Starting Strength and Parkinson's

[tertius]

Based on the pathogenesis of Parkinson's I don't see how endurance training could be responsible for it. People who have dementia pugilistica (like boxers and football players) from repeated head trauma can have "parkinsonism" among their symptoms -- but this is due to repeated head trauma that is way out of proportion to the jostling one might get from trail running.

Sure, I doubt that being a trail-runner contributed to the disease in the sense of causation. But it left him in a position where he already had little muscle mass, and was in a position to rapidly undergo severe loss of function, and be at risk from degenerative problems much more quickly than someone who was not already at 2 pounds of bodyweight per inch of height.

Anyway, in principle I don't see any reason not to do weight training, but it depends first and foremost on how functional you are. The motor problems in Parkinson's are mainly at rest -- and they get better when you initiate movement. The midbrain's suppression of unwanted movements is deficient in Parkinson's, but this can be somewhat overcome when you send a more deliberate motor signal to the muscles -- so, for instance, many patients have this "pill rolling" tremor in their fingers, but when they point or write or something it gets suppressed.

This leads me to think that lifting a weight will actually suppress the symptoms while the weight is being lifted. It isn't going to really do anything for the disease itself -- I mean if the problem is dopamine deficiency in the substantia nigra of your midbrain, then no squat is going to fix that. But if you're stronger and fitter it's only going to help you maintain mobility and functionality for longer.

I suspect there's also issues here about recruitment, motor units available, relative strength expenditures for tasks and simple mass relative to involuntary contraction, not just loss of suppression.

To echo Rip, this sort of "Well, it ain't gonna cure the disease" stuff is beyond obnoxious.

No one is claiming that barbell training is going to cure Parkinson's. But it has clearly improved his quality of life, even with a guy who is starting out post-retirement, and from a skinny, low muscle ultra-runner state. And it has the potential to help him maintain his quality of life for who knows how long, where otherwise he might barely be able to function normally in society (reclaiming the ability to sign your own name is a big deal, as anyone who has lost it will tell you).

And that's what matters.

[wal]

Xultrarunner I have family who are marathon runners, typically training up to 10 Km per day for 50 Km runs. However I have not seen the conditions you have written about in them. The 2lbs per 1 inch height ratio never seen it. Although they are not what I call extreme by running to destruction.

Is not the part of the problem over training and not allowing enough time for recovery? The atrial fibrillation is a concern though.

[Jonathon Sullivan]

It isn't going to really do anything for the disease itself -- I mean if the problem is dopamine deficiency in the substantia nigra of your midbrain, then no squat is going to fix that.

"Fixing" is a tall order, Paul. But I will presume you are actually saying that no squat, regardless of any salutary effect on function or well-being, is going to get at the underlying pathophysiology of the disease.

You may be right about that, and you may not. In fact, you're just guessing. And you're playing in my sandbox, now.* Neurodegeneration is still, therapeutically, a very tough nut, but the underlying mechanisms are coming into sharper focus. Neurodegenerative disease is not the black box it once was, and putative approaches to neuroprotection are becoming more targeted and sophisticated all the time. My graduate adviser, a pioneer in the field of neuronal death, a visionary physician-scientist, and one of the most brilliant men I ever knew, cognizant of the profound complexity of these processes, scoffed at the clinical prospect of effective post-ischemic neuroprotection with something as simple as hypothermia. That was just fifteen years ago. It's standard of care now. You just never know.

In my sleep I can dream up very plausible and comprehensive mechanisms leading from resistance training to stabilization and salvage of nigrostriatal neurons, all the way down to the receptors, signaling intermediates, caspases, transcription factors and gene products. Speculation? Absolutely. And no single therapeutic intervention short of direct neuronal repair or replacement (beyond even Dr. McCoy!) is likely to be definitive or curative in a disease like PD. But based on what I know about neurodegeneration, I'm completely unwilling to dismiss the potential for resistance training to have some effect on the underlying pathophysiology of the disease, quite possibly in a dose-dependent manner.

But that's all a bit beside the point, if you think about it.



*(1, 2, 3, 4, 5, 6, 7, 8).

[ColoWayno]

Just tell me the OP meant 12-15 minute miles and not 12-15 MPH, please.

[vhalros]

Krista Scott-Dixon published a series of articles/correspondnace a while ago with a parkinson's sufferer , Neil Sligar, who was also engaged in heavy lifting.

http://www.stumptuous.com/shaky-man-in-the-gym
http://www.stumptuous.com/shaky-man-...keep-on-shakin
http://www.stumptuous.com/shaky-man-...ng-but-no-fear

There is also this video with a little of his training (there is some lifting, and some parkinson's therapy type stuff).



Might be of interest to the OP?

[milktruckcopilot]

Just tell me the OP meant 12-15 minute miles and not 12-15 MPH, please.

I was thinking the same thing.

[Forest]

Just tell me the OP meant 12-15 minute miles and not 12-15 MPH, please.

What? You think that running at 15MPH for several hours at a time through forest is unreasonable???

[Paul1]

Paul, this typical doctorspeak bullshit is not helpful.

Well, it's not doctorspeak bullshit that there are advanced Parkinson's patients who are about as mobile as Stephen Hawking with a broken wheelchair, so excuse me if I can't glean from his post exactly whether he has enough postural stability to be safe. You can't either.

What you seem to be reacting to is my typical "curbside consult" demeanor, which is basically the following: If you ask me a medical question, and I haven't had the opportunity to do a REAL clinical encounter with a full history and exam, then I'm not going to give you anything beyond general principles. Doctors have been successfully sued for generic advice they give out on the internet -- so I'm not going to be as reckless as to suggest that I know exactly what's good for him.

And by the way, if someone asked a question about something for which I have the most expertise, I would be just as cautious. General principles are great. But everyone is unique even in health, let alone disease. And by the way, people's self-reported histories are logged as "Subjective" for a reason. Because people may or may not be accurate or complete about what they tell us. So I respect his and everyone else's self-reported history, but lacking divine omniscience I can't be sure how accurate or complete it is. Hence caution.

The fact that you don't see any reason not to do the thing he said has helped him the most is one of the reasons we don't like most doctors on this board.

You disagree with this? You DO see a reason for him not to do it? What is that reason, pray tell, as long as he is safe? Or did you just misread me?

[Paul1]

"Fixing" is a tall order, Paul. But I will presume you are actually saying that no squat, regardless of any salutary effect on function or well-being, is going to get at the underlying pathophysiology of the disease.

You may be right about that, and you may not. In fact, you're just guessing. And you're playing in my sandbox, now.

All I'm saying is that the Parkinson's is going to do what it will do. So in the meantime, the "use it or lose it" axiom of fitness applies just as well to him as to everyone else.

I mean I spend half my life sending people to rehab after hospital stays. Better to start from a higher level of strength, mobility, etc. So long as it's safe. That principle applies to everyone. As for Parkinson's, I have a REAL problem with heavy squats in someone who has serious akathisia, truncal instability, or who can't manage more than a shuffling gait. On the other hand, if all he has is a little tremor right now, then I've got no problem with it.

I don't think you and I disagree about anything here.

[tomskarda]

Not a doctor, but I think anyone who underestimates the effect of reinforcing the endocrine system to the degree that the compound lifts in barbell training do is missing something important.

Many of the propblems associated with old age come from poor endocrine system production, hence the popularity of HRT.

Barbell training, amongst many other things, appears to be a way to provide an HRT type effect without the negative side effects associated with introducing pharmacueticals to the human body.