Module Objectives:

• Gain a basic understanding of Parkinson’s Disease (PD)
• What are the symptoms of PD
• Learn about the common medications used to treat PD

What is Parkinson’s Disease?

Parkinson’s disease (PD) is a disease that affects the central nervous system. It is the second most common neurodegenerative disorder and the most common movement disorder in adults. Neurodegenertive is an umbrella term used to describe a loss of function of neurons in the brain. A movement disorder is the neurological condition affecting speed, fluency, and control of movement.

Part of the disease process develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantia nigra. Nerve cells in the substantia nigra send out fibers to tissue located in both sides of the brain. There the cells release essential neurotransmitters that help control movement and coordination. This neurotransmitter is called dopamine.                                                             

Parkinson’s disease is caused by the degeneration of the neurons in the mid-brain that produce the neurotransmitter dopamine. Dopamine helps send or transmit messages to the brain creating smooth coordinated muscle movements in the body. The decrease of dopamine producing cells in the brain cause the disruption of the brain circuitry. This disruption causes the symptoms of Parkinson’s disease. People have a harder time in their every day activities due to the lack of ability to control their movements.

This disease is chronic and progresses gradually. It gets worse over time. The symptoms and degree of impairment of the disease varies from person to person.
No one knows for sure why these nerve cells break down. But scientists are doing a lot of research to find an answer.

After diagnosis, people can live for many years. There is currently no cure for Parkinson’s however, there are ways to control symptoms which help enhance the quality of life.

Characteristic motor symptoms of PD:

1. Tremor:
Shaking or twitching of limbs is a common early sign of Parkinson’s Disease.

2. Bradykinesia
Slowness of voluntary movement. Hard to adjust body’s position. This can lead to a “mask- like” or expressionless face.

3. Stiffness or rigidity:
Stiffness in the limbs or trunk. Can cause muscle aches and pains. People sometimes say they feel “stuck on the floor” sometimes called “freezing”.

4. Postural instability:
Impaired or lost reflexes can make it difficult to adjust posture to maintain balance.

5. Parkinsonian gait:
May develop a shuffling walk with a stooped position.

Secondary symptoms of Parkinson’s disease
The characteristic symptoms are movement- related with progressive loss of muscle control. As the disease advances, the brain becomes more damaged leading to secondary symptoms. The severity and number of the symptoms varies greatly in each individual.
Secondary symptoms include:
Loss of smell
Anxiety
Confusion or memory loss
Constipation
Depression
Inability to swallow or excessive salivation
Slow, Quieter speech or monotone voice
Urinary frequency or urgency
Skin issues

The symptoms are important for you to be aware of but remember that you are not a doctor. You are not diagnosing this disease. We want to try to help alleviate some of these symptoms with the cycling program and have a better quality of life by mastering and implementing the Parkinson’s Cycle Coach Program.

How is Parkinson’s Disease treated?

Most people who experience symptoms seek treatment from their primary care doctor first. He or she will refer that person to a neurologist who treats nervous system disorders.

The treatment of Parkinson’s disease is directed by treating the symptoms that are most bothersome to the person affected by the disease. Treatment approaches include medications, lifestyle modifications such as exercise and rest, surgery, and support groups.

It is significant to know that there is no known cure for Parkinson’s as of today, but the Parkinson’s Disease Foundation states that medications and exercise can slow symptom progression and enhance the quality of life.**

Researchers such as Dr. Jay Alberts from the Cleveland Clinic have found that “forced exercise” may produce improvements in a Parkinson patient’s motor function control. “Forced exercise” is defined as exercising beyond a voluntary level. This action could be viewed as simple math. More rather than fewer pedal strokes per minute cause more muscle contractions. These muscle contractions cause more nervous system messages to the brain. Researchers believe that biochemical reactions are the result of these nervous system messages. The more nervous system messages the brain receives, the greater the response resulting in better motor function.

Studies by Dr. Jay Alberts of the Cleveland Clinic have focused on bicycle riding and now indoor cycling. Establishing a controlled environment of 67-68 degrees (ACSM guidelines) where Parkinson’s individuals are encouraged and monitored to bring intense exercise into their lives is creating noticeable results in symptom management. Riding a stationary bike is especially valuable due to the balance issues that many Parkinson‘s patients experience.

Dr. Albert’s studies utilizing Forced exercise (FE) have demonstrated that motor scores in Parkinson’s patients improve approximately 35%. Research also shows that patients who exercise at a voluntary level well below 80RPMs will receive the same aerobic benefits as those using Forced Exercise but not the significant motor skill improvement. These motor skill improvements can be maintained for up to 4 weeks after ending the exercise.

This protocol is not intended to replace medication. The protocol is used in connection with medication management.

Before your program begins, every individual is screened and then eventually challenged to ride an indoor cycling bike at an RPM of 80-90 in their aerobic zone over a 50-60 min in a class setting. This intense exercise causes the brain to use the chemical called dopamine more efficiently and effectively allowing for better brain function.

Stages of Parkinson’s Disease

Most Parkinson’s patients are seen by a neurologist who evaluates and determines an individualized treatment. Parkinson’s disease is evaluated in Five separate phases.
Let’s do a brief review of the stages and what you might see as an instructor.

Stage I-
This is the initial phase of the disease. The symptoms are mild and may cause inconvenience with day to day tasks. Tremors, rigidity and difficulty in movement are generally exclusive to one side of the body. Many time this stage is overlooked by the person affected, his/her family, or doctor.

Stage II-
Bilateral or midline involvement, without balance problems.
This stage is a more moderate form of the disease. The symptoms can be more pronounced than in Stage I. Stiffness, tremors and trembling may be more noticeable and facial expressions begin to change. Balance is normally not affected in this stage. The symptoms begin to develop on both sides of the body and difficulty in speech can occur. This stage can be difficult to diagnosis sometimes dismissed as normal signs of aging.

Stage III-
Stage III is mid- disease progression. Loss of balance and decreased reflexes begin to be pronounced. Daily tasks are definitely challenging but they can be done. It will just take a little extra time. Independent lifestyles are usually common in Stage III.

Stage IV-
Movement in Stage IV begins to be very challenging. A person might be able to stand but the assistance of a walker or another assistive device usually is needed. Living alone becomes difficult and somewhat dangerous. That is what usually characterizes Stage III transitioning into Stage IV.

Stage V-
Stage V is the most advanced and debilitating. Advanced stiffness of the legs and “freezing” when standing or walking is common. The use of wheelchairs are necessary and independent living is not suggested.

The individual’s difference in the stage progression is difficult to predict. It can take months or years and also depends on successful treatment or unsuccessful treatment.

Parkinson’s Medications

It is common for people with Parkinson’s to take a variety of medications sometimes with different doses and at different times of the day. Most neurologists suggest that patients in an exercise program take their medications 30 minutes before class to maximize the medication’s effect.
It is a good idea to familiarize yourself with the common drugs used to treat your clients.
Although there is no cure for Parkinson’s disease, medicines can often provide dramatic relief from the symptoms. However, there are limits to their effectiveness, and scientists are working to find better ways to treat the disease such as fast pedaling on a stationary bike.

Three classes of medications
Medications for Parkinson’s fall into three groups.
1.The first group includes drugs that increase the level of dopamine in the brain.
Levodopa/Carbidopa Therapy- Sinamet
This remains the most effective drug for Parkinson’s.
Dopamine agonists
Not as potent as Levodopa/Carbidopa. Can be combined with other Parkinson’s medications.
Mirapex, Requip
Anticholernegetics-can be helpful for tremor
Artane
MAO-B inhibitors-block an enzyme in the brain that breaks down dopamine
Eldepryl, Zelapar
COMT inhibitors – newest drugs for Parkinson’s disease
Comtan, Tasmar