Rethinking Parkinson’s, #83

Jaclyn Morrill:

What we really try to do is serve a population that can't just go anywhere. There is a huge gap right now between the medical world and the community, and if we don't fill that void, we will not be able to provide sustainable change.

Dr. Jim Cavanaugh:

So 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. The consequences of being immobile are reversible. 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. And that's really important.

Dr. Lisa Belisle:

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, 2013. This week's guests will be University of New England Parkinson's disease researcher Dr. James Cavanaugh and Jacqueline Morrill, 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 benefited from his leadership, he was named Maine's principal of the year. In 1993, at age 60, Dr. Nye became a poet. He published four books of poetry, one of which included the piece Going Home at Twilight. Coming down the trail at twilight, I am 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 from childhood. His love of gardening, bird watching, travel, literature, tractors, riddle, joke, storytelling, swimming, sailing, ice cream, musicals, etc. 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 Cavanaugh from the University of New 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 Morrill, 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 meant to engage fully during each of the seven 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 Morrill. Thank you for joining us.

Dr. Lisa Belisle:

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, much broader scope than that, are sitting with me today. I have Dr. James Cavanaugh, who is

Dr. Lisa Belisle:

an assistant professor in the Department of

Dr. Lisa Belisle:

Physical Therapy at the University of New England, and Jacqueline Morrill, who is the

Dr. Lisa Belisle:

owner of the Medically Oriented Gym, or MOG in South Portland.

Dr. Lisa Belisle:

So 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.

Dr. Jim Cavanaugh:

It's good to be here.

Dr. Lisa Belisle:

Yes.

Jaclyn Morrill:

Thank you.

Dr. Lisa Belisle:

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

Jaclyn Morrill:

For about three years, I was working in the area of cardiac rehabilitation with Maine Medical center. And we, in that time, just started to realize more and more the need to work within a, you know, multidisciplinary practice where we kind of live in these professional silos and focus on the patient with the issue that they're referred to us for. But there's a lot more that goes on to that. And when we. 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 comorbidities 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 that time. It was about three years ago. And we started to collaborate with the physical therapist there, and 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. And so it was really phenomenal to be able to be part of that, you know, 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 are 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 that's been pretty phenomenal to be able to be a part of.

Dr. Lisa Belisle:

Explain to me what the difference between

Dr. Lisa Belisle:

physical therapy and exercise physiology is. And 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. So you want to take a stab at that.

Dr. Jim Cavanaugh:

Sure. So physical therapy is a health profession in which the providers, the therapists see folks from across the lifespan. And the general focus of the interventions are to improve people's ability to move around so they function better in their daily lives. And so 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. And so 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.

Dr. Lisa Belisle:

And you have a specialty that I found kind of intriguing. So you have a special.

Dr. Lisa Belisle:

You're a clinical specialist in neurologic physical therapy.

Dr. Lisa Belisle:

Most of us, when we think of physical therapists, we think more of bones and joints and muscles. But yours is a little bit different, right?

Dr. Jim Cavanaugh:

Probably 20 years ago or so, the profession developed these clinical specializations. So these are licensed physical therapists who've had a minimum of two years of experience, most of which has been in a dedicated practice area working with a specific population, like folks with neurological issues. There's an exam, an examination, a written exam that's required, and upon passing the exam, you're awarded the specialization credential. And so what that means for folks in the community is that if they're searching for a physical therapist and they have a specific issue, one way to go about determining whether or not you can, or one way to go about finding an expert is to look for the specialization credential.

Dr. Lisa Belisle:

So if somebody has Parkinson's or Ms. Or ALS or something that's neurologically oriented, they could find somebody.

Dr. Jim Cavanaugh:

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.

Dr. Lisa Belisle:

And how might people interact with an exercise physiologist?

Jaclyn Morrill:

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. So 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. So, you know, 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. And so we've matched those two. The other profession that we have, who. My partner, Chris Pribish, is a licensed athletic trainer and strength and conditioning specialist who has worked in the area of physical therapy. For 10 plus years. And so 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. And so 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. And so everything that happens at the level of your feet can affect your shoulders and your neck and your knees and vice versa. And so 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.

Dr. Lisa Belisle:

Dr. Kavanaugh, you're an assistant professor in the department of Physical Therapy at the University of New England. And I know that the University of New England has just, I don't even want to say exploded, but exploded literally a lot. 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?

Dr. Jim Cavanaugh:

Yeah, in addition to this movement towards more health promotion, injury prevention, the other area that 25 years ago when I trained that was virtually non existent was they had to do with measurement. And so currently physical therapy students in training learn 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 healthcare reform and continued 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 payers, et cetera. So measuring outcomes is really important. So that particular thing and communicating those outcomes not only to third party payers, but to physicians and family members of the patients themselves is a really growing. Has become a very important area of the practice.

Dr. Lisa Belisle:

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.

Jaclyn Morrill:

Oh, thank you.

[Unidentified voice]:

I didn't come up with it.

Jaclyn Morrill:

I can't take credit for that.

Dr. Lisa Belisle:

But yeah, but I don't think. But mog, I mean it's such a stupid. 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. So talk to me about that.

Jaclyn Morrill:

So it was a 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 and that that happens every year. So he had approached us about doing a research study with Parkinson's patients. And so 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? And that required us to reach out to Terry Ellis at Boston University, and 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. So 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. 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, and it's just continued to grow from there. And 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. And 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 diagnoses 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. But the body also has other needs outside of that disease state. And there's a lot that's unknown about the benefits with Parkinson's. And 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.

Dr. Lisa Belisle:

We'll return to our program in a

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

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Dr. Lisa Belisle:

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, and 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?

Dr. Jim Cavanaugh:

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. And 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. So you're right. There is a rather large body of literature that supports 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. And 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. So 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 studies, reproduce them in a real life community wellness facility that is dedicated to people with chronic health conditions. And we were successful. It was a small study, but we felt good about the outcomes that were achieved by the participants.

Dr. Lisa Belisle:

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.

Dr. Jim Cavanaugh:

Correct. I was talking a few minutes ago about the importance of measurement. So 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, 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 by the numbers, I guess, in quantitative terms, is really important for people.

Dr. Lisa Belisle:

Jaclyn, why do we need a medically oriented gym? There's so many gyms out there. How is your gym different?

Jaclyn Morrill:

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. And if we don't fill that void, we will not be able to provide sustainable change. And I think the other thing that's really exciting too is as going through school and pursuing my advanced degrees, 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 and the healthcare reform and providing the residents of Maine services that are found in other parts of the country. But when we. There's 11 other Mogs in the country. And 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. And it's really an honor to feel like we can be a leader and 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. And it's opened numerous doors. And 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 stop someone from coming in to exercise. Well, our members and our patients will come in no matter what. And maybe that day they have to have heat and stim to help them get through that flare up of sciatica. And 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. And 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 to pass and continue on. And I think being outcome based, research based, and really dedicated to the long term is something that we're very proud of.

Dr. Jim Cavanaugh:

I just wanted to say that from my perspective as somebody who works in a university setting, that one of the unique things about the MOG for me is that it is what is increasingly becoming known as an interprofessional practice. Very unusual in a community wellness setting. Not so unusual in hospital or rehabilitation settings, but in a community wellness setting, to have an exercise physiologist, physical therapy and athletic training working together with and for patients and their caregivers or whoever is unusual. And it is where medicine is going in general. And so if you're looking for reasons that to distinguish the MOG from other types of. That would be a really strong point. Yeah. And then the other thing 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 provided on that day so that the person, hopefully tomorrow comes back and can resume their program. So 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. And so 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.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

I think it is very compelling that we've 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 that we all think as individuals and within our society. Jacqueline, I think you had some experience with maybe relationships not being Always there within the traditional medical community. And did that influence your decision to go towards more of a relationship, patient centered care model?

Jaclyn Morrill:

Absolutely. You know, 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 those pieces, ultimately success will not happen for that person. And so seeing the transition that has happened in healthcare and trying to empathize with the demand and the challenge that is being put on physicians to see a certain number of patients every day in 15 minute blocks and, you know, 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 and you get to the appointment and no one has talked to each other. And it's something that affects your entire life getting an answer to this. And I think it takes compassion and empathy and an incredible amount of energy to be able to provide that for the patients. And it is not easy. I definitely don't sit here saying that what we do every day 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 one what has been done, what has been communicated about that patient and what actions have been carried out. And it does. It takes a lot of energy and it takes an army to be successful at it. But I think we can do it. And 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. 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 NPs that you see a lot. We're there to do our part, no matter what. I think that's really important.

Dr. Lisa Belisle:

Dr. Kavanaugh. 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?

Dr. Jim Cavanaugh:

Yeah, absolutely. I mean, 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 in laboratories and making it work in the community. So there is a gap there. And 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. And so 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.

Dr. Lisa Belisle:

When I was looking at the 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.

Dr. Lisa Belisle:

Is there research out there that suggests

Dr. Lisa Belisle:

that things like Tai Chi and yoga might be good for neurologic issues?

Dr. Jim Cavanaugh:

Yes. For folks with Parkinson's disease, research to date supports the idea that exercises good. I think we all would have guessed that on our own, but the form of exercise or the form of movement that can benefit folks with Parkinson's is actually, there are a lot of choices. And so whether it's walking on a treadmill at a certain pace or a yoga class or a Tai chi class or dance or just dancing with a partner, there are a 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. And so 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 can was lifting weights, well, 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.

Dr. Lisa Belisle:

I agree. I think it is the notion of play and the notion of actually doing something, not adding another thing that feels like 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,

Dr. Lisa Belisle:

is it especially

Dr. Lisa Belisle:

important to be dealing with when you're talking about neurologic conditions, Ms. or multiple

Dr. Lisa Belisle:

sclerosis or Parkinson's disease that don't necessarily

Dr. Lisa Belisle:

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?

Dr. Jim Cavanaugh:

I'm not sure that it's important to be more creative. To me, the more choices, generally speaking, that's better for anybody. But for many people who have these 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. And what many people fail to appreciate is that that's not true. And 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, being immobile. So 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. So 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, 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. And that's really important.

Dr. Lisa Belisle:

And 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. They become more and more immobile and their lives become less and less complex and they're challenging cure 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.

Dr. Jim Cavanaugh:

Right? Right. People, healthy, 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 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. And as people 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. So 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 they don't want. That's a really important part of health.

Dr. Lisa Belisle:

We'll return to our interview in a moment. We on 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 every day. As a physician and small business owner,

Dr. Lisa Belisle:

I rely on Marcy Booth from Booth, Maine to help me with my own

Dr. Lisa Belisle:

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[Unidentified voice]:

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Dr. Lisa Belisle:

And we do know also that people who have, well, not only Parkinson's, Mississippi, but also things like arthritis and things like heart disease, we know that there is actually a psychological, emotional component. I mean, depression is something that comes up a lot for these populations. So there's even one more reason why people should be exercising and that that goes beyond the physical, right?

Jaclyn Morrill:

Absolutely.

Dr. Jim Cavanaugh:

And the partnership part that Jaclyn was speaking of a few minutes ago, that's really important too. So 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 is 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 to

Jaclyn Morrill:

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. But I think what we're providing. One thing we evaluate in the Parkinson's population is it's called a PDQ 39. So it's a 39 item questionnaire about, you know, 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, you know, their Parkinson's from the public if they go out into the grocery store or. And so 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 every day. And so 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. So 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, you know, someone who isn't experiencing those symptoms. And, you know, everybody has, has something that they come into an exercise class with insecurities, or am I, am I going to be as flexible or am I going to fall, or am I not going to be able to do it? And I think the, the cohesiveness of the groups is huge. And so the Tai Chi doesn't necessarily differ that much from a, you know, 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 and you're comfortable to try different things. And everyone is very supportive.

Dr. Lisa Belisle:

That's an interesting point because I know that when I've had patients and I've tried, I've said tai chi, qigong, yoga. Here are some options. Sometimes these are patients who may or may not have anything wrong with them that's limiting their ability to exercise. But 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

Dr. Lisa Belisle:

worse, they go to a class and

Dr. Lisa Belisle:

they overdo it, but they don't have any way to know what the modifications should be. And maybe they haven't spoken to the instructor. So that kind of leads you down a bad path. And it's interesting to have that similar starting place for all of the patients who are in those classes that you've described.

Dr. Jim Cavanaugh:

Yeah, actually, I mean, I think it's important for folks to know that when they come to the Mogul, nobody comes to the MOG and is thrown into an exercise class. It doesn't work that way. They come to the MOG and they meet the staff and they go through a comprehensive, medically oriented, physically oriented evaluation. And it's out of that that the MOG staff learn 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 factors. So 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 into a group format where you carry out your routine where everybody else is doing their version of it and working together. Right. So it's not just, you know, because 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. And 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.

Dr. Lisa Belisle:

And there is, of course, this older, slightly older population for whom sports in childhood wasn't necessarily a given. I mean, my mom talks about coming along before the equal rights changes brought girls in on the playing field, and she didn't have an exposure to sports when she was growing up. And she's not that old. She hasn't even. She hasn't retired yet. So she's still in that sort of 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. So do you think that your approach can be helpful in that way?

Jaclyn Morrill:

Absolutely, because I think we can make exercise something other than just exercise, you know, one of our taglines. We're a medically oriented gym, but we're also more than an ordinary gym. So I think a lot of people come with the thought that they're coming to exercise, but they're coming, you know, to socialize, which is a huge aspect. We take their mind off the fact that they're coming, you know, to do this tedious exercise routine, because that's not really, you know, what. What we're providing. We will provide that if that's what they want, you know, which. A lot of people come in and say, you know, 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. But 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. And again, a passion of mine is the heart. The heart is our engine. And I think it's really important for our members to understand that our body does not live in compartments. And, you know, if your heart is not strong, then your ability to do anything will be compromised. And again, there's, you know, piles and piles of evidence around the fact that, you know, the stronger your heart is, the reduced risk of mortality or early death from, you know, A heart event. And to speaking to what you said before, I think one of the most empowering things I learned in my time in cardiac rehab was, you know, 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. And 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, you know, get into it as well. And their goals might be canoeing with their grandchildren or grandchildren, being able to travel. We just got a picture from pictures from one of our Parkinson's participants who's now in Italy, traveling around and walking and, you know, kind of seeing, seeing the sights and that's what keeps them going. So 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, busy work activities of daily living very early on, the farming and whatnot and 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.

Dr. Jim Cavanaugh:

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 someplace and receive some education and training and have the opportunity to participate in a program has at times changed people's outlook about what the experience of living with Parkinson's is going to be about. And so Jacqueline mentioned the person a few minutes ago who recently traveled to Italy. And 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. So there are a lot of examples of people who, even though that they may not have, 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. So 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. And it's common with people with Parkinson's. And so for them to go through a program or to spend a few months at the MOG and if the main outcome for them is, is that they're no longer worried about falling. That's a significant improvement. So 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.

Dr. Lisa Belisle:

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

Dr. Jim Cavanaugh:

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. And the mog, because Jacqueline and company do such a great job at it, is a great way to promote that work. So we, the plan is to 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. So 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. So if you really want to know what this is all about about, go to the MOG website.

Dr. Lisa Belisle:

So, Jacqueline, what is the MOG website?

Jaclyn Morrill:

The MOG website is www.mainmog.com so m a I n e m o g.com and 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 layperson. So we do a lot of that. We also have someone who does nutrition blogging kind of everything. So a lot of, a lot of the blogs about Parkinson's and tai chi and whatnot will be, 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, so that will be out as well. And it's all about kind of our collaborative relationship with une.

Dr. Lisa Belisle:

Well, I have been very privileged to spend this time with you today. We've been talking with Dr. James Cavanaugh, who's an assistant professor in the Department

Dr. Lisa Belisle:

of Physical Therapy at the University of

Dr. Lisa Belisle:

New England and also exercised physiologist Jacqueline Morrill, 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.

Dr. Jim Cavanaugh:

It's been a pleasure.

Jaclyn Morrill:

Thank you.

Dr. Lisa Belisle:

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 Morrill of the medically oriented gym, please visit drlisabelisle.com 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 doctor and read my take on health and well being on the bountiful blog bountifulpath.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 the show this week to to Dr. Kenneth Nye, my Yarmouth High School principal, and also to all of 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 will see the trail and know that the trail will bring them home. Thank you for allowing me to be

Dr. Lisa Belisle:

a part of your day.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle. May you have a bountiful life.

Jaclyn Morrill:

Sa.