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Tai Chi for Parkinson's Disease

Public Health Report by: Eric L. Zielinski


 

Introduction

A relatively recent disorder, Parkinson’s disease (PD) has become a common household name due its effect on famous celebrities like Michael J. Fox, Muhammad Ali, Janet Reno and Pope John Paul II. Primarily a motion-related disease, it is very encouraging to see researchers target Tai Chi and other movement-centered alternative therapies in an attempt to find natural treatments and preventative measures.

 

Parkinson’s Disease

 

Parkinson’s disease is a neurological condition resulting from the loss of dopamine-producing brain cells. The National Institute of Neurological Disorders and Stroke (a division of the NIH) states that the four primary symptoms of PD are, “Tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination.”

 

According to the Parkinson’s Disease Foundation (PDF):

 

  • As many as one million Americans live with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease.
  • Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year, and this number does not reflect the thousands of cases that go undetected.
  • An estimated seven to 10 million people worldwide are living with Parkinson’s disease.
  • Incidence of Parkinson’s increases with age, but an estimated four percent of people with PD are diagnosed before the age of 50.
  • Men are one and a half times more likely to have Parkinson’s than women.

 

It is shocking to learn that the medication costs for an individual with PD average $2,500 a year and therapeutic surgery can cost up to $100,000 dollars per patient. In total, the PDF states that the economic burden Parkinson’s has on the U.S. alone is nearly $25 billion per year; including treatment, social security payments and lost income from inability to work.

 

Sadly, the cause of Parkinson’s is still unknown, which makes it impossible for physicians to treat this disorder properly. At present, patients only receive symptom-based care, which ultimately masks the root cause.

 

Medical Research and Management

The National Institute of Neurological Disorders and Stroke states that at present there is no known cure for PD. However, they suggest a number of common medical treatment options to consider such as:

 

  • Levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain’s dwindling supply. It is believed that levodopa can help at least three-quarters of PD cases, but not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only slightly reduced. Moreover, problems with balance and other symptoms may not be alleviated at all.
  • Anticholinergics. A well-known antispasmodic, this drug may help control tremor and rigidity.
  • Bromocriptine, pramipexole, and ropinirole. These drugs mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.
  • Amantadine. This antiviral drug appears to reduce stiffness and shaking.
  • Rasagiline. In May 2006, the FDA approved this monoamine oxidase-B (MAO-B) inhibitor to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.
  • Surgery. The newest surgery for PD is called deep brain stimulation (DBS) and has now been approved by the U.S. Food and Drug Administration. In this procedure, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS requires careful programming of the stimulator device in order to work correctly. It is believed to reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesia that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. According to PDF, “[DBS] is most effective – sometimes, dramatically so – for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesia’s.”

 

In addition to the obvious risks to open brain surgery, the list of side effects for drugs used to treat PD is alarming. A sample list includes:

 

  • Dangerously high blood pressure, fast heart rate, chest pain, uneven heartbeats, shortness of breath
  • Severe headache, buzzing in the ears
  • Blurred vision, hallucinations
  • Anxiety, agitation, confusion
  • Sudden numbness or weakness (especially on one side of the body)
  • Tremor, muscle twitching or stiffness
  • Problems with speech or balance
  • Unusual thoughts or behavior
  • Nausea, vomiting, diarrhea, loss of coordination, fainting;
  • Fainting
  • Seizure
  • Skin cancer

 

Ironically, all of the symptoms that they are supposed to address, these drugs can cause.

 

Research showing Tai Chi’s ability to help improve Parkinson’s

Research findings suggest that mobility in people with PD is disrupted by poor coordination and insufficient postural adjustments. Ultimately, there is an inability to quickly switch motor programs in the brain and this causes motion disturbances like trembling and shaking that is so common see in Parkinson’s. Additionally, the difficulty with switching motor programs causes people with PD to experience difficulty maneuvering in new and challenging environments and a decreased ability to change postural transitions such as turning, standing from a sitting position, and rolling over. It has also been shown that people with PD have difficulties sequencing motor actions. Thus, they oftentimes experience a delay between their anticipated postural adjustments and voluntary movements, such as rising onto toes.

 

  • To address these constraints, Oregon Health and Sciences University researchers have developed a “constraint-focused agility exercise program, incorporating movement principles from Tai Chi, kayaking, boxing, lunges, agility training, and Pilates exercises.” The expertise that contributed to the program includes an internationally recognized neurologist specializing in movement disorders for more 35 years, five physical therapists experienced in treating people with PD, including three with PhDs with a focus on PD and six certified athletic trainers who regularly work with people with PD were recruited. Centered on fundamental Tai Chi principles, the researchers propose that the “agility exercise program is based on a strong scientific framework and includes progressive levels of sensorimotor, resistance, and coordination challenges that can be customized for each patient while maintaining fidelity. Principles for improving mobility presented here can be incorporated into an ongoing or long-term exercise program for people with [Parkinson’s disease.]” In addition, researchers have discovered that implementing Tai Chi exercises and principle with other exercises can actually help slow down the inevitable mobility problems people with mid-to-late-stage Parkinson’s experience.

 

  • In the world-renown New England of Medicine (NEMJ) a study was published in which 195 people were randomly assigned with stage one to four Parkinson’s disease to three experimental groups – Tai Chi, resistance training, and stretching. The patients participated in 60-minute sessions twice a week for 24 weeks. The researchers reported that “the Tai Chi group performed consistently better than the resistance-training and stretching groups in maximum excursion…The Tai Chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai Chi lowered the incidence of falls as compared with stretching but not as compared with resistance training.” Fascinatingly, the positive effects of Tai Chi training were “maintained at three months after the intervention” showing that its benefits were not short-lived. In addition to no serious adverse events being observed, the authors concluded, “Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson’s disease, with additional benefits of improved functional capacity and reduced falls.”

 

  • In 2013, a similar study was published in the Journal of Physiotherapy in which Tai Chi’s ability to increase postural control was tested for Parkinson’s patients between 40 – 85 years old. 195 participants were recruited and 65 were allocated to participate in a 24-week Tai Chi program, 60-minute sessions, twice a week. Similar findings with the NEMJ article above, the study reported that maximal excursion, directional control, stride length and functional reach, increased considerably for the Tai Chi in comparison to the other two groups in which 65 underwent leg muscles strengthening exercises and 65 upper and lower body stretching regimens. In addition, the Tai Chi group reported significantly less falls and was proven by the research team to “effective in reducing balance impairments in patients with mild to moderate Parkinson’s disease.”

 

  • To determine the effect on balance and strength, University of Connecticut School of Medicine recruited 110 participants to engage in 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains. Subjects were 110 healthy and were an average age of 80 years. They were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions. Short-term training (3 months) occurred 3 times/week (45 minutes Balance and Strength, 90 minutes Balance + Strength). Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback. Strengthening consisted of lower extremity weight lifting. All subjects than received long-term group Tai Chi instruction for 6 months; one hour per session, one time per week. Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger. Strengthening also increased isokinetic torque of eight lower extremity movements. Of particular interest is that “gains persisted after 6 months of Tai Chi” suggesting that Tai Chi contributes not only to improved balance, but also strength-building.

 

  • In 2006 the British Journal of Sports Medicine published a study in which researchers from Taiwan investigated the effects of a 12-week program of regular Tai Chi on functional mobility, beliefs about benefits of exercise on physical and psychological health, and immune regulation in middle aged volunteers. Recruiting 14 men and 23 women who were considered of normal health, it was shown that “regular [Tai Chi] exercise had a highly significant positive effect on functional mobility, and beliefs about the health benefits of exercise, in the 37 participants. Total white blood cell and red blood cell count did not change significantly, but a highly significant decrease in monocyte count occurred. A significant increase in the ratio of T helper to suppressor cells was found, along with a significant increase in CD4CD25 regulatory T cells. Production of the regulatory T cell mediators transforming growth factor ß and interleukin 10 under specific antigen stimulation (varicella zoster virus) was also significantly increased after this exercise program.” The researchers were thus able to confidently conclude that, “A 12 week program of regular TCC exercise enhances functional mobility, personal health expectations, and regulatory T cell function.”

 

  • Oregon Health and Sciences University researchers suggest that for PD patients, “An exercise program should include complex, multi-segmental, whole-body movements and should include tasks requiring quick selection and sequencing of motor programs such as practicing postural transitions (e.g., moving from stance to the floor, rolling, and arising from the floor to stance). One such exercise approach is Tai Chi, which helps patients to learn increasingly complex sequences of movement and to focus on smooth timing and synchronization of whole-body movements. It is further believed that rigorous exercise programs that focus on anticipated problems of mid-to-late-stage Parkinson’s may actually help patients who are asymptomatic are early on in the degenerative process.

 

Thus, by helping build strength, increase balance control, and even slow down mobility impairments research continues to validate Tai Chi as a cost-effective, safe treatment option for people with PD. Moreover, as the British Journal of Sports Medicine study referred to above indicates, the positive effects Tai Chi has on the immune system may give us a clue as to why many PD patients respond so favorably to Tai Chi. It is possible that – as we see when growth factor ß and interleukin 10 were significantly increased after the varicella zoster virus infection – people who practice Tai Chi may actually boost their natural antiviral immune function in a similar way the antiviral drug Amantadine does and, thus, reduces stiffness and shaking.

 

 

Conclusion

In summary, Tai Chi has a very provable and reliable ability to help prevent and manage a number of issues that Parkinson’s patients struggle with. Therefore, Parkinson’s patients who practice Tai Chi put themselves in the position in which they will have much greater control over their movements as the disease progresses. There is even good reason to suspect that by stimulating specific pathways Tai Chi can help improve movement brain patterns, however, further research is needed to show how and if Tai Chi can address the disease itself.

 

Medical Studies and Resources

Oregon Health and Sciences University

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664996/

 

British Journal of Sports Medicine

http://www.ncbi.nlm.nih.gov/pubmed/16505081

 

Journal of Physiotherapy

http://www.ncbi.nlm.nih.gov/pubmed/23419917

 

University of Connecticut School of Medicine

http://www.ncbi.nlm.nih.gov/pubmed/8617896

 

New England Journal of Medicine

http://www.nejm.org/doi/full/10.1056/NEJMoa1107911

 

 

 

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