Timothy A. Leichliter, MD, a neurologist at Allegheny Health Network, provided context on the institution’s boxing program for Parkinson disease, and the need for patients to remain active.
Allegheny Health Network’s (AHN) Cahouet Center for Comprehensive Parkinson’s Care provides several types of care for patients with Parkinson disease (PD), including support groups, educational programs, food support services, and daily living support. In addition, the center offers exercise classes, including boxing classes, for these individuals. There are several benefits to exercise, improving cognition, depression, fatigue, and sleep.
Boxing has become a more widely-used approach for this patient group, emphasizing agility, speed, endurance, accuracy, hand-eye coordination, footwork, and strength. These exercises are meant to be vigorous and push patients beyond what they perceive they are capable of performing. Additionally, previous research has shown that exercise help prevent or slow disease progression, manage symptoms such as balance and constipation, and avoid isolation, a common theme for patients with neurological disorders.
Recently, NeurologyLive® sat down with Timothy A. Leichliter, MD, a neurologist at AHN who treats patients with PD, essential tremors, dystonia, Huntington disease, ataxia, and tic disorders. In the interview, Leichliter provided perspective on the benefits of exercise and boxing, the need to make exercise part of a patient’s treatment program, and the challenges of implementing it for each individual. He also spoke about the need for a well-organized multidisciplinary team, and why boxing programs continue to promote comradery among patients with PD.
NeurologyLive®: Why is boxing such an effective strategy for Parkinson disease?
Timothy A. Leichliter, MD: There's a few boxing programs scattered around the city that we partner with, and mainly because it’s good exercise. That's the long and short of it, but there's a little bit more than that. Exercise is the best medicine for people with Parkinson disease. In my clinic, exercise, and how important is it so stay active, get up, get moving, is something I talk about the most with my patients. Boxing not only takes exercise to the next level, but it also doubles as a support group. Everybody who goes to the boxing classes enjoys not just the physical aspect and the exercise aspect of it, but the camaraderie of being with other people who are sharing the same issues, going through the same things, dealing with a lot of the same problems, working on the same problems maybe in different ways, and they all work together. They almost act as a backup, they feel accountable for one another showing up to the boxing class and doing the work which we think is the best thing for them. If you put all that together in one program, one venue, it makes for a powerful resource for people with Parkinson disease to do the best they can.
What are some of the challenges of implementing exercise programs for these patients when one size doesn’t fit all?
There's a lot. It's both physical as well as kind of motivational. Not only is it difficult physically—a lot of my patients have stiffness and tremors, and balance problems that lend itself to difficulties getting on a treadmill or getting to a gym or lifting weights—but sometimes pain comes along with those things. Joint pain, back pain, neck pain, all because of the mechanical disabilities and the mechanics that aren't correct. On top of that, there's such a motivation problem, as anxiety and depression plays such a role in my patients, as well as sleep problems. Fatigue is a common complaint. You can imagine how hard it is to convince yourself, “Hey, I have to get up and exercise and do it when you don't [want to], or when you're tired all the time. You don't have that motivation and things hurt. Not only do they have the physical aspects of the disease that make it difficult for exercise, but there's also the emotional and the mental component that make it even more difficult. It's an uphill battle, but again, that's where the classes, support groups, and programs come into play to help people do the best they can. And it really does work.
What should the Parkinson community look forward to over the next coming years?
It’s been frustrating. You hear about these potential beneficial trials that just fizzle out or don't meet their endpoints and everybody gets let down time and time again. The one area that I think is improving, which came out fairly recently, is the first step in that trajectory towards a disease modifying medication or something more important, which is biomarkers. There was a recent report from the Michael J. Fox Foundation about a biomarker that they're working on that showed some promise. Because Parkinson disease is such a variable condition, and it's not just one thing, everybody has something a little bit different, a different genetic makeup, a different environmental trigger. A different combination of things, getting to the root causes through biomarkers, through genetics, through a lot of this tailored or precision medicine, is the wave of the next 5 or 10 years, which will then allow us to study certain subgroups of patients or certain populations of patients to see if we can impact the disease. That's the way to do it. The news that just came out is step one of multiple steps to get there, but a really important step one.
What other aspects of care do you feel should be more universal for patients?
Outside of exercise, which is the most important thing for everybody, it's building a team. This is not a one-man effort, this is not an individual sport, it's a group effort. It’s not just the patient, their family, friends, and social support groups. It's not just me or a movement disorder specialist, but it's a good primary care team with good other subspecialists. I refer patients to many other people: dermatology, gastroenterology, sleep specialists. You name it, every organ system and every aspect of life is impacted by Parkinson disease. You need more than just 1 or 2 people trying to work on this to help you provide the best care, you need a whole team. The other universal thing outside of being active is to make sure you get the appropriate team members in place early on because you're going to need them. That is the best way to work on all the facets of the disease to get the best out of it.
Transcript edited for clarity.