Finding Energy with Parkinson’s

Sierra Farris, PA-CNeurological Physician Assistant

Certified Clinical Exercise Specialist

Sponsors Northwest Parkinson’s Foundation and Teva Neurosciences

@Sierra Farris 2011

@Sierra Farris 2011

Fatigue & Parkinson’s

• Earliest reference to fatigue 1967, first papers on fatigue in PD published 1993 – “a sense of tiredness, no energy, total body give out”– “infuriating and awful feeling”

• debilitating • frustrating • exhaustion • heaviness

@Sierra Farris 2011

Understanding General Fatigue

Mental – Neuroconnections and Neurotransmitters

Physical – Mass - Physiologic - Biochemical

Use It or Lose It

@Sierra Farris 2011

Understanding General Fatigue

• difficulty initiating and sustaining mental and physical tasks

• Reduced focus or attention

• Reduced motivation

• Every movement is with effort

• Causes Vary

Mental

May respond to

targeted treatment

@Sierra Farris 2011

Understanding General Fatigue

• Loss of power

• Associated with sedentary life-style

• Motor inefficiency

• Higher energy cost to move

• Not related to muscle overuse (exercise)

PhysicalResponds to rest nutrition

exercisemindfulness

Fatigue - PD Symptom or Side Effect?

• Medication side effects can be elusive– Fatigue– Tiredness– Sleepiness– Drowsiness– Lightheadedness– Low blood pressure

@Sierra Farris 2011

@Sierra Farris 2011

Fatigue and PD SymptomsMental

• More energy to initiate and sustain mental and physical tasks

• Depression and Anxiety

• Insomnia

• Every movement is with effort

Physical

• Tremor

• Stiffness

• Slowness

• Posture

• Dyskinesia

• Off Time

Improves with rest nutrition exercise

medicationmindfulness

@Sierra Farris 2011

Confounding Factors

• Fatigue is more common if:– Decreased leisure physical activity– Excessive Daytime Sleepiness– Lower frequency vigorous physical activity– Less time doing routine tasks– Lower blood pressure– Lower aerobic capacity– Longer time from sit to stand = routine tasks

Extreme Example…But,Parkinson’s related fatigue can feel like you are literally climbing a mountain every day.

Analyze and Prepare

• @Sierra Farris 2011

@Sierra Farris 2011

Comprehensive Approach to Gain Energy

• Nutrition• Supplements• Hydration• Rest• Exercise• Mindfulness• Stress Reduction• Medical Evaluation

@Sierra Farris 2011

Comprehensive Approach to Gain Energy

• Record some details for your doctor– When and Severity– Associated factors

• Cramps or RLS

– Prior night’s sleep– Prior two days of tasks– Meals and Fluids– Exercise log– Blood Pressures

@Sierra Farris 2011

Medical Search for Contributing Factors

– Anemia – Complete Blood Count– Thyroid Function– Nutritional labs B12, protein, iron, electrolytes– Infection – (Bladder)– Anxiety and/or Depression– Insomnia– Stressors– Medication Side Effects

@Sierra Farris 2011

Is there a pill to fight fatigue?2009 World Congress Reports

• Dr. Stocchi, Italy• Azilect showed benefit

for fatigue over a 9 month study

• DBPC N= 1176 PWP• P<0.01 Significance over

placebo

• Dr. Ferreira, Portugal• 19 trials reviewed• Azilect only drug

associated with decreased risk of fatigue

@Sierra Farris 2011

Modafinil (®Provigil)

• Modafinil improved Excessive daytime sleepiness but not fatigue in a small PCT 2010 (n=13)

@Sierra Farris 2011

Fatigue Fighting – Energy Promoting Exercises

• Yoga• TaiChi• Dance• Aquatic Therapy• Trekking Poles• Wii• Walking

• Single leg stance• Tandem Stance• Tandem Walk• Corner Standing• Posture Exercises• Hiking• Wall Climbing

@Sierra Farris 2011

Energy Foods and Nutrients• Antioxidants

• Anti-inflammatory Fats

• Good Carbs, Protein

• Fluids

• Grazing better than one large daily meal

• Magnesium, Calcium, Potassium

What does your food pyramid look like?

@Sierra Farris 2011

Energy Conservation• Proper body mechanics

(posture)• Plan ahead• Pace yourself• Scheduled rest time• Prioritize activities• Limit environmental

impacts

– 2008 MS Study – Mastery over the environment

@Sierra Farris 2011

Exercise and L-dopa

• Moderate exercise increases clinical efficacy of L-dopa

– No alteration in pharmacokinetics of L-dopa Muhlack et al 2007

• During exercise, growth hormone concentration is increased

– No change in L-dopa levels Miller et al 2007

(Egypt J. Neurol. Psych. Neurosurg., 2004, 41(1): 141-150). 35min cycling (15m post drug)

Every Victory Counts Essential Information and Inspiration for a Lifetime of Wellness

Worksheet

• @Sierra Farris 2011

Proper Footwear

@Sierra Farris 2011

@Sierra Farris 2011

Strength

Flexibility

@Sierra Farris 2011

Endurance

@Sierra Farris 2011

Take Time to Assess

@Sierra Farris 2011

@Sierra Farris 2011

Assist Device

Companions

@Sierra Farris 2011

@Sierra Farris 2011

The top ten guesses will win an Every Victory Counts manual – Essential Information and Inspiration for a Lifetime of Wellness with Parkinson’s disease by Dr. Monique Giroux and Sierra Farris PA-C. Must be present at the September 10, 2011 Team PD Kilimanjaro event in Shoreline. Registration @ NWPF.org

How many steps does it take to climb Kilimanjaro?