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Improving Brain Function with Exercise, Connectedness and Creativity
By Julie H. Carter, R.N., M.S., A.N.P.
Over the past 30 years, we have come to better understand the role that people with Parkinson’s disease (PD) may play in altering the progression of their disease. When I began working in the field, we used to tell people who were newly diagnosed — who understandably wanted to know what to expect from the disease — “Parkinson’s is a highly variable disease. We wish we could be more definitive, but some people progress slowly and others progress more rapidly.” Today, I am glad to report that we can give a different answer: you actually can have some control over the symptoms of this disease.
Parkinson’s disease varies from person to person, as do the rates at which it progresses. But we now know that in addition to your medications, there are some activities that may ease your motor symptoms, improve your quality of life…and perhaps even change your brain.
Changing Your Brain: A Three-Part Plan
What has changed in the last three decades is that we now know that the brain can change and adapt to new circumstances, an ability we call neuroplasticity. Until recently, the scientific community believed that brain development stopped at adulthood. Research has shown otherwise, demonstrating three key findings: areas of the brain that are used intensely can increase slightly in size; new pathways of communication among brain cells can form; and the brain has the ability to make new cells.
Because of the nature of Parkinson’s, in which dopamine neurons in the brain are lost and damaged, these findings are incredibly pertinent. In addition, there is now scientific evidence to suggest that certain activities — exercise, social connectedness and creativity — may not only be therapeutic for Parkinson’s symptoms, but may actually change the brain.
One real life demonstration of this theory in practice is my patient, John, who has had PD for 20 years. John remains very active by walking and hiking, maintains flexibility through Pilates, plays golf to practice hand-eye coordination and agility, memorizes and writes poetry, finds a creative outlet in his garden and helps other people with PD to develop individualized exercise routines. His physical abilities have certainly changed over time because of Parkinson’s disease, but his habits of keeping physically active, remaining involved in his community and staying intellectually challenged have helped him to maintain a high quality of life and have potentially changed the way in which his brain works.
How can others follow John’s example? It is important to remember that not everyone’s reaction will be the same as John’s. With that said, let’s walk through a three-part plan for taking charge of Parkinson’s and discuss the research that is helping us to better understand its impact on the brain.
First, there is compelling scientific evidence demonstrating that exercise improves both the symptoms of PD and quality of life and suggesting that it may help the brain. Given the wide range of motor symptoms that can occur with Parkinson’s — slowness, rigidity, having a narrow base of body support, freezing, sequencing movement, trouble turning, instability and difficulty doing two things at once — we are still learning what particular types of exercise are most helpful for which symptoms and why.
Already, we have learned that exercise is important for people with PD in maintaining and improving mobility. In one study, people with PD who did high-intensity training on a treadmill — 30 minutes a day, four days a week — could walk more quickly and with improved stability after six weeks than they could before starting the regimen. They also improved their scores both on a standard motor exam for PD (the Unified Parkinson’s Disease Rating Scale, or UPDRS) and another scale that measures quality of life.
Is this type of repetitive aerobic exercise sufficient to address the complex issues that occur in PD? In another ongoing study, people with PD are participating in a program that includes a variety of exercises: Tai Chi to increase limits of stability; kayaking to improve trunk rotation; an agility course, to help anticipate and prevent freezing; lunging, to practice taking bigger steps; and simple Pilates exercises. The difficulty of each routine is increased over time. A recent report on this program suggests that not only does it improve motor problems; it may even prevent them.
In addition to improving strength and agility, exercise — especially when it involves learning new motor skills — may increase the connections between neurons and improve blood flow in the brain. Experiments about these connections with people have been inspired by animal studies, where research has shown that in mice with Parkinsonian symptoms, exercise helps retain dopamine neurons and may allow neurons to use dopamine more efficiently.
Another study looked at Parkinsonian mice who exercised in an “enriched environment” – one that is stimulating both cognitively and to the senses. For the mice, this meant new toys and exercising with other mice. This group had better motor function after three weeks and more dopamine neurons in their brains than the mice that exercised in a nonstimulating environment.
The results are preliminary, but the bottom line for people with Parkinson’s disease who want to stimulate their brains may be this: do your exercise in an enriched environment and try to exercise with others!
If you do begin to exercise, consult with your doctor first…and remember that exercise does not have to be strenuous. Activities such as walking and stretching can be quite beneficial.
It is not a new idea that social connectedness — knowing that one is loved, esteemed and belongs to a network of mutual obligation — may affect the brain and our health. For years, scientific evidence has pointed to the health benefits of social networks, such as the capacity to improve the immune system and to decrease stress. By contrast, people with few social ties seem to have higher mortality rates.
We don’t yet have much evidence to show how connectedness changes the brain, but we do know that the mind-body connection may affect neuroplasticity. Researchers studied the brain activity of Buddhist monks with electroencephalogram tests (EEGs) and found that those who meditated had more “gamma-wave synchrony” — an indication of neurons communicating across different areas of the brain — than people who were not trained in advanced meditation. The monks had, in effect, changed their brains. If changing the way we feel affects our brains, then increasing social connectedness could do the same. Yet many people have barriers that limit social interaction and, as we age, we are all at increased risk for becoming isolated.
The first steps in expanding and maintaining social ties are to identify what keeps you from feeling comfortable in social interactions and then to figure out what type of connectedness might work for you. Some people with PD have found that a support group provides a sense of community. Others prefer meeting peers who share their interests, such as art, community service or music. Perhaps you feel that a support group isn’t right for you, or you find it difficult to get out of the house. In these cases, an online community may provide a good alternative.
To sum up social connectedness, I remember the words a patient once shared with me: find somebody to love, find something to do, and have something to look forward to. Connections to social support can change the way we feel and perhaps in doing so, can help change our brains for the better.
7 Tips for Staying Socially Connected
1. Identify what is stopping you from interacting with others
2. Commit to something
3. Join a support group
4. Explore a new activity
5. Find people who inspire you
6. Be a support to someone else
7. Express yourself artistically
One other way that you may be able to change your brain is through creativity, an area of study which is now gaining interest among neuroscientists. Contrary to what many think, creativity is neither restricted to artistic genius nor to extraordinary talent. It is within reach for all of us.
Creativity involves a cognitive brain process in which ideas first diverge and then come back together in a new way — also known as “thinking outside the box.” It is not limited to the arts — there can be creativity in science, for example, or in any kind of problem solving. For an activity to be creative, there needs to be an end product — a musical score, a painting or a solution to a problem — that displays the process to others.
Creative problem solving uses the frontal and parietal parts of the brain. The frontal lobe is an area that is also affected by Parkinson’s, often causing issues with problem solving, multi-tasking and divergent thinking. In a recent preliminary study, however, scientists showed that despite the association between PD and this portion of the brain, the disease does not hinder a person’s creative abilities. Actually, exercising them may improve the experience of living with it.
In one report, researchers found that musicians who performed with symphony orchestras experienced increased communication between the right and left sides of the brain and increased visual spatial function. It needs to be replicated, but along with other studies, it suggests that we may be able to change cognitive function through our creative activities.
Perhaps if we engaged each day in a brain fitness program in the same way we do our bodies (as my patient John does by reading and writing poetry), we could help strengthen the connections in our brain and delay some of the cognitive changes that occur in Parkinson’s.
Exercising, staying socially connected and being creative require a lot of motivation. To become and remain motivated, you have to have self-confidence, to feel like you have some control over your life and have connections to other people. When you are living with Parkinson’s, all of these areas can take a hit. What we know now is that empowering yourself in these areas can enable you to live a fuller and richer life. This three-part plan we have reviewed here isn’t a cure for Parkinson’s. But it gives you a chance to be in charge. You can make a difference.
Julie H. Carter, R.N., M.S., A.N.P., is a Professor of Neurology at Oregon Health & Science University, and Associate Director at the OHSU Parkinson Center of Oregon. For a full list of the research studies referenced in this article, visit www.pdf.org or contact PDF at (800) 457-6676 or firstname.lastname@example.org to request a copy.
This article was adapted from Dr. Carter’s presentation at a recent PDF symposium, now available at www.pdf.org/en/edu_events_texas.