An Australian treatment approach that uses intensive exercise to -retrain the brain' of people with Parkinson's disease may be able to modify progression of the debilitating disease in up to 80,000 Australian sufferers.
Described as a 'game changer" in how Parkinson's disease is treated, the combination of challenging physical exercise and mental activity has been shown to improve mobility and confidence levels in people with the degenerative movement disorder.
Known as PD Warrior, the Parkinson's disease clinic in Sydney's north is modelled on recent scientific evidence that supports the introduction of specialist rehabilitation exercises from the time of diagnosis.
'Exercise is front line defence for people with Parkinson's disease. The PD Warrior program aims to retrain the brain to allow everyday movements and activities to be performed with greater ease," said Melissa McConaghy, founder of PD Warrior and specialist neurological physiotherapist at Advance Rehab Centre.
'Purposeful movement can combat the loss of motor control seen in Parkinson's disease. Our program combines a high effort, intensive work-out with exaggerated movements and mental stimulation."
Commenting on the first four months of the PD Warrior program, Mrs McConaghy said, 'The initial results have been very impressive. We are now planning a study to assess the effectiveness of PD Warrior on the mobility and quality-of-life of people with Parkinson's disease. We also plan to launch a national training program for other physiotherapists in the New Year."
People outside of Sydney can look forward to the benefits of PD Warrior through accredited regional physiotherapists in the New Year.
'We know that periods of inactivity in people with Parkinson's disease can lead to further and faster deterioration of the brain's function. The right kind of exercise can improve the functioning of brain pathways not already destroyed by the disease," Mrs McConaghy said.
Until recently, management of Parkinson's disease primarily relied on the use of medication and the introduction of movement strategies and falls prevention techniques only in the later stages of the disease when balance and walking became problematic.
'Medication has an important role to play in reducing the symptoms. Specialised exercise techniques combining physical and mental activity can also deliver long-term benefits. I have seen this in many of the patients referred to this program," said Dr Stephen Tisch, neurologist at St Vincent's Hospital.
Parkinson's disease is a progressive neurodegenerative disease which affects the part of the brain responsible for initiating and coordinating movement. Over time symptoms worsen, leading to severe disability caused by tremor and muscle stiffness, slow movement and impaired balance. This can impact on everyday tasks such as walking, talking, swallowing and fine motor skills such as writing and doing up buttons.
Approximately 30 Australians are diagnosed with Parkinson's disease every day. 'For newly diagnosed Parkinson's disease patients, starting treatment early is important for maximum benefit and to maintain physical function. Patients with more advanced disease may also benefit significantly from specialised physical therapy programs." said Dr Tisch.
Cindy Summers, a regular PD Warrior participant, explained that the program can be confronting. 'It is often only when people start the classes that they realise what the disease has robbed them of," she said.
A growing number of people with Parkinson's disease travel across Sydney and as far as the Central Coast to benefit from the unique PD Warrior circuit classes.
'The people that attend the program have varying degrees of symptoms, but one thing they have in common is their determination to improve their quality-of-life," explained Lynn Tullock, co-founder of PD Warrior and neurological physiotherapist at Advance Rehab Centre.
About Parkinson's' Disease:
One in every 350 Australians lives with Parkinson's disease.
20 per cent of people affected by the disease are of working age (15-64 years).
It costs people with Parkinson's disease about $12,000 a year to manage their condition.
Based in St Leonards, Sydney, Advanced Rehab Centre is a specialist neurological rehabilitation service dedicated to improving the lives of people with neurological and complex care needs. The experienced team provides a comprehensive outpatient rehab service including physiotherapy, occupational therapy, hydrotherapy, clinical psychology and speech pathology.
No doctor referral is required for PD Warrior however everyone is required to have a full neurological assessment and program prescription prior to entering the circuit class.
For more information please see our interview with Cindy Summers: www.femail.com.au/cindy-summers-parkinsons-disease-interview
Question: What is PD Warrior?
Melissa McConaghy: PD Warrior is the first program in Australia designed as an exercise class which is an intense circuit class using physical and mental activity to drive the brains natural ability to protect itself and create more efficient pathways in the brain. The program contains highly advanced exercises for people with early diagnosed Parkinson's Disease.
Question: How do these exercise techniques help those with Parkinson's disease?
Melissa McConaghy: Typically people with Parkinson's disease, even with really early diagnoses, present with poverty of movement which basically means their movements have become really slow and very small, even in the very early stages. These exercises are designed to get the participants moving more freely with bigger movements in a more normal capacity.
Question: Why did you think it was important to introduce exercise techniques to those newly diagnosed with Parkinson's disease?
Melissa McConaghy: We started seeing a new population of newly diagnosed people and there wasn't anything out there in terms of assessment tools that were sensitive enough to pick up their impairment nor was there any exercise protocol that was really delivering any significant benefit to this population. We saw a real need to create something that would help this population because there wasn't anything out there. A colleague and I both travelled to the States to train in a program over there and that started us on our journey looking at what was possible for this population and it absolutely revolutionised the way that we thought about treatments for people with Parkinson's. The program turned the way we treat people with Parkinson's on its head and completely changed the way we work.
My colleague, Lynn Tullock and I have spent the last 18 months developing a model that we think suits the literature, the best available evidence at the moment, plus our own clinical experience to get the best for this population.
Question: Can you talk about how PD Warrior uses mental activity to -retrain the brain'?
Melissa McConaghy: We retrain or rewire the brain using mental activity such as 'Name all the suburbs, where you have lived" or 'Count backwards in threes from 81" and all type of dual tasking cognitive task that we add to a physical task which means they are doing two things at once which stretches the capacity of the brain and forces them to learn how to do more things at one time, which is very difficult in a population with Parkinson's disease with damage to the basal ganglia; typically they find it very difficult to have automatic movement, walking for instance is less automatic and they have to devote more attention to walking and you'll often find people with Parkinson's disease when walking and talking will either stop talking or walking as they can't do both due to the mental overload. In the class we train that dual tasking aspect to enhance their day-to-day capacity to do dual tasking activities.
Question: What type of exercises are we referring to?
Melissa McConaghy: We based our model on amplitude based training which is exaggerated movement training which teaches them how to big again and we do treadmill training which is very important for forcing you as people tend to work at a self-selected pace which is slow and small, this program forces them to get back into a normal movement pattern and normal movement output.
Question: What results have you seen from this treatment, so far?
Melissa McConaghy: We've had fantastic results! We have a really lovely example from a gentleman who emailed me last week, his a PD Warrior and his actually in France at the moment, he out-cycled six of his mates up arguably one of the hardest cycle routes in France which is phenomenal.
I also have a lady who came to me, three months ago, who said 'I'm really upset, I've been diagnosed with Parkinson's disease and I don't have the confidence to go to my daughter's wedding, in France". She's not only over in France now and been to her daughter's wedding she is holidaying over there – that is extraordinary and PD Warrior has given her the confidence to get back to living life.
Question: What other methods of treatment do those with Parkinson's disease use?
Melissa McConaghy: We do not recommend or prescribe medication but I do think personally that optimal medication is really important in this population. We do recommend that people see their neurologist and get put on the optimum dose of medication. What we're saying is that medication unfortunately is not disease modifying, it doesn't slow disease progression; exercise is the only thing that has shown any progress in this area. The style of exercise that we do, although we haven't tested it thoroughly enough to state that it will slow disease progression down, that is what our hope is and it also provides a really positive atmosphere for people that can otherwise become very depressed, isolated and debilitated.
Question: When can we see the program Australia wide?
Melissa McConaghy: Absolutely! We've been inundated with calls all over Queensland and Victoria and I had someone email me, this morning, from Batemans Bay wanting to begin a program. We've got Shoalhaven and Newcastle starting up shortly and I'd like to think Queensland and Victoria will be open in the New Year.
Interview by Brooke Hunter