Muscle Enzyme Explains Weight Gain in Middle Age, Cancer and Aging

By Dr. Francis Collins

The struggle to maintain a healthy weight is a lifelong challenge for many of us. In fact, the average American packs on an extra 30 pounds from early adulthood to age 50. What’s responsible for this tendency toward middle-age spread? For most of us, too many calories and too little exercise definitely play a role. But now comes word that another reason may lie in a strong—and previously unknown—biochemical mechanism related to the normal aging process.

An NIH-led team recently discovered that the normal process of aging causes levels of an enzyme called DNA-PK to rise in animals as they approach middle age. While the enzyme is known for its role in DNA repair, their studies show it also slows down metabolism, making it more difficult to burn fat. To see if reducing DNA-PK levels might rev up the metabolism, the researchers turned to middle-aged mice. They found that a drug-like compound that blocked DNA-PK activity cut weight gain in the mice by a whopping 40 percent!

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Jay H. Chung, an intramural researcher with NIH’s National Heart, Lung, and Blood Institute, had always wondered why many middle-aged people and animals gain weight even when they eat less. To explain this paradox, his team looked to biochemical changes in the skeletal muscles of middle-aged mice and rhesus macaques, whose stage in life would be roughly equivalent to a 45-year-old person.

Their studies, published recently in Cell Metabolism, uncovered evidence in both species that DNA-PK increases in skeletal muscle with age [1]. The discovery proved intriguing because the enzyme’s role in aging was completely unknown. DNA-PK was actually pretty famous for a totally different role in DNA repair, specifically its promotion of splicing the DNA of developing white blood cells called lymphocytes. In fact, lymphocytes fail to mature in mice without a working copy of the enzyme, causing a devastating immune disorder known as severe combined immunodeficiency (SCID).

Further study by Chung’s team showed that DNA-PK in the muscle acted as a brake that gradually slows down metabolism. The researchers found in these muscle cells that DNA-PK decreases the capacity of the mitochondria, the powerhouses that burn fat for energy. The enzyme also causes a decline in the number of mitochondria in these cells.

The researchers suspected that an increase in DNA-PK in middle age might lead directly to weight gain. If correct, then blocking the enzyme should have the opposite effect and help stop these mice from piling on the pounds.

Indeed, it did. When the researchers treated obese mice with a drug called a DNA-PK inhibitor, they gained considerably less weight while fed a high-fat diet. The treatment also protected the animals from developing early signs of diabetes, which is associated with obesity. Fortunately, there was no sign of trouble in the immune systems of middle-aged mice treated with the DNA-PK inhibitor, presumably because those essential DNA splicing events in lymphocytes had already occurred. Neither was there a sign of serious side effects, such as cancer.

As people age and their weight increases, they also tend to become less physically fit. The new evidence implicates DNA-PK in that process, too. Obese and middle-aged mice treated with the DNA-PK inhibitor showed increased running endurance. With treatment, they ran about twice as long on a tiny mouse treadmill than they would normally.

While the findings are in mice, they suggest that an increase in DNA-PK could explain why it becomes so frustratingly difficult for many of us to stay lean and fit as we age.

It also paves the way for the development of a new kind of weight-loss medication designed to target this specific biochemical change that comes with middle age.

Chung says they are now looking for DNA-PK inhibitors that might work even better than the one in this study. But given the fact that DNA-PK has other roles, testing its safety and effectiveness will take time.

While we await the results, the best course to help fight that middle-age spread hasn’t changed. Eat right and follow an exercise plan that you know you can stick to—it will make you feel better. Take it from me, a guy who decided eight years ago that it was time to shape up, stopped eating honey buns, got into a regular exercise program with a trainer to keep me accountable, and lost those 30 pounds. You can do it, even without a DNA-PK inhibitor!

Reference:

[1] DNA-PK promotes the mitochondrial, metabolic, and physical decline that occurs during aging. Park SJ, Gavrilova O, Brown AL, Soto JE, Bremner S, Kim J, Xu X, Yang S, Um JH, Koch LG, Britton SL, Lieber RL, Philp A, Baar K, Kohama SG, Abel ED, Kim MK, Chung JH. Cell Metab. 2017 May 2;25(5):1135-1146.

Links:

Overweight and Obesity (National Heart, Lung, and Blood Institute/NIH)

Health Tips for Older Adults (National Institute of Diabetes and Digestive and Kidney Diseases/NIH)

Jay H. Chung (National Heart, Lung, and Blood Institute/NIH)

NIH Support: National Heart, Lung, and Blood Institute; Office of the Director


From wiki

DNA damage appears to be the primary underlying cause of cancer,[8][9] and deficiencies in DNA repair genes likely underlie many forms of cancer.[10][11] If DNA repair is deficient, DNA damage tends to accumulate. Such excess DNA damage may increase mutations due to error-prone translesion synthesis. Excess DNA damage may also increase epigenetic alterations due to errors during DNA repair.[12][13] Such mutations and epigenetic alterations may give rise to cancer.

PRKDC (DNA-PKcs) mutations were found in 3 out of 10 of endometriosis-associated ovarian cancers, as well as in the field defects from which they arose.[14] They were also found in 10% of breast and pancreatic cancers.[15]

Reductions in expression of DNA repair genes (usually caused by epigenetic alterations) are very common in cancers, and are ordinarily even more frequent than mutational defects in DNA repair genes in cancers.[16]

DNA-PKcs expression was reduced by 23% to 57% in six cancers as indicated in the table.

Frequency of reduced expression of DNA-PKcs in sporadic cancers

Cancer Frequency of reduction in cancer Ref.
Breast cancer 57% [17]
Prostate cancer 51% [18]
Cervical carcinoma 32% [19]
Nasopharyngeal carcinoma 30% [20]
Epithelial ovarian cancer 29% [21]
Gastric cancer 23% [22]

It is not clear what causes reduced expression of DNA-PKcs in cancers. MicroRNA-101 targets DNA-PKcs via binding to the 3′- UTR of DNA-PKcs mRNA and efficiently reduces protein levels of DNA-PKcs.[23] But miR-101 is more often decreased in cancers, rather than increased.[24][25]

HMGA2 protein could also have an effect on DNA-PKcs. HMGA2 delays the release of DNA-PKcs from sites of double-strand breaks, interfering with DNA repair by non-homologous end joining and causing chromosomal aberrations.[26] The let-7a microRNA normally represses the HMGA2 gene.[27][28]

In normal adult tissues, almost no HMGA2 protein is present. In many cancers, let-7 microRNA is repressed.

As an example, in breast cancers the promoter region controlling let-7a-3/let-7b microRNA is frequently repressed by hypermethylation.[29] Epigenetic reduction or absence of let-7a microRNA allows high expression of the HMGA2 protein and this would lead to defective expression of DNA-PKcs.

DNA-PKcs can be up-regulated by stressful conditions such as in Helicobacter pylori-associated gastritis.[30] After ionizing radiation DNA-PKcs was increased in the surviving cells of oral squamous cell carcinoma tissues.[31]

The ATM protein is important in homologous recombinational repair (HRR) of DNA double strand breaks. When cancer cells are deficient in ATM the cells are “addicted” to DNA-PKcs, important in the alternative DNA repair pathway for double-strand breaks, non-homologous end joining (NHEJ).[32] That is, in ATM-mutant cells, an inhibitor of DNA-PKcs causes high levels of apoptotic cell death. In ATM mutant cells, additional loss of DNA-PKcs leaves the cells without either major pathway (HRR and NHEJ) for repair of DNA double-strand breaks.

Elevated DNA-PKcs expression is found in a large fraction (40% to 90%) of some cancers (the remaining fraction of cancers often has reduced or absent expression of DNA-PKcs). The elevation of DNA-PKcs is thought to reflect the induction of a compensatory DNA repair capability, due to the genome instability in these cancers.[33](As indicated in the article Genome instability, such genome instability may be due to deficiencies in other DNA repair genes present in the cancers.)

Elevated DNA-PKcs is thought to be “beneficial to the tumor cells”,[33] though it would be at the expense of the patient.

As indicated in a table listing 12 types of cancer reported in 20 publications,[33] the fraction of cancers with over-expression of DNA-PKcs is often associated with an advanced stage of the cancer and shorter survival time for the patient. However, the table also indicates that for some cancers, the fraction of cancers with reduced or absent DNA-PKcs is also associated with advanced stage and poor patient survival.

Aging

Non-homologous end joining (NHEJ) is the principal DNA repair process used by mammalian somatic cells to cope with double-strand breaks that continually occur in the genome.

DNA-PKcs is one of the key components of the NHEJ machinery. DNA-PKcs deficient mice have a shorter lifespan and show an earlier onset of numerous aging related pathologies than corresponding wild-type littermates.[34][35]

These findings suggest that failure to efficiently repair DNA double-strand breaks results in premature aging, consistent with the DNA damage theory of aging. (See also Bernstein et al.[36])

————

Serine/threonine protein kinase which is a central regulator of cellular metabolism, growth and survival in response to hormones, growth factors, nutrients, energy and stress signals.

MTOR directly or indirectly regulates the phosphorylation of at least 800 proteins. Functions as part of 2 structurally and functionally distinct signaling complexes mTORC1 and mTORC2 (mTOR complex 1 and 2). Activated mTORC1 up-regulates protein synthesis by phosphorylating key regulators of mRNA translation and ribosome synthesis. This includes phosphorylation of EIF4EBP1 and release of its inhibition toward the elongation initiation factor 4E (eiF4E).
  • Moreover, phosphorylates and activates RPS6KB1 and RPS6KB2 that promote protein synthesis by modulating the activity of their downstream targets including ribosomal protein S6, eukaryotic translation initiation factor EIF4B, and the inhibitor of translation initiation PDCD4.
  • Stimulates the pyrimidine biosynthesis pathway, both by acute regulation through RPS6KB1-mediated phosphorylation of the biosynthetic enzyme CAD, and delayed regulation, through transcriptional enhancement of the pentose phosphate pathway which produces 5-phosphoribosyl-1-pyrophosphate (PRPP), an allosteric activator of CAD at a later step in synthesis, this function is dependent on the mTORC1 complex.
  • Regulates ribosome synthesis by activating RNA polymerase III-dependent transcription through phosphorylation and inhibition of MAF1 an RNA polymerase III-repressor. In parallel to protein synthesis, also regulates lipid synthesis through SREBF1/SREBP1 and LPIN1.

To maintain energy homeostasis,  mTORC1 may also regulate mitochondrial biogenesis through regulation of PPARGC1A.

  • mTORC1 also negatively regulates autophagy through phosphorylation of ULK1. Under nutrient sufficiency, phosphorylates ULK1 at ‘Ser-758’, disrupting the interaction with AMPK and preventing activation of ULK1.
  • Also prevents autophagy through phosphorylation of the autophagy inhibitor DAP.
  • mTORC1 exerts a feedback control on upstream growth factor signaling that includes phosphorylation and activation of GRB10 a INSR-dependent signaling suppressor.
Among other potential targets mTORC1 may phosphorylate CLIP1 and regulate microtubules. As part of the mTORC2 complex MTOR may regulate other cellular processes including survival and organization of the cytoskeleton. Plays a critical role in the phosphorylation at ‘Ser-473’ of AKT1, a pro-survival effector of phosphoinositide 3-kinase, facilitating its activation by PDK1. mTORC2 may regulate the actin cytoskeleton, through phosphorylation of PRKCA, PXN and activation of the Rho-type guanine nucleotide exchange factors RHOA and RAC1A or RAC1B. mTORC2 also regulates the phosphorylation of SGK1 at ‘Ser-422’. Regulates osteoclastogensis by adjusting the expression of CEBPB isoforms (By similarity).

Catalytic activityi

ATP + a protein = ADP + a phosphoprotein.

Enzyme regulationi

  • Activation of mTORC1 by growth factors such as insulin involves AKT1-mediated phosphorylation of TSC1-TSC2, which leads to the activation of the RHEB GTPase a potent activator of the protein kinase activity of mTORC1.
  • Insulin-stimulated and amino acid-dependent phosphorylation at Ser-1261 promotes autophosphorylation and the activation of mTORC1.
  • Activation by amino acids requires relocalization of the mTORC1 complex to lysosomes that is mediated by the Ragulator complex, SLC38A9, and the Rag GTPases RRAGA, RRAGB, RRAGC and RRAGD (PubMed:18497260, PubMed:20381137, PubMed:25561175, PubMed:25567906).
On the other hand, low cellular energy levels can inhibit mTORC1 through activation of PRKAA1 while hypoxia inhibits mTORC1 through a REDD1-dependent mechanism which may also require PRKAA1. The kinase activity of MTOR within the mTORC1 complex is positively regulated by MLST8 and negatively regulated by DEPTOR and AKT1S1. MTOR phosphorylates RPTOR which in turn inhibits mTORC1. MTOR is the target of the immunosuppressive and anti-cancer drug rapamycin which acts in complex with FKBP1A/FKBP12, and specifically inhibits its kinase activity.
  • mTORC2 is also activated by growth factors, but seems to be nutrient-insensitive. It may be regulated by RHEB but in an indirect manner through the PI3K signaling pathway.8 Publications

GO – Molecular functioni

GO – Biological processi

Cardio-based body weight exercises

I have been doing 30 min quick fit at nc.fit every day. And here are samples of the workout that is cardio based using your own body weight.

How to Use This List

Create your own workout: Pick 3 or 4 moves from the list below and add them to any workout. Do the moves between strength training exercises as an active rest or add them on to the start of a run or other cardio routine. Perform each exercise for 30 to 60 seconds and complete 2 to 3 rounds.

Try our workout: Skip the guesswork and scroll to the end to do Greenwell’s workout.

Beginner

1. Inchworm

Stand with feet hip width and core tight. Bend from the waist, place hands on the ground, and walk hands forward, keeping legs straight. When you arrive in a high plank, quickly walk hands back toward feet and stand.

Make it harder: Add a push-up when you are in the high plank position.

2. Power Skip

Stand with feet hip width and core tight. Raise right knee up as you bring left arm forward and hop off left foot. Land on the ball of your left foot then immediately bring right foot down and repeat on the other side. Focus on height not speed.

3. Uppercut

Stand in a split stance with right foot one step ahead of left foot and hips squared (facing forward). With right hand, punch up and to the left with a scooping motion. Quickly repeat on the other side. Continue to alternate as quickly as possible while maintaining loose knees and a tight core. Halfway through, switch stance to the other side.

4. Mountain Climber Twist

From a high plank position with core tight, run left knee in toward right elbow, then right knee in toward left elbow. Continue to alternate as quickly as possible without hiking hips.

Make it easier: Run knees straight in toward chest rather than twisting.

5. High Knees

Stand with your feet hip width and run in place by pulling right knee up toward chest, then left knee up toward chest. Continue to alternate as quickly as possible.

Make it easier: If running isn’t part of your game plan, perform this move as a march, using your core to pull your knee toward your chest.

6. Punch

Start in the same split stance that you used for uppercuts, with right foot one step ahead of left foot. Raise both fists up, keeping elbows pulled in to rib cage. Punch forward with left hand, slightly rotating torso as you do. Punch as quickly as possible for half of your time, then switch your stance and punch on the other side.

7. Plank Jacks

From a high plank position, with core tight, jump feet apart then jump them back together. Repeat as quickly as possible while trying to maintain level hips.

8. Butt Kick

Run in place kicking heels toward glutes. Swing arms at side or allow them to rest against butt so that heels kick palms. Make sure the movement is being driven from your hamstrings (not your feet kicking up dust).

9. Fast Feet Shuffle

With feet wider than hip width, bend knees slightly, sending hips back and keeping core tight. Shuffle feet to the right for 4 paces (or for as much space as you have), then shuffle back the other way. Stay low and make your feet move as quickly as possible to get the most out of this exercise.

10. Plank-to-Knee Tap

From a high plank position with core engaged, shift back and pike hips as you lift right hand to tap left shin (or ankle if you’re extra flexible!). Return to high plank position and repeat on the other side. Move through the exercise as quickly as possible while maintaining good form.

11. Jumping Jack

This classic cardio move is a great way to warm up or do active rest between more difficult moves. Start with feet together, hands at sides, core engaged. Now jump legs apart and bring arms overhead, clapping at the top. Keep knees bent as you jump feet back together and bring arms down. Repeat as quickly as possible.

12. Vertical Jump

The goal here is simple: Try to jump as high as possible. Stand with a slight bend in the knees and feet hip width. Swing both arms back as you bend a little deeper. Then, as you swing arms forward, jump up, extending arms overhead. Land lightly and repeat.

13. Skaters

Stand with feet hip width and a slight bend in knees. Jump to the right with right foot, landing lightly on the ball of your right foot and sweeping left foot behind right leg. Do not put weight on left foot if you can help it! Immediately jump to the left with left foot, allowing right foot to sweep behind left leg. Continue to alternate sides.

Intermediate

14. Long Jump With Jog Back

Stand with feet hip width and a slight bend in knees. Swing both arms back and bend a little deeper, then swing arms forward and jump forward as far as possible with both feet, landing lightly on the balls of your feet. Now, as quickly as possible, jog backward to starting place and repeat.

15. Tuck Jump

It’s time to catch some air. Stand with knees slightly bent and jump up, bringing knees to chest and extending arms out straight in front of chest. Lower arms as you land lightly on the floor.

16. Corkscrew

From a high plank position with core tight, shift weight onto left hand, lift right hand off ground, then rotate to the right and kick left foot out to the right. Tap left foot with right hand. Repeat on the other side moving as quickly as possible.

17. Diver’s Push-Up

If you’ve been to yoga before, you’ll recognize this as a near chaturanga—but a little faster. Start in a down dog position with hands on the ground, hips high in the air, and feet on the ground so you form a triangle shape. In a fluid motion, dive head toward the floor, coming into a low push-up position, and then swoop chest forward and up so you end in an upward dog position. From there, push hips up to return to starting position.

18. Wide Mountain Climbers

From a high plank position with core tight, bring right foot forward to the outside of right hand so you are in a low lunge position. Jump and switch feet in midair so that you land with your left foot to the outside of your left hand with your right foot straight back. Continue to alternate as quickly as possible.

Make it easier: Skip the hop. Instead, step right foot back then quickly step left foot forward.

19. Invisible Jump Rope

Hop over an invisible rope (no need to jump more than 1 or 2 inches off the ground) by staying on your toes and pushing off with the balls of your feet. Make quick, small movements with your wrists as if you’re holding a rope.

20. 3 Hops to Push-Up

Stand on right foot with left foot elevated and core tight. Hop 3 times then bend down and quickly walk hands out so you are in a high plank position with left foot still off ground. Do 3 push-ups, never putting left foot down. Walk hands back and stand up to return to starting position. Repeat for half the time on one side only, then switch sides.

21. Step-Up

You’ll need a bench or sturdy chair for this move. Place right foot on the bench and, using glutes, push up so right leg is straight and left foot is off the ground. Slowly lower, allowing left foot then right foot to come down to the ground. Repeat, focusing on using only your right glutes (do not push off with left foot).

22. Classic Burpee

It’s the move we love to hate (and our model makes it look so easy!). Stand with feet hip width and core tight. Jump up then immediately drop to the floor, placing hands on the ground and shooting feet back so you’re in a high plank position. Do a push-up. Quickly jump feet back to hands and, in one movement, stand and jump up to complete 1 rep.

23. Single-Leg Hop

Stand on right leg, lift left foot off ground, and brace core. Jump forward 3 to 5 times, each time landing lightly on the ball of your foot. Switch feet and jump back to start.

Make it harder: Jump in a box formation: forward, side, back, side, then switch directions before hopping on the other side.

24. Runner’s Skip

Start in a low lunge position with right foot forward, left foot back, and fingertips touching the ground for balance. In one smooth movement, bring left foot forward and, as you stand on right foot, continue to lift left knee toward chest and hop up on right foot. Land lightly on right foot and immediately slide left foot behind you to return to starting position. Repeat for half the time then switch to the other side.

25. Flutter Kick

Lie faceup on your back with navel pulled toward spine. You can slide both hands under the curve of low back for added support. Using your core, lift both feet 3 to 4 inches off the ground and kick feet up and down several inches, keeping core engaged throughout. If you feel any discomfort in your low back, skip this exercise.

26. Sprinter Sit-Ups

Start in a seated position with legs extended in front of you and arms bent to 90-degree angles (think robot). Lean back slightly as you lift right leg with right knee bent and bring left elbow to right knee, engaging obliques as you twist upper torso to the right. Return to starting position and repeat on the other side.

Advanced

27. Squat Jump

Do a perfect squat. As you come up, jump up, extending legs fully and pushing arms down to help with your momentum. Land lightly on toes and immediately drop into a squat again. Greenwell suggests holding hands behind head (as shown), which helps to keep chest open and posture straight.

28. Plyometric Push-Up

Master a perfect push-up before attempting this move. Do a perfect push-up, but as you push up, push even harder so that both hands come off the ground and you can clap hands together before landing in a high plank again. Plyometric moves are great for building strength and power. Get even more ideas in our article here.

29. Tricep Push-Up With Mountain Climber

Two moves is better than one, right? You may want to do this move on a mat or a towel for padding. Start in a high plank position with core tight. Lower onto both forearms at the same time, maintaining a tight core and level hips. Now push back up onto hands at the same time to return to starting position. Finish by drawing right knee into chest, then left knee into chest, doing a mountain climber.

Make it easier: Lower and push back up one arm at a time, rather than both arms at once. You could also perform a push-up on your knees then lift knees to do the mountain climber.

30. Box Jump

You’ll need a box or sturdy bench to complete this move. If you’ve never attempted box jumps, start with a box that is mid-calf height and progress to higher heights from there. Stand in front of box with feet shoulder-width apart. Bend knees, send hips back, swing arms back, and, as you swing arms forward, explode up onto box. Land lightly on toes (no loud thuds!) then step down one foot at a time and repeat.

31. Donkey Kick

From a high plank position with core tight and hips level, jump feet up and kick butt with heels. Your weight should come forward onto hands, but shoulders should stay in line over wrists. Extend legs and land lightly on toes to return to starting position.

32. Lateral Jump

This move works best if you use a low bench. With the low bench at your right side, start with knees slightly bent and hips back. Shift weight to left foot then jump over the bench first with right foot, allowing the left foot to follow. Land lightly on right foot first then left foot. Reverse the move, starting with left foot, to return to starting position.

33. Jumping Lunges

This move is sure to get your heart racing in no time. Master a basic lunge before progressing to this version. With right foot ahead of left foot and core tight, drop into a low lunge, bending both knees to 90 degrees. Now jump up, switching feet in middair so you land with left foot ahead of right foot and immediately drop into a low lunge on the other side.

The Workout

Greenwell created this inventive (and sweaty!) quick cardio workout by combining 3 of the moves from our list above. Do each move below in order for the indicated number of reps.

  1. Tricep Push-Up With Progressing Mountain Climber
    Start with 1 push-up and 1 mountain climber. Next time, do 1 push-up and 2 mountain climbers. Then 1 push-up and 3 mountain climbers. Continue until you get to 10 mountain climbers.
  2. Hops and Push-Up Combo
    ​Do 3 hops on one leg then 3 push-ups. That’s 1 rep. Do 10 to 15 reps per side.
  3. Squat Jump
    Do 20 seconds of squat jumps followed by a 10-second squat hold. Repeat for 5 minutes.

Special thanks to Josey Greenwell of Barry’s Bootcamp, who modeled these moves and created this workout.

https://greatist.com/fitness/cardio-bodyweight-exercises

Calories burned per exercise type

Calories burned per exercise type:

Exercise & Calories Burned per Hour
130 lbs
155 lbs
180 lbs
205 lbs
Aerobics, general
384
457
531
605
Aerobics, high impact
413
493
572
651
Aerobics, low impact
295
352
409
465
Aerobics, step aerobics
502
598
695
791
Archery
207
246
286
326
Backpacking, Hiking with pack
413
493
572
651
Badminton
266
317
368
419
Bagging grass, leaves
236
281
327
372
Bakery, light effort
148
176
204
233
Ballet, twist, jazz, tap
266
317
368
419
Ballroom dancing, fast
325
387
449
512
Ballroom dancing, slow
177
211
245
279
Basketball game, competitive
472
563
654
745
Basketball, playing, non game
354
422
490
558
Basketball, shooting baskets
266
317
368
419
Basketball, wheelchair
384
457
531
605
Bathing dog
207
246
286
326
Bird watching
148
176
204
233
Boating, power, speed boat
148
176
204
233
Bowling
177
211
245
279
Boxing, in ring
708
844
981
1117
Boxing, punching bag
354
422
490
558
Boxing, sparring
531
633
735
838
Calisthenics, light, pushups, situps…
207
246
286
326
Calisthenics, fast, pushups, situps…
472
563
654
745
Canoeing, camping trip
236
281
327
372
Canoeing, rowing, light
177
211
245
279
Canoeing, rowing, moderate
413
493
572
651
Canoeing, rowing, vigorous
708
844
981
1117
Carpentry, general
207
246
286
326
Carrying 16 to 24 lbs, upstairs
354
422
490
558
Carrying 25 to 49 lbs, upstairs
472
563
654
745
Carrying heavy loads
472
563
654
745
Carrying infant, level ground
207
246
286
326
Carrying infant, upstairs
295
352
409
465
Carrying moderate loads upstairs
472
563
654
745
Carrying small children
177
211
245
279
Children’s games, hopscotch…
295
352
409
465
Circuit training, minimal rest
472
563
654
745
Cleaning gutters
295
352
409
465
Cleaning, dusting
148
176
204
233
Climbing hills, carrying up to 9 lbs
413
493
572
651
Climbing hills, carrying 10 to 20 lb
443
528
613
698
Climbing hills, carrying 21 to 42 lb
472
563
654
745
Climbing hills, carrying over 42 lb
531
633
735
838
Coaching: football,basketball,soccer
236
281
327
372
Coal mining, general
354
422
490
558
Construction, exterior, remodeling
325
387
449
512
Crew, sculling, rowing, competition
708
844
981
1117
Cricket (batting, bowling)
295
352
409
465
Croquet
148
176
204
233
Cross country snow skiing, slow
413
493
572
651
Cross country skiing, moderate
472
563
654
745
Cross country skiing, racing
826
985
1144
1303
Cross country skiing, uphill
974
1161
1348
1536
Cross country skiing, vigorous
531
633
735
838
Curling
236
281
327
372
Cycling, <10mph, leisure bicycling
236
281
327
372
Cycling, >20mph, racing
944
1126
1308
1489
Cycling, 10-11.9mph, light
354
422
490
558
Cycling, 12-13.9mph, moderate
472
563
654
745
Cycling, 14-15.9mph, vigorous
590
704
817
931
Cycling, 16-19mph, very fast, racing
708
844
981
1117
Cycling, mountain bike, bmx
502
598
695
791
Darts (wall or lawn)
148
176
204
233
Diving, springboard or platform
177
211
245
279
Downhill snow skiing, moderate
354
422
490
558
Downhill snow skiing, racing
472
563
654
745
Electrical work, plumbing
207
246
286
326
Farming, baling hay, cleaning barn
472
563
654
745
Farming, chasing cattle on horseback
236
281
327
372
Farming, feeding horses or cattle
266
317
368
419
Farming, feeding small animals
236
281
327
372
Farming, grooming animals
354
422
490
558
Fencing
354
422
490
558
Fire fighter, climbing ladder, full gear
649
774
899
1024
Fire fighter, hauling hoses on ground
472
563
654
745
Fishing from boat, sitting
148
176
204
233
Fishing from riverbank, standing
207
246
286
326
Fishing from riverbank, walking
236
281
327
372
Fishing in stream, in waders
354
422
490
558
Fishing, general
177
211
245
279
Fishing, ice fishing
118
141
163
186
Flying airplane (pilot)
118
141
163
186
Football or baseball, playing catch
148
176
204
233
Football, competitive
531
633
735
838
Football, touch, flag, general
472
563
654
745
Forestry, ax chopping, fast
1003
1196
1389
1582
Forestry, ax chopping, slow
295
352
409
465
Forestry, carrying logs
649
774
899
1024
Forestry, sawing by hand
413
493
572
651
Forestry, trimming trees
531
633
735
838
Frisbee playing, general
177
211
245
279
Frisbee, ultimate frisbee
472
563
654
745
Gardening, general
236
281
327
372
General cleaning
207
246
286
326
Golf, driving range
177
211
245
279
Golf, general
266
317
368
419
Golf, miniature golf
177
211
245
279
Golf, using power cart
207
246
286
326
Golf, walking and pulling clubs
254
303
351
400
Golf, walking and carrying clubs
266
317
368
419

Slowing bone loss with weight-bearing exercise

 

exercise to help slow bone loss
Image: iStock

As with loss of muscle mass, bone strength starts to decline earlier than you might imagine, slipping at an average rate of 1% per year after age 40. About 10.2 million Americans have osteoporosis, which is defined by weak and porous bones, and another 43 million are at risk for it.

Numerous studies have shown that weight-bearing exercise can help to slow bone loss, and several show it can even build bone. Activities that put stress on bones stimulate extra deposits of calcium and nudge bone-forming cells into action. The tugging and pushing on bone that occur during strength and power training provide the stress. The result is stronger, denser bones.

Get your copy of Strength and Power Training for All Ages

Product Page - Strength and Power Training for All Ages
Studies attest that strength training, as well as aerobic exercise, can help you manage and sometimes prevent conditions as varied as heart disease, diabetes, arthritis, and osteoporosis. It can also protect vitality, make everyday tasks more manageable, and help you maintain a healthy weight. This report answers your strength training questions and helps you develop a program that’s right for you.

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Even weight-bearing aerobic exercise, like walking or running, can help your bones, but there are a couple of caveats. Generally, higher-impact activities have a more pronounced effect on bone than lower impact aerobics. Velocity is also a factor; jogging or fast-paced aerobics will do more to strengthen bone than more leisurely movement. And keep in mind that only those bones that bear the load of the exercise will benefit. For example, walking or running protects only the bones in your lower body, including your hips.

By contrast, a well-rounded strength training program that works out all the major muscle groups can benefit practically all of your bones. Of particular interest, it targets bones of the hips, spine, and wrists, which, along with the ribs, are the sites most likely to fracture. Also, by enhancing strength and stability, resistance workouts reduce the likelihood of falls, which can lead to fractures.

To learn more about the benefits of strength training, buy Strength and Power Training for All Ages, a Special Health Report from Harvard Medical School.

Parkinson and Exercises

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Parkinson’s Disease and Exercises

Dancing with music is the best exercise followed by Tai Chi. When lying on the bed, use the ROM exercise given by Physical therapists for bed-ridden clients. Pilates stretches your body and practice stretching as you wake up the morning.

Call Connie for bay area caregivers at 408-854-1883 for 24-hr response for live in or 4-hr care. Holistic health coaching for PD is available with personalized diet plan. Email motherhealth@gmail.com

Monitor important health vitals using Worldgn Wearable at this site or ask Connie to join and refer others for 10-20% income globally:

https://my.worldgn.com/store/careme

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Exercises to improve mobility

Decreased flexibility decrease in the body axis of individuals with PD may interfere with their balance and impair performance of activities that require trunk mobility. A study by Vaugoyeau et al. demonstrated that an increased tonus of the body axis in individuals with PD results in “en bloc” axial movement, and also disturbs the execution of important activities such as movement in bed and turning while walking.

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Schenkman et al. developed a program which emphasized exercises for axial mobility associated with muscle relaxation and diaphragmatic breathing to increase range of motion of the neck and trunk. The results showed that 10 weeks of exercise improved in axial mobility and postural control of individuals with PD (Schenkman et al. 1998). Recently, Schenkman suggested that postural control and functional capacity specific training should incorporate axial mobility exercises to maximize gains in physical and functional performance as a whole (Schenkman 2010). (see Rodriguez JW et al., 2006).

Exercises to improve muscle strength

Recent studies have shown that muscular strength is reduced in Parkinson’s patients when compared to individuals without the disease (Inkster et al. 2003, Nallegowda et al. 2004, Allen et al. 2009). The cause of decreased muscular strength remains unclear. However, it is believed that central mechanisms may be responsible through the reduction of facilitative stimulus for motoneurons (Glendinning 1997). Despites the causes, individuals with PDoften complain of weakness in their lower limbs. Researchers have observed the presence of some selectivity in the distribution of muscle weakness (Corcos et al. 1996, Bridgewater & Sharpe 1998). Clinically, there is an inability of proximal and axial muscles to generate adequate power, especially the extensors of the trunk and hip. It is possible that the selective alteration in muscular strength contributes to a flexion posture, gradually observed in patients. The ability to perform various functional activities such as sitting to standing and walking can be compromised due to muscle weakness in the lower limbs of individuals with PD (Inkster et al. 2003, Nallegowda et al. 2004, Schilling et al. 2009).

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Strength training programs were effective in increasing muscular strength, and in some cases, the mobility of individuals with PD (Scandalis et al. 2003, Hass et al. 2007). These programs were implemented in a relatively short period of time with a training frequency of 2-3 times per week, one set of exercise per muscle group, and involved only concentric contraction. More recent studies suggested muscular strength and functional gains are greater when high-intensity protocols are used involving primarily eccentric contraction (Dibble et al. 2006, Dibble et al. 2009). The principle of this type of exercise is that high levels of force are generated during muscle stretching with minimal oxygen consumption in relation to the amount of work produced (Lastayo et al. 1999). Some studies have found that high intensity strength training was better for motor and functional performance in individuals with PD than training based on flexibility exercises, balance and concentric strength training of limbs (Dibble et al. 2006, Dibble et al. 2009). It is possible that these results are associated with a greater muscle hypertrophy observed in the high intensity protocol group. According to Dibble et al., the observed increase in muscle volume may be important for improving muscular strength and mobility of PD patients. Moreover, high-intensity training can minimize loss in bone integrity, preserve eccentric muscular strength and promote metabolic and structural plasticity in the musculoskeletal system (Pang & Mak 2009, Falvo et al. 2007).

Thus, it is possible that high-intensity exercises are most desirable to minimize the progressive dysfunction of PD. However, since individuals with PD have a lower physical fitness and are often unmotivated to practice physical activity, it is necessary to raise awareness about the use of high-intensity exercise in their treatment, since such exercise will require more physical effort which could lead to individuals’ fatigue.

Exercises to improve balance

Despite medical treatment, individuals with PD fall frequently with devastating consequences (Canning et al. 2009). Approximately 66% of individuals with PD will suffer falls and 46% will experience recurrent falls (Wood et al. 2002).

Factors such as gait freezing, muscular weakness and balance disorders were found as causes of falls in individuals with PD (Boonstra et al. 2008, Toole et al. 2000, Olanow & Koller 1998). Accordingly, different authors have used external cues for gait training, balance exercises, and strength training programs (Hirsch et al. 2003, Dibble et al. 2006, Nieuwboer et al. 2007) finding improvement in each of these factors.

Hirsch et al. showed greater gains in muscular strength and balance when individuals with PD underwent a combined protocol of strength and balance training compared to the balance exercises group. After the intervention, the combined group had an increase of 52% in muscular strength, better performance in balance and permanence of gains after four weeks. It is possible that the intensity of strengthening exercises with 80% of the maximum resistance elicited permanent non-hypertrophic muscle adaptations favoring maintenance of the effect after one month of intervention.

Recently, an exercise program was developed with the aim of delaying the progressive loss of mobility associated with balance and gait disorders in individuals with PD (King & Horak 2009). In this program, movements used in techniques such as “Tai Chi” and Pilates can be combined in order to facilitate sensory integration in postural control. Thus, somatosensory information can be encouraged by large and coordinated movements in order to move the center of mass with speed, safety and balance (King & Horak 2009). Some recent studies have investigated the effects of “Tai Chi” in motor and functional performance of individuals with PD (2008 Hackney & Earhart, MS et al. 2008). Hackney & Earhart showed that individuals with PD practicing “Tai Chi” for 13 weeks achieved gains in balance and functional performance when compared to the control group without intervention. The authors suggest that “Tai Chi” can be a safe and beneficial exercise in the treatment of moderately to severely affected PD patients (Hackney & Earhart 2008). Nevertheless, a recent literature review concluded that the evidence is not sufficient to support “Tai Chi” as an effective treatment for PD patients yet (MS et al. 2008). Therefore, further studies are needed to assess the possible effects of “Tai Chi” in improving balance and reducing the occurrence of falls in individuals with PD.

The physiological mechanisms involving gain of muscular strength and balance is not well known. The results of the studies mentioned strongly suggest that the postural control in PD must be worked through exercises that involve both somatosensory and musculoskeletal systems so individuals will be able to respond to sudden center of mass perturbations inherent in daily activities.

A recent study investigated the circumstances of the occurrence of falls in 124 patients with PD (Ashburn et al. 2008) and observed that most falls occurred at home. The main causes were tripping on obstacles and falling while standing, i.e., one in three falls occurred in the standing posture (Ashburn et al. 2008). Therefore, physiotherapists should address specific training in standing position, such as activities involving clothing and hygiene. Therapists should also carry out an environmental assessment in order to remove possible obstacles and suggest holders such as handrails and / or walking aids.

Importantly, the use of mechanical supports for walking should be investigated and its prescription should be made with caution. Based on the slowness in adapting to changes in support surfaces and difficulties in performing simultaneous activities (Morris 2000), such as walking and moving the stick at the same time, patients with PD may fall during walking using a mechanical support as it becomes a potential destabilizing agent.

Exercises to improve physical conditioning

Individuals with PD show loss in muscle and cardiorespiratory function. These individuals have similar levels of maximal aerobic capacity when compared to asymptomatic individuals, but the maximum peak occurs at lower intensities of exercise suggesting low metabolic efficiency (Protas et al. 1996). This result is consistent with recent studies that have shown a lower cardiovascular response in individuals with PD (Barbick et al. 2007, Oka et al. 2006). According to Protas et al., these individuals spend about 20% more energy than healthy individuals during exercise stress testing, which may indicate reduced movement efficiency due to the higher energy cost required for the test.

Aerobic exercise programs on a treadmill and walking training showed improvement in gait and quality of life of individuals with PD (Herman et al. 2007, Rodrigues-de-Paula et al.2006). The study by Rodrigues-de-Paula et al. demonstrated a significant improvement in quality of life after a strength training program and aerobic exercises using walking and stepping activities with heart rate monitor. The advantage of this training is that it can be applied clinically, since it does not require complex or expensive equipment.

Recently, Muhlack et al. suggested aerobic exercise can improve the effectiveness of levodopa, and therefore patients’ motor response. As suggested in some studies using animal models, it is also possible that regular and intense aerobic exercises produce a neuroprotective effect and contribute to the restoration of neuronal pathways impaired by the PD (Fisher et al. 2004, Pothakos et al. 2009).

Despite some promising results, few studies have investigated the effect of aerobic fitness in physical function of individuals with PD. Thus, this subject needs more through exploration.

Exercises to improve gait

Gait impairment is an important clinical manifestation of PD and is considered as one of the most disabling aspect of this disease (Herman et al. 2009). Gait related mobility problems have a negative impact on quality of life and well being of individuals with PD (de Boer et al. 1996, Martinez-Martin 1998). Despite advances in medical therapy and surgical techniques, gait dysfunctions are observed throughout the disease with limited improvement of symptoms (Bloem et al. 2004).

From a physical therapy standpoint, several studies have emphasized the contribution of specific exercises and intervention strategies to improve gait in individuals with PD. Treadmill training, use of external cues and specific task training have been investigated and different parameters of gait and quality of life of these individuals (Nieuwboer et al.2007, Miyai et al. 2000, Miyai et al. 2002).

According to Herman et al., treadmill training can promote a more stable and dynamic gait pattern in individuals with PD. Furthermore, some studies suggested that treadmill training is more effective in improving gait than other traditional approaches (Miyai et al. 2000, Miyai et al. 2002). It is possible that this intervention is beneficial because the subject is induced to maintain a steady rate with regular and uniform speed through the generation of rhythmic gait cycles due to periodic somatosensory and vestibular receptor stimulation (Frenkel-Toledo et al. 2005a, b, Toole et al. 2005). Thus, stimuli are transferred to neural circuits modulating gait in different central nervous system levels with rhythmic steps. Therefore, training on a treadmill can be seen as a kind of external cue to trigger the motor activity to be performed (Frenkel-Toledo et al. 2005 b). A recent review suggested that training on a treadmill can be performed in combination with physiotherapy at a frequency of three times per week, for about 20-30 minutes (Herman et al. 2009). For these authors, long-term treadmill training without weight-bearing is a safe and economical method to increase gait speed, restore gait rhythm and improve the quality of life of individuals with PD. Moreover, these effects may last for several weeks after the end of training (Miyai et al.2002, Herman et al. 2007).

External visual and auditory rhythmic cues are important features in the treatment of PD, although not widely used in clinical practice. Studies have shown improvement in electromyographic and spatio-temporal parameters of gait in Parkinson’s patients undergoing gait training with auditory, visual and tactile cues, (Thaut et al. 1996, Muller et al. 1997, Marchese et al. 2000, Lewis et al. 2000, Nieuwboer et al. 2001). Cues are defined as environmental stimuli or the one generated by the patient, consciously or not to facilitate automatic and repetitive movements (Kwakkel et al. 2007). Although the way which cues improve movement is not clear yet, recent neurophysiologic studies have suggested theoretical mechanisms for how external cues affect movement performance (Rowe et al.2002). Thus, it is believed that individuals with PD have a lower activity in certain brain areas which are responsible for the internal markup needed to implement automatic and sequential movements, common for most of our motor activities (Rowe et al. 2002). It is also possible that individuals with PD can use alternative circuits such as the pre-motor parietal-thalamic pathways, which are usually activated by external stimuli in individuals without neurological disorders (Kwakkel et al. 2007).

Recently, Nieuwboer et al. demonstrated that three weeks of external cue training at home improved walking speed, step length and freezing severity of individuals presenting these frequent and disabling symptoms. Each individual chose their preferable cue modality (auditory, visual or somatosensory) and was trained in a variety of situations and daily activities. The authors suggested that further studies should be performed to develop duration and intensity criteria as well as the most appropriate training period so the benefits obtained through the use of cues in individuals with PD would be extended for as long as possible.

Task specific training proved to be more effective than traditional exercises to improve functional performance in individuals with neurological disorders such as stroke survivors (Sullivan et al. 2007, Wolf et al. 2008). For example: Task –specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at six months than resisted leg cycling alone (Sullivan et al. 2007). This type of training has proven to be beneficial in gait and balance restoration in individuals with PD (Morris et al. 1996, Jobges et al. 2004, Lehman et al. 2005). Lehman et al. showed improvement in gait velocity and step length in individuals with PD after 10 days of walking and specific orientations for a longer step length. The literature indicates that learning is more effective when the task is carried out repetitively, and generalized to different contexts (Carr & Shepherd 1998). Even though, studies are needed to explain the mechanisms behind this type of motor training at improving different mobility aspects in individuals with neurological disorders such as Parkinson’s.

Exercises on brain’s health of individuals with PD

Recent studies in neuroscience have shown the effect of exercise on the brain’s function through animal models with neurological disorders (Petzinger et al. 2007, Pothakos et al.2009). These studies have emphasized the role of exercise on neuroplasticity (the brain’s ability to form new synaptic connections) and on brain self-repairing. These findings suggest that intensive exercise programs can improve brain performance in individuals with PD. Changes in brain function changes through physical activity can lead to behavioral alterations as a result of the plasticity mechanisms and protection of brain function (Tillerson et al. 2002, Fisher et al. 2004).

Some studies have shown that exercise can restore motor function through a variety of molecular repair mechanisms in the basal ganglia circuit affected by PD (Fisher et al. 2004, Petzinger et al. 2007). Fisher et al. initiated an intensive and progressive protocol of training on a treadmill in rats with PD for 30 days at a frequency of 2 times a day. The results showed significant improvement in motor performance of animals (running duration and speed). Moreover, changes were observed in neurotransmitter interaction (i.e.glutamate-dopamine) and were considered as a possible mechanism responsible for the neuroprotective effect of exercise. Petzinger et al. using the same protocol showed similar motor gains in treadmill performance and an increase in dopamine release within the motor basal ganglia area.

Tillerson et al. 2002 suggested that the molecular mechanism responsible for cerebral protection may require continued use of the exercise. In addition, the results of other studies highlighted the importance of exercise intensity and suggested that PD patients without specific contraindications should be encouraged to practice physical activities in a higher intensity than that self-selected by the patient (Hirsch & Farley 2009).

The emerging knowledge about the effects of physical exercise on brain function is accompanied by more information about the effects of physical inactivity in PD. Nowadays, it is possible to have a better understanding on the consequences of lack of exercise not only in the musculoskeletal system, but also in the brain’s ability to respond negatively to a lack of stimulus. Studies showed that periods of inactivity or stress in PD can revert protection and behavior benefits gained by doing regular physical activities leading to deterioration of brain’s function and disease progression (Tillerson et al. 2002, Howells et al. 2005).

The results highlighted above demonstrate the ability of the PD brain to restructure under some circumstances. However, it is important to take caution in generalizing these findings to the whole population of individuals with PD. The results should be the basis for further research conducted in humans allowing a better understanding of the effect of exercise on brain’s function in individuals with PD.

http://cirrie.buffalo.edu/encyclopedia/en/article/336/


Research has shown that regular exercise benefits people with Parkinson’s disease.

Exercise:

  • reduces stiffness
  • improves mobility, posture, balance and gait

Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based memory exercises can also help keep our memory sharp (PositscienceLumosity).

Click on question below to jump ahead to a particular answer or scroll down to read each in order.

  1. What types of exercise are best for people with Parkinson’s disease?
  2. Is there any value in strength training?
  3. What about swimming?
  4. Will exercise make my muscles less stiff?
  5. When should I exercise in relation to medication?
  6. How often should I exercise?
  7. Is there anything else I should know?
  8. When should I request a referral for Physical Therapy?
  9. Are there techniques to help me walk?
  10. Are there hints to help me get out of bed?
  11. What is ‘forced use’ exercise?     

What types of exercise are best for people with Parkinson’s disease?

There is increasing evidence that aerobic and learning-based exercises could be neuroprotective in aging individuals and those with neurodegenerative disease.  Facilitating exercise programs that challenge our heart and lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best.  Dancing to music may be particularly good for decreasing stiffness.

Although research on this subject is ongoing, it does appear that beyond aerobic activities performed with healthy movement patterns, exercises challenging the individual to change tempo, activity, or direction (what is referred to as “random practice” exercise) benefits people with Parkinson’s disease. It is also important to keep variety in exercise activities, because individuals with Parkinson’s disease often have difficulty in shifting from one activity to another or in performing two activities at the same time. Exercises that require balance and preparatory adjustment of the body are also important along with rhythmic activities such as dancing, skipping and cycling can maintain the ability to perform reciprocal movements.   Finally, exercises that promote attention and learning are beneficial.

Types of exercises that do this:

  • Walking outside or in a mall
  • Dancing
  • Yoga classes
  • Tai Chi classes
  • Stepping over obstacles
  • Marching to music with big arm swings
  • Sports (ping pong, golf, tennis, volleyball)
  • Aerobic/Jazzercise classes

Types of exercises that promote cardiopulmonary fitness:

  • Paced walking (treadmill walking at different speeds and different inclines)
  • Hiking using walking sticks
  • Swimming with different strokes with the eyes open and closed (+)not only challenge motor learning but also increase heart rate and provide good cardiopulmonary conditioning.
  • New bodyweight-supported treadmills can also be helpful to protect from falling, and to facilitate easier coordinated movements for fast walking with a long stride or jogging.

Types of exercise that do NOT challenge motor planning:

  • Riding a stationary bicycle without doing other activities
  • Weight lifting
  • Treadmill walking at a slow speed
  • Lap swimming can be very habitual and also automatic.

These exercises for cardiovascular, endurance and strengthening could be enriched by performing simultaneous activities such as reading, writing, problem solving, singing, watching the news or a movie or throwing and catching balls. Exercises that demand attention, repetition, progression of difficulty with spaced practice over time are the best exercise routines to promote learning.

You can purchase learning programs from Positscience and Lumosity. Currently, Dr. Dowling and Dr. Melnick in collaboration with Red Hills Studio are developing fun motor learning programs that can improve posture and balance. The Wii sports games and balance activities may be generally fun and helpful (Wii Study at UCSF).

Is there any value in strength training?

Weight lifting per se is NOT the best choice of an exercise program for the person with Parkinson’s disease, particularly if it is the only exercise activity.  Individuals need to be careful how they perform strengthening exercises to minimize increasing stiffness and rigidity. When performed properly, strengthening exercises do have some value.

As one ages, more exercise must be performed to maintain muscle mass.  Muscle mass and strength allow an individual to complete daily chores and to maintain balance.  Additionally, strengthening postural muscles may help to maintain a more upright posture. Integrative, functional exercises other than weight-training may strengthen muscles in ways that are more beneficial to individuals with Parkinson’s disease.

Examples of alternative exercises to weight lifting:

  • Activities in a standing position strengthen legs
  • Pushing up to rise on the toes
  • Modified squats
  • Repetitively rising and sitting from a chair
  • Wearing ankle and wrist weights around the house or out on a walk
  • Push-ups or wall push-ups for arms

Light weights are just as effective as heavy weights in maintaining muscle tone and do not increase stiffness as much.  Walking with ankle and wrist weights can help strengthen while encouraging increased awareness of arm swinging and high stepping. Moderation is the best word for strength training without other forms of exercise.  However, integrating strengthening and flexibility exercises into aerobic, rhythmic and learning-based exercise routines that are fun, engaging, progressing in difficulty and rewarding are the best.

What about swimming?

Swimming provides good cardiopulmonary training and maintains muscle strength.  However, lap swimming does not challenge balance or stimulate variety of movements.  Therefore, lap swimming is a second-choice activity. However, since the arms, legs and head may be doing different things, it may increase coordination.  The resistance of the water increases stiffness in some people and decreases it in others.

Activities to try:

  • Adding resistance with paddles and trunk support – provides more opportunity for reciprocal movements and circling movements of the arms and the legs
  • Rolling and somersaults – in the pool are good for those who are particularly comfortable in the water

Remember:

For individuals with Parkinson’s disease who have difficulty in breathing, swimming may not be a comfortable aerobic activity. Thus, swimming may be an appropriate choice of exercise for individuals who have enjoyed it in the past and are comfortable with the techniques and those with musculoskeletal conditions particularly of the knee and back. Swimming using certain strokes can also help increase shoulder range of motion.

Will exercise make my muscles less stiff?

Exercises that require large, rhythmical movements through a full range of motion have been shown to decrease rigidity.  For example, in a program of aerobic exercise using music, there was a reduction in rigidity in 9 out of 10 participants immediately after the exercise program.

Exercises to decrease stiffness:

  • Large, rhythmical movements
  • Rotating the trunk
  • Vibration, rocking and swinging

Other considerations to decrease stiffness:

  • Avoiding tremors (e.g. touching the limb that is shaking to quiet the movement) can also decrease tension
  • Decreasing stress in ones life – having fun, thinking positively about planning and carrying out challenging, socially engaging and learning-based activities
  • Cooling or warming the tense extremity can sometimes be helpful.

When should I exercise in relation to medication?

The best time to exercise is when mobility is best. For individuals who take medications for Parkinson’s disease, the best level of function often occurs about 1 hour after a dose of medications.  The answer to this question varies by individual. The individual reaction to the medication is also important.

How often should I exercise?

The guidelines for people with Parkinson’s disease are no different from those without the disease (i.e. 4-5 times a week for at least 30-40 minutes).  This assumes that your heart is beating at 70 to 80% of maximum (220 – your age times 70 or 80%).

Make the exercise time fun:

Engage in group exercise, movement or dancing classes.  For many, participating in activities with other people, can be more stimulating and increase compliance.

Stay active and integrate exercise into your usual day:

  • Walk whenever possible instead of driving
  • Climb the stairs instead of taking the elevator
  • Take regular 5 minute breaks every 30 minutes (lifting the arms up over your head, performing wall glides, breathing diaphragmatically, getting up to get a glass of water, or putting theraband on chairs to work on some strengthening)
  • Avoid long periods of time watching TV and or using a computer

 Is there anything else I should know?

A “cool-down period” is important.  After exercise, allow yourself a longer time for a cool-down than others would need (Individuals who exercised before developing Parkinson’s disease typically double their cool-down time).

A cool-down period accomplishes 2 goals:

1)      Promotes a slow decrease in heart rate

2)      Allows the muscles time to cool down gradually so they do not become stiff.

A cool-down period consists of the same exercise activity but at a progressively slower pace.  During the cool-down, all muscles need to go through a slow, full range of motion.  If you feel exhausted and want to fall asleep immediately after exercise, then you are not cooling down slowly enough.

Learn something new every day:

If you listen to the news, talk to someone about it.  Listen to educational programs and discuss what you learned.  Do crossword puzzles or participate in memory training programs on the web or from a CD.

Challenge yourself to go out each day:

If you are retired, consider volunteering your time to help others ( e.g. Red Cross, Meals on Wheels).  Move about in the community and learn the tricks of keeping your eyes on a target to improve stability. Carry a cane to let people know that it would be best not to bump you.

Practice writing:

Learn to hold your pen lightly and write with big cursive type movements. Consider making the surface of your pen rough or sticky. This will help decrease the force of your squeezing the pen. Write by moving the whole arm, not just the fingers.  Practice writing to music and even say the words out loud as you write. Circle making big movements. Get a drawing pad from a toy store where your can lift up the writing surface and erase your practice strokes.

Exercise your voice:

Talk slowly, clearly and loudly with a lot of expression of your eyes and your face. Have everyone speak loudly and slowly. If you find you continue to talk softly and quickly and people are having difficulty understanding you, then ask a friend to read and record some passages from a book. Then you put the head set on and hear your friends voice as you read the same passages.  This may strengthen the learning.

When should I request a referral for Physical Therapy?

When first diagnosed, all patients should have a consultation with a physical therapist to define the appropriate exercise program tailored to “you”.  This will also establish a baseline of your current physical status.

Ideally, all patients with PD should have a good fitness program as well as specific exercises to maintain good posture and balance as well as improve symmetry in flexibility and strength. Then, one may benefit from a consultation with a physical therapist when signs and symptoms increase the risk for falling or limit comfortable community mobility and confidence.  The therapist will also work on improving gait with practice using visual and auditory cues, as well as without those cues.

As the disease progresses, periodic re-evaluations are helpful to assure your exercise program is having the maximum benefit.  A program of individualized exercises addressing posture, balance and gait has been shown to be beneficial in decreasing the risk of falling.  In some cases, where balance or musculoskeletal problems develop, supervised outpatient treatments a few times per week may be helpful for a few weeks.

Safe mobility may be enhanced by using a bodyweight supported treadmill to minimize discomfort, assure stability, decrease the fear of falling and facilitate normal movement. (Available with Dr. Nancy Byl’s Neurofit program at UCSF Mission Bay)

In addition to physical exercise, it is important for everyone to maintain a high level of learning-based exercise activities to improve the ability to do multiple tasks simultaneously and safely without falling. The combination of learning-based memory training, aerobic exercise, over ground gait practice and integrative, engaging activities in the community are essential to positive health and well being despite aging or neurodegenerative disease.

Are there techniques to help me walk?

Often individuals with Parkinson’s disease have problems with abruptly halting or “freezing,” when walking.

To help decrease freezing, try:

  • Reciprocal arm swinging
  • High long steps
  • Scanning the environment and using visual fixation on an object in the distance or auditory cues (listening to music, singing to yourself, counting)
  • Thinking about making big steps to clear obstacles on the floor or marching (high steps)
  • Walking hand-in-hand, swinging the arms with a friend or family member
  • Having someone place their foot in front of you as a cue to step high and over
  • One person found that throwing pennies and stepping over them was helpful (“But,” he added, “don’t bend down to pick them up.”).
  • Loud rhythmical clapping
  • Paced walking with high stepping.
  • Using walking sticks (using them for sensory feedback and sense of stability may be more important than using a cane. Of course, using a cane or a walker can be helpful if there is a lot of weakness and stiffness.)

Pushing one’s self to stay active should be the goal.

Are there hints to help me get out of bed?

For some people with Parkinson’s disease, getting out of bed may become difficult. First, you might practice rolling on your bed. Roll back and forth and get a rhythm. Then with some momentum, roll to your side and come to sitting. You might have a dresser near the side of your bed so you could touch the dresser for stability if you need to.

When specifically trying to come to sitting from lying in bed, roll over on your side. Push on your elbow and let your feet come over the edge of the bed and then sit up at the edge.  Sit there for a minute to adjust and then rise to stand and then walk.  This technique is not only easier but better for your back.

Techniques to make it easier to move around in bed:

  • Wear satin pajamas or use satin sheets (but not both).
  • Practice standing up and sitting down quickly from a chair without using your handsto improve your transitional movement skills
  • Practice getting up quickly from a chair and taking a few big steps and then turn around and go sit back down.
  • Practice safe skills by climbing and descending stairs.

If you are seeing a physical therapist, the last three bullets are some of the activities that should be practiced.

What is ‘forced use’ exercise?  

 

Frequently patients with Parkinson’s disease have one limb or one side that is more involved.  It is easy to stop using the more involved side because it is too difficult.  This leads to overuse of the lesser affected side and neglect of the more affected side.  This disuse of the affected limb can lead to a worsening of the signs and symptoms. There is evidence that constraining the least affected side, and forcing the use of the more affected side can lead to improved function and increased “mindfulness” of the limb.

Forced use and constraining the least affected side has been effective in driving neural adaptation.  This has been demonstrated in animal studies with drug induced PD.  It has also been demonstrated in patients post-stroke.  This forced use can be enhanced not only by  physical practice, but mental practice as well. Each day, time should be spent on strengthening, range of motion, task performance and coordination exercises of the more involved limb.  Force yourself to do as many tasks as possible with the involved upper limb, using the other limb only to help stabilization.  In addition, do some drills like tap the fingers, tap the wrist and then tap the forearm moving from the elbow as fast as possible. You can also practice turning the palm up and down as fast as possible, throwing and catching balls, putting small objects in small containers, taking your index finger to quickly touch objects that are moving those that and still.  Do similar activities with the leg.

This principle of targeting specific task-oriented use of an extremity is similar to forcing yourself to exercise at an intense versus a low level. ‘Forced,’ in this context, means that you work harder than you would usually work.  In other words, in your general exercise routine, you want to work with a faster speed and potentially for a longer period to keep your nervous system and your cardiovascular system adaptable and responsive.  This will also allow your nervous system to respond more crisply when faced with unexpected and surprise events.  This will also facilitate better balance responses and improved postural alignment.

http://pdcenter.neurology.ucsf.edu/patients-guide/exercise-and-physical-therapy


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20 Minutes of Exercise May Suppress Inflammation

Summary: A new study reports 20 minutes of moderate exercise can act as an anti-inflammatory. The findings could be beneficial for those with inflammatory diseases such as fibromyalgia and arthritis.

Source: UCSD.

One moderate exercise session has a cellular response that may help suppress inflammation in the body.

It’s well known that regular physical activity has health benefits, including weight control, strengthening the heart, bones and muscles and reducing the risk of certain diseases. Recently, researchers at University of California San Diego School of Medicine found how just one session of moderate exercise can also act as an anti-inflammatory. The findings have encouraging implications for chronic diseases like arthritis, fibromyalgia and for more pervasive conditions, such as obesity.

The study, recently published online in Brain, Behavior and Immunity, found one 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response.

“Each time we exercise, we are truly doing something good for our body on many levels, including at the immune cell level,” said senior author Suzi Hong, PhD, in the Department of Psychiatry and the Department of Family Medicine and Public Health at UC San Diego School of Medicine. “The anti-inflammatory benefits of exercise have been known to researchers, but finding out how that process happens is the key to safely maximizing those benefits.”

The brain and sympathetic nervous system — a pathway that serves to accelerate heart rate and raise blood pressure, among other things — are activated during exercise to enable the body to carry out work. Hormones, such as epinephrine and norepinephrine, are released into the blood stream and trigger adrenergic receptors, which immune cells possess.

This activation process during exercise produces immunological responses, which include the production of many cytokines, or proteins, one of which is TNF — a key regulator of local and systemic inflammation that also helps boost immune responses.

“Our study found one session of about 20 minutes of moderate treadmill exercise resulted in a five percent decrease in the number of stimulated immune cells producing TNF,” said Hong. “Knowing what sets regulatory mechanisms of inflammatory proteins in motion may contribute to developing new therapies for the overwhelming number of individuals with chronic inflammatory conditions, including nearly 25 million Americans who suffer from autoimmune diseases.”

The 47 study participants walked on a treadmill at an intensity level that was adjusted based on their fitness level. Blood was collected before and immediately after the 20 minute exercise challenge.

“Our study shows a workout session doesn’t actually have to be intense to have anti-inflammatory effects. Twenty minutes to half-an-hour of moderate exercise, including fast walking, appears to be sufficient,” said Hong. “Feeling like a workout needs to be at a peak exertion level for a long duration can intimidate those who suffer from chronic inflammatory diseases and could greatly benefit from physical activity.”

Image shows a man running up steps.

Inflammation is a vital part of the body’s immune response. It is the body’s attempt to heal itself after an injury; defend itself against foreign invaders, such as viruses and bacteria; and repair damaged tissue. However, chronic inflammation can lead to serious health issues associated with diabetes, celiac disease, obesity and other conditions.

“Patients with chronic inflammatory diseases should always consult with their physician regarding the appropriate treatment plan, but knowing that exercise can act as an anti-inflammatory is an exciting step forward in possibilities,” said Hong.

ABOUT THIS NEUROLOGY RESEARCH ARTICLE

Study co-authors include Stoyan Dimitrov, and Elaine Hulteng, UC San Diego.

Funding: Funding from American Recovery and Reinvestment Act, National Institutes of Health.

Source: Michelle Brubaker – UCSD
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation” by Stoyan Dimitrov, Elaine Hulteng, and Suzi Hong in Brain, Behavior, and Immunity. Published online December 21 2016 doi:10.1016/j.bbi.2016.12.017

CITE THIS NEUROSCIENCENEWS.COM ARTICLE
UCSD “20 Minutes of Exercise May Suppress Inflammation.” NeuroscienceNews. NeuroscienceNews, 12 January 2017.
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Abstract

Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation

Regular exercise is shown to exert anti-inflammatory effects, yet the effects of acute exercise on cellular inflammatory responses and its mechanisms remain unclear. We tested the hypothesis that sympathoadrenergic activation during a single bout of exercise has a suppressive effect on monocytic cytokine production mediated by β2 adrenergic receptors (AR). We investigated the effects of 20-min moderate (65–70% VO2 peak) exercise-induced catecholamine production on LPS-stimulated TNF production by monocytes in 47 healthy volunteers and determined AR subtypes involved. We also examined the effects of β-agonist isoproterenol and endogenous β- and α-agonists epinephrine and norepinephrine, and receptor-subtype-specific β- and α-antagonists on TNF production in a series of in vitro investigations. LPS-stimulated TNF production by peripheral blood monocytes was determined intracellularly by flow cytometry, using an intracellular protein transport inhibitor. Percent TNF-producing monocytes and per-cell TNF production with and without LPS was suppressed by exercise with moderate to large effects, which was reversed by a β2-AR antagonist in spite that plasma TNF levels did not change. This inhibitory response in TNF production by exercise was mirrored by β-AR agonists in an agonist-specific and dose-dependent manner in vitro: similar isoproterenol (EC50 = 2.1–4.7 × 10−10 M) and epinephrine (EC50 = 4.4–10 × 10−10 M) potency and higher norepinephrine concentrations (EC50 = 2.6–4.3 × 10−8 M) needed for the effects. Importantly, epinephrine levels observed during acute exercise in vivo significantly inhibited TNF production in vitro. The inhibitory effect of the AR agonists was abolished by β2-, but not by β1- or α-AR blockers. We conclude that the downregulation of monocytic TNF production during acute exercise is mediated by elevated epinephrine levels through β2-ARs. Decreased inflammatory responses during acute exercise may protect against chronic conditions with low-grade inflammation.

“Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation” by Stoyan Dimitrov, Elaine Hulteng, and Suzi Hong in Brain, Behavior, and Immunity. Published online December 21 2016 doi:10.1016/j.bbi.2016.12.017

Effects of intense exercise on the female reproductive system

Women have become increasingly physically active in recent decades. While exercise provides substantial health benefits, intensive exercise is also associated with a unique set of risks for the female athlete. Hypothalamic dysfunction associated with strenuous exercise, and the resulting disturbance of GnRH pulsatility, can result in delayed menarche and disruption of menstrual cyclicity.

Specific mechanisms triggering reproductive dysfunction may vary across athletic disciplines. An energy drain incurred by women whose energy expenditure exceeds dietary energy intake appears to be the primary factor effecting GnRH suppression in athletes engaged in sports emphasizing leanness; nutritional restriction may be an important causal factor in the hypoestrogenism observed in these athletes. A distinct hormonal profile characterized by hyperandrogenism rather than hypoestrogenism is associated with athletes engaged in sports emphasizing strength over leanness.

Complications associated with suppression of GnRH include infertility and compromised bone density. Failure to attain peak bone mass and bone loss predispose hypoestrogenic athletes to osteopenia and osteoporosis. Metabolic aberrations associated with nutritional insult may be the primary factors effecting low bone density in hypoestrogenic athletes, thus diagnosis should include careful screening for abnormal eating behavior.

Increasing caloric intake to offset high energy demand may be sufficient to reverse menstrual dysfunction and stimulate bone accretion. Treatment with exogenous estrogen may help to curb further bone loss in the hypoestrogenic amenorrheic athlete, but may not be sufficient to stimulate bone growth. Treatment aimed at correcting metabolic abnormalities may in fact prove more effective than that aimed at correcting estrogen deficiencies.