Exercising to Better Health With Parkinson's: Israeli Hospital Opens Cutting-edge Rehab Unit

The disease still has no cure, but as part of an interdisciplinary approach, guided therapy and vigorous exercise can help restore the quality of life to those afflicted with it.

A file photo showing a man exercising against the backdrop of Jerusalem's Old City.
Olivier Fitoussi

Parkinson’s disease remains incurable but its causes and effects are becoming clearer, as are ways to live reasonably with the condition.

Sheba Medical Center in Israel has opened a unit equipped with cutting-edge technologies to rehabilitate Parkinson’s patients, which already has a long waiting list, and now a new book also offers guidance on home-based exercise regimens that sufferers can follow to help regain control of their balky limbs.

Parkinson’s is one of several degenerative conditions caused when genetic mutations cause naturally occurring proteins in the brain to be produced with malformations. These mutated proteins form gummy, cumulative deposits in the brain that are, in autopsy, the hallmark of Parkinson’s.

“People diagnosed with Parkinson’s typically seek medical help when they sense slowness in their movement, usually starting on one side of the body. They experience problems in walking and tremors,” says Dr. Gabi Zeilig, head of the Neurological Rehabilitation Department at Sheba Medical Center, Tel Hashomer, located in Ramat Gan, outside Tel Aviv.

By the way, certain anti-psychotic medications can cause much the same effects, so if you’re taking any, don’t leap to gratuitous conclusions, Zeilig helpfully points out.

At a later stage, walking and other coordinated movements become increasingly difficult, and dementia may set in as the condition spreads through the brain.

Parkinson’s is the second most prevalent neurodegenerative condition in the world, affecting slightly over 1 percent of the population. The disease is progressive and irreversible, but in some cases its symptoms can be rolled back, Zeilig notes.

Generally treatment starts with drugs, mostly based on dopamine, which have side effects. “Some patients do fine with the side effects and live reasonably well, are able to dress themselves and function and have sex,” he says.

If the drugs don’t work, or stop working, however, the next stage may be neurosurgery – deep brain stimulation, for example.

But many sufferers can stabilize their condition, even for years, with the help of drug- and “goal-based” exercise regimens, which mean focusing on the areas causing trouble. (Note, though, that their functioning will fluctuate during the day.) For instance, if a patient has problems eating soup, the exercises would target regaining control of the arms and hand.

In one of many papers on the topic, a ground-breaking 2011 article in the medical journal Lancet, “Does vigorous exercise have a neuroprotective effect in Parkinson disease?”, argues that the benefits of vigorous exercise, whether among animals or elderly individuals afflicted with the disease, are perfectly clear.

Indeed, the overall empirical evidence suggests that such exercise should be central to treating Parkinson’s.

The norm in American Parkinson’s treatment, for instance, is around 150 minutes of physical activity a week, Zeilig explains, depending on the patient’s abilities.

Why does it work? Lots of reasons. “It causes happiness,” says Zeilig, summing up a whole encyclopedia of physiological responses to vigorous exercise, starting with endorphin release.

Sheba Medical Center is working on cutting-edge therapy for neuro-rehabilitation, with the help of robotics and virtual reality. In late 2015 the hospital opened a designated rehab program on its sprawling campus for Parkinson’s patients, and, Zeilig reports it has been successful in improving their functioning. “We already have a waiting list,” he adds.

“Because the problems Parkinson’s patients suffer are in all sorts of directions – speech and swallowing, movements, soul and cognition – an interdisciplinary approach is better than [treatment by] a single therapist,” the doctor says. It isn’t enough to send a patient to a physiotherapist who might help them regain control of balance; they may need speech therapy too, for example, and psychological support.

Back at home, patients can also make progress by themselves. In the first part of their 2016 book “Goodbye Parkinson’s. Hello life!” by Alex Kerten, with David Brinn, the authors stress the need for a positive attitude. In the second part, they basically provide a manual for anaerobic and aerobic goal-based exercises (to music), which may help sufferers regain some control over their treacherous limbs.

For his part, Zelig says this is a good, educational book for patients. It elaborates on the physiological aspects of the disease, and dwells at some length on a key problem for Parkinson’s sufferers following diagnosis – moving beyond despair.

Devoting much attention to the “unholy alliance” between the anthropomorphized disease and the patient’s fear, Kerten and Brinn suggest that some of the symptoms patients suffer may result more from anxiety and fear, and less from morbidity.

Patients should move from the mindset of being doomed to inevitable decline and death, to an optimistic frame of mind that they’re still alive and can feel better.

The thrust of the several dozen pages of exercises, broken down by the body section being addressed, is to help Parkinson’s patients regain control one body part at a time.

Think of it this way. You probably don’t normally think about controlling your elbow, or left foot, or right thumb. Or eating. You just live, until you lose control, or some control, of these body parts. The point of the exercises is to bring them back to the full attention of your mind and to retrain yourself to use them.

One caveat: “Hello Life!” implies that if its method doesn’t work, it is the patient’s fault for having the wrong mindset. That is unfair. Not even chocolate works for everyone.