When Dr. Jay Kogon, DPT, ATC, GCS, works with Parkinson’s patients at his Neuro-Fitness Therapy facility in Wilmington, he isn’t too worried about whether they can hit a curve ball or handle a 100-mph heater. But as he describes the goals of the program, he is happy to use a baseball metaphor.
Just about all big-league ballplayers attend batting practice before games, but teams also have batting cages within stadiums’ basements that allow for some in-game work. A hitter could spend time before the first pitch honing his swing and then head underground in the fifth inning to take some more cuts, the better to create a motion that is consistent and effective.
“He’s building muscle memory,” Kogon says. “We are doing the same thing for patients by redeveloping their movement patterns.”
Throughout Delaware and across the country, people like Kogon are working with Parkinson’s patients to improve the quality of their lives through exercise. A concept first developed a couple decades ago has grown in popularity thanks to research and the growing anecdotal reports from people like Kogon, who are working every day to help those afflicted with the disease lead fuller lives.
Parkinson’s is a progressive neurological disorder that affects movement and can produce tremors, stiffness, rigid muscles, inability to perform previously automatic movements and speech difficulties, among other symptoms. It occurs when the brain’s neurons break down and die, and can be triggered by a person’s genes, old age and sex. (Males are more predisposed to Parkinson’s than women.)
The key is not just exercise but intensive activity that raises the heartbeat and gets people moving in ways that go well beyond a leisurely walk. By combining aerobic exercise and strength training, patients can retrain their neurons and even heal those that have been impacted by Parkinson’s. Kogon and others aren’t trying to have 80-year-olds running wind sprints, but it is vital that all Parkinson’s patients are moving at far brisker paces than they do during ordinary activity. As he says, “Plain, old walking is not intensive enough.” Kogon and his therapists aren’t always kind and gentle with patients. They want them to work hard, so they push and sometimes even yell. The results are impressive. And lest you think this is a sales pitch by gym owners, consider the medical community’s opinion.
“In the past, we spoke about treating symptoms to improve the quality of life, but now we are stressing the importance of exercise,” says Dr. Justin Martello, a Parkinson’s and movement disorder specialist at Christiana Care Neurology Specialists in Newark. “That’s the only thing that can slow down the progression of the disease.”
Martello tells his patients that they must embark upon a program that includes 150 minutes of exercise a week, and he emphasizes to them that it is non-negotiable. The movement and strength training helps meds become more effective than they would be by themselves, because they make patients feel better and therefore more receptive to the drug therapies.
“Some neurologists are fearful of being too aggressive too soon in treatment, because they think the meds will stop working,” Martello says. “But we now want to use the meds early to make patients start feeling good and wanting to move.”
According to Martello, the life expectancy for Parkinson’s patients has increased to almost where it is for those not afflicted by the disease—the mid-70s. A generation ago a patient could expect five to 10 fewer years than that. And those who exercise can make that extra time a lot more enjoyable and fulfilling.
Kogon began his Neuro-Fitness program 2 1/2 years ago and bases it on LOUD, a program developed by a speech therapist 15 years ago that was designed to help Parkinson’s patients communicate more effectively. The physical partner to LOUD is BIG, which is taught around the world, and Kogon uses its principles.
It goes beyond just putting someone on the treadmill and telling him or her to walk for 10 or 15 minutes. Kogon and his therapists work one-on-one with people to help them exercise at a pace that is healthy, and to push them to achieve things they didn’t think they could. The therapists at Neuro-Fitness have been trained to work with Parkinson’s patients, and in addition to the physical component of the program, they also provide occupational and speech therapy. By working across multiple disciplines, the therapists help retrain patients’ brains, allowing them to develop protocols for the movements that begin to become more difficult as the disease progresses. As they relearn how to do things, patients build confidence and can continue to perform everyday functions, despite Parkinson’s efforts to prevent those behaviors.
“The brain controls the body,” says Kogon, who is also a board-certified geriatric specialist. “Parkinson’s is a movement disorder, so it’s not about a patient who can’t get out of a chair because he is weak. It’s because he doesn’t have a movement strategy.”
To many, the idea of putting Parkinson’s patients in a boxing ring is an exceedingly poor idea. For Elena Doherty, it makes perfect sense.
Doherty is a physical therapist at Pivot Physical Therapy’s Newark location. She is also a multiple sclerosis-certified specialist and runs the Rock Steady Boxing program at Knockout Boxing, which she started in September 2017. It’s a high-intensity program geared toward helping Parkinson’s patients improve their balance and cardiovascular health. And it uses actual boxing—although no one is trying to knock anyone out.
“It makes patients aware of their physical abilities,” Doherty says. “We give them a fast-paced workout, because if they have a tremor, and they work quickly, the tremor can stop. We have a 91-year-old in our class who’s doing burpees (squat thrusts).”
Elena Doherty’s Rock Steady Boxing program is geared toward helping Parkinson’s patients.// photo by Jim Coarse
The boxers may not be slugging it out in the ring, but they definitely are throwing punches and elevating their heart rates. Doherty says that some people are surprised that Parkinson’s patients are doing these workouts, but she reports the 12-to-16 person classes that meet for an hour three times a week are filled with enthusiastic participants. And the results are real.
“I can’t tell you how many people tell me they are able to get on the floor with their grandchildren and get onto the ground to garden,” Doherty says.
Kogon reports that one person with whom he and his staff worked went to the doctor and was told her brain function was 40 percent better than it was six months previous. “We see that kind of thing every day,” he says.
Participants in Doherty’s classes improve their posture, become more flexible and are less prone to falling because they aren’t afraid to move. And by taking her classes into the ring, Doherty can work with her participants on how to get up, should they tumble, where the ground is more forgiving. Then there is the camaraderie among those in the class. People build their days around the classes, and there are strong mental and psychological components to the program, as well as the confidence built physically.
Elena Doherty is a physical therapist at Pivot Physical Therapy’s Newark location.// Photo by Jim Coarse
“For some, it’s the one thing that gets them out of the house,” Kogon says. “Some people sit around all day, and this is the one thing that gets them up and makes them more productive. Plus, the class acts as a support group for people.”
Martello is adamant that the key to fighting the advancement of Parkinson’s is the strenuous exercise people can get at facilities like Neuro-Fitness Therapy and Knockout Boxing. He believes the hard work people perform is extremely important to preserve the neurons that are functioning well. It’s not about reversing the disease. It’s more about preserving what has not been affected.
“We know exercise is more important than any cognitive work that people do,” Martello says. “It’s better for neurological health than anything else, even among people who don’t have Parkinson’s.
“This is not just your doctor telling you to exercise. There is a significant difference among patients who exercise and those who don’t. Their quality of life improves. They have less depression. Their anxiety is lower. You have to do it. It may cause fatigue but you have to do it.”
And it’s the best way to fight back against a formidable foe.