June 4, 2025 • 37 mins
Are you living with Parkinson's and wondering if pushing your limits with high-intensity exercise could be a game-changer? This episode of dives deep into High-Intensity Interval Training (HIIT) for Parkinson's disease. We cut through the noise to explore the cutting-edge research and practical considerations you need to know. Could HIIT be the key to slowing progression, improving symptoms, and enhancing your quality of life? Or are there risks to be aware of?
Join us as we discuss:
- What defines "high-intensity" exercise for people with Parkinson's.
- The latest research on neuroprotection: Can HIIT actually slow Parkinson's progression by impacting BDNF, dopamine, and neuroplasticity?
- Significant improvements in motor symptoms like gait, balance, and bradykinesia reported in studies.
- How HIIT may positively influence non-motor symptoms such as fatigue and mood.
- Key studies and meta-analyses that highlight the benefits of high-intensity aerobic training.
- A crucial comparison: How high-intensity exercise may offer unique advantages over moderate activity.
- Is HIIT right for you? Understanding the practical considerations, safety protocols, and the importance of professional guidance.
- Tips for accountability to help you stick with a high-intensity program.
This episode is a must-listen for anyone with Parkinson's, caregivers looking for evidence-based insights into advanced exercise strategies.
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#ParkinsonsDisease #HIITforParkinsons #HighIntensityExercise #ParkinsonsResearch #Neuroprotection #ParkinsonsSymptoms #ExerciseForP
Disclaimer: This podcast is for educational purposes only is not intended to treat or diagnose Parkinson's Disease. Please ensure that you are following the treatment plan developed by your doctor. Please ensure before starting anything new you get approval from your doctor. The information being provided is based on my own personal experiences and does not guarantee that it will benefit everyone.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Hello and welcome to Live Parkinson's Live an
Exceptional Life.
I'm your host, chrisKastenbader, and I've been
living an exceptional life withParkinson's for the past 15
years.
The mission of this podcast isto help as many people as
possible living with Parkinson'sto lead a great quality of life
.
Today's topic is Parkinson'sand HIIT.
Is high-intensity exercise safeand effective for Parkinson's?
(00:32):
Imagine an exercise that cannot only manage your Parkinson's
symptoms but potentially slowits progression.
Sounds almost too good to betrue.
Right Today, we're diving intothe high-intensity interval
training, or HIT, forParkinson's disease.
Is this intense approach safe?
More importantly, could it bethe game-changer that you've
(00:56):
been looking for?
Let's look at this as we unpackthe science and practical
realities of HIT.
I like to exercise and I'malways looking for new exercises
that can help me on myParkinson's journey.
So as I was reading and doingsome research, I kept reading
about intensity intervaltraining.
It almost seemed to be afrequently asked question in
some of the chats I was trainingfor football way back, since it
(01:18):
was a health benefit and riskfor people with Parkinson's.
After all, I don't want to besharing information if it wasn't
a safe option.
So in this episode, I want toshare what I've learned about
high-intensity interval trainingso that you can ask your health
professional if it'sappropriate for you.
Now let's give you a roadmap ofwhat we'll be covering in this
episode.
We'll start out with definingwhat high-intensity aerobic
(01:43):
exercise is for Parkinson's andthe concept of forced exercise.
Then it's time to talk aboutthe research.
What does the science say?
We'll talk about its effects onneuroprotection and symptom
management and compare itsresults to moderate exercise.
Then we'll transition into somepractical considerations.
Is it right for you?
(02:03):
Then we'll transition into somepractical considerations.
Is it right for you?
Then talk about how to getstarted in maintaining intensity
for this type of workout, ifit's appropriate for you.
Now in this segment, we'lldiscuss choosing your activity,
the structure of the workouts,the role of a coach and trainer
and accountability, and thenI'll give you some tips for
(02:24):
staying consistent.
Then we'll wrap it up in a nicepackage and arm you with the
information you need to reviewwith your doctor to make sure
this program is right for you.
So if you want to get a betterunderstanding of high-intensity
interval training, then join meon this journey of exploration.
Now, before we get too deepinto this topic, I just have a
disclaimer that the informationbeing provided is for
(02:46):
informational purposes only anddoes not constitute medical
advice or exercise advice.
Please consult your neurologistand primary care physician to
determine if this type ofexercise is appropriate for you.
All right, you might have heardterms like forced exercise or
pushing past your comfort zonein relation to Parkinson's, but
(03:08):
what exactly does high intensitymean in this particular context
?
But, more importantly, is highintensity interval training
truly beneficial and is it rightfor you?
So let's start by clarifyingwhat we mean by high intensity
in the context of Parkinson's.
No, it's not about being anOlympic athlete, but about
(03:30):
reaching a certain physiologicalthreshold.
In essence, high intensityinterval training, also known as
HIIT or simply vigorous cardio,involve periods of intense
physical activity interspersedwith short recovery periods.
So for individuals withParkinson's, this means
elevating your heart rate to asignificant level than typical
(03:55):
moderate exercise.
So you're generally aiming for70 to 85% of your maximum heart
rate, where talking becomesdifficult, but it's still
possible.
Well, that really sounds great,chris.
But how do we figure out what 70to 85 percent of my maximum
heart rate is?
Well, I came across a commonformula that is often used, and
(04:17):
what they do is they take 220minus your age.
So, for example, in my case,minus your age.
So, for example, in my case, mymaximum heart rate figure is
220 minus 61, which is my age,which brings me to 159, and
that's 159 beats per minute.
Then to calculate 70% of that,we multiply 0.7 times the 159,
(04:44):
and that's going to give me 111.
And then to calculate the 85%,I would take that 159 beats per
minute times 0.85, and thatgives me 135.
So my target heart rate rangewould be 111 to 135 beats per
(05:05):
minute during moderate tovigorous exercise.
So this range is often calledthe target heart rate zone,
helping sure you're exercisingan intensity that is effective
but safe.
Now it's important to understandthat high intensity is relative
to individuals and theircurrent fitness level and their
(05:25):
Parkinson's symptoms.
You want to keep that in mindas well.
Now, what's high intensity forone person might be different
for someone else.
The key is the effort and thephysiological response, not
necessarily based on specificspeeds or how much weight you're
using.
It's important that you getapproval from your doctor before
(05:46):
starting any new exerciseprogram, though.
Now let's take a look at someexamples of high-intensity
aerobic exercises forParkinson's.
When done at the rightintensity, we'll start off with
brisk walking or power walking,and what you do there is you're
pushing the pace of your walk tothe point where your breathing
(06:06):
becomes hard and you're startingto sweat, and then maybe you
can even try throwing in someinclines.
So what you want to do is youwant to make sure that you get
your heart rate up for a periodof a minute and then you can
bring it back down for 20seconds and then bring it up for
a minute.
Those will be examples ofinterval training.
So you're bringing your heartrate up and then you're bringing
it back down for 20 seconds andthen bring it up for a minute.
(06:26):
Those will be examples ofinterval training.
So you're bringing your heartrate up and then you're bringing
it back down.
Another would be cycling.
Stationary bikes are oftenpreferred for safety, especially
if you have balance concerns,and this can be done with either
a high resistance or a fastcadence.
So what you might want to do isyou might do a 20-second sprint
and then a 10-second rest.
(06:47):
A 20-second sprint, a 10-secondrest, and maybe you do six reps
of those.
That would be an example ofhigh-intensity training.
And then tandem cycling hasalso been studied as a forced
type of exercise where astronger rider helps the person
with PD maintain a higher pacethan they normally would cycle,
(07:08):
and then this is the basis forthe Pedaling for Parkinson's
program through the Davis FinneyFoundation.
Another would be treadmillwalking or running, adjusting
speed and incline to reach yourtarget heart rate.
Now, before I was diagnosedwith Parkinson's, I used to run
on the treadmill three times aweek and one of the days I would
(07:29):
do intervals where I would runfor 30 seconds at a constant
speed and then 30 seconds at ahigher speed, maybe half a mile
to two miles an hour faster thanI normally could, and I would
keep alternating back and forth.
Now, could I do this now?
No, because the treadmill wouldprobably shoot me across the
(07:52):
room.
But I do increase and decreasemy speed when I'm walking, so
I'll walk fast and then slow mypace a bit, and then walk fast
and then bring it back to mynormal pace.
Now another example iselliptical training slow my pace
a bit and then walk fast andthen bring it back to my normal
pace.
Now, another example iselliptical training, and that's
a low impact option that canprovide a full body workout at a
high intensity.
(08:13):
And then we have vigorousdancing.
Certain types of dance caninvolve sustained periods of
high energy movements.
Now you may be saying, okay,chris, are you going to provide
some examples?
Oh, alright, here we go.
Here's some examples ofvigorous dance that would fit
the bill.
These would include salsa andmamba, which are both fast-paced
(08:35):
with your feet, so you've got alot of fast-paced footwork with
continuous motion.
Another would be Irish dancesteps.
They use lightning fast legmovements with minimal upper
body movement.
Jazz and contemporary, whereyou have sharp, either dynamic
leaps and turns, which I don'tknow that most of us with
(08:56):
Parkinson's are going to be ableto do.
But then you have swing andlindy hop.
I know what swing is, but Ireally didn't know what Lindy
Hop was.
And then, finally, zumba andAerobic Dance, which is designed
for sustaining cardio intensity.
Now, all these dances requirestrength, stamina and precision
to maintain their high energymovements.
(09:19):
Now boxing non-contact, ofcourse.
Now I don't know about you, butI don't like getting punched in
the face.
So non-contact is the way to go.
And there's programs like RockSteady Boxing which can
incorporate high-intensityintervals.
And then, finally, rowing.
If you've ever done a rowingmachine, it can provide a
(09:39):
full-body aerobic workout,because you're using your arms,
your legs, your back, and it's agreat way to do interval
training.
All right, now that we've lookedat some of the exercises that
are high intensity, let's answerthe question why someone might
consider trying high-intensityaerobic exercises for
Parkinson's.
Well, there's a growing body ofresearch that suggests that
(10:02):
high-intensity aerobic exercisemay offer unique and significant
benefits for people withParkinson's, going beyond what
normal, moderate exercise alonecan provide.
So here's some reasons whysomeone might consider it.
Now, again I want to emphasizeyou should review any new
exercise plans with your doctorto ensure that it's appropriate
for your specific needs, doctor,to ensure that it's appropriate
(10:27):
for your specific needs.
Now, the first reason peoplemight consider it is for the
potential for neuroprotectionand disease modification, and
this is probably the mostcompelling reason.
Emerging research suggests thathigh-intensity exercise may have
a neuroprotective effect,potentially and that's the key
word slowing the degeneration ofdopamine-producing neurons in
the brain.
Now, an article entitledHigh-Intensity Exercise and Its
(10:50):
Protective Mechanisms on theBrain by Judd Eason that was
published at helpforpdorg, andthe author references a Yale
study that included 10 peoplewith Parkinson's.
Each person received theirParkinson's diagnosis less than
four years prior to the study.
The group completed a six-monthhigh-intensity exercise
(11:13):
training program.
The participants had an MRI anda PET scan at baseline, and at
the conclusion of the study theresearchers reported that after
six months of exercise theneurons had grown to be
healthier and produced strongerdopamine signals.
According to the article, thebrain imaging showed a
(11:35):
significant increase in signalswithin the substantia nigra,
which is the area of the brainthat produces dopamine.
The article quotes tworesearchers.
Dr Evan Morris shared that thisis the first time imaging has
been used to confirm the biologyof the brain in those suffering
with PD is changed by intenseexercise.
Dr Sul Tinez MD, the leadinvestigator, stated the
(12:01):
medications that we haveavailable are only for
symptomatic treatment.
They do not change the courseof the disease, but exercise
seems to go one step beyond andprotects the brain at the
neuronal level.
The article also references twoadditional studies that showed
that engaging in high-intensityexercise three times a week for
(12:22):
six months correlated with lesssevere motor symptoms.
Moderate to low-intensityexercise has not been shown to
have the same effects on ourbrain.
Now, another reason peopleconsider high-intensity interval
training is enhanced functionalabilities.
Exercise has not been shown tohave the same effects on our
brain.
Now, another reason peopleconsider high-intensity interval
training is enhanced functionalabilities by improving core
(12:44):
motor symptoms, high-intensityexercise can translate to better
functional independence indaily activities, making our
daily tasks like walking,dressing and reaching easier.
Another reason is improvednon-motor symptoms.
High-intensity exercise hasbeen linked to improvements in
non-motor symptoms such asfatigue, mood and that's
reducing anxiety and depression,and even cognitive function,
(13:06):
involving our memory andthinking.
Now there's also cardiovascularbenefits.
Like all aerobic exercise,high-intensity training
significantly boostscardiovascular fitness, which is
beneficial for our overallhealth and can help us manage
other issues often seen with PDhealth.
(13:28):
The intense challenge posed bythese workouts can stimulate
neuroplasticity it's the brain'sability to reorganize and form
new neural connections, and it'sparticularly helpful when
you're learning a new skill orhobby.
So this can help the braincompensate for changes caused by
PD.
And, as a final consideration,some people see increased
(13:50):
motivation and adherence.
So for people that like achallenge and see tangible
results, the perceived benefitsof high-intensity training can
be a strong motivator, helpingthem stick with their exercise
program.
All right now, before we godiving feet first into
high-intensity aerobic training,there are some important
considerations that need to beunderstood before starting this
(14:13):
type of exercise program.
While the potential benefitsare exciting, I do want to
emphasize that high intensityexercise for Parkinson's should
be approached with caution andprofessional guidance.
Now, it's not suitable foreveryone, especially those with
advanced PD, significant balanceissues or if you have
(14:33):
underlying cardiovascularconditions.
So before trying anyhigh-intensity program, it's
absolutely essential to consultyour neurologist and your
primary care physician formedical clearance.
That way you can undergo anassessment by a physical
therapist or an exercisephysiologist specializing in
Parkinson's to create a safe andpersonalized plan.
(14:55):
As always, you want to startgradually and then you want to
progress slowly, so build intoit All.
Right now let's switch gears andtalk about the research behind
high-intensity aerobic intervaltraining.
So what does the science say?
Interestingly, the research onhigh-intensity aerobic interval
training for people with PD isan exciting and rapidly evolving
(15:17):
field of study.
While, historically, exercisemight have been viewed as less
impactful, there's a significantbody of evidence that's emerged
which suggests thathigh-intensity exercise offers
distinct and potentiallysuperior benefits compared to
moderate or low intensityactivity.
So let's look at what some ofthe science has to say.
(15:38):
Well, actually it doesn't talk,but I actually had to read the
science and study this myself.
So let's start withneuroprotection and slowing
disease progression.
Now, one of the most compellingparts of high-intensity exercise
in Parkinson's is its potentialfor neuroprotection.
Now what do I mean by that?
(16:00):
That it might actually protectbrain cells and slow disease
progression rather than justmanaging our symptoms.
So let's look at what some ofthe studies are evaluating in
the area of neuroprotection andlet's lead it off with
brain-derived neurotropic factor, which is BDNF.
Now, multiple studies,including both systematic
(16:24):
reviews and meta-analysis, whichcompare multiple studies,
indicate that exercise, andparticularly high-intensity
exercise, can increase levels ofthe brain-derived neurotropic
factor in the body.
Now, bdnf is a crucial proteinthat supports the survival of
existing neurons and helpspromote the growth of new
(16:46):
neurons and new synapses.
So in Parkinson's, wheredopamine-producing neurons are
degenerating, increasing theBDNF is hypothesized or believed
to offer protective effects.
Now research suggests thatexercise-induced increases in
circulating BDNF may serve as atherapeutic benefit in
(17:09):
Parkinson's, and that comes fromthat Yale study.
Now, next up is dopaminereceptor sensitivity and
production.
Some research using imagingtechniques like PET scans have
shown that high-intensityaerobic exercise can lead to an
increase in dopamine release incertain regions of the brain and
may improve the sensitivity ofdopamine receptors.
(17:30):
Now, that's critical forParkinson's because we know it's
related to the loss ofdopamine-producing neurons.
Now the Yale pilot study, forinstance, indicated that
high-intensity exercise mightpreserve and even make healthier
dopamine-producing neurons,leading to stronger dopamine
signals.
(17:51):
Now let's look at research onsymptom management, and that
includes both motor andnon-motor benefits.
Now, beyond potentialneuroprotection, high-intensity
aerobic exercise hasdemonstrated some significant
benefits in managing both motorand non-motor symptoms.
In terms of motor symptoms,research consistently highlights
(18:13):
improvements in key motorsymptoms.
First is gait Research hasshown increased gait speed,
improved stride length andreduced double limb support time
have been observed.
And then balance, which isimportant for all of us, because
I think a lot of us haveproblems with balance.
In terms of balance improvepostural stability and better
(18:36):
scores on balance scales, whichare crucial for fall prevention.
Then we have bradykinesia, orslowness of movement, exercises
showing improvements in thespeed and fluidity of movements.
And then rigidity Some studiesnoted a reduction in Parkinson's
hypertonia and muscle stiffness.
All right, chris.
(18:56):
So what is Parkinsonianhypertonia?
Look, I'm going to be honestwith you, I wasn't familiar with
that term either.
So I did a little research andit refers to muscle rigidity or
hypertonicity, which is a commonfeature of Parkinson's.
And then, in terms of overallmotor function, significant
improvements in overall diseaseseverity, as measured by scales
(19:20):
like the Unified Parkinson'sDisease Rating Scale, or the
UPDRS Part 3 Motor Score, thatyour neurologist or movement
disorder specialist may useduring your examinations.
Now let's take a look at somenon-motor symptom benefits.
These are the ones that gobeyond our physical movement and
our motor symptoms.
And we'll start it off with thedreaded fatigue.
(19:43):
Participants in HIT oftenreport a decrease in perceived
fatigue.
In terms of mood, studies haveshown positive effects on mood,
potentially reducing symptoms ofdepression and anxiety, both of
which are common in people withParkinson's and cognition
improvements in cognitivefunction, including attention,
(20:06):
executive function.
Now, these are those skillsthat help us plan, organize and
complete tasks.
Now, these are those skillsthat help us plan, organize and
complete tasks.
And then, working memory andcognitive flexibility have been
observed in some studies,particularly those involving HIT
.
All right, this soundswonderful, but it's also nice to
know where these particularbenefits come from.
(20:28):
So let's take a look at some ofthe studies and break them down
into simple summaries.
You don't need to be PhDresearchers here Now.
I like to look at things insimple and straightforward terms
.
So let's look at a few examplesNow.
The first one I'm familiar withbecause it relates to cycling.
Now I'm a certified Pedalingfor Parkinson's instructor
(20:51):
through the Davis PhinneyFoundation and I lead a weekly
Pedaling for Parkinson'sinstructor through the Davis
Phinney Foundation and I lead aweekly Pedaling for Parkinson's
class with a great group ofpeople with Parkinson's and as
part of that training,certification, we had to be
familiar with these studies andthe first one is Forced, not
Voluntary, exercise ImprovesMotor Function in Parkinson's
Disease Patients.
(21:11):
That was conducted at theCleveland Clinic Dr Alberts and
it compared two groups 10patients with mild to moderate
Parkinson's were randomlyassigned to complete eight weeks
of either forced exercise,where you're pushing yourself
past what you typically do, orvoluntary exercise.
So what does that mean?
The forced exercise group, withthe assistance of a trainer,
(21:35):
pedaled at a rate of 30% greaterthan their preferred voluntary
rate.
So that's what they typicallyrode at, and the voluntary group
pedaled at their preferred rate.
Now the aerobic intensity wasidentical for both groups 60 to
80 percent of their individualtraining heart rate.
Now the results showed theaerobic fitness improved in both
(22:00):
groups, but the motor scores inthe forced exercise group
improved by 35 percent, whilethe voluntary group did not show
any improvement.
Though being forced to exerciseat a higher intensity than
usual, they were able to seebenefits in their motor symptoms
.
Now, the next study was theSPARX S-P-A-R-X trial, which is
(22:28):
the study in Parkinson's diseaseof exercise.
Now, this was a landmark phasetwo randomized clinical trial.
Now, the study was a randomizedcontrolled trial of high
intensity treadmill exercise inParkinson's disease that was
published in the Journal ofNeurology in 2017.
Now, the focus of this studywas to directly compare high
intensity treadmill exercise,which was 80 to 85% of maximum
(22:49):
heart rate, to moderateintensity, or 60 to 65% of
maximum heart rate, and theusual care in early stage PD.
Now, the key motor findingsdemonstrated that high-intensity
exercise was safe and feasibleand significantly improved the
worsening of motor symptoms, asmeasured by the unified
(23:10):
Parkinson scale over six months.
Compared to the control group,the high-intensity group showed
essentially no worsening, whilethe control group did.
Now, the moderate-intensitygroup also showed less worsening
than the control, but not asmuch as the high-intensity group
.
Now, another study feasibilityand effect of high-intensity
(23:32):
training on the progression ofmotor symptoms in adult
individuals with Parkinson'sdisease a systematic review and
meta-analysis that was publishedin the Journal of Neurological
Sciences in 2023.
And its focus was lookingspecifically at high-intensity
training and that concluded thathigh-intensity exercise,
(23:53):
performed in both continuous andinterval modes, when compared
with control groups, may providemotor function benefits for
individuals with Parkinson's.
It also found benefits formaximum oxygen consumption and
overall quality of life.
And the final study looking atnon-motor symptoms was physical
(24:32):
exercise for treating non-motorsymptoms.
While it found trends forgeneral exercise, it noted that
aerobic exercise showednear-large effects compared with
conventional exercise fornon-motor symptoms.
So that begs the question howdoes high-intensity aerobic
(24:54):
exercise compared to moderateexercise?
Well, while moderate exercise isundoubtedly beneficial to all
of us and it's one of thecornerstones of Parkinson's
management, some researchsuggests that high-intensity
exercise may offer additional orunique advantages, particularly
concerning its potentialneuroprotective effects.
Now, the idea is that greaterphysiological challenge of
(25:16):
high-intensity training mighttrigger more robust adaptive
responses in the brain and thebody.
This could lead to a moresignificant upregulation of what
they call neurotropic factors,like the BDNF that we talked
about a little bit earlier.
Now, some studies directlycomparing HIT to
(25:37):
moderate-intensity continuoustraining have showed that while
both can improve cardiovascularfitness and motor symptoms, hit
might lead to larger changes incertain parameters like maximum
oxygen consumption, or havespecific advantages for muscular
endurance or certain gaitmetrics.
Now it's important to note thatsome animal studies suggest a
(26:00):
saturation point, meaning thatwhere increasing the intensity
beyond a certain moderate levelmight not yield significantly
more neuroprotection, implyingthat consistent, vigorous
exercise may be key rather thanextreme intensity.
Now it's important to note thatthe research is ongoing and not
(26:21):
all questions are definitelyanswered.
The quote, optimal dose orfrequency, duration and specific
intensity of high-intensityexercise for different stages of
PD is still being refined Now,once large-scale long-term
randomized control trials areneeded to confirm the
neuroprotective effects andunderstand the mechanisms
(26:43):
involved.
Also, variability among peoplewith Parkinson's means that what
works best for one person mightdiffer from somebody else.
But despite these ongoingquestions, the trend is
promising.
Cumulative evidence stronglysuggests that feasibility and
significant benefits of highintensity interval training as a
(27:05):
powerful tool in the managementof Parkinson's.
So this can offer hope for bothsymptom management and
potentially slowing diseaseprogression.
So the research soundspromising, but it's not a
one-size-fits-all recommendation.
High-intensity exercise by itsnature requires careful
consideration.
(27:25):
Is it right for you?
Well, let's discuss somepractical considerations to make
sure it's right for you.
Number one and I talked aboutthis before consult your doctor
and neurologist, and this isparamount.
So before you start any newexercise program, especially
high intensity, discuss it withyour neurologist and your
(27:46):
primary care physician.
They know your history, yourmedications and any underlying
conditions that you have.
Number two is assessment by aphysical therapist.
A physical therapistspecializing in Parkinson's can
conduct a thorough assessment ofyour current fitness level,
your balance and your gait andany other potential limitations
(28:06):
that you have, and they can helpdetermine if you're a good
candidate for high-intensityinterval training and then how
to get started safely.
Third is gradual progression.
Now you don't jump intohigh-intensity training, it's a
gradual ramp-up.
So discuss principles ofprogressive overload, starting
with moderate intensity and thenslowly increasing the duration
(28:29):
and frequency of intensity.
And then number four ismonitoring and listening to your
body.
Emphasize the importance ofmonitoring your heart rate using
a heart monitor or use aperceived exertion scale where
you understand the signs ofoverexertion.
So if you're breathing too hard, you're sweating, you're
getting dizzy, so you need tounderstand all those.
(28:50):
And then distinguishing betweenchallenge and then pain and
fatigue.
And then five you want toconsider safety considerations,
so you want to discuss anypotential risk like falls or
cardiovascular strain if you'renot medically cleared.
Overtraining and injury areother key considerations.
(29:10):
So make sure you use properform in a safe environment and
that's why you need to useeither a physical therapist or
trained, certified professionalthat's used to working with
people with Parkinson's.
Now number six is what if it'snot right for you?
Now, remember that for somepeople, high intensity may not
be appropriate due to advancedPD or if you have significant
(29:32):
balance issues, heart conditionsor other health concerns.
Remember, any exercise isbetter than no exercise and
moderate exercise still offerssignificant benefits.
So before trying anyhigh-intensity exercise, you
want to take all theseconsiderations into account with
your doctor to make sure thatit's right for you.
All right.
(29:54):
If, after consulting yourhealthcare team, and they say
that high-intensity aerobicexercise is appropriate for you,
how do you actually get started?
And then also, how do youmaintain that intensity?
So the first step is to findyour baseline and you want to
work with a certified personaltrainer or physical therapist to
help you determine your targetheart rate zones.
(30:17):
And then the next step is goingto be crucial and that's
selecting activities that youenjoy, because, let's be honest,
no one's going to have aconsistent exercise program if
you don't like what you're doing.
So ask yourself what activitiesdo I enjoy?
Is it cycling?
And that could be a stationarybike for safety if you have
(30:37):
balance issues.
Do you like doing brisk walkingon a treadmill, doing the
elliptical, swimming and again,safe, you need to be cleared for
that Dancing and boxing.
Now you know the saying varietyis the spice of life.
The same holds true here, thatyou can select as many different
activities as you like, so it'sgreat to add variety.
(31:01):
And then, next, you want tostructure your workouts.
Ask a trainer or physicaltherapist for help in setting up
an exercise program.
Now let me give you a coupleexamples of what it might look
like.
So you might do two to threeminutes of high intensity and
that could be walking, cyclingor elliptical followed by one to
two minutes of recovery, orthey call those sustained
(31:22):
periods.
And then a person might dothese three to five sessions per
week, aiming for 20 to 30minutes at a heart rate target
where you have a little bithigher intensity, the 70 to 85%.
Now, remember, that's just anexample.
So find a coach or trainer, andthe reason this is important is
(31:42):
to ensure that you're usingproper technique, form and
progression so that you don'tinjure yourself.
And you want to try to find acertified trainer or physical
therapist, maybe with someexperience in dealing with
people with neurologicalconditions.
And then, finally, last but notleast is accountability.
Accountability is absolutelycrucial for consistent adherence
(32:05):
to any exercise program,especially high-intensity
interval training, because ofits demanding nature and unique
challenges faced by individualswith Parkinson's, like fatigue,
apathy and fluctuating symptoms.
So here are some tips forbuilding accountability with HIT
in Parkinson's.
First is professional guidanceand supervision.
(32:26):
Now, as I mentioned earlier,work with a Parkinson's
specialized either physicaltherapist or certified trainer
with experience in working withParkinson's patients, so that
they can help you develop apersonalized HIP program so that
you ensure that you're usingproper form and that you're
adjusting intensity safely,based on your daily symptoms,
(32:47):
and they're going to help youprovide direct accountability.
And then, knowing you have adefined appointment can also be
a strong motivator if you'regoing to be seeing these people
on a regular basis.
Number two is find an exercisebuddy, and this is one of the
most effective strategies.
Committing to exercise with afriend, family member or a
fellow PD warrior is going tocreate mutual accountability.
(33:09):
You're less likely to skip asession if you know someone's
waiting or counting on you.
You're less likely to skip asession if you know someone's
waiting or counting on you.
I play a weekly pickleball withmy Parkinson's friends.
It's great exercise and it'sfun, but it makes me accountable
to people as well.
Number three join a class.
Pd-specific exercise classeslike rock-steady boxing, power
(33:31):
moves or specific dance classesoften incorporate high-intensity
elements.
Now, the camaraderie shared andthe shared experience and
scheduled nature of theseclasses help provide
accountability, and it alsopromotes a sense of community
and belonging as well, which isgreat.
Number four set SMART goals.
Now, what are SMART goals?
(33:52):
Well, s is specific.
For example, I'll do HIITtraining for 20 minutes three
times a week.
M is measurable I will increasemy time in the 80 to 85%
maximum heart rate zone byworking with a coach.
A is achievable.
Make sure the goal is realistic, given your current fitness
level and symptoms.
(34:13):
R is relevant Connect it to whyyou're doing HIIT in the first
place.
Do you want to?
For instance, maybe you want toimprove your gait speed.
And then T is time bound.
I will consistently complete myHIIT sessions for the next four
weeks.
So using SMART goals is goingto help as well.
And then number five is to keepan exercise log or journal by
(34:36):
manually tracking your workouts,and that can include things
like your date, duration of yourworkout, the type of exercise,
perceived exertion symptoms andyour mood for that day can help
you see progress over time.
Number six is schedule exerciselike an important appointment.
Don't leave exercise to chance.
(34:57):
You want to block out time inyour calendar.
And that leads us to our lasttip, number seven, which is find
your best time.
For many people withParkinson's, our symptoms are
going to fluctuate throughoutthe day.
So schedule hit for when youfeel your best.
Now that might be.
For me it would be the morning.
All right now some finalthoughts and takeaways.
(35:18):
So to recap, high-intensityaerobic exercise holds
significant promise for peoplewith Parkinson's, potentially
influencing disease progressionand improving symptoms.
But remember, it's not adecision to be taken lightly.
So some key takeaways againconsult your healthcare team
first to get professionalassessment.
Next, you want to progressgradually.
(35:41):
Listen to your body andunderstand that safety is of
utmost importance.
Now remember, the best exerciseis the one that you're going to
do consistently.
Now remember, the best exerciseis the one that you're going to
do consistently.
If high-intensity exerciseisn't for you, there are many
other highly beneficial forms ofexercise for Parkinson's.
Your journey with Parkinson'sis unique.
(36:03):
Empower yourselves withinformation, but you should
always prioritize safety andprofessional guidance when
designing an exercise program.
Now, I hope this episode hasprovided valuable insights into
high-intensity aerobic exercisefor Parkinson's.
If you found this helpful,please share it with others who
might benefit, and then you canfind more resources and articles
(36:25):
on my website, libparkinsonscom, and you can also subscribe to
the free monthly newsletter.
Now, if you feel that thispodcast provides a benefit and
you want to support the podcastand the website so that I can
reach more people, please visitmy Ko-fi page at ko-ficom slash
liveparkinsons and buy me a cupof coffee.
Thank you so much for listening.
(36:47):
I hope the information I'mproviding is helping you in your
daily lives and giving you hopeand determination to live your
best life with Parkinson's.
Now remember stay strong, stayhealthy and live your best life
with Parkinson's.
We're here to support you everystep of the way, and thanks
again for listening and I hopeto see you soon.
(37:08):
Thank you.
Hello and welcome to Live Parkinson's Live an
Exceptional Life.
I'm your host, chrisKastenbader, and I've been
living an exceptional life withParkinson's for the past 15
years.
The mission of this podcast isto help as many people as
possible living with Parkinson'sto lead a great quality of life
.
Today's topic is Parkinson'sand HIIT.
Is high-intensity exercise safeand effective for Parkinson's?
(00:32):
Imagine an exercise that cannot only manage your Parkinson's
symptoms but potentially slowits progression.
Sounds almost too good to betrue.
Right Today, we're diving intothe high-intensity interval
training, or HIT, forParkinson's disease.
Is this intense approach safe?
More importantly, could it bethe game-changer that you've
(00:56):
been looking for?
Let's look at this as we unpackthe science and practical
realities of HIT.
I like to exercise and I'malways looking for new exercises
that can help me on myParkinson's journey.
So as I was reading and doingsome research, I kept reading
about intensity intervaltraining.
It almost seemed to be afrequently asked question in
some of the chats I was trainingfor football way back, since it
(01:18):
was a health benefit and riskfor people with Parkinson's.
After all, I don't want to besharing information if it wasn't
a safe option.
So in this episode, I want toshare what I've learned about
high-intensity interval trainingso that you can ask your health
professional if it'sappropriate for you.
Now let's give you a roadmap ofwhat we'll be covering in this
episode.
We'll start out with definingwhat high-intensity aerobic
(01:43):
exercise is for Parkinson's andthe concept of forced exercise.
Then it's time to talk aboutthe research.
What does the science say?
We'll talk about its effects onneuroprotection and symptom
management and compare itsresults to moderate exercise.
Then we'll transition into somepractical considerations.
Is it right for you?
(02:03):
Then we'll transition into somepractical considerations.
Is it right for you?
Then talk about how to getstarted in maintaining intensity
for this type of workout, ifit's appropriate for you.
Now in this segment, we'lldiscuss choosing your activity,
the structure of the workouts,the role of a coach and trainer
and accountability, and thenI'll give you some tips for
(02:24):
staying consistent.
Then we'll wrap it up in a nicepackage and arm you with the
information you need to reviewwith your doctor to make sure
this program is right for you.
So if you want to get a betterunderstanding of high-intensity
interval training, then join meon this journey of exploration.
Now, before we get too deepinto this topic, I just have a
disclaimer that the informationbeing provided is for
(02:46):
informational purposes only anddoes not constitute medical
advice or exercise advice.
Please consult your neurologistand primary care physician to
determine if this type ofexercise is appropriate for you.
All right, you might have heardterms like forced exercise or
pushing past your comfort zonein relation to Parkinson's, but
(03:08):
what exactly does high intensitymean in this particular context
?
But, more importantly, is highintensity interval training
truly beneficial and is it rightfor you?
So let's start by clarifyingwhat we mean by high intensity
in the context of Parkinson's.
No, it's not about being anOlympic athlete, but about
(03:30):
reaching a certain physiologicalthreshold.
In essence, high intensityinterval training, also known as
HIIT or simply vigorous cardio,involve periods of intense
physical activity interspersedwith short recovery periods.
So for individuals withParkinson's, this means
elevating your heart rate to asignificant level than typical
(03:55):
moderate exercise.
So you're generally aiming for70 to 85% of your maximum heart
rate, where talking becomesdifficult, but it's still
possible.
Well, that really sounds great,chris.
But how do we figure out what 70to 85 percent of my maximum
heart rate is?
Well, I came across a commonformula that is often used, and
(04:17):
what they do is they take 220minus your age.
So, for example, in my case,minus your age.
So, for example, in my case, mymaximum heart rate figure is
220 minus 61, which is my age,which brings me to 159, and
that's 159 beats per minute.
Then to calculate 70% of that,we multiply 0.7 times the 159,
(04:44):
and that's going to give me 111.
And then to calculate the 85%,I would take that 159 beats per
minute times 0.85, and thatgives me 135.
So my target heart rate rangewould be 111 to 135 beats per
(05:05):
minute during moderate tovigorous exercise.
So this range is often calledthe target heart rate zone,
helping sure you're exercisingan intensity that is effective
but safe.
Now it's important to understandthat high intensity is relative
to individuals and theircurrent fitness level and their
(05:25):
Parkinson's symptoms.
You want to keep that in mindas well.
Now, what's high intensity forone person might be different
for someone else.
The key is the effort and thephysiological response, not
necessarily based on specificspeeds or how much weight you're
using.
It's important that you getapproval from your doctor before
(05:46):
starting any new exerciseprogram, though.
Now let's take a look at someexamples of high-intensity
aerobic exercises forParkinson's.
When done at the rightintensity, we'll start off with
brisk walking or power walking,and what you do there is you're
pushing the pace of your walk tothe point where your breathing
(06:06):
becomes hard and you're startingto sweat, and then maybe you
can even try throwing in someinclines.
So what you want to do is youwant to make sure that you get
your heart rate up for a periodof a minute and then you can
bring it back down for 20seconds and then bring it up for
a minute.
Those will be examples ofinterval training.
So you're bringing your heartrate up and then you're bringing
it back down for 20 seconds andthen bring it up for a minute.
(06:26):
Those will be examples ofinterval training.
So you're bringing your heartrate up and then you're bringing
it back down.
Another would be cycling.
Stationary bikes are oftenpreferred for safety, especially
if you have balance concerns,and this can be done with either
a high resistance or a fastcadence.
So what you might want to do isyou might do a 20-second sprint
and then a 10-second rest.
(06:47):
A 20-second sprint, a 10-secondrest, and maybe you do six reps
of those.
That would be an example ofhigh-intensity training.
And then tandem cycling hasalso been studied as a forced
type of exercise where astronger rider helps the person
with PD maintain a higher pacethan they normally would cycle,
(07:08):
and then this is the basis forthe Pedaling for Parkinson's
program through the Davis FinneyFoundation.
Another would be treadmillwalking or running, adjusting
speed and incline to reach yourtarget heart rate.
Now, before I was diagnosedwith Parkinson's, I used to run
on the treadmill three times aweek and one of the days I would
(07:29):
do intervals where I would runfor 30 seconds at a constant
speed and then 30 seconds at ahigher speed, maybe half a mile
to two miles an hour faster thanI normally could, and I would
keep alternating back and forth.
Now, could I do this now?
No, because the treadmill wouldprobably shoot me across the
(07:52):
room.
But I do increase and decreasemy speed when I'm walking, so
I'll walk fast and then slow mypace a bit, and then walk fast
and then bring it back to mynormal pace.
Now another example iselliptical training slow my pace
a bit and then walk fast andthen bring it back to my normal
pace.
Now, another example iselliptical training, and that's
a low impact option that canprovide a full body workout at a
high intensity.
(08:13):
And then we have vigorousdancing.
Certain types of dance caninvolve sustained periods of
high energy movements.
Now you may be saying, okay,chris, are you going to provide
some examples?
Oh, alright, here we go.
Here's some examples ofvigorous dance that would fit
the bill.
These would include salsa andmamba, which are both fast-paced
(08:35):
with your feet, so you've got alot of fast-paced footwork with
continuous motion.
Another would be Irish dancesteps.
They use lightning fast legmovements with minimal upper
body movement.
Jazz and contemporary, whereyou have sharp, either dynamic
leaps and turns, which I don'tknow that most of us with
(08:56):
Parkinson's are going to be ableto do.
But then you have swing andlindy hop.
I know what swing is, but Ireally didn't know what Lindy
Hop was.
And then, finally, zumba andAerobic Dance, which is designed
for sustaining cardio intensity.
Now, all these dances requirestrength, stamina and precision
to maintain their high energymovements.
(09:19):
Now boxing non-contact, ofcourse.
Now I don't know about you, butI don't like getting punched in
the face.
So non-contact is the way to go.
And there's programs like RockSteady Boxing which can
incorporate high-intensityintervals.
And then, finally, rowing.
If you've ever done a rowingmachine, it can provide a
(09:39):
full-body aerobic workout,because you're using your arms,
your legs, your back, and it's agreat way to do interval
training.
All right, now that we've lookedat some of the exercises that
are high intensity, let's answerthe question why someone might
consider trying high-intensityaerobic exercises for
Parkinson's.
Well, there's a growing body ofresearch that suggests that
(10:02):
high-intensity aerobic exercisemay offer unique and significant
benefits for people withParkinson's, going beyond what
normal, moderate exercise alonecan provide.
So here's some reasons whysomeone might consider it.
Now, again I want to emphasizeyou should review any new
exercise plans with your doctorto ensure that it's appropriate
for your specific needs, doctor,to ensure that it's appropriate
(10:27):
for your specific needs.
Now, the first reason peoplemight consider it is for the
potential for neuroprotectionand disease modification, and
this is probably the mostcompelling reason.
Emerging research suggests thathigh-intensity exercise may have
a neuroprotective effect,potentially and that's the key
word slowing the degeneration ofdopamine-producing neurons in
the brain.
Now, an article entitledHigh-Intensity Exercise and Its
(10:50):
Protective Mechanisms on theBrain by Judd Eason that was
published at helpforpdorg, andthe author references a Yale
study that included 10 peoplewith Parkinson's.
Each person received theirParkinson's diagnosis less than
four years prior to the study.
The group completed a six-monthhigh-intensity exercise
(11:13):
training program.
The participants had an MRI anda PET scan at baseline, and at
the conclusion of the study theresearchers reported that after
six months of exercise theneurons had grown to be
healthier and produced strongerdopamine signals.
According to the article, thebrain imaging showed a
(11:35):
significant increase in signalswithin the substantia nigra,
which is the area of the brainthat produces dopamine.
The article quotes tworesearchers.
Dr Evan Morris shared that thisis the first time imaging has
been used to confirm the biologyof the brain in those suffering
with PD is changed by intenseexercise.
Dr Sul Tinez MD, the leadinvestigator, stated the
(12:01):
medications that we haveavailable are only for
symptomatic treatment.
They do not change the courseof the disease, but exercise
seems to go one step beyond andprotects the brain at the
neuronal level.
The article also references twoadditional studies that showed
that engaging in high-intensityexercise three times a week for
(12:22):
six months correlated with lesssevere motor symptoms.
Moderate to low-intensityexercise has not been shown to
have the same effects on ourbrain.
Now, another reason peopleconsider high-intensity interval
training is enhanced functionalabilities.
Exercise has not been shown tohave the same effects on our
brain.
Now, another reason peopleconsider high-intensity interval
training is enhanced functionalabilities by improving core
(12:44):
motor symptoms, high-intensityexercise can translate to better
functional independence indaily activities, making our
daily tasks like walking,dressing and reaching easier.
Another reason is improvednon-motor symptoms.
High-intensity exercise hasbeen linked to improvements in
non-motor symptoms such asfatigue, mood and that's
reducing anxiety and depression,and even cognitive function,
(13:06):
involving our memory andthinking.
Now there's also cardiovascularbenefits.
Like all aerobic exercise,high-intensity training
significantly boostscardiovascular fitness, which is
beneficial for our overallhealth and can help us manage
other issues often seen with PDhealth.
(13:28):
The intense challenge posed bythese workouts can stimulate
neuroplasticity it's the brain'sability to reorganize and form
new neural connections, and it'sparticularly helpful when
you're learning a new skill orhobby.
So this can help the braincompensate for changes caused by
PD.
And, as a final consideration,some people see increased
(13:50):
motivation and adherence.
So for people that like achallenge and see tangible
results, the perceived benefitsof high-intensity training can
be a strong motivator, helpingthem stick with their exercise
program.
All right now, before we godiving feet first into
high-intensity aerobic training,there are some important
considerations that need to beunderstood before starting this
(14:13):
type of exercise program.
While the potential benefitsare exciting, I do want to
emphasize that high intensityexercise for Parkinson's should
be approached with caution andprofessional guidance.
Now, it's not suitable foreveryone, especially those with
advanced PD, significant balanceissues or if you have
(14:33):
underlying cardiovascularconditions.
So before trying anyhigh-intensity program, it's
absolutely essential to consultyour neurologist and your
primary care physician formedical clearance.
That way you can undergo anassessment by a physical
therapist or an exercisephysiologist specializing in
Parkinson's to create a safe andpersonalized plan.
(14:55):
As always, you want to startgradually and then you want to
progress slowly, so build intoit All.
Right now let's switch gears andtalk about the research behind
high-intensity aerobic intervaltraining.
So what does the science say?
Interestingly, the research onhigh-intensity aerobic interval
training for people with PD isan exciting and rapidly evolving
(15:17):
field of study.
While, historically, exercisemight have been viewed as less
impactful, there's a significantbody of evidence that's emerged
which suggests thathigh-intensity exercise offers
distinct and potentiallysuperior benefits compared to
moderate or low intensityactivity.
So let's look at what some ofthe science has to say.
(15:38):
Well, actually it doesn't talk,but I actually had to read the
science and study this myself.
So let's start withneuroprotection and slowing
disease progression.
Now, one of the most compellingparts of high-intensity exercise
in Parkinson's is its potentialfor neuroprotection.
Now what do I mean by that?
(16:00):
That it might actually protectbrain cells and slow disease
progression rather than justmanaging our symptoms.
So let's look at what some ofthe studies are evaluating in
the area of neuroprotection andlet's lead it off with
brain-derived neurotropic factor, which is BDNF.
Now, multiple studies,including both systematic
(16:24):
reviews and meta-analysis, whichcompare multiple studies,
indicate that exercise, andparticularly high-intensity
exercise, can increase levels ofthe brain-derived neurotropic
factor in the body.
Now, bdnf is a crucial proteinthat supports the survival of
existing neurons and helpspromote the growth of new
(16:46):
neurons and new synapses.
So in Parkinson's, wheredopamine-producing neurons are
degenerating, increasing theBDNF is hypothesized or believed
to offer protective effects.
Now research suggests thatexercise-induced increases in
circulating BDNF may serve as atherapeutic benefit in
(17:09):
Parkinson's, and that comes fromthat Yale study.
Now, next up is dopaminereceptor sensitivity and
production.
Some research using imagingtechniques like PET scans have
shown that high-intensityaerobic exercise can lead to an
increase in dopamine release incertain regions of the brain and
may improve the sensitivity ofdopamine receptors.
(17:30):
Now, that's critical forParkinson's because we know it's
related to the loss ofdopamine-producing neurons.
Now the Yale pilot study, forinstance, indicated that
high-intensity exercise mightpreserve and even make healthier
dopamine-producing neurons,leading to stronger dopamine
signals.
(17:51):
Now let's look at research onsymptom management, and that
includes both motor andnon-motor benefits.
Now, beyond potentialneuroprotection, high-intensity
aerobic exercise hasdemonstrated some significant
benefits in managing both motorand non-motor symptoms.
In terms of motor symptoms,research consistently highlights
(18:13):
improvements in key motorsymptoms.
First is gait Research hasshown increased gait speed,
improved stride length andreduced double limb support time
have been observed.
And then balance, which isimportant for all of us, because
I think a lot of us haveproblems with balance.
In terms of balance improvepostural stability and better
(18:36):
scores on balance scales, whichare crucial for fall prevention.
Then we have bradykinesia, orslowness of movement, exercises
showing improvements in thespeed and fluidity of movements.
And then rigidity Some studiesnoted a reduction in Parkinson's
hypertonia and muscle stiffness.
All right, chris.
(18:56):
So what is Parkinsonianhypertonia?
Look, I'm going to be honestwith you, I wasn't familiar with
that term either.
So I did a little research andit refers to muscle rigidity or
hypertonicity, which is a commonfeature of Parkinson's.
And then, in terms of overallmotor function, significant
improvements in overall diseaseseverity, as measured by scales
(19:20):
like the Unified Parkinson'sDisease Rating Scale, or the
UPDRS Part 3 Motor Score, thatyour neurologist or movement
disorder specialist may useduring your examinations.
Now let's take a look at somenon-motor symptom benefits.
These are the ones that gobeyond our physical movement and
our motor symptoms.
And we'll start it off with thedreaded fatigue.
(19:43):
Participants in HIT oftenreport a decrease in perceived
fatigue.
In terms of mood, studies haveshown positive effects on mood,
potentially reducing symptoms ofdepression and anxiety, both of
which are common in people withParkinson's and cognition
improvements in cognitivefunction, including attention,
(20:06):
executive function.
Now, these are those skillsthat help us plan, organize and
complete tasks.
Now, these are those skillsthat help us plan, organize and
complete tasks.
And then, working memory andcognitive flexibility have been
observed in some studies,particularly those involving HIT
.
All right, this soundswonderful, but it's also nice to
know where these particularbenefits come from.
(20:28):
So let's take a look at some ofthe studies and break them down
into simple summaries.
You don't need to be PhDresearchers here Now.
I like to look at things insimple and straightforward terms
.
So let's look at a few examplesNow.
The first one I'm familiar withbecause it relates to cycling.
Now I'm a certified Pedalingfor Parkinson's instructor
(20:51):
through the Davis PhinneyFoundation and I lead a weekly
Pedaling for Parkinson'sinstructor through the Davis
Phinney Foundation and I lead aweekly Pedaling for Parkinson's
class with a great group ofpeople with Parkinson's and as
part of that training,certification, we had to be
familiar with these studies andthe first one is Forced, not
Voluntary, exercise ImprovesMotor Function in Parkinson's
Disease Patients.
(21:11):
That was conducted at theCleveland Clinic Dr Alberts and
it compared two groups 10patients with mild to moderate
Parkinson's were randomlyassigned to complete eight weeks
of either forced exercise,where you're pushing yourself
past what you typically do, orvoluntary exercise.
So what does that mean?
The forced exercise group, withthe assistance of a trainer,
(21:35):
pedaled at a rate of 30% greaterthan their preferred voluntary
rate.
So that's what they typicallyrode at, and the voluntary group
pedaled at their preferred rate.
Now the aerobic intensity wasidentical for both groups 60 to
80 percent of their individualtraining heart rate.
Now the results showed theaerobic fitness improved in both
(22:00):
groups, but the motor scores inthe forced exercise group
improved by 35 percent, whilethe voluntary group did not show
any improvement.
Though being forced to exerciseat a higher intensity than
usual, they were able to seebenefits in their motor symptoms
.
Now, the next study was theSPARX S-P-A-R-X trial, which is
(22:28):
the study in Parkinson's diseaseof exercise.
Now, this was a landmark phasetwo randomized clinical trial.
Now, the study was a randomizedcontrolled trial of high
intensity treadmill exercise inParkinson's disease that was
published in the Journal ofNeurology in 2017.
Now, the focus of this studywas to directly compare high
intensity treadmill exercise,which was 80 to 85% of maximum
(22:49):
heart rate, to moderateintensity, or 60 to 65% of
maximum heart rate, and theusual care in early stage PD.
Now, the key motor findingsdemonstrated that high-intensity
exercise was safe and feasibleand significantly improved the
worsening of motor symptoms, asmeasured by the unified
(23:10):
Parkinson scale over six months.
Compared to the control group,the high-intensity group showed
essentially no worsening, whilethe control group did.
Now, the moderate-intensitygroup also showed less worsening
than the control, but not asmuch as the high-intensity group
.
Now, another study feasibilityand effect of high-intensity
(23:32):
training on the progression ofmotor symptoms in adult
individuals with Parkinson'sdisease a systematic review and
meta-analysis that was publishedin the Journal of Neurological
Sciences in 2023.
And its focus was lookingspecifically at high-intensity
training and that concluded thathigh-intensity exercise,
(23:53):
performed in both continuous andinterval modes, when compared
with control groups, may providemotor function benefits for
individuals with Parkinson's.
It also found benefits formaximum oxygen consumption and
overall quality of life.
And the final study looking atnon-motor symptoms was physical
(24:32):
exercise for treating non-motorsymptoms.
While it found trends forgeneral exercise, it noted that
aerobic exercise showednear-large effects compared with
conventional exercise fornon-motor symptoms.
So that begs the question howdoes high-intensity aerobic
(24:54):
exercise compared to moderateexercise?
Well, while moderate exercise isundoubtedly beneficial to all
of us and it's one of thecornerstones of Parkinson's
management, some researchsuggests that high-intensity
exercise may offer additional orunique advantages, particularly
concerning its potentialneuroprotective effects.
Now, the idea is that greaterphysiological challenge of
(25:16):
high-intensity training mighttrigger more robust adaptive
responses in the brain and thebody.
This could lead to a moresignificant upregulation of what
they call neurotropic factors,like the BDNF that we talked
about a little bit earlier.
Now, some studies directlycomparing HIT to
(25:37):
moderate-intensity continuoustraining have showed that while
both can improve cardiovascularfitness and motor symptoms, hit
might lead to larger changes incertain parameters like maximum
oxygen consumption, or havespecific advantages for muscular
endurance or certain gaitmetrics.
Now it's important to note thatsome animal studies suggest a
(26:00):
saturation point, meaning thatwhere increasing the intensity
beyond a certain moderate levelmight not yield significantly
more neuroprotection, implyingthat consistent, vigorous
exercise may be key rather thanextreme intensity.
Now it's important to note thatthe research is ongoing and not
(26:21):
all questions are definitelyanswered.
The quote, optimal dose orfrequency, duration and specific
intensity of high-intensityexercise for different stages of
PD is still being refined Now,once large-scale long-term
randomized control trials areneeded to confirm the
neuroprotective effects andunderstand the mechanisms
(26:43):
involved.
Also, variability among peoplewith Parkinson's means that what
works best for one person mightdiffer from somebody else.
But despite these ongoingquestions, the trend is
promising.
Cumulative evidence stronglysuggests that feasibility and
significant benefits of highintensity interval training as a
(27:05):
powerful tool in the managementof Parkinson's.
So this can offer hope for bothsymptom management and
potentially slowing diseaseprogression.
So the research soundspromising, but it's not a
one-size-fits-all recommendation.
High-intensity exercise by itsnature requires careful
consideration.
(27:25):
Is it right for you?
Well, let's discuss somepractical considerations to make
sure it's right for you.
Number one and I talked aboutthis before consult your doctor
and neurologist, and this isparamount.
So before you start any newexercise program, especially
high intensity, discuss it withyour neurologist and your
(27:46):
primary care physician.
They know your history, yourmedications and any underlying
conditions that you have.
Number two is assessment by aphysical therapist.
A physical therapistspecializing in Parkinson's can
conduct a thorough assessment ofyour current fitness level,
your balance and your gait andany other potential limitations
(28:06):
that you have, and they can helpdetermine if you're a good
candidate for high-intensityinterval training and then how
to get started safely.
Third is gradual progression.
Now you don't jump intohigh-intensity training, it's a
gradual ramp-up.
So discuss principles ofprogressive overload, starting
with moderate intensity and thenslowly increasing the duration
(28:29):
and frequency of intensity.
And then number four ismonitoring and listening to your
body.
Emphasize the importance ofmonitoring your heart rate using
a heart monitor or use aperceived exertion scale where
you understand the signs ofoverexertion.
So if you're breathing too hard, you're sweating, you're
getting dizzy, so you need tounderstand all those.
(28:50):
And then distinguishing betweenchallenge and then pain and
fatigue.
And then five you want toconsider safety considerations,
so you want to discuss anypotential risk like falls or
cardiovascular strain if you'renot medically cleared.
Overtraining and injury areother key considerations.
(29:10):
So make sure you use properform in a safe environment and
that's why you need to useeither a physical therapist or
trained, certified professionalthat's used to working with
people with Parkinson's.
Now number six is what if it'snot right for you?
Now, remember that for somepeople, high intensity may not
be appropriate due to advancedPD or if you have significant
(29:32):
balance issues, heart conditionsor other health concerns.
Remember, any exercise isbetter than no exercise and
moderate exercise still offerssignificant benefits.
So before trying anyhigh-intensity exercise, you
want to take all theseconsiderations into account with
your doctor to make sure thatit's right for you.
All right.
(29:54):
If, after consulting yourhealthcare team, and they say
that high-intensity aerobicexercise is appropriate for you,
how do you actually get started?
And then also, how do youmaintain that intensity?
So the first step is to findyour baseline and you want to
work with a certified personaltrainer or physical therapist to
help you determine your targetheart rate zones.
(30:17):
And then the next step is goingto be crucial and that's
selecting activities that youenjoy, because, let's be honest,
no one's going to have aconsistent exercise program if
you don't like what you're doing.
So ask yourself what activitiesdo I enjoy?
Is it cycling?
And that could be a stationarybike for safety if you have
(30:37):
balance issues.
Do you like doing brisk walkingon a treadmill, doing the
elliptical, swimming and again,safe, you need to be cleared for
that Dancing and boxing.
Now you know the saying varietyis the spice of life.
The same holds true here, thatyou can select as many different
activities as you like, so it'sgreat to add variety.
(31:01):
And then, next, you want tostructure your workouts.
Ask a trainer or physicaltherapist for help in setting up
an exercise program.
Now let me give you a coupleexamples of what it might look
like.
So you might do two to threeminutes of high intensity and
that could be walking, cyclingor elliptical followed by one to
two minutes of recovery, orthey call those sustained
(31:22):
periods.
And then a person might dothese three to five sessions per
week, aiming for 20 to 30minutes at a heart rate target
where you have a little bithigher intensity, the 70 to 85%.
Now, remember, that's just anexample.
So find a coach or trainer, andthe reason this is important is
(31:42):
to ensure that you're usingproper technique, form and
progression so that you don'tinjure yourself.
And you want to try to find acertified trainer or physical
therapist, maybe with someexperience in dealing with
people with neurologicalconditions.
And then, finally, last but notleast is accountability.
Accountability is absolutelycrucial for consistent adherence
(32:05):
to any exercise program,especially high-intensity
interval training, because ofits demanding nature and unique
challenges faced by individualswith Parkinson's, like fatigue,
apathy and fluctuating symptoms.
So here are some tips forbuilding accountability with HIT
in Parkinson's.
First is professional guidanceand supervision.
(32:26):
Now, as I mentioned earlier,work with a Parkinson's
specialized either physicaltherapist or certified trainer
with experience in working withParkinson's patients, so that
they can help you develop apersonalized HIP program so that
you ensure that you're usingproper form and that you're
adjusting intensity safely,based on your daily symptoms,
(32:47):
and they're going to help youprovide direct accountability.
And then, knowing you have adefined appointment can also be
a strong motivator if you'regoing to be seeing these people
on a regular basis.
Number two is find an exercisebuddy, and this is one of the
most effective strategies.
Committing to exercise with afriend, family member or a
fellow PD warrior is going tocreate mutual accountability.
(33:09):
You're less likely to skip asession if you know someone's
waiting or counting on you.
You're less likely to skip asession if you know someone's
waiting or counting on you.
I play a weekly pickleball withmy Parkinson's friends.
It's great exercise and it'sfun, but it makes me accountable
to people as well.
Number three join a class.
Pd-specific exercise classeslike rock-steady boxing, power
(33:31):
moves or specific dance classesoften incorporate high-intensity
elements.
Now, the camaraderie shared andthe shared experience and
scheduled nature of theseclasses help provide
accountability, and it alsopromotes a sense of community
and belonging as well, which isgreat.
Number four set SMART goals.
Now, what are SMART goals?
(33:52):
Well, s is specific.
For example, I'll do HIITtraining for 20 minutes three
times a week.
M is measurable I will increasemy time in the 80 to 85%
maximum heart rate zone byworking with a coach.
A is achievable.
Make sure the goal is realistic, given your current fitness
level and symptoms.
(34:13):
R is relevant Connect it to whyyou're doing HIIT in the first
place.
Do you want to?
For instance, maybe you want toimprove your gait speed.
And then T is time bound.
I will consistently complete myHIIT sessions for the next four
weeks.
So using SMART goals is goingto help as well.
And then number five is to keepan exercise log or journal by
(34:36):
manually tracking your workouts,and that can include things
like your date, duration of yourworkout, the type of exercise,
perceived exertion symptoms andyour mood for that day can help
you see progress over time.
Number six is schedule exerciselike an important appointment.
Don't leave exercise to chance.
(34:57):
You want to block out time inyour calendar.
And that leads us to our lasttip, number seven, which is find
your best time.
For many people withParkinson's, our symptoms are
going to fluctuate throughoutthe day.
So schedule hit for when youfeel your best.
Now that might be.
For me it would be the morning.
All right now some finalthoughts and takeaways.
(35:18):
So to recap, high-intensityaerobic exercise holds
significant promise for peoplewith Parkinson's, potentially
influencing disease progressionand improving symptoms.
But remember, it's not adecision to be taken lightly.
So some key takeaways againconsult your healthcare team
first to get professionalassessment.
Next, you want to progressgradually.
(35:41):
Listen to your body andunderstand that safety is of
utmost importance.
Now remember, the best exerciseis the one that you're going to
do consistently.
Now remember, the best exerciseis the one that you're going to
do consistently.
If high-intensity exerciseisn't for you, there are many
other highly beneficial forms ofexercise for Parkinson's.
Your journey with Parkinson'sis unique.
(36:03):
Empower yourselves withinformation, but you should
always prioritize safety andprofessional guidance when
designing an exercise program.
Now, I hope this episode hasprovided valuable insights into
high-intensity aerobic exercisefor Parkinson's.
If you found this helpful,please share it with others who
might benefit, and then you canfind more resources and articles
(36:25):
on my website, libparkinsonscom, and you can also subscribe to
the free monthly newsletter.
Now, if you feel that thispodcast provides a benefit and
you want to support the podcastand the website so that I can
reach more people, please visitmy Ko-fi page at ko-ficom slash
liveparkinsons and buy me a cupof coffee.
Thank you so much for listening.
(36:47):
I hope the information I'mproviding is helping you in your
daily lives and giving you hopeand determination to live your
best life with Parkinson's.
Now remember stay strong, stayhealthy and live your best life
with Parkinson's.
We're here to support you everystep of the way, and thanks
again for listening and I hopeto see you soon.
(37:08):
Thank you.
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