More and more research is finding that exercise may be particularly helpful for people who have neurologic conditions—with benefits seen in movement, balance, and even cognition. For example, in people with Parkinson's disease (PD), studies have found that mind-body practices such as tai chi create positive changes in mobility and stress levels. (See http://bit.ly/WdjHjO, http://bit.ly/YJGXWU.)
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Lisa Shulman, M.D., professor of neurology at the University of Maryland School of Medicine, director of the Maryland Parkinson's Disease and Movement Disorders Center, and Fellow of the American Academy of Neurology, has studied the positive effects of exercise on people with PD. For example, she recently completed a study comparing treadmill walking to resistance exercise (using weights) in people with PD. “We found that patients with PD who did the treadmill exercise improved their cardiovascular and aerobic conditioning but not their muscle strength. And those patients who used weights showed an improvement in muscle strength, but not in aerobic conditioning,” Dr. Shulman says.
In other words, various types of exercise can be beneficial—just not all in the same way. For PD in particular, mindfulness—paying attention to body movements—may be an important element of exercise because many patients experience a disconnection between the mind and body, according to Dr. Shulman.
Mindfulness is central to the exercise practice known as Nia, which has become increasingly popular among people with PD. Debbie Rosas, co-creator of Nia, tells Neurology Now, “Walk into a Nia class for PD and you'll see people of many ages—some standing, some sitting, some with their caregivers—guided to move in their own way and in their own time. You'll see whole-body movement and detailed movements of the fingers, feet, pelvis, chest, and head. You'll hear people using their voices and singing to help integrate the breath and body.”
THE ORIGINS OF NIA
As a young child, Rosas experienced several medical conditions—all affecting the senses in some way, she recalls. She had constant ear infections, severe dyslexia, and a lisp—all of which were barriers to communication with teachers and peers in school. “I always felt different,” she says. Her experience with “the body,” she says—as if to underline that it didn't feel like her body—was one where “there was something wrong with me. I felt that everybody else had intelligence that I didn't have.”
Rosas graduated from high school and attended community college. But after the birth of her second child, she experienced serious depression. Someone suggested she try exercise as therapy. When she began to exercise, Rosas says, the depression lifted.
In 1976, Rosas and a friend created an exercise studio called The Bod Squad. But six years later, Rosas felt something was missing. So with Carlos AyaRosas (her then-husband and colleague), she created Nia, a sensory-based movement practice that draws from martial arts, dance, and healing arts. Rosas, who is now 62 years old, continues to teach, practice, and train new teachers in Nia. She still believes in “the wisdom of the body—that everybody can learn, everyone can feel better, no matter if they're well or not,” she says.
NIA FOR PD
Nia is taught in 49 countries by 2,500 teachers. Classes are open to anyone, with or without a specific medical problem. However, many people with chronic health conditions—such as PD, fibromyalgia, autism, arthritis, and cancer—have found Nia beneficial.
Recently, Nia has been incorporated into several comprehensive treatment programs for PD. For example, the Edmond J. Safra Parkinson's Wellness Program, a partnership between New York University Langone Medical Center Parkinson's and Movement Disorders Center and the Jewish Community Center (JCC) in Manhattan, incorporates Nia in their efforts to treat PD through medicine, therapy, exercise, support, and community engagement.
Amy Lemen, L.C.S.W., a clinical neurology social worker and the program supervisor, says, “We've developed a welcoming hub for the PD community. Some people with PD experience isolation, shame, and stigma. We've really worked to reduce that as much as possible through education, engagement, and action.”
When she learned about Nia, Lemen recalls, “It was like a light bulb turned on. We realized that Nia was a perfect fit for our PD patients because it incorporates movement, rhythm, vocalization—and it's fun. Also, Nia aims to take advantage of the brain's ability to adapt—even to injury and disease—throughout life.” The response has been enthusiastic. “In our other fitness classes, we try to keep a low student to teacher ratio of 8 to 10, but we've had an overwhelming response to Nia, with some classes as large as 25 people,” Lemen notes.
Nia has not been studied for its effect on PD symptoms. However, some studies have shown improvement in PD with tai chi, Dr. Shulman tells Neurology Now. “Tai Chi focuses on balance and mindfulness of movement, a philosophy which seems to be shared by Nia.”
Some people with PD say Nia has helped them with balance, strength, endurance, and vocalization. Anecdotally, Lemen says, they are hearing a lot of stories from participants about their increased confidence in mobility, as well as the benefits to depression and anxiety. “They're getting a sense of ‘I can do this,’” in the Nia group.
Caroline Kohles, senior director of health & wellness at the JCC, teaches classes on Nia for PD. “In any Nia class, we work with patterns and repetition,” she says, noting that repetition can be very helpful to people with PD who are trying to enhance their movement and speech. She also makes room for robust self-expression. “One of the things that I do specifically with my students who have PD is to get them to sing. Since PD affects the voice, I really want them to be as expressive as possible,” she says.
Most importantly, Kohles says, “we want people to have a good time. If they are having a good time, they will remember the movement and engage in it more deeply.”
Some people with PD feel like their bodies have betrayed them, Kohles tells Neurology Now. “But in Nia, we ask the body, ‘How can we move you towards pleasure and out of pain?’”
Nia can be practiced by individuals at any stage of PD—from newly diagnosed to very advanced. Kohles has some students in class who exercise in their chairs and some caregivers who accompany them. “We just do not discriminate in any way—Nia embraces every b-o-d-y,” she says.
When Kohles asked her PD students what practicing Nia does for them, they told her: “Nia gets me out of the house,” “It helps us be fluid in all of our parts,” and “It uses all of us.”
Of course, you should see your primary care practitioner before enrolling in an exercise program, Dr. Shulman advises, regardless of whether or not you have a neurologic disorder. But in particular, “people with problems with balance need their exercise programs tailored for their individual needs to avoid the risk of falls,” she says. Dr. Shulman tells her PD patients that exercise is one area where they can do something important for themselves, and the best outcomes over time will come from a “combination of standard medical care, including medication, plus routine weekly exercise.”
Visit nianow.com, parkinson.med.nyu.edu/wellness-center, or jccmanhattan.org/parkinsons for more information and class schedules. And see page 40 of this issue for a “Speak Up” essay about dance for people with PD.