Wednesday December 19, 2018

Boxing for Fitness Takes the Fight to Parkinson’s Disease

Parkinson's mainly affects the dopamine-producing cells in the brain. That leads to a lack or a loss of dopamine, which contributes to the movement difficulties

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Boxing
The Rock Steady Boxing nonprofit was founded in 2006 by attorney Scott C. Newman, who was looking for ways to stay active after being diagnosed with Parkinson's at age 40. Pixabay
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Rock Steady Boxing NOVA gym opened in McLean, Virginia, outside Washington, D.C., last December. That was the good news for 75-year-old Neil Eisner, who was diagnosed with Parkinson’s six years ago and finds boxing an effective way to fight back against the disease.

Rock Steady Boxing (RSB) was designed especially for people with Parkinson’s, a neurodegenerative disorder that leads to tremors and balance problems. Each exercise in the program focuses on a specific skill — one is combining punches on a bag to work on strength, another is crawling across the floor. Eisner says the exercises help him perform everyday tasks like moving around and getting in and out of bed.

Some strengthening exercises target vocal cords. “One of the things that’s interesting enough is [Parkinson’s patients] tend to have a [softer] voice. When you have that lower voice, and people can’t hear you, you don’t realize. So, he asks us to bring our voice clearly and more loudly,” Eisner said.

Becoming an RSB trainer

For personal trainer Alec Langstein, working with an older population is familiar. He understands their health issues and the need for them to stay active.

boxing-gym
Parkinson’s patient Jim Coppula gets some pointers from his daughter Ellen as he works out on a bag during his Rock Steady Boxing class in Costa Mesa, California, Sept. 18, 2013. (VOA)

“My aunt has a gym in Westchester, New York, and she does a Rock Steady Boxing program there,” he said. “She invited me up to her gym to check out the program. She thought it would be a perfect fit for what I do. I helped out with a few classes, and it was just, I thought, an amazing program.”

The Rock Steady Boxing nonprofit was founded in 2006 by attorney Scott C. Newman, who was looking for ways to stay active after being diagnosed with Parkinson’s at age 40. Since then, more than 500 boxing programs have been introduced in the U.S. and around the world.

Langstein went to the organization’s headquarters to become an RSB-licensed trainer, and a few months later, he opened his Rock Steady Boxing NOVA gym.

“It’s a typical boxing program,” he explained. “They focus on balance, hand-eye coordination, reaction, footwork. There is some cognitive stuff because in boxing, certain numbers equal certain punches. So, when I yell certain numbers, you have to move and react at the same time. So, the brain and the body are working together. It’s also taking out the aggression some people may have out of having the disease.”

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A Parkinson’s patient waits for his training session in the ring during his Rock Steady Boxing session in Costa Mesa, California, Sept. 16, 2013. (VOA)

Improving quality of life

To understand how RSB can help Parkinson’s patients, physical therapist Danielle Sequira says it’s important to know what triggers the symptoms.

“Parkinson’s mainly affects the dopamine-producing cells in the brain. That leads to a lack or a loss of dopamine, which contributes to the movement difficulties,” she said.

While boxing and other exercises don’t cure the disease or stop the dopamine decline, they can improve the patient’s quality of life. Exercises can be modified for people with Parkinson’s, including those in wheelchairs.

“The research shows that exercise helps the brain use dopamine more efficiently,” Sequira said. “My goal usually, after I work with some of my patients with Parkinson’s, is to refer them out to get involved in an exercise program out in the community.”

Parkinsons
Parkinson’s patients stretch as they begin their workout at Rock Steady Boxing in Costa Mesa, California, Sept. 16, 2013. (VOA)

The social effect

RSB seems to have helped Victoria Hebert reduce the symptoms of her Parkinson’s. She has a tremor in her left hand, and says certain situations trigger it.

“Being cold, being hot, or sitting with a crowd I’m not very comfortable with, I can’t help starting to shake. I end up having to sit on my hand just to keep it still,” she said.

Also Read: Study: Experimental Drug can Halt Parkinson’s Progression

But with this crowd, Hebert doesn’t feel the need to hide the disease. “These people have become very close in the four or five months we’ve been together.”

“That’s the big part of it, sharing experiences with others,” she added. “I have to say, it’s very embarrassing, but over eight years of time I’ve never met another person with Parkinson’s. Then, I came here, and it was like a whole class of 20, 25 people with it. It was kind of surprising to me, kind of surprising that I, myself, didn’t reach out to anybody before that.” (VOA)

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Risk Of Parkinson’s Disease And Appendix Removal Linked: Scientists

There are other unrelated risks for Parkinson's disease, such as suffering a traumatic brain injury.

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Sclerosis, Parkinson's Disease, Kepler, NASA, tissue
A researcher takes a tissue sample from a human brain at the Multiple Sclerosis and Parkinson’s UK Tissue Bank, at Imperial College London, Britain June 3, 2016. An appendix, often considered useless, seems to store an abnormal protein, which if it makes its way into the brain, has been found to become a hallmark of Parkinson's. VOA

Scientists have found a new clue that Parkinson’s disease may get its start not in the brain but in the gut – maybe in the appendix.

People who had their appendix removed early in life had a lower risk of getting the tremor-inducing brain disease decades later, researchers reported Wednesday.

Why? A peek at surgically removed appendix tissue shows this tiny organ, often considered useless, seems to be a storage depot for an abnormal protein – one that, if it somehow makes its way into the brain, becomes a hallmark of Parkinson’s.

The big surprise, according to studies published in the journal Science Translational Medicine: Lots of people may harbor clumps of that worrisome protein in their appendix – young and old, people with healthy brains and those with Parkinson’s.

Parkinson's Disease
Parkinson’s Disease Gets Awareness From Various Events. Flickr

But don’t look for a surgeon just yet.

“We’re not saying to go out and get an appendectomy,” stressed Viviane Labrie of Michigan’s Van Andel Research Institute, a neuroscientist and geneticist who led the research team.

After all, there are plenty of people who have no appendix yet still develop Parkinson’s. And plenty of others harbor the culprit protein but never get sick, according to her research.

The gut connection

Doctors and patients have long known there’s some connection between the gastrointestinal tract and Parkinson’s. Constipation and other GI troubles are very common years before patients experience tremors and movement difficulty that lead to a Parkinson’s diagnosis.

Wednesday’s research promises to re-energize work to find out why, and learn who’s really at risk.

Parkinson's Disease
GREAT MANCHESTER RUN 2010.Parkinson’s UK Runners

“This is a great piece of the puzzle. It’s a fundamental clue,” said Dr. Allison Willis, a Parkinson’s specialist at the University of Pennsylvania who wasn’t involved in the new studies but says her patients regularly ask about the gut link.

Parkinson’s Foundation chief scientific officer James Beck, who also wasn’t involved, agreed that “there’s a lot of tantalizing potential connections.”

He noted that despite its reputation, the appendix appears to play a role in immunity that may influence gut inflammation. The type of bacteria that live in the gut also may affect Parkinson’s.

But if it really is common to harbor that Parkinson’s-linked protein, “what we don’t know is what starts it, what gets this whole ball rolling,” Beck said.

For years, scientists have hypothesized about what might cause the gut-Parkinson’s connection. One main theory: Maybe bad “alpha-synuclein” protein can travel from nerve fibers in the GI tract up the vagus nerve, which connects the body’s major organs to the brain. Abnormal alpha-synuclein is toxic to brain cells involved with movement.

Parkinson's Disease
That’s a crucial finding because it means merely harboring the protein in the gut isn’t enough to trigger Parkinson’s. Flickr

There have been prior clues. People who decades ago had the vagus nerve cut as part of a now-abandoned therapy had a reduced risk of Parkinson’s. Some smaller studies have suggested appendectomies, too, might be protective – but the results were conflicting.

Labrie’s team set out to find stronger evidence.

First, the researchers analyzed Sweden’s huge national health database, examining medical records of nearly 1.7 million people tracked since 1964. The risk of developing Parkinson’s was 19 percent lower among those who had their appendix surgically removed decades earlier.

One puzzling caveat: People living in rural areas appeared to get the benefit. Labrie said it’s possible that the appendix plays a role in environmental risk factors for Parkinson’s, such as pesticide exposure.

Further analysis suggested people who developed Parkinson’s despite an early-in-life appendectomy tended to have symptoms appear a few years later than similarly aged patients.

parkinson's disease
The main symptoms of Parkinson’s disease are tremor, slowness of movement (bradykinesia) and muscle stiffness or rigidity. Wikimedia commons

A common protein

That kind of study doesn’t prove that removing the appendix is what reduces the risk, cautioned Dr. Andrew Feigin, executive director of the Parkinson’s institute at NYU Langone Health, who wasn’t involved in Wednesday’s research.

So next, Labrie’s team examined appendix tissue from 48 Parkinson’s-free people. In 46 of them, the appendix harbored the abnormal Parkinson’s-linked protein. So did some Parkinson’s patients. Whether the appendix was inflamed or not also didn’t matter.

That’s a crucial finding because it means merely harboring the protein in the gut isn’t enough to trigger Parkinson’s, Labrie said. There has to be another step that makes it dangerous only for certain people.

“The difference we think is how you manage this pathology,” she said – how the body handles the buildup.

Parkinson’s disease is named after Dr James Parkinson (1755-1824), the doctor that first identified the condition. Wikimedia commons
Parkinson’s disease is named after Dr James Parkinson (1755-1824), the doctor that first identified the condition. Wikimedia commons

Her team plans additional studies to try to tell.

The reservoir finding is compelling, Feigin said, but another key question is if the abnormal protein also collects in healthy people’s intestines.

Also Read: Travelling To Space May Alter Brain, Says Study

And Penn’s Willis adds another caution: There are other unrelated risks for Parkinson’s disease, such as suffering a traumatic brain injury.

“This could be one of many avenues that lead to Parkinson’s disease, but it’s a very exciting one,” she said. (VOA)