“How can I slow disease progression?” That’s a question that Laurie Mischley, ND, PhD, MPH and her team at Bastyr University Research Institute are working to answer. By following people with Parkinson’s over many years and examining their lifestyles, Dr. Mischley’s research aims to give people with Parkinson’s practical advice on how to improve their health outcomes. We sat down with her to get the latest scoop on her work.
1. Tell us a little about your longitudinal study of people with Parkinson’s.
We are currently following over 1000 individuals with PD from around the world, looking for modifiable lifestyle variables associated with different rates of disease progression. We recently presented a poster at the World Parkinson Congress (WPC) demonstrating the Mediterranean diet, exercise, rasagiline (Azilect), oral glutathione and coenzyme Q10 were associated with improved outcomes in PD. We’re writing up the manuscript now for publication, and hope to have the manuscript available to the public in a few months.
We’re still recruiting and invite anyone with a diagnosed or suspected form of Parkinsonism to join the study: www.CAMCarePD.bastyr.edu.
The more people who participate, the more we learn about lifestyle factors that may affect disease progression. For example, we can see already that wine is associated with improved PD outcomes. Now we need more participants to discriminate between red and white.
2. What do you hope to learn from this study?
For the past 199 years since Parkinson’s was first described, people have been asking their doctors, “Is there anything I can do to slow disease progression?” The goal of this study is to answer this question, in a completely pragmatic and patient-centered way. What do those doing unusually well have in common? What about the people doing unusually poorly – what do they have in common? The next steps will be to analyze these data over time and find out whether changing diet and exercise improves health outcomes.
For instance, Indu Subramanian, MD presented data at WPC showing individuals who do yoga are more than twice as likely as sedentary individuals to say their overall disease had improved over the six months prior. It may be that the feel-good chemicals released in the brain during a yoga practice make them think they’re doing better, or maybe yoga results in clinical improvements.
3. What are a few of your key findings so far?
I’m especially interested in what we’re seeing with the medications and supplements. Both coenzyme Q10 and rasagiline (Azilect) had a series of studies suggesting they may slow PD progression, but both failed to demonstrate this effect in Phase 3 clinical trials. Our data show that in a real-life setting, individuals who take coenzyme Q10 and rasagiline do seem to have a slower progressing disease.
There are a lot of reasons why a therapy may not perform well in a randomized clinical trial, but may work outside of a clinical trial. For instance, in both these clinical trials, individuals did not use dopamine replacement therapies, whereas most patients are on dopaminergic therapies in a real world setting. One hypothesis is that a person must be on dopamine replacement in order to get the benefits from coenzyme Q10 or rasagiline.
4. Can people still participate in the study? If so, how do they get involved?
Yes! The more people who participate, the more we learn. You can get involved by visiting www.CAMCarePD.bastyr.edu.
5. What one piece of lifestyle advice would you give to someone with Parkinson’s?
Social health is as important as exercise and nutritious food!
Laurie Mischley, ND, PhD, MPH is an associate clinical investigator at Bastyr University Research Institute in Seattle, Washington and a medical advisory board member at BGF. Her clinical specialties include Neurology, Nutritional Medicine and Prevention. To learn more about Dr. Mischley’s work, visit www.CAMCarePD.bastyr.edu.
Meditation helps to reduce stress and improve immune system function. For people with Parkinson’s, meditation can also help with symptoms such as anxiety and depression. Ready to give it a try? Find a quiet place to relax to try this mindful meditation exercise:
1. Find a quiet and comfortable place. Sit in a chair with your feet on the floor, hands in your lap. Close your eye.
2. Focus on your breathing. Take nice full breaths in and out. Imagine filling a balloon as you inhale, and letting the air out of the balloon as you exhale.
3. Continue to focus on your breathing.
4. Your mind will wander. When it does, bring it back to your breath.
5. If you find yourself getting carried away in your thoughts, observe where your mind is wandering to, without judging. Remember not to be hard on yourself if this happens.Return to focusing on your breathing.
6. When you are ready to come out of the meditation, remind yourself where you are and feel where you are sitting. Slowly bring yourself back to the room.
Record temperatures mean extra precautions when it comes to your skin! Everyone should be careful when they’re out in the sun – and people with Parkinson’s have an increased risk of skin cancer, which makes sun safety especially important. Here are a few tips to remember:
1. Wear a “broad spectrum” sunscreen to protect against UVA and UVB rays. Wear it everyday.
2. Wear sunscreen in all weather and in every season. (See tip #1.)
3. Apply sunscreen at least 30 minutes before going outdoors. Reapply every two hours, or more frequently if you’re swimming or sweating.
4. Stay out of the sun during peak periods. This is typically between 10am-2pm.
5. Wear wide-brimmed hats, long shirts and pants, and sunglasses with total UV protection.
6. Avoid tanning beds.
The next time you’re at the doctor, talk to them about getting a skin check. And remember to use your sunscreen!
For many years, we all have known that exercise is an important part of living a healthy, balanced life. Exercise has proven to keep people well from a cardiac, pulmonary, mental and physical standpoint. Over time, the benefit of exercise for people with Parkinson’s disease (PD) has grown with researchers closely studying exactly what exercise does for those with PD. Regardless of the condition of the person with Parkinson’s, as they start exercising, they are likely to experience benefit.
How does exercise benefit a person with PD?
1. Management of Symptoms: Studies have shown that exercising through walking (treadmill or over ground), physical therapy (balance, weights, gait training, cognitive challenge), Tai Chi and dancing have a positive effect on walking speed and quality, balance, posture, tremor, quality of life and coordination. Most importantly, those who exercise regularly tend to have a decreased chance of experiencing a fall.
2. Changes in the brain: Researchers have been successful in showing, in animal models, how the brain uses dopamine more efficiently when having exercised. Many people with PD will echo this and report how they move better and feel better after exercising.
When should I start exercising?
1. The earlier the better. Research has indicated that starting an exercise routine early in the disease process can slow or limit disease progression.
2. Anyone can benefit, not matter how long ago diagnosis occurred. Although the preference would be starting exercising early in the disease process, many may not have this opportunity for a variety of reasons. We have seen benefit in mobility, walking, strength and quality of life in those that start exercising, even in the mid to latter stages of Parkinson’s disease.
How can I start exercising?
1. Although research has shown benefit from particular types of exercise, most neurologists and physical therapists will encourage ANY type of exercise. Particularly, we find it important to identify an exercise or drug comparison benicar vs lisinopril. If you are unsure about starting or want to be sure you can handle exercise, consult with your physician or a physical therapist.
2. Find a group or exercise partner to help you stay motivated and engaged. Many community programs now offer classes specifically for people with Parkinson’s disease. At several of our outpatient medical offices we offer Parkinson’s exercise classes, you should speak with your neurologist or physical therapist to pursue if you are interested.
If you would like more information on starting an exercise routine or learning about exercise groups in your area, contact your neurologist or physical therapist for assistance.
Our cause is health.
Our passion is service.
We’re here to make lives better.
Erin Vestal, PT, DPT, NCS is a neurological clinical specialist
