(gentle upbeat music) - Hi, I'm Margaret Preston, President of Power Over Parkinson's. And today, in conjunction with our POP Profile Series, we have Dr. Daniel Corcos, Professor of Human Physical Therapy and Human Movement Sciences at Northwestern University. Dr. Corcos, thank you so much for being with us today. - Margaret, thank you so much for inviting me. I'm really delighted and honored.
- Yeah, we're thrilled to expand on our Profile Series, and certainly someone with your background can share a lot of light to our community here in Richmond in Central Virginia and beyond. So thank you. As we begin with our discussion, I'd like for you to tell our listeners, share a little bit about what led you into a career in neurology and specifically Parkinson's disease. - So I got my PhD at the University of Oregon, and I studied how one controls limb movement.
I then went on and had a post-doctoral fellowship, where I continued to study how one controls limb movement and the muscle activation patterns that underlie limb movement. I wrote a series of papers in which we really began to fully understand how the brain activates muscle to control movement. And once we had that all worked out, I then started to ask myself, well, is it interesting to ask questions about disease?
And I started to look at the literature on Parkinson's disease and how people with Parkinson's disease activate their muscle to make movements. And I decided that this would be a good avenue for me to follow. So I wrote to an NIH grant to study movement patterns in people with Parkinson's disease, and I went to the Institute of Neurology in England in 1994 to 1995. At the time, the Institute of Neurology had arguably the most famous movement disorder specialist in the world there.
His name was Professor C. D. Marsden, who has written extensively about Parkinson's disease, movement in Parkinson's disease, the pharmacology of Parkinson's disease. There was also Professor John Rothwell who is a world famous expert on muscle activation in people with Parkinson's disease and all neurological diseases. So Professor Rothwell and I, we designed a study, very simple study.
We just wanted to know whether people with Parkinson's disease become weaker when you take them off their medication. So we studied people with Parkinson's disease when we took them off their medication, and we demonstrated quite clearly that they become much weaker. That therefore told us that the dopamine deficiency was related to an inability to activate muscle, and this wasn't due to muscle disuse.
It wasn't due to doing less activity, because muscle doesn't change that quickly, but medication does. So we showed that the neural drive to muscle is compromised when you come off medication, and then we published several papers on that. I then asked myself the question, well, if a person is weak, what do you do about that? Well, you give them strengthening exercises.
So I wrote another NIH grant in which we did a two year study of progressive resistance exercise and its benefits on people with Parkinson's disease. We published the results of that paper in 2013 and showed that the signs and symptoms of Parkinson's disease are reduced when you work out with weights. Surprisingly at the time, but not surprisingly now, we also showed from the same study that when you work out with weights, when you get stronger, you also improve your cognition.
So we had people take various tests of cognition, basically related to attention, executive function, and the people improved over the two year period, whereas normally we would expect a decline. In that part of the study, we didn't find a dramatic difference between resistance exercise and another more gentle form of exercise, but both exercises improved cognition. It was also very clear if you looked at CDC guidelines at the time that exercise is good for people.
Guidelines coming out are very clear, and so my colleagues and I thought, well, endurance exercise is probably good for people with Parkinson's disease. And so we designed a phase two clinical trial for people with Parkinson's disease, and we published those results in 2018. And they showed clear benefit of high intensity endurance exercise for people with Parkinson's disease.
So my interest and my ability to understand Parkinson's disease probably started sometime back in 1993, to answer your question. - Okay. Well, let's dovetail off of that, because you've been working with Parkinson's and in the Parkinson's disease arena for quite some time. So the next question, I think, dovetails nicely. How do you remain?
And I like to, I should preface this that I like to ask a lot of my interviewees this question, because it is an inevitable decline, inevitable progression with this neurological disorder. How do you remain optimistic and hopeful as you continue to work and research in this space? - That's a good question. I'm generally an optimistic person, and so I think part of how I stay optimistic is I always see a glass half full and I never a glass half empty, and I think that's just my nature.
More specifically with respect to Parkinson's disease, I get several emails coming to me from people who really have decided to exercise, and it's very nice to read the emails. People express a real deep gratitude and thanks for the results of the research that has been done. So a third reason I stay very optimistic is that I give talks to people with Parkinson's disease. I've talked to state associations in seven different states.
On March 1, I gave a talk to 120 people in the San Francisco area. That's one of the reasons I have the bridge, the Golden Gate Bridge behind me. And when you actually see in a Zoom 120 people with Parkinson's disease actively engaged, taking ownership of their life, taking ownership of their disease, it gives you great reason for optimism. - Sure. - I understand that it's a very difficult disease for some people. I understand apathy. I understand the depression.
I understand the potential cognitive decline, and I understand why for many people, this is very, very difficult. But I also see a lot of people who have created a wonderful community for themselves, and who basically get on with life. I realize that life's a little bit harder. Parenthetically, I've just ruptured my Achilles tendon, and so I've been in a boot for a month. I'm in a hard boot for four weeks, and I fully realize that restricted mobility, just everything is harder.
Everything takes me longer. But at the end of the day, when I meet people, the feedback that I get is overwhelmingly positive. I'm also, by the way, this is very important, I'm fully aware that I very often reach out to the people who don't need any help, and there's still a lot of people out there who don't get access to the kind of help that they need. And so I don't want to underplay this, but I am, I am optimistic when I meet people.
And I think what POP is doing for people in Virginia is truly impressive, and I remain very optimistic. And I've had very, very little negative feedback. In fact, I've had none, and so I think, I think people want to look after themselves, and so I remain very, very optimistic. - Well, what you said certainly echoes the climate here in Virginia, in terms of what we've seen, in terms of the positivity and that positivity creating really a community among people.
The socialization is just so important, and we see that here, and we see the optimism and the community that's established through the social events, the gatherings, the resources that lead people together. So I would certainly echo your sentiment that it's enriching to see, from a POP standpoint, the community that's established and that positivity, and that's a driving force for us as well. So I can certainly echo that. - Yep, absolutely.
- So, moving on, a lot of your research, the premise of your research and your work really stems from exercise being medicine, exercise being really critical in managing the disease. And that really aligns with what POP has been doing in terms of providing resources to people to get out and move, whether it's bowling or at the driving range and beyond. It certainly aligns with our mission, in terms of how important physical activity is.
So at a high level, can you explain to our listeners what makes exercise so impactful, and how does it slow the progression of the disease? - So what makes exercise impactful is that many people have excessive inflammation, and many people are potentially slightly overweight, and many people have health related issues. BMI is a little bit high in many people. There's a high prevalence of diabetes.
And so many people are not quite as healthy as they should be, and I think the COVID-19 epidemic has really, really illustrated this. So for example, age clearly affects how COVID-19 affects one, and certainly older people do suffer proportionally more than younger people. But it's also very, very clear evidence that if you're a really, really healthy, super healthy 75 year old, your resistance to COVID-19 is greater than an unhealthy 65 year old, or a really unhealthy 55 year old.
So you can go across medicine. One doesn't, this message is independent of Parkinson's disease, that when you go across medicine, whatever your disease, whether it's cancer, whether it's COVID-19, whether it's a heart problem, diabetes. These are all better treated when one is really healthy to begin with.
A very good friend of mine, world famous neurologist, Dr. Jose Obeso, when he sees a patient for the first time, he talks to the patient with Parkinson's disease now about their general health. Well, he tells them, "We're gonna get you healthy, and then we're going to take issue with your Parkinson's disease." - That's great. - Because there is no question that when one is good, in general good health, then any aspect of disease, and inflammation is a big deal.
So exercises reduces inflammation in Parkinson's disease. There's very strong evidence for this now. Neurotrophic factors tend to be reduced in Parkinson's disease. You exercise, you increase your brain derived neurotrophic factor, which is very good. So a lot of people with Parkinson's disease, measurements which are elevated get reduced with exercise, and measurements which are reduced gets increased. So you're kind of trending back to a normal, healthy profile.
And so the argument that exercise is medicine is simply that there's no pill which can do all of this. Now specifically, clearly dopamine is a wonderful pill for Parkinson's disease, but it doesn't affect one's overall general global health. So the idea of coupling dopamine replacement therapies, Sinemet, or deep brain stimulation, which also affects the brain, with exercise is very good.
So it's a generic, wonderful pill that is good for everybody, from little kids all the way through to people much, much older, and its benefits are terrific, and it mitigates against a lot of other problems. - What a great takeaway you just said, that the initial treatment being almost normalized. So you've got Parkinson's, but the initial treatment is doing what everybody without Parkinson's should do. It's just stay healthy.
So it's almost normalizing that treatment and eliminating the barrier from the patient, potentially, that I have to treat my Parkinson's. I have a laundry list of things I have to do for my Parkinson's, but instead, you've opened it up to almost normalizing it and saying, I have to get healthy. Parkinson's is a piece, but I have to get healthy, just like anybody else. So I love that takeaway that you just said, so thank you for sharing that. - No, I certainly believe that.
I'm not trying to downplay that tremor can be embarrassing and disabling, or slowness of movement, but generally, you can deal with all of those so much better if you're coming from a really healthy mind-body relationship, than if you're starting off with a really unhealthy mind body relationship. - Yeah, that's great. And my next question probably is a talk in and of itself.
You can probably go on for a couple of hours regarding the progression of the disease, a typical progression of the disease, and how it contrasts from those who have the disease and have a routine, consistent workout schedule. So can you talk to me a little bit about that?
- Yes. So Parkinson's disease is a progressive neurological disease, and so when you see your movement disorder specialist, and for all of you listening, it is really essential, or I think close to essential to make sure that periodically you see a movement disorders specialist. Somebody who sees people with Parkinson's disease all the time. Somebody who really understands the pharmacology of Parkinson's disease.
And people like that kind of know the 20-25, depending on when you get the disease, progression of the disease. And what's gonna happen is you're gonna slow down a little bit. You may or may not have tremor. You will be more rigid. You'll feel stiff, and when a person moves your limb, they're harder, it's harder to move. The limb lacks rigidity. Your posture will start to stoop a little bit. You may have falls. You may lose balance. You may feel very fatigued.
And then in parallel, you have a series of non-motor symptoms. Your sleep may be disrupted. Cognition can be impacted. The autonomic system isn't working as well, and these are all progressing over time. And all of these things, most of these are in fact peculiar to Parkinson's disease, but you also have an age related progression. So as people age, aspects of memory become a little bit harder. So what the exercise does is slows this down.
So imagine that every year, your disease is progressing three points. So if a physician gives you a test and they say at the end of your test, you've got a score of 20 out of perhaps 108 or some other number. Then every year your disease progresses by two or three points. It's a relentless progression. But if you really look after yourself, and it's not just exercise. The more you exercise, the more you have to balance your nutrition, your rest and your sleep.
So if you reach a point of reaching that balance of those four factors, then the speed at which your disease progresses should slow down a little bit. It's gonna progress. Person has Parkinson's disease. This is, this is inevitable, but whether it progress two, four, six, eight points a year, I think is, in part, under the control of the person and their position. A really good physician can medically manage a person, so that the time at which the postural problems come is delayed.
A physical therapist can give a person strategies to deal with falling over, freezing of gait. But the idea here is that as your disease progresses, it progresses more slowly when you look after yourself. Now, I really wanna kind of expand a little bit on this, because for some people, exercise is just not a word they like. And I get that. I really do. Other people thrive on the term, but other people, exercise is not me. So part of this is a mind game issue.
So think of it as looking after yourself, and looking after one's self should be what all of us do. And so you get your diet right, you get your rest right, you get your sleep right, and then think of it in terms of activities. Fun things. So words like exercise are just not a good idea and don't use it. You happen to like dancing, go and dance. And it's doing much the same for your body. It's just not using the E word, which some people find a little bit hard to use. - Right. That's so true.
We found, at least here with our Parkinson's Activity League events that we have tried to provide the fun around the E word, and maybe not say. It's an activity league. It's not an exercise league. So folks are bowling. They're going in the driving range. They're playing various bocce ball, skee-ball games that end up being games, but look a little bit like exercise and activity.
So we found success around that in terms of, and communicating around that, that getting out in whatever capacity and moving is better than zero. You might not be at a gym, but you're out here bowling and you're out here moving in some capacity. So that's been, it's been exciting to see people gravitate, who might be gym-averse, but gravitate towards these things that, you know, there's fun involved. I think it's a nice aspect and incentive. - Absolutely. It should be made fun.
And you know, what does fun do? Fun probably releases dopamine, so it's probably therapeutic in and of itself, so. I think one has to tailor activities, events for people. - Yes. Very true. I think here in Richmond, we are attempting to provide a holistic approach where we offer an array of modes of movement, and people can self-select. They have that latitude and hopefully that drive and initiative to sign up for these things.
And it doesn't have to be everything, but it's something that fits your interests, in terms of moving. So I think, I think it's so important to see, to have that available to people, and we've been excited to be able to provide that and free of charge to folks with Parkinson's and their care partners. - I think that's great, and I think the free of charge is a big deal. I think the people who need it the most are those probably who can afford it the least. - Right.
- So the free of charge, I think what you're doing there is, I think it's brilliant. - Yeah, thank you. And I think we all are working, and especially over this last year in terms of eliminating those barriers to resources. So if we can eliminate, no one can 100% eliminate COVID and the barriers in terms of getting out with that. But if we can eliminate a financial barrier, and maybe some other barriers along the way, I think that's a success in and of itself. - It is, it's a huge success.
- Yeah. So tell us, as we move on to some of your research, your current research, as a lead investigator, share with our listeners a little bit about your SPARX research. I know there's iterative phases. Tell us what phase you're in, what phases you've concluded, and what you've garnered from those, and how people can get involved, if they would like. - Yes, so currently, I'm the PI of a phase three clinical trial.
Phase three clinical trials are very well known by most people nowadays because COVID-19 is having one phase three clinical trial after another phase three clinical trial come to market, and you can see that it's the phase three clinical trial which really affects clinical practice. So if a drug is slowing or preventing COVID-19 without serious adverse effects, that will go straight into changing medicine. - Right.
- And so we have a 29 side phase three clinical trial in which we're testing the hypothesis that there may be a benefit to exercising at high intensity, as oppose to at a moderate intensity. So to be clear, moderate intensity is very good for you, and high-intensity is very good for you. But our hypothesis is that there is something to be gained by working out at the high intensity.
I realize for some people, this is the area which is not fun, but the idea of the phase three clinical trial is to provide clear, robust evidence that if you're willing to do the high intensity exercise, that you will get a benefit above and beyond that from moderate intensity exercise. This is a two year study. There is one site in the State of Virginia. Unfortunately it is not in Richmond, but it is 30 miles away from Richmond.
So if you go online and you have search for SPARX3, or you search under my name, you will find that the SPARX3 phase three clinical study. The site in Richmond, sorry, the sites in Virginia is very, very good, and they will be enrolling in the next few months. - Okay. - And if you haven't yet started taking medication and you'd like to exercise, it will be a wonderful opportunity for you, and helping out science is always very important too.
The science is only as good as the people willing to enroll. - Yeah. Well, how, I always find it to be empowering to the patient. Hopefully patients feel this way that they have an ownership and they're involved in the next stage of care and treatment. So hopefully that's certainly a benefit to people here in Richmond and the other sites that you're working with, that people want to be involved in the next phase of treatment.
- No, absolutely, and for people in Richmond, we can certainly tell you what you should be doing. So you should not feel that because there isn't a site there, you can't benefit from what's going on. We can make very clear to you what we think the current evidence suggests. It's just that it's not possible to have sites everywhere. - Everywhere. (laughs) - But the site we have in Charlottesville is very good. - And for the folks here, we understand that Charlottesville is not a bad place to be.
So it's a good place to travel. It's beautiful. We all try to, I think we try to get out there, us Richmonders, as much as possible in the mountains. So it's a beautiful place to be. - Oh, it's a beautiful university, and they have world famous exercise physiologists there, world famous. - Yes. We've touched on a little bit, we've said the C word, COVID, a little bit, but I'd be remiss if I didn't bring it up and ask you a more pointed question.
What high level advice, targeted advice would you give to people with Parkinson's right now who have just fallen a little bit with their typical exercise routine, and how to get back into managing the symptoms through exercise. So what advice would you give to those folks? - Well, it's very much an individual preference.
I think for a long while still, even with vaccines, even with masks, even with social distancing, some people are going to be adverse to going near a gymnasium, and I understand that, and I respect that. What has happened, so COVID-19 has been very sad and it has been a disaster. But one or two little things have happened which will probably have longterm benefit. And so many people who do exercise have become absolutely masters at presenting classes over Zoom.
And so you can find online, and I can put you in contact. The group I talked to in California, I talked to 120 people who exercise in their home, and the instructor teaches them what to do in their home, and for many people, this is beneficial. It means you don't have to travel. It means you save a lot of time. There are clearly advantages to gymnasiums, but if it's not working for you at the moment.
I work with a group in Chicago, they're called the Movement Revolution, and they've got wonderful, wonderful Zoom programs. So if you're reluctant to go to a gym, there's an immense amount online, and I can put you in contact with two groups who are very, very good. I think as the vaccines come forth, I actually go to the health club myself. I've gone back, and the health club is very good. You have to check that they're doing everything right.
So one thing which is very important is how air circulates, and most really top health club right now have got their air circulation done really well. There's a mask mandate. You can't go very close to people, and they're following really best practice. So if you've had a vaccine, and if there's a gym around following best practice and you're comfortable. The advantage of being in a gym is, even the best home gym doesn't quite have all the options you have when you go to a gym.
Another advantage of a gym is it may have classes for you, and sometimes just getting out of the house is a good thing. I think to be in a house all the time may not be a good thing. - Yeah. - So I think it's very important to know oneself, to know your sense of safety, or a sense of what you're willing to. And there's always a slight risk going out. I think the risk is falling.
And at the end of the day, the risk of doing nothing is actually far greater than perhaps the risk of going out, so you have to kind of balance this. But there's no question that if COVID-19 is still high in your area, that there's a huge amount that can be done at home, and the personal fitness industry have become masters at delivering into your home, and it's terrific. And in fact, you know, if it was me, talking for myself, I would probably do a balance.
I actually like working out at home, but I can't do all that I want to do at home, and I miss seeing my friends when I go out. So I would probably reach that balance. - Yeah, that's a good takeaway, the balance is so important, as well as what you noted to have the patient really understand what their tolerance is, and what makes them feel comfortable. So I think, and there is resources for both ends of the spectrum, so I think that's a great takeaway for our listeners.
You know, as we summarize, I want you to share, if you can, where people can go to learn more a little bit about the SPARX study online, and a little bit more about you and your work at Northwestern University. - Certainly people can email me. You asked much earlier on in the interview, you know, what keeps me optimistic?
Well, I just get lots of nice emails where people email me and say, "I followed your guidelines in the 2018 SPARX study, and my disease has progressed very little over the last year." Those emails certainly give me further optimism. So I am Daniel.corcos@northwestern.edu. I'm beginning to get a little bit of a web presence, so if you Google my name, make sure you add the DM, otherwise you may find that Corcos who's a very, very famous cook, which would also be good for you.
You'll find Tuscany cuisine, and maybe what you need to do is get some of Gabriele Corcos' great Tuscan cuisine before or after you exercise. But if you Google on Corcos DM, you'll come up with me. If you Google SPARX3, you will, it'll come up quite high in your search, or you will be taken to clinicaltrials.gov. You should all know that if you're interested in taking part in research, clinicaltrials.gov is where every study is registered.
And so NIH and the government do a very good job of tracking all the studies, so that when people pay their hard earned taxes to fund research, that they find that the research is cataloged, and that the research gets written up, and that the results are made available to people. But that's the way to find me, Daniel.corcos@northwestern.edu, and it'd be great to hear from people.
- Yeah, well, we'll certainly provide a slide on that information, and I want to note that SPARX is with an S, an X, rather, with our listeners. So, but we'll certainly provide a slide with that information. - Okay, so when you Google it, it is SPARX with an X 3. So the 3 is because we're a clinical trial. So we're SPARX3, and you'll find it, and we'd love to have people join in. - Wonderful. It's an exciting time. Dr. Corcos, thank you so much for being with us in our POP Profile series.
This has just been a delight, and I hope our listeners can certainly garner lots of takeaways, certainly as it relates to this past year, and in Parkinson's as a whole. So thank you so much. - Well, thank you for inviting me. It's been a lot of fun. - All right, thank you. (gentle upbeat music)