Neuroplasticity- a focus on movement
Neuroplasticity is defined as the ability of brain cells and neural networks (brain circuits) to change or increase their connections in response to new activities. These new or enhanced connections promote better brain function and improve performance. There are many activities that can enhance Neuroplasticity or brain function. It is not too surprising to learn that many of the same activities that improve quality of life also promote Neuroplasticity. In other words, our brains have developed to respond in ways that further help us get the most out of activities that improve our quality living.
We all know that exercise is good for our general health- strengthening our heart, muscles and body. Exercise is also good for the brain. The following information reviews research findings that show how exercise and movement improves our brain activity. Much of this research is in its infancy and there is much more that needs to be done. However, there are some general ideas or concepts important to improving your motor control and everyday living with Parkinson’s.
Something is better than nothing! Brain imaging shows an increase in brain activity over the motor cortex (cell area on the surface of the brain that controls and regulates movement) after a single 15 to 30 minute practice session. Activity is recorded over a specific area of the motor cortex in response to thumb movements in one direction only. Thumb movements in the opposite direction do not activate this area. However, with practice this changes. Thumb movements in the opposite direction can increase brain activity in new areas after just 15- 30 minutes of practice. Many people with Parkinson’s say that they do not have enough time or are too tired to exercise. This finding reminds us of the importance and positive impact of practice on brain activity - if even for a short period of time. Remember this and set aside a few minutes in the day to exercise or practice a task that is bothering you such as handwriting, speaking loudly or working on balance- even if it is only a short duration of time.
Repetition is key! Performing a task over and over again will improve brain function, strengthen new connections and increase performance. An Olympic athlete will train over and over again to improve performance to an extreme level. You do not have to be an Olympic athlete to benefit. Repetition will improve performance at any level of ability or disability. This is the idea behind the ‘forced use’ physical therapy technique used to treat people with stroke causing arm weakness. In this form of physical therapy, the good arm is restrained ‘forcing’ the weaker arm to do everyday tasks such as dressing, eating, phone and computer work. Both brain activity as measured by brain imaging and measures of strength and hand function are improved with this therapy when compared with standard physical therapy. Use this principle in your everyday tasks. If your Parkinson’s affects one side of the body more than the other (as is usually the case), use the affected side for daily tasks when appropriate rather than letting the better side take over. For example, you may be right handed and now find that you are using your left hand to do more activities such as dressing, eating or writing. Talk to your healthcare provider or visit an occupational therapist to see if changes in treatment or strategies can be put in place to help you use your right side.
Adding aerobic and endurance activities may be important! Aerobic exercise that is physically challenging may be helpful for Parkinson’s. Research examining the Neuroprotective effects of exercise on brain dopamine cells in Parkinson’s is highlighted in the accompanying article, Neuroprotection- exercise to protect dopamine nerve cells.
Quality not just Quantity! Research with rats shows that animals that were given more complex exercises with a ‘jungle gym’ environment had more connections between nerve cells in an area of the brain important for movement control called the cerebellum compared with those that did not exercise or exercised on a simple wheel. The enriched animals that exercised in a complex ‘jungle gym’ environment had more nerve cell connections than those that simply ran on a wheel. The interesting finding is that this increase was found even though the animals ran in the ‘jungle gym’ ran 10- 19 times less than those on the simple wheel. Another study showed that greater areas of motor cortex were activated in people (with no piano playing history) that practiced finger movements by playing the piano compared with those that practiced simple finger movements. These studies remind us that complex movements exposing us to new situations or that require thought, problem solving and action may be more important than simple routine movement. Add complexity to your own exercise routine. If balance is a problem, try a dance class, if dexterity is an issue- take up art or piano lessons.
Make it enriching and fulfilling! A neurotoxin called MPTP causes dopamine nerve cell damage and is used in research to cause a parkinson-like condition in animals. Mice will develop movement problems and brain changes similar to Parkinson’s when given this neurotoxin. This model can be used to explore treatments that might prevent these changes or protect nerve cells from damage caused by this toxin. In rodents, exercise can protect nerve cells from damage by this neurotoxin (see accompanying article, Neuroprotection- exercise to protect nerve cells). In one study with mice, dopamine nerve cells in the substantia nigra region (cells that are destroyed in Parkinson’s) showed greatest protection from the toxic effect of MPTP when they were placed in an enriched environment that changed over time, included more mice littermates and had challenging obstacles compared with those housed in a standard research cage. This effect was stronger than that seen by exercise alone. Make your exercise routine less routine and more fulfilling. Think about adding activities that are creative, result in positive reinforcement, and add variety or new challenges. Consider group exercise to benefit from the support, social interaction, encouragement and camaraderie of the group to stay motivated and lend support to others. Add some fun and make exercise a game.
Don’t forget about stress! Animal studies show that exercise helps protect nerve cells from the toxic effects of MPTP that would otherwise cause parkinsonism. When mice were exercised and stressed they had more cell damage from this toxin than the mice that exercised but were not stressed. Interestingly the stressed and exercised mice also had more cell damage compared to mice that did not exercise. Stress is a big part of life and chronic stress affects more than our mood and anxiety. Consider adding exercises that include mindfulness training, relaxation and stress management techniques such as Yoga and Tai chi. Add mindfulness training and stress reduction techniques to your daily life routine.
The accompanying articles, Neuroplasticity- more than just movement and Move to remember- exercise to help cognitive abilities, explores the connection between stress management, cognitive and emotional health and Neuroplasticity.
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Journal of the American Medical Association 2006. 296; 2095
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Neurobiology of Learning and Memory 2000.74; 27
Journal of Neurophysiology 1995. 74;1037
Molecular Brain Research. 2005 134:170
Behavioral Brain Research 2005. 165:210
Author: Monique L. Giroux, MD Medical Director NWPF