Rethinking Parkinson’s, #83

More from the Show

Speaker 1:     You’re listening to the Dr. Lisa Radio Hour and Podcast, recorded at the studios of Maine Magazine at 75 Market Street, Portland, Maine. Download past shows and become a podcast subscriber of Dr. Lisa Belisle on iTunes. See the Dr. Lisa website or Facebook page for details.

Speaker 1:     The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors: Maine Magazine; Dr. John Herzog of Orthopedic Specialists; Sea Bags; Booth Maine; Apothecary By Design; Mike LePage and Beth Franklin of RE/MAX Heritage; Tom Shepherd of Shepherd Financial and Ted Carter Inspired Landscapes.

Lisa:                This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast, show number 83, Rethinking Parkinson’s, airing for the first time on April 14^th 2013. This week’s guests will be University of New England Parkinson’s disease researcher, Dr. James Cavanaugh and Jacqueline Morrow, co-founder of the Medically Oriented Gym. My high school principal died of Parkinson’s in 2012. Dr. Kenneth Nye was just 70 and had struggled for 15 years with this disease. Despite his diagnosis, he lived his life fully and completely.

Dr. Nye was a fine educator. Many a young Belisle graduated from Yarmouth High School having benefitted from his leadership. He was named Maine’s principal of the year in 1993. At age 60, Dr. Nye became a poet. He published 4 books of poetry, one of which included the piece Going Home at Twilight, “Coming down the trail at twilight, I’m perilously close to being stranded in darkness. Earlier, I had figured I could ski the loop before it got dark. I was wrong. But I know where I am and in the dwindling light, I see the trail. And the trail will bring me home.”

According to his obituary, Dr. Nye enjoyed crafting pewter soldiers, his favorite toys form childhood. His love of gardening, bird-watching, travel, literature, tractors, riddles, jokes, story-telling, swimming, sailing, ice cream, musicals, etcetera, kept him engaged in life to the last. Dr. Nye was a vibrant, intelligent man. It seemed particularly ironic that a disease of the brain and nervous system would prove his undoing.

People like Ken Nye remind us that Parkinson’s disease, though yet incurable, can be managed better, longer, by staying active. Here in Maine, we are fortunate to have researchers such as Dr. James Cavanagh from the University of England, examining the relationship between Parkinson’s and physical activity. We are equally fortunate to have places such as the Medically Oriented Gym, co-founded by Jacqueline Morrow, offering settings where Parkinson’s patients can exercise in a supervised manner.

Sometimes, the simplest approaches to healing yield the best and least expensive results. Sometimes, although we may feel that we are stranded in the darkness, we need only go back to basics to find that we know where we are. Dr. Kenneth Nye always knew where he was. He knew that he was mentally engaged fully during each of the 7 decades he was given to live. He also knew that in his twilight years, he was on the trail that would finally lead him home. We hope that you enjoy our show today, Rethinking Parkinson’s with Dr. James Cavanaugh and Jacqueline Morrow. Thank you for joining us.

Lisa:                I really enjoy bringing great minds together and having the chance to work with people who collaborate because I think that when we are talking about health and wellness, collaboration is key. Two individuals that I know are already doing some really significant collaboration in the area of Parkinson’s, multiple sclerosis, neurologic issues and really a much broader scope than that are sitting with me today. I have Dr. James Cavanaugh, who is an assistant professor in the Department of Physical Therapy at the University of New England and Jacqueline Morrow, who is the owner of the Medically Oriented Gym or MOG in South Portland. Thank you so much for coming in and spending time with me. It’s really a pleasure to have both of you with me today.

James:                        It’s good to be here.

Jacqueline:   Yes. Thank you.

Lisa:                We first became aware of the MOG some time last fall, Jacqueline. I think charity from the MOG had gotten in touch with me and said you really need to know about this. I went over and I spent some time there. I really was impressed with the work that you’re doing. I think other people have been impressed too. Dr. Connor Moore who’s going to be on our show after yours. He wrote to me and said, “I have Parkinson’s disease. I’ve been working with the Medically Oriented Gym. What they’re doing is I think groundbreaking for Southern Maine.” Why did this become a priority for you?

Jacqueline:   For about 3 years, I was working in the area of cardiac rehabilitation with Maine Medical Center. We, in that time, just started to realize more and more the need to work within a multidisciplinary practice where we kind of live in these professional siloes and focus on the patient with the issue that they referred to us for but there’s a lot more that goes on to that when we talk about exercise and the need to allow people and help facilitate them exercising for the rest of their life. It’s a very complex issue because there’s multiple co-morbidities that tend to exist within one person’s condition.

At that time, I had reached out to the Medically Oriented Gym. They were fairly new at the time. It was about three years ago. We started to collaborate with the physical therapist there. It started to work really well understanding that if a patient comes in for rehabilitation for their heart, we still have to address bilateral knee pain and sciatica and whatever it is that’s going to be a barrier for them to continue exercising even when they’re done with cardiac rehab.

It was really phenomenal to be able to be part of that, that process and just more and more I got involved with the MOG and became very passionate about the need in the community to help fill that gap that happens when a patient is in a really intense program and they see a lot of success. But then, they get discharged either from PT or cardiac rehab or VNA and then they were left trying to figure it out in the community. There’s not a lot of opportunities for all of these professions to really work together on a daily basis and then that’s been pretty phenomenal to be able to be a part of.

Lisa:                Explain to me what the difference between physical therapy and exercise physiology is. I guess I’ll start with you Jim because you’re the physical therapy end of this even though the MOG has physical therapists in it. Can you … Want to take a stab at that?

James:            Sure, so physical therapy is a health profession in which the providers, the therapists see folks from across the lifespan. The general focus of the interventions are to improve people’s ability to move around so they function better in their daily lives. With that, we have a tendency to focus most of our efforts on people who have specific health conditions or reasons why bilateral knee pain, sciatica, Parkinson’s disease, why moving around is difficult. That’s our primary focus. It’s only I would say in recent years that we’ve tended to spend more of our attention on issues related to health promotion and physical activity and just general healthy lifestyles.

Lisa:                You have a specialty that I found kind of intriguing. You have a special- … You’re a clinical specialist in neurologic physical therapy.

James:            Mmhmm (affirmative).

Lisa:                Most of us when we think of physical therapist, we think more of bones and joints and muscles but yours is a little bit different?

James:            Right, probably 20 years ago or so, the profession developed these clinical specializations. These are licensed physical therapists who have had a minimum of two years of experience, most of which has been in the dedicated practice area working with a specific population like folks with neurological issues. There’s an examination, a written exam that’s required and upon passing the exam, you’re awarded the specialization credential.

What that means for folks in the community is that if they’re searching for physical therapist and they have a specific issue, one way to go about determining whether or not you … or one way to go about finding an expert is to look for the specialization credential.

Lisa:                So somebody has Parkinson’s or MS or ALS or something that’s neurologically-oriented, they could find somebody like you?

James:            Exactly, and folks who have issues related to orthopedics can look for an orthopedic clinical specialist, pediatric clinical specialists. There’s a variety of different credentials.

Lisa:                How might people interact with an exercise physiologist?

Jacqueline:   That’s a great question. I think within the MOG, one of the biggest barriers we face is people understanding from the public eye what these disciplines mean. As an exercise physiologist, my specialty is more in the physiology of the body, how the heart works, how it becomes more efficient with exercise, how exercise can physiologically help to reduce your blood pressure over the long term, how it can help to control your blood sugar and help to control diabetes, reduce your cholesterol, how the muscles become more efficient with utilizing oxygen.

I specialize more what goes on inside the body and I think what we’ve been able to do is match with the discipline of PT, which aside from the neurological stuff, typically the orthopedic issues happen outside the body so the bones and the joints. We’ve matched those two. The other profession that we have, who my partner, Chris Pribish is a licensed athletic trainer and strengthen conditioning specialist who has worked in the area of physical therapy for 10 plus years. He has a really unique background in that he’s able to work with high school athletes that are looking to improve their performance all the way to an 85-year-old stroke patient who’s looking to rehabilitate and become more active.

He has very much of a strong orthopedic background understanding how the body moves and how it works and very simply, the body is a chain, it’s a kinetic chain. Everything that happens at the level of your feet can affect your shoulders and your neck and your knees and vice versa. It really, when you’re putting together an exercise program with all these complexities, it’s so important to understand every aspect of movement and know how that can benefit but also be a detriment to the patient if it’s done improperly.

Lisa:                Dr. Cavanaugh, you’re an assistant professor in the Department of Physical Therapy at the University of New England. I know that the University of England is just … I don’t even want to say exploded but exploded literally …

James:            Grown a lot, it’s like …

Lisa:                It’s everywhere and it’s really bringing a lot of very high-quality health professionals into the State of Maine. What changes have you seen in physical therapy education in the last 10, 20 years?

James:            Yeah, in addition to this movement towards more health promotion, injury prevention, the other area that 25 years ago when I trained that it was virtually non-existent was they had to do with measurement. Currently, the physical therapy students in training learned a lot about metrics, ways to measure people’s progress and improvement on a variety of different levels, diagnostic tests that didn’t exist 25 years ago. That’s important because as we move forward with health care reform and continue changes, our ability to be accountable for what it is that we do in terms of improving patients’ lives is becoming increasingly important to third party parents etcetera so measuring outcomes is really important. That particular thing and communicating those outcomes not only to third party parents but to physicians and family members, the patient themselves is a really growing … has become a very important area of the practice.

Lisa:                This is something that you’ve been working with the MOG and congratulations on that name by the way. It really sticks in one’s mind.

Jacqueline:   Thank you. I didn’t come up with that. I can’t take credit for that but yeah.

Lisa:                I don’t think … but MOG, it’s such a … It stands out on its own. This is something that you focus on at the MOG and you’ve been working together on a project that has to do with Parkinson’s patients. Talk to me about that.

Jacqueline:   It was year and a half ago or so that Jim approached us about through our collaborative efforts, one thing that we really want to support is the student research that happens every year so he had approached us about doing research study with Parkinson’s patients. It started with a pilot program but before doing that, one of the things that we needed to determine once we figured out what the study was going to be was the metrics. What are the outcomes that we’re going to measure? That required us to reach out to Terry Ellis at Boston University. They provided us some training on the standardized tests that we now carry out with all of the Parkinson’s patients that we do pre and post and quarterly in order to measure outcomes.

That was a privilege to be able to go through that training. Boston University is … You can probably speak better to this than I but is known as the place for in terms of Parkinson’s research, really the best resource to go to. We got trained by the best which was a privilege. We launched the pilot study. We launched an open house. It was hugely successful. We enrolled participants. We measured data. It’s just continued to grow from there. It’s been an amazing population to work with truly. The cohesiveness of the group, their dedication to participating on a regular basis is phenomenal.

Their attendance rate is through the roof. They’re just excited as you’ve seen with Dr. Moore to really be a part of helping increase the awareness of the importance of exercise with Parkinson’s. I think a lot of times, certain diagnosis can lead to more of a medication management focus, how are we going to manage symptoms. That’s kind of the first line of defense and certainly there is a place for that. The body also has other needs outside of that disease state. There’s a lot that’s unknown about the benefits with Parkinson’s.

I think we’re really hoping to be able to be a part of a group that can demonstrate that we really can improve symptoms, we can hopefully demonstrate we can slow the progression and improve people’s quality of life even if it’s improving other aspects of their life, their muscular strength, their balance. We know all of that will improve with exercise so we’re just continuing that research.

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Lisa:                I have in front of me an article that was published in the journal of the American Physical Therapy Association, which was also a collaborative effort with other organizations. It talks about the importance of exercise and Parkinson’s. How does Parkinson’s, for people who are listening, how does Parkinson’s impact people physically?

James:            All right, so the cardinal signs of Parkinson’s disease, I think it’s most known for the tremor that it produces. It also produces for most people a general slowing of their movement and included with that is a general reduction in the amount of movement that they produce in the course of a day. Then, it also produces problems with walking and balance in particular. People become … They move slowly. They become stiff. There’s often a tremor. They fall as the disease progresses.

You’re right, there is a rather body of literature that supports the benefits of exercise for people with Parkinson’s primarily to address the problems with balance and falls and a general reduction in their movement capability. It’s that body of work that led to the work that Jacqueline and I are doing at the MOG in particular. Most of those studies were done under by researchers under well-controlled laboratory conditions which is great. However, oftentimes, in real life, we can’t necessarily replicate what gets done with a well-funded study. Our recent work together last year, the research project was simply an attempt to reproduce the positive outcomes that have been published in some of those times. We produce them in a real life community wellness facility that is dedicated to people with chronic health conditions. We were successful. It was a small study but we felt good about the outcomes that were achieved by the participants.

Lisa:                Isn’t that the direction we should be heading in anyway? Having more sort of real life, real time research so that we know what’s happening with … I won’t even call them patients or subjects. I’ll call them individuals and families who live out in the community, how this really impacts them in their lives.

James:            Correct. I was talking a few minutes ago about the importance of measurements. It’s one thing for a person to participate in an exercise program for a period of time and feel better about themselves but when you have a chronic health condition in particular like Parkinson’s that tends to slow you down and reduce your movement over months and years knowing that your risk for falls is reduced, knowing that you’re sustaining the amount of movement that you do, your mobility and so on from month to month and year to year, knowing that in … by the numbers, I guess, in quantitative terms, it is really important for people.

Lisa:                Jacqueline, why do we need a Medically Oriented Gym? There are so many gyms out there. How is your gym different?

Jacqueline:   What we really try to do is serve a population that can’t just go anywhere. There certainly are a lot of gyms out there with a lot of different staff at the gyms with different certifications or backgrounds and a lot of qualified people. I think our facility, the multidisciplinary approach that we’re taking and the dedication we have to connect with physician groups and really as we spoke earlier, really bridge that gap.

There is a huge gap right now between the medical world and the community. If we don’t fill that void, we will not be able to provide sustainable change. I think the other thing that’s really exciting too is as going through school and pursuing my advanced degree, is I always felt like I had to go somewhere else to get an experience that we are now able to provide in Maine and to feel like Maine can really be at the forefront of what is happening in our nation, in the health care reform and providing the residents of Maine services that are found in other parts of the country. There’s 11 other MOGs in the country.

I think what’s really exciting for us is that a lot of them are looking to us to provide guidance and to provide insight. It’s really an honor to feel like we can be a leader in that because of our amazing relationships that we’ve established with the community. We have this triad of collaboration that’s happening between physician groups, university settings and now the community. It’s opened numerous doors. I really do feel like the background and knowledge of our staff is so beneficial to the patients that no matter what … One of my favorite examples is a lot of times the orthopedic issues and the pain stops someone from coming in to exercise.

Our members and our patients will come in no matter what and maybe that day they have to have heat and steam to help them get through that flare up of sciatica. Then, the next day they come in and they’re feeling great but at least we’ve prevented that break in their routine and we’ve kept them on track. The second they need something that we don’t provide, we send them to where they need to go and really help to keep that ball rolling instead of pausing and saying let’s just wait for it pass and continue on. I think being outcome-based, research-based and really dedicated to the long-term is something that we’re very proud of.

James:            I just wanted to say that from my perspective as somebody who works in the university setting that one of the unique things about the MOG for me is that it is what is increasingly becoming known as an inner professional practice, very unusual in a community wellness setting, not so unusual in a hospital or rehabilitations settings but in a community wellness setting, they have an exercise physiologist, physical therapy and athletic training working together with and for patients and their caregivers or whoever, is unusual. It is where medicine is going in general. If you’re looking for reasons to distinguish the MOG from other types of … that would be a really strong point.

The other I was going to say is that Jacqueline just told the story about somebody who comes in and they can’t exercise today because their knees hurt and so they alter the care provider in that day so that the person hopefully tomorrow comes back and can resume their program. That’s one of the most important things that anyone, in particular people with Parkinson’s, but it’s true for the general population, the need to sustain their level of physical activity and whether it’s through a structured exercise program or just getting out and being active, to be able to sustain that day after day or week after week, month after month, year after year is really important for preventing long-term problems.

The MOG, because they’re so agile in terms of how they alter their care for someone on a given day, really promotes that idea.

Lisa:                The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.

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Lisa:                I think it is very compelling that we have come to a place where now the metrics, the measurements are important but we’ve actually needed to return to the place where relationships are important and that there always has to be a balance in modern medicine especially with healthcare reform but really just with the way we all think as individuals and within our society. Jacqueline, I think you had some experience with maybe relationships not being always there within a traditional medical community. Did that influence your decision to go towards more of a relationship patient-centered care model?

Jacqueline:   Yeah, absolutely. I’ve always been very passionate about collaboration whether it’s from one professional to another or from the professional to the patient with their families because I believe in the whole picture and I believe that if we don’t connect with those pieces, ultimately success will not happen for that person. Seeing the transition that has happened in health care and trying to empathize with the demand and the challenge that is being put on physicians to see a certain number of patients everyday in 15 min blocks.

Personal examples of my own with care that we went through for our son and your faith in the information that you’re being given is definitely affected when you don’t feel like one physician is talking to the other physician and you’re waiting months for an appointment then you get to the appointment and no one has talked to each other. It’s something that affects your entire life getting an answer to this. I think it takes compassion and empathy and an incredible amount of energy to be able to provide that for the patients. It is not easy. I definitely don’t sit here saying that what we do everyday is easy or simple.

It is incredibly complex. It takes an incredible amount of communication among our staff, putting systems in place so that we know from one day to the next what has been done, what has been communicated about that patient and what has been … what actions have been carried out. It does, it takes a lot of energy. It takes an army to be successful at it. I think we can do it. I think providing that support for the physicians and gaining their trust in what we’re able to provide will only help to cultivate that so regardless of what happens with healthcare reform, whether the physicians are going to go more into their own private practices like the MDVIPs of the world or stay in the traditional settings where there’s PAs and MPs that you see a lot. We’re there to do our part no matter what. I think that’s really important.

Lisa:                Dr. Cavanaugh, part of what I think happens with UNE is also attempting to do a lot of collaborative work, but to also help translate what has been found from the research and the educational setting into more of a clinical setting and the relationship setting. Has this become more of a priority that you’ve noticed over the years?

James:            Yeah absolutely. In fact, I chose after I went back to school and got another degree and embarked on this research career, I specifically chose because it’s important to focus my attention on this translation piece that you just mentioned, taking what’s been done under controlled conditions and laboratories and making it work in the community. There is a gap there. To have people who are working to take what sometimes comes across as very sophisticated technical information and putting it in terms that everybody can use and use in a way that it was intended for the purposes that it was intended, is important. That’s why for me working with Jacqueline and the MOG and the people with, folks with Parkinson’s disease, that’s where all that comes together and what makes it so exciting.

Lisa:                When I was looking at the MOG website, I was noticing things like Tai Chi for Parkinson’s and I think yoga for Parkinson’s and maybe also yoga for MS, definitely programs that are more integrative in their scope. Is there a research out there that suggests that things like Tai Chi and yoga might be good for neurologic issues?

James:            Yes. For folks with Parkinson’s disease, research today supports the idea that exercise is good. I think we all would’ve guessed that on our own. The form of exercise or the form of movement that can benefit folks with Parkinson’s is actually, there are a lot of choices, whether it’s walking on a treadmill at a certain pace or a yoga class or a Tai Chi class or dance, just dancing with a partner. There are variety of different modalities that can benefit folks and so that’s really important because there are some people and perhaps a lot of people in the world who the thought of going to a gym and sitting in front of a machine and lifting weights is really not appealing at all.

To know that there are options and choices based on one’s personal preference that one can take advantage of and achieve similar outcomes as somebody who was lifting weights. That’s really nice for the person on the street who’s just looking for something that will appeal and allow them to sustain that behavior for a long period of time.

Lisa:                I agree. I think it is the notion of play and the notion of actually doing something, not adding another thing that feels like a ‘should’ into a life that for most people feels like has a lot of ‘shoulds’. It’s something additional that is enjoyable and that goes back to the motivation piece over the longer term. Is it especially important to be dealing with, when you’re talking about neurologic conditions, MS or multiple sclerosis or Parkinson’s disease that don’t necessarily have what we would consider to be a cure? Is it especially important to be more creative about the way we approach things like exercise?

James:            I’m not sure that it’s important to be more creative. To me, the more choices, that generally speaking that’s better for anybody. For many people who have this degenerative health conditions whether it’s arthritis or Parkinson’s or multiple sclerosis, for many of them especially early on, there’s a sense that while there’s no cure, I’m doomed. This is the end of the road for me. What many people fail to appreciate is that that’s not true. The reason why it’s not true is because as someone becomes more immobile as a result of whatever the health condition is. They become weaker and unsteadier and deconditioned, if you will, partly as a result of just being immobile.

There’s really two things going on here. One is the disease process makes it harder to move around so then people don’t move around as much and they get weaker because they’re not moving around. If they are able to find some outlet, whether it’s the MOG or something else that works for them, the consequences of being immobile are reversible. The consequences of the primary disease process may not be all that changeable but the immobility part is absolutely changeable and so yes, it’s important that people look for and take advantage of these options to move around as much as they can because they can. We believe it’s still … There’s a growing hypothesis that people who are able to sustain their activity levels for a long period of time are potentially able to alter the rate at which their function diminishes over time. That’s really important.

Lisa:                When you and I were speaking yesterday, you talked about often things go in the other direction as somebody gets a diagnosis and they feel as if they’re more immobile. It’s sort of a self-fulfilling prophecy to become more and more immobile and their lives become less and less complex and they’re challenging fewer of their muscles and their nerve cells so they’re actually kind of going against what they need to be doing in order to continue to sustain a healthy life.

James:            Right, right. Most healthy individuals who are relatively active and mobile, if you look at their patterns of activity, their patterns of behavior from one day to the next, one week to the next, there’s a lot of variability. One day you go to the doctors. The next day you’re at the gym. The next day, you go to the park with your kids and so on. As people become more limited from a health condition, their daily patterns tend to be more predictable and structured and that lack of variability over time is believed to sort of contribute to the overall decline. Anything that would help somebody not only be mobile but to be able to exercise choice and so that on any given day, they can go out and do something different or exciting, something … that’s a really an important part of health.

Lisa:                We’ll return to our interview in a moment. We in the Dr. Lisa Radio Hour and Podcast hope that our listeners enjoy their own work lives to the same extent we do and fully embrace everyday. As a physician and small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marci.

Marci:             So did you ever wonder why geese fly in a V formation when they head South for the winter? Amazingly they know that a V pattern increases their speeds by more than 70% versus flying in another pattern or alone. When in formation, they share the leadership and have a mutual respect for their common goal which is to arrive safely at their destination. They equally divide the hardest tasks, gather their faculties and combine their resources and talents. This unified effort, their formation makes the journey easier.

Less energy is expended because they are all working together for a common cause. When the leader tires, he goes back to the end of the formation and another team member takes the lead. Each goose or a member of the team uses their voice or quack to encourage the leader to stay focused and to keep organized. How does the V formation of migrating geese apply to running your business or your household? In a word, team. A group working together to accomplish and achieve the same goal with mutual respect and understanding. Those teams will always come out ahead unlike the lowly seagull who scavages and shouts mine, only looking out for its own best interest without ever seeming to get anywhere. Geese are unified and always looking out for each other, applying the law of least effort and gaining the most. It’s a lesson we all could learn.

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Lisa:                We do know also that people who have well not only Parkinson’s, MS but also things like arthritis and things like heart disease, we know that there is actually a psychological, emotional component. Depression is something that comes up a lot for these populations. There’s even one more reason why people should be exercising that goes beyond the physical.

James:            Right.

Jacqueline:   Absolutely.

James:            The partnership part that Jacqueline was speaking of a few minutes ago, that’s really important too. If you’re somebody in the community who was recently diagnosed with Parkinson’s disease, for example, although we could substitute any health condition and you’re feeling lonely like you’re the only one who knows what it’s like, the knowledge that there’s a place in the community that has targeted programs for folks with chronic health conditions who understand, who know what the barriers are and are working to address those. That partnership, that ability to form that relationship is a very powerful tool in your toolbox of things that you use to sort of move forward.

Jacqueline:   To speak to the special populations that we offer programs for, I think in terms of the modality of exercise, there’s nothing that’s magic about that. I think the staff that are providing the service are knowledgeable about the symptoms that the participants will experience and I think that’s really important. I think what we’re providing, one thing we evaluate in the Parkinson’s population, it’s called the PDQ 39. It’s a 39-item questionnaire about their quality of life and how they perceive life from mobility to activities of daily living to something called stigma and do they feel like they have to conceal their Parkinson’s from the public if they go out to the grocery store.

When it comes to Tai Chi or yoga, I think any modality like that like Jim had spoken to, the variety that you’re offering, your body and the challenge that you’re imposing on it will always be more beneficial than doing the same thing everyday. I think what we’re trying to provide the participants is that variety with the comfort of being surrounded by fellow peers that struggle with the same thing. They’re not coming into it feeling embarrassed or shameful or nervous about having to be in a yoga or a Tai Chi class with someone who isn’t experiencing those symptoms.

Everybody has something that they come into an exercise class with, insecurities or am I going to be as flexible or am I going to fall or am I not going to be able to do it. I think the cohesiveness of the groups is huge and so the Tai Chi doesn’t necessarily differ that much from a Tai Chi class that’s offered to any other population other than the level of understanding of the symptoms and modifications that need to happen but also providing that avenue for you to be in a room and to just let go and understand that the person next to you may have tremors too and may not have good balance. You’re comfortable to try different things and everyone is very supportive.

Lisa:                That’s an interesting point because I know that when I’ve had patients that I’ve tried, I’ve said Tai Chi, Qigong, yoga, here are some options. Sometimes, and these are patients who may or may not have anything wrong with them that’s limiting their ability to exercise. Sometimes, there’s a sense of competition like they have to sort of pre-train before they can go to a yoga class or they can go to a Tai Chi class or even maybe worse, they go to a class and they overdo it but they don’t have any way to know what the modification should be and maybe they haven’t spoken to the instructor. That kind of leads you down a bad path. It’s interesting to have that similar starting place for all of the patients who are in those classes that you’ve described.

James:            Yeah, actually I mean I think it’s important for folks to know that when they come to the MOG, nobody comes to the MOG and just thrown into an exercise class. It doesn’t work that way. They come to the MOG and they meet the staff. They go through a comprehensive medically-oriented, physically-oriented evaluation. It’s out of that, that the MOG staff learned about the patient’s preferences, their previous history of exercise. The MOG staff is able to judge sort of what level of exercise would be best for them given their health condition and any other associated factor.

You’re not just joining a class. You are being given an individualized, customized routine with support and then you’re often, but not always, plugged in to a group format where you carry out your routine where everybody else is doing their version of it and working together. It’s not just … What you just described is exactly right. People who have a bad experience coming in the door to when they go to a gym or whatever are unlikely to go back. I think the MOG is unique in that way in that they really work to keep people engaged by giving them something that works for them.

Lisa:                There is of course this slightly older population for whom sports and childhood wasn’t necessarily a given. My mom talks about coming along before the equal rights changes brought girls in on the playing field. She didn’t have an exposure to sports when she was growing up. She’s not that old. She hasn’t retired yet. She’s still in that boomer phase and I … There’s a whole segment of the population that’s like that for whom physical activity really wasn’t … It wasn’t something that was done, at least not formally. Do you think that your approach can be helpful in that way?

Jacqueline:   Absolutely, because I think we can make exercise something other than just exercise. One of our taglines, we’re a Medically Oriented Gym but we’re also more than an ordinary gym. I think a lot of people come with the thought that they’re coming to exercise but they’re coming to socialize which is a huge aspect. We take their mind off the fact that they’re coming to do this tedious exercise routine because that’s not really what we’re providing.

We will provide that if that’s what they want which a lot of people come in and say I really want to go through this very structured, very challenging exercise program but a lot of people come in, they don’t like to sweat. They don’t like to feel the soreness of their muscles. They don’t like the feeling of the fatigue. I think a huge part that comes out of this is education. We really take the time to educate the participants on the benefits and why they’re seeing benefits. Again, a passion of mine is the heart. The heart is our engine.

I think it’s really important for our members to understand that our body does not live in compartments and if your heart is not strong, then your ability to do anything will be compromised. Again, there’s piles and piles of evidence around the fact that the stronger your heart is, the reduce risk of mortality or early death from a heart event. To speaking to what you said before, I think one of the most empowering things I learned in my time in cardiac rehab was our ability to teach the participants that cardiac rehab isn’t about teaching you what you can’t do anymore, it’s about teaching you what you can do and can continue to do.

These inspiring stories of people turning their lives around and finding things that they love because they’re motivated to be healthy and stay strong and their spouses and partners and family get into it as well. Their goals might be canoeing with their grandchildren or grandchildren, being able to travel. We just got a pictures from one of training Parkinson’s participants who’s now in Italy traveling around and walking and seeing the sights. That’s what keeps them going. I think

there is a huge component to sports and activity and exercise was not always a part of … and certainly not structured exercise. A lot of it was busy work activities to daily living very early on, the farming and whatnot, chopping wood to now more structured exercise and busy lives but we can really fit … we can fit exercise into any component of somebody’s life.

James:            For people with Parkinson’s, specifically who didn’t think … who may have been a non exerciser before, the notion that you can come to some place and receive some education and training and have the opportunity to participate in the program has at times change people’s outlook about what the experience of living with Parkinson’s is going to be about. Jacqueline mentioned the person a few minutes ago who recently traveled to Italy. I don’t know that person specifically but my guess is they couldn’t have imagined prior to starting the program that that was in their future because of what they had experienced with Parkinson’s disease.

There are a lot of examples of people who, even though that they may not ha- … It’s not like we’ve turned them into a whole new person but making a series of small little changes, seeing small little improvements that over time have sort of accumulated that then all of a sudden allow them to do something fairly significant happens routinely. Somebody who, for example, comes in to the MOG with Parkinson’s who one of their fears is that they’re going to fall because they’ve had that experience. It’s common with people with Parkinson’s. For them to go through a program or to spend a few months at the MOG and if the main outcome for them is that they’re no longer worried about falling, that’s a significant improvement. There are stories that are like that. They’re all unique to the individual because everybody has their own little thing that they find important.

Lisa:                How can people find out about the work that you’re doing with the University of New England?

James:            Yeah, so the Parkinson’s research work, one of the benefits of being a partner with a place like the MOG and with Jacqueline is that for me the most important thing to promote is how the work benefits people with Parkinson’s disease, people in the community. The MOG, because Jacqueline and company did such a great job at it, is a great way to promote that work.

The plan is to routinely make available the brief summaries of our work at the MOG and the projects and descriptions and the scientific poster of the last research project is now at the MOG and so on. The short answer to that question is look at the MOG website. The university website is full of lots of information that have nothing to do with what I do. If you really want to know what this is all about, go to the MOG website.

Lisa:                Jacqueline, what is the MOG website?

Jacqueline:   The MOG website is www.mainemog.com, so M-A-I-N-E-M-O-G dot com. We also have a blog that you can link to through that, my MOG blog that has a lot of interesting stories and informational things from kind of explaining scientific literature that comes out so that it can be easily understood by the lay person. We do a lot of that. We also have someone who does nutrition blogging, kind of everything so a lot of the blogs about Parkinson’s and Tai Chi and whatnot will be there as well. Email is there so anyone can send an email at any time. We’ll also have an article in the Maine Health Learning Resource Center Parkinson’s newsletter this month. That will be out as well. It’s all about kind of our collaborative relationship with UNE.

Lisa:                I’ve been very privileged to spend this time with you today. We’ve been talking with Dr. James Cavanaugh, who’s an assistant in the Department of Physical Therapy at the University of New England and also exercise physiologist Jacqueline Morrow, one of the co-owners of the MOG or Medically Oriented Gym in South Portland. Thanks for being a part of our show and to share all the wonderful work you’re doing.

James:            It’s been a pleasure.

Jacqueline:   Thank you.

Lisa:                You have been listening to the Dr. Lisa Radio Hour and Podcast show number 83, Rethinking Parkinson’s. For more information on our guests, Dr. James Cavanaugh and Jacqueline Morrow of the Medically Oriented Gym, please visit doctorlisa.org. The Dr. Lisa Radio Hour and Podcast is downloadable for free on iTunes.

For a preview of each week’s show, sign up for our e-newsletter and like our Dr. Lisa Facebook page. You can also follow me on Twitter and Pinterest, doctorlisa, and read my take on health and well-being on the bountiful blog, bountiful-blog.com. We do love to hear from you so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows.

Also, let our sponsors know that you have heard about them here. I’m privileged that our sponsors enable us to bring the Dr. Lisa Radio Hour to you each week. This is Dr. Lisa Belisle, hoping you have enjoyed our show on Rethinking Parkinson’s. We dedicate this show this week to Dr. Kenneth Nye, my Yarmouth High School principal and also to all those out there and their families who are dealing with Parkinson’s disease. Many of us come to the place where we believe that we could ski the loop before it gets dark, as Dr. Nye suggested in his poem, Going Home at Twilight and ultimately find that our time may be more limited. I’m sure that our listeners just as Dr. Kenneth Nye did, will spend that time in the most meaningful way possible. And in the dwindling light, we’ll see the trail and know that the trail will bring them home. Thank you for allowing me to be a part of your day. This is Dr. Lisa Belisle. May you have a bountiful life.

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The Dr. Lisa Radio Hour and Podcast is recorded at the studios of Maine magazine at 75 Market Street in Portland, Maine. Our Executive Producers are Kevin Thomas and Dr. Lisa Belisle, audio production and original music by John C. McCain. Summaries of all our past shows can be found at doctrolisa.org. Become a subscriber of Dr. Lisa Belisle on iTunes. See the Dr. Lisa website or Facebook page for details.