I am getting asked a lot about the study recently reported in The New York Times about the positive effects of high-intensity treadmill exercise for people with Parkinson’s disease. Is it the treadmill or the intensity that has the benefits? I can answer that quickly. It’s not the treadmill, it’s the intensity!
Intensity is the key to slowing down the progression of PD. With intensity, there are a lot more opportunities to create results for brain change. We’ll start with the basics of intensity. Here is a quick overview of the article:
This study reports that intense exercise can be safe for people may substantially slow the progression of Parkinson’s disease. But the same study’s results also indicate that gentler exercise, while safe for people with Parkinson’s, does not seem to delay the disease’s advance.
- One group walked gently for 30 minutes, 4X/week, keeping their heart rate between 60-65 % of Max HR. The other group walked strenuously for 30 minutes, 4X/week, keeping their heart rate between 80-85 % of Max HR
- To no one’s surprise, those just did mild or no exercise, continuing with their previous lives showed some worsening. Their scores on the disease scale had declined on average by more than three points.
- Those in the moderate exercise (60-65% Max HR) group showed declines of around two points.
- But the group that had worked out intensely (80-85% Max HR) showed almost no decline in their disease scores. It had helped! Just as important, it had been tolerable. Almost all completed six months of regular exercise without injuries and with only sporadic complaints of sore muscles.
Sounds easy, just exercise harder. The problem is, people generally do not realize how hard “high intensity” really is. As a coach, I do a lot of tough-love pushing to get my students to work hard and keep up the intensity. It’s constant and it takes a lot of coaches in one class to keep reminding people to work harder.
Because PD causes slowness of movement, it also creates a false perception of how hard they are working. It’s really hard and not recommended to do the bulk of your exercise alone if you have PD. It’s best in a class where you have someone to push you constantly. Feedback from a heart rate devise (many on the market now) is best for people with PD. I’ll explain why in a minute.
The big question is: how hard is “high intensity?” It’s very individualized. It takes into account your age and we can further use the RPE (Rating of Perceived Exertion) scale to fine-tune it.
In clinical research settings, the Karvonen Formula is used to determine your target heart rate (HR) training zone. However, it requires a lot of measurements and is not convenient. Instead, we can use a simpler equation that usually comes within just a few beats of the Karvonen method by using age-predicted maximum heart rate.
For a person over 50 years old:
- Predicted Max HR = 208 – (0.7 x Your Age). For example: If you are 65 years old,
Predicted Max HR = 208 – (0.7 x 65) = 163 beats per minute (bpm).Next, calculate 80-85% training zone of your age predicted Max HR: - 80% Training Zone = .8 x Predicted Max HR
- 85% Training Zone = .85 x Predicted Max HR
For a person under 50 years old:
- Use the same method above, but in Step 1 use 220 – (.7 x Your Age).
The high intensity heart range for a 65-year old individual, for example, is 130-139 BPM. By wearing a heart monitor, you can make sure your heart beat gets to the high intensity training rate.
Being aware of your intensity is the key. The subjects in the study were in the 1st and 2nd stage of PD and healthy enough to safely get their heart rate up and sustain it. Not everyone can do that.
What if you are on beta blockers for a cardiac condition or blood pressure? Then you can use the Borg Rating of Perceived Exertion Scale (RPE), but remember perception is difficult to evaluate when you have PD. Some people with PD must be careful of low blood pressure, feeling of lightheadedness should be considered.
The BORG scale below ranges from 6 to 20, where 6 means “no exertion at all” or sitting in a chair and 20 means “maximal exertion.” Choose the number from below that best describes your level of exertion. This will give you a good idea of the intensity level of your activity. Your own feeling of effort and exertion is important, not how it compares to other people’s. For our purposes of high-intensity you should be working at a 13-15 rating.
9 is “very light” exercise. It’s like walking or strolling slowly at your own pace.
13 is “somewhat hard” exercise – You notice you are breathing heavier and you can talk (but rather not) but you can’t sing or tell a story. We are starting to sweat now.
15 is “hard” – you can continue but you can not have a conversation comfortably. You are breathing heavy and probably sweating quite a bit.
17 “very hard” – is very strenuous. A healthy person can still go on, but really must push themselves.
19 This is the most strenuous exercise most people have ever experienced.
Find your high intensity training level and make it your goal to reach your level every workout!