HM: What have you observed in terms of helpful/harmful therapies?
SM: I have found CAM to be very helpful in promoting relaxation, and also relieving anxiety which exacerbates symptoms.
From the relaxation perspective, we know that people with PD have hyperactive networks in the brain. We see this on MRI. The tremor and rigidity are physical signs, and procedures such as deep brain stimulation downregulate this hyperactivity.
Activities such as deep breathing and meditation calm down the nervous system. This has been studied and is a valuable skill for people with PD. Many of my patients have learned to control their tremor with relaxation exercises.
In my clinic, we also use a sound-based therapy called Vibroacoustic Sound Therapy. This is a bed that transmits vibrations and relaxes the muscles and cells. Each session lasts 30 to 60 minutes of lying down on the bed. After the session, people realize how good they feel when they take time to rest. Over time, they learn to achieve relaxation states at home with biofeedback or lifestyle regulation.
Yoga and Tai Chi are excellent because they promote mind-body connection and also retrain the nervous system for better movement, on top of facilitating a relaxed neurophysiological state.
HM: Does the quality of the instructor matter?
SM: Yes. Both the quality of the instructor, and also the relationship that develops over time between the patient and the provider. A therapeutic relationship itself becomes a catalyst for improved mood, motivation, connection, and a reliable collaborator to talk through health issues. One of the aspects that I am fascinated by, how can we as doctors cultivate an intentionally healing relationship.
A last prerequisite for complementary therapies, in my view, is that the patient ultimately develops capacity to govern his or her own health. it is about providing new awareness to our patients and giving them tools to understand when and why their bodies are out of balance. It's not just medications that help them feel better, but their choices on a day to day basis that determines what kind of a day they are able to have.
HM: Do you have any patients who do not want to take or can't take medication for their PD? Have they had any reasonable alternatives?
SM: The use of CAM works alongside medications. I have had patients seek me out who prefer to avoid medication and it's a case by case basis. One of the nice things about CAM is how many options there are. From lifestyle coaching to acupuncture, massage, yoga or meditation—we can customize a unique plan for each person, accounting for their individualized preference. And typically, this plan includes medications in addition to other activities they enjoy and benefit from.
HM: Are there any exercises that you don't recommend for patients with PD to do on their own due to safety?
SM: It really depends on the situation. It is important to have proper instruction for any new physical exercise. Movement classes can be particularly tricky, because group classes can have variability and there is risk of injury. Safety should always be considered first and foremost for someone who hasn't exercised before;; consider 1:1 training before joining a group class.
HM: Do you think any particular exercises are more suited/easier for patients with PD to do on their own?
SM: The best exercise or activity is something that a person naturally is interested in. Since there are so many options, aligning with a person's preferences and interest has much more chance of success.
For those who are not sure, I focus on simple and clear instructions, and small achievable goals. For example, if stress is an issue, following a guided meditation or breathing practice every day for a week is a good place to start. For people who are sedentary, purchasing an activity tracker gives them new insights into how many steps they take each day, or how sleep quality improves when they are more active. Whenever a new exercise is started, I recommend that patients start a journal, so they can keep track of the impact.
Ultimately, CAM is about helping each individual regain ability to take control of their health- to whatever extent that they can. It's an encouraging and inspiring field, because we see people feel better, and they learn to achieve this themselves.