change throughout their lifetime. When people learn skills or an area is injured, the brain reorganizes from environmental changes or things that happen to the body. It might diminish but the brain is still very capable throughout the lifetime. 

Question: Any recommendations for helping people stay motivated with video visits (instead of in-person visits) due to COVID-19?

Answer: Telehealth has changed through the pandemic, and there are downsides. In the future it’ll probably be in-person augmented by telehealth visits. Motivation is difficult regardless of disease. The biggest predictors is having other people around you who exercise, and having a partner to exercise with. Having people around you who value you exercising and hold you accountable even if they can’t do it themselves is motivating. Building habits helps with motivation, and starting small is best. Finding success stories are also motivating.

Question: Do you recommend Rock Steady Boxing?

Answer: Yes, it helps with balance, mobility, strengthening, rotation, and aerobic benefits.  There is also a socialization piece that helps with brain health. 

Question: Once patients end up in the hospital or a living facility, it can be difficult to exercise more (especially if staff recommend a walker or wheelchair)? What can people do in a facility study to stay active?

Answer: Advocate for ongoing physical and occupational therapy. Try to have ongoing exercise and walking. An important thing is also encouraging the ability to walk around with a nurse, or visitory, and trying to stand more and sit less. Physical therapy or exercise routines found on the internet are helpful. Some can even be done in a seated position. 

Question: What do you recommend for someone in the later stages of a disease, especially in Parkinson’s where rigidity and stiffness are issues?

Answer: If they are able to sit up (in a chair or wheelchair), any activity or movement that they can do on their own is recommended, such as moving their arms. They can also do active assisted exercise where they are helping lift the arm and move with them. There are also a lot of activities (called range of motion or assisted range of motion) that can be done lying down. Nurses are trained in a range of motion exercises, ask if you can do that. They can be passive where the nurse moves it for you which can be helpful. In later stages, it is important to be in an upright seated position as often as possible, which can help with many things (strengthening, avoiding pneumonia, or skin breakdown).

Question: How good does your cognition need to be for Rock Steady Boxing? Is it possible to participate if you are having problems with your cognition?

Answer: I recommend keeping instructions and activities simple, they shouldn’t throw many things at you at once. With Rock Steady boxing, the programs are designed knowing that some people might have cognitive difficulties, so they might do the instruction slower, but it is very individualized among the levels. I would try it, don’t do it because you are worried about cognition. Also try dancing. 

Question: If a loved one has a heart condition (AFib, orthostatic hypotension), what exercise modifications can be done?

Answer: Before a physical therapist creates a program for you they will do a screening, and most heart conditions benefit from exercise, but you do need to monitor symptoms (don’t feel dizzy, chest pain, lightheadedness etc). Low intensity aerobic exercise is beneficial, and being mindful of changes in position or doing more seated exercises are helpful for orthostatic hypotension. If you feel dizzy, sit back down and wait for your blood pressure to regulate.