Along with many others, I'm interested in the use of forced exercise for PD. In this context, the example that's normally given is cycling, so the part of the body that's mainly being exercised is the legs. To avoid covering the same ground, I've looked at forced exercise for the arms.

To force an arm to move I've used an upturned mixer drill, which is fixed to the floor. This type of drill was chosen because it is geared to rotate less quickly than a normal drill and to provide more torque. The rotational speed can be adjusted. A tube is fixed to the side of the mixer paddle. Over this is placed a handle which can rotate freely. To use, I stand next to the drill with one hand placed palm down on the top of the handle. The hand is free to let go at any time. The machine is switched on and off using a switch next to the free hand. Note: this set up is not entirely safe: the handle is moving quickly and would do damage if it hit you.

My test set up is as follows:

Measurement: immediately before the first forced exercise session of the day I do a tap test in which I move my most affected hand horizontally between two screws 13 cm apart for 1 minute, counting the number of taps as I go.

Number of forced exercise sessions per day: 2, one when I'm on, one when I'm off
Session length: 5 minutes
RPM: 100 -120
Diameter of rotation: 13 cm.
Hand tested: the most affected

I've followed this regime each day for a week. The number of taps in a minute varies from day to day (a typical score is 80, equivalent to an rpm of 40). I can't see a trend. I do notice that my tremor is worse than normal. I don't know if this is linked to the forced exercise.

I'd be interested in any advice on how to improve the effectiveness of the approach. I'd be particularly grateful to anyone who argued that the approach was unwise.

If I saw any improvement due to forced exercise, I would extend the set up to move a number of parts of the body independently and concurrently. Do you think this would increase neuroplasticity or burn up dopamine so quickly it actually did harm?

John

Hi John, You may be on the right track. I have jst ordered a book called Dumb Bells and Dopermine which should be here in a day or two. The author whom i can't recall off hand has reduced his medications drastically by a strict exercise regime. Search it in an online book site such as Booktopia, Amazon. It appealed to me ....will let you know!

Just noodling here, though I wonder if the level of exercise is depleting /stressing mitochondria, resulting in depressed ATP production. Forced exercise is disastrous for my husband; we attribute this effect to mitochondrial dysfunction due to stress from too much exercise. Though this may not be the explanation at all. Madelyn

I've not officially researched this topic of forced exercise, but I tend to agree with olsen. Not everyone gets this sort of feedback from their bodies,m but when I force exercise, my pain level jumps about two-fold. Then with the pain, I go into a horrible off time. However, I have found that when I get bad dskinesia ands dystonia, lying down and trying to be perfectly still, and "dream" that I am floating on clouds or something. I also breathe very slowly and deeply - inhalling to try to fill the lower lobes of my lungs, andf exhale really slowly. (It reminds me of meditation)

All of this crazy stuff I am doing helps me far more than forcing my arms to pull a PT band or to use a cycle wheel or weights.

I guess I am just a bit strange.
Peg

Peg, Madelyn,

Thanks for your replies. I value them especially because they are critical of the approach. It is good that a reader of the thread can see that not everyone is positive about FE.

I'd be grateful if you would describe what made Mr Olsen's experience of using FE "disastrous". What were the differences in his symptoms?

My experience over the last few days has been a bit better. I've increased the training to 30 minutes per day. I now use both arms, some of the time seperately and some of the time together. My tapping speed is about 10% faster than when I started. My arms feel looser. BUT my tremor is still worse than normal. Again, I don't know whether there is any causality.

John

Just to be sure I understand the mechanism of what you created here. The idea of the Cleveland Clinic Study with Dr Jay Albert for forced exercise is that you are forced to exert yourself at faster pace than you otherwise would set for yourself. Hence you work harder than you would choose to exert yourself. In this case on a tandem bike where a trainer sets the pace faster than the patient would set it. This was believed to release chemicals worked to reduce PD symptoms. Is the study to which you refer?

I'm wondering on your drill if you set a rotational speed or torque if you are actually exerting yourself faster or if you are moving your arm at a set speed driven by the rpm of the drill with or without exertion. In essence do you have the ability to measure torque or rpm then exceed continually that torque/rpm throughout your workout? If so then you would be duplicating the study. Is that your purpose or is it to test a different aspect of movement at a certain rate not necessarily exertion? In other words is this forced exercise or forced movement?

In the study it was the legs tested but hands (taps/twists/etc, gait, station, leg taps etc (standard neuro testing you do in the doc's office) that measurably scored better. The better neuro exams lasted 4-6 weeks after stopping the exercise. I didn't see any note of how long the CC patients participated before noting improvement (unless I missed it).

Forgive me if I misunderstand, I'm just trying to get your idea here. A drill has a set torque/rpm. Are you by some mechanism able to exceed its speed through gearing? If so you meet the criteria in the study if you could measure or exceed rpm for the whole of your workout. If the drill runs at speed and you go along with it then that would not meet the criteria of the CC study. Not to criticize though, this is a novel and interesting approach.

The enticing question is would you notice improvement if you followed through with more than two days? If you were able to do this for a few months and film standard neuro tests (like timing x number of finger taps or foot taps) which would be measurable hard data and show an improvement on time to complete x number of taps other than just rpm of your taps.

If so maybe Cleveland are on sort of right track with this test but not entirely. They are not testing most affected limbs but are going more for exertion of whole body (i.e. heart rate, respiratory) or cardio. If you notice help without the entire cardio or measure your pulse rate and are able to achieve a similar pulse or cardio benefit then that would be notable. It would be helpful for people who could not walk to use hand bikes or in your case affected limbs only. It would also be notable that not achieving a high pulse rate but exerting an affected limb at a given rate.

There is also a study at Wilfrid Laurier University in Canada, with Dr Quincy Almeda, where they are trying to understand what specific movements help activate the basal ganglia based on animal models to activate critical areas of the brain and crucial neurons to slow progress. The study is 6 months. The idea is to find out what type of movement activates things. These are not nec cardio or leg driven movements. Animals don't all show that cardio or leg driven movements nec activate the basal ganglia. The precise movement mechanism is not yet known. http://www.youtube.com/watch?v=H1Q7DZKVpHw

Since you noticed no real correlable results yet, and I wouldn't expect you could after 2 sessions maybe keep at it for several months and keep a log especially a video log would be helpful and provable. Noting when you are on or off and or do it at the same time each day for a while then change times. The keys you would be looking for to match the study would be improvement during and directly after the exercise, which lasts for hours. All of the patients interviewed but one had been OFF when they started but much better while exercising and after for many hours and weeks.

Since they don't know the mechanism if you had better statistical results then you might be able to throw a new variable into the mix. If over several weeks you could demonstrate through measured results improvements then you might be on to something. I wouldn't expect results given the study parameters after two times so I wouldn't nec be discouraged. You might Google the Cleveland Clinic and see if you can find out more about how they measure or record

See interviews for Cleveland Clinic with Dr Jay Albert
http://www.youtube.com/watch?v=dJoTYLrm1Ak
http://www.youtube.com/watch?v=LRGCW...4ACB52FC8DB30E

Similar study done by layperson like us starting with standard neuro tests and timing, then work out, then you have some results to be noted. This guy shows a clear improvement after one vigorous workout to his neuro testing times.
http://www.youtube.com/watch?v=R_-nRQmO8ko

This is how problems get solved. Novel approaches.

I recently hurt my hip trying to get off sinemet and went thru PT to help strengthen things and noticed a large improvement in gait and station by making myself stronger. This is a use it or lose it process. But tinkering with the fine adjustments might make it possible as you suggest to allow lesser able people to make things better for themselves.

Be careful! I'll be interested to hear how you fare. BTW I recently was diagnosed after 10 years as NOT having PD but perhaps sinemet induced PD or a mimic of PD. Might this be a means by which to separate those misdiagnosed? It's very interesting to hear that some people are very negatively impacted. I think it also goes to show that there are probably more than one type of PD and hence should be many types of treatments not just a standard l-dopa & agonist treatment. I still think there are many misdiagnosed that could be living normal lives. It doesn't take a doctor to come up with the solution. I asked many years ago about several things that were coincidental about my diagnosis and was dismissed out of hand. Now I find many of my questions are now proving to have been spot on. The docs need to be looking more to the patients not the other way around.

This goes with Paula_w's post of a Ted Talk http://www.ted.com/talks/dave_debron...ient_dave.html of patient based treatment. This always made more sense to me.

the albert's paper indicates there was improvement in upper body movement, i quote it: (he sent me a copy, can't link to it).

"From a clinical perspective, our results suggest that exercise
intervention programs for PD patients can be relatively
intensive from an aerobic perspective and that patients may
need to be pushed beyond their voluntary limits to exercise at
rates sufficient to induce global improvements in motor function.
The enhanced control and coordination of upper extremity
motor activities, following a lower extremity FE intervention,
provides preliminary evidence that FE does alter central motor
control processes. One implication of improved central motor
processing is that FE is enhancing neuroplasticity or altering
brain biochemistry, both of which could alter the course
of PD.
We acknowledge that the use of an actual tandem cycle is
not feasible from a clinical perspective for a number of reasons
(eg, accessibility, requirement to have a relatively fit exercise
partner, practicality). Therefore, the next step in this line of
investigation is to determine the clinical efficacy of FE in a
larger group of PD patients using a paradigm readily and rapidly
adapted to clinical and home use. A follow-up study in
which a motor-driven stationary cycle is used for VE and FE
is currently underway. Future studies will also be directed at
identifying the duration of the motor benefits, the effects of FE
on biomechanical measures of lower extremity function and
postural stability, the optimal rate and dose of FE, and
mechanism(s) underlying the benefits of FE compared to VE.
-----------------------

so it seems that the whole body benefits by aerobic exercise and the biggest bang for the buck would be using the legs.

i use a stationary bicycle and a portable stair stepper and take more sinemet as needed so i can maintain a decent aerobic rate.

I use an elliptical and keep the rpms 10-30%+ over what I would choose at the gym. It was helping tremor until unrelated hip injury temp has me on hiatus. Agree tandem bike & trainer not always feasible. Thanks for addtn info.

In answer to a few of the questions raised:

What is forced?
I am forcing the cadence, not the work done. It's not clear to me from the tandem studies what is forced: using the gears, a strong cyclist at the front can increase the cadence, but can't force the person at the back to do any more useful work.

Forced exercise or forced movement
It's unclear to me the extent to which the arm is passive in my set-up. It seems to me that it soon keeps pace with the movement. Some work is done, but at a much lower rate than appears to be the case in the tandem tests.

Forced movement would be a reasonable description but for the fact that some people may take that to mean things like stretching. I've not looked at that, not least because it is potentially dangerous.

I've now got 4 weeks of data. The measure of performance is the number of taps in a minute. (Remember making a tap to the left and then to the right counts as 2. So to get an equivalent cadence or rpm figure you need to divide by 2.) The protocol described above was followed (except for changes already described, and in the last two weeks the drill's rpm was set to approximately 90). The daily sequence of results were:

88 74 81 88 88 79 87 87 90 108 99 101 101 99 112 106 115 111 104 110 109 106 114 103 115 114 100 115

The weekly averages are 84, 99, 110 and 110.

Subjective assessment: right (worst affected arm) less stiff, left arm more tremor; overall up and down as usual, on average about the same.

It is too early to say whether there is any causality.

The usefulness of the results is affected by:
- the placebo effect;
- the extent to which the increase in the performance metric is due to learning to pass the test itself, rather than underlying ability. I should have allowed at least a week doing the test without FE to get a better baseline.

John

[QUOTE=pegleg;... Then with the pain, I go into a horrible off time. However, I have found that when I get bad dskinesia ands dystonia, lying down and trying to be perfectly still, and "dream" that I am floating on clouds or something. I also breathe very slowly and deeply - inhailing to try to fill the lower lobes of my lungs, andfexhale really slowly. (It reminds me of meditation)....
I guess I am just a bit strange.
Peg[/QUOTE]

Well, I will avoid joining the debate about Peg being 'just a bit" strange.

\But what you are doing is in line with part of the Continuum method that I use several times a day - not the only weapon I use, but it is the only weapon I use every time I have what I call a "spastic attack" - in pain, sometimes writhing on floor, contorted, muscles pulling to crush me, almost completely unable to walk, speech slurred; sometimes near panic:

Lie down, let the pain rage for 10 minutes but I listen to it, I listen to what my body is doing, the muscles that are grabbing, the legs and hands shaking, and I sort of remain silent, non-judgmental, and just say "Well here you are again."

Then, for 20 minutes or however long it takes, I breathe deeply in, pausing just slightly at the top and bottom of each breath, and I place both hands on my head, (and after 3 or 4 breaths, move my hands over my eyes, then onto my chest, and often the abdomen, where there is often pain) AND when I exhale I make a sound all the time I exhale, such as eeeeee or ooooooooooo, or like a snake: ttthhhhhhhhhhh and so I breathe deeply and slowly 10 or 20 or 30 times AND THEN i relax with my eyes closed and i think of nothing - they call it Open Attention - i listen to my body and to myself and to the planet turning - listening, feeling and paying non-judgmental, non-critical attention - and over the months i start to become much more aware of just exactly my muscles are doing, for example, and I do that again and again until I feel really better OR the store whose floor i am lying on call 911 - better done at someone's home; but not always have that choice. Park benches are good because no one will look at you if they think you are just homeless. There is more to this method than breathing and sounding, of course, but I use the very basics of it in battle to fight the pain, the incapacitation, the Beast, to REGAIN CONTROL of my body and myself. This method has been used by dancers - Linda Rabin is a dancer and has trained dancers for 40 year and she trained me for an hour and a half a week for a year; note that she has nothing to do with Parkinson's; she is in the dance world; what she teaches me was never designed to deal with Parkinson's which to me is a good sign.

Dancers know about body movement, and how it is hot-wired to your psyche and you cannot fake it, and a dancer cannot go out on stage and have a movement disorder; their artform is perfection of movement control, the mind and the soul and the persona giving instructions to the body.

I am not using it to dance, i am using it to take action, to get in close with my physical self, below words, below intellect, below concept - and yes, also below emotion - right down to the wordless, primitive, sensations of the body.

And i also do exercise that resembles a bit what this thread is about:
When I am not in pain, when I can move freely, I exercise beyond my limits so that I have to sit down and puff and pant to recover. I have to do this almost every day for 2 or 3 months until i really notice as big difference. '

Now don't tell my neuro about this because he worries enough already: what works best for me is cutting down trees, chopping the wood, and stacking it. The chopping especially is very powerful. And I have FOUR chain saws.
But I must push myself to where I am puffing and panting. Less does not work. it is not so much the work, it is the panting and puffing.

None of the above gives me a longer life. But the difference in life quality is excellent. I suffer every day, and it gets really bad. But then it is not unusual that i have hours where i feel better about myself and about the universe than i ever did before i got PD.

AND I also use music, dance, acting (street theatre where no one knows they are now in the play I am making up as I speak to them); and whatever else i can grab hold of to fight the sabre-tooth tiger who sees me as cat food.

AND here's the kicker - everybody figures, hey, an hour every Thursday night in the church basement making movements to music with 40 other people - YES that is a good start. But I heard of Alex Kerten saying: You are training for the fight of your life, you are going to be in the Olympics and you are going to play solo piano at Carnegie Hall.
An hour a week to get ready? Hahahaha! You are not serious. FOUR HOURS A DAY
Alex was as combat engineer, doing things like building bridges while under enemy fire. Same thing as PD - building bridges under fire.
As you were, soldiers.