Saturday, March 17, 2012

Studies and PD: If A Parkie Falls in a Forest...

Viartis, that often-gloomy-but-sensible oracle of Parkinson's Disease knowledge on the Web, recently published this takedown of Tai Chi as especially beneficial to people with Parkinson's Disease:

"A clinical trial assessed the effect of Tai Chi on postural control in Parkinson's Disease. Tai Chi is a traditional Chinese martial art and form of exercise. Participants took part in 60-minute exercise sessions twice weekly for 24 weeks. Although the researchers claimed that Tai Chi performed consistently better than other methods, the improvement was only 5% better than resistance training, and 12% better than stretching exercises. The Tai Chi group performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai Chi lowered the incidence of falls when compared with stretching exercises but not when compared with resistance training.

Out of the previous studies in the medical literature concerning Tai Chi and Parkinson's Disease, four were either non-randomised or uncontrolled clinical trials. Two failed to show any effect. Only one study showed Tai Chi to be superior to conventional exercise for Parkinson's Disease. So the evidence is insufficient to suggest that Tai Chi is effective in Parkinson's Disease."  
So, should we just go back to falling with no hope of improving our balance, but smugly aware that we're at least not wasting our time on mumbo-jumbo? Well just hold on a second partner, there may be more here than meets the eye. "Tai Chi performed better than stretching but not better than resistance training." But what if resistance training also helps us avoid falling?  I haven't been able to find anything specific saying it does  or doesn't. But There has been a flurry of articles on how terrific weight training is for people with PD. Perhaps both improve balance. In which case Tai Chi  might be "better" than resistance training, but certainly not worse. And way better than nothing.

Once again we are left wandering in a forest of studies trying to sort our way through a variety of unknowns and extraneous factors. How well-designed were the studies? How comparable were their sample groups? Scientists, like the rest of us , are human, all too human. Frustrated yet? I am. But as sure as the sun appears to rise in the East, one thing seems to be trending clearly. Exercise is emerging as a powerful coping tool for those that have Parkinson's Disease. Tai Chi, dance, Yoga, walking, weightlifting, bicycling.... surely one of these forms of exercise appeals to you enough to get your commitment.  What if the benefit is marginal? If the margin is where I can make some headway against PD, the margin is where I will do it.


Steve said...

Peter, I was thinking the same thing - that this didn't say it didn't do good, but it showed only slight more improvement than other activities.

We know that in drug tests researchers have shown that placebo affect works to improve many people. It seems to me that just going out and doing tai chi (or whatever) has to do some good. And it might do more than that. I doubt it would do any harm.

Adele said...


I see the headlines as attention seeking missiles. I don't think there is really a disagreement over which exercise is best. No one has studied that. There is agreement that many kinds of exercise help people live better with or without Parkinson's and help us improve our balance. I am sure that improving our balance reduces our risk of falls. I am sure that having a stronger body reduces the impact of the falls we do take.

I have been working hard at Physical Therapy since December. Usually I am there 6 hours a week. I have seen that as I have increased my stamina and strengthened my arthritic knee, my gait has smoothed out from something I saw in a monster movie to something like normal. I do two tests of balance every session: I walk heel to toe on a line frontwards and backwards, and I stand on one foot and touch the other foot to four cones, on at a time, in a quarter circle. Just this week, I have been able to do both with smoothness and control. A year ago, I didn't really think I could do anything to slow the progression of my Parkinson's disease. Now, I see myself pushing it back.

I see benefits to my balance from both slow (58-79 strokes per minute) biking and from fast (80-90 strokes per minute) biking.

Scientifically, I know I am just a piece of anecdotal evidence but my improvement has astonished me. I truly see exercise as a key to living the healthiest life I can live with Parkinson's with the least number of falls.

I love what you said about making headway in the margin, Peter!

Adele Hensley
Clinton, MS

Peter Dunlap-Shohl said...

@Adele "Scientifically I know I am just a piece of anecdotal evidence." And that shows the limits of scientific thinking. The experimental method calls for a control group and a large enough sample to minimize statistical noise. Each of us has our own case of Parkinson's Disease, and is a sample group of one. We can't really apply the scientific method to our case and say that what holds for us will be true of all. But we must experiment and find what does work for us on an individual basis. Glad you found a way that works for you and can suggest possibilities to others.

@ Steve I guess the harm could come in wasting time not doing the perfect exercise routine, getting only limited benefits from one form of exercise when you could be putting time and energy into a better focused regimen. But as Adele notes, that regimen is yet to be found. My guess is that it will be a number of activities, and I'm willing to take it on faith that anything beats nothing when it comes to Parkinson's and exercise.