I don’t doubt that, like any other exercise modality, this form of forced exercise is going to be limited in its applications to a narrow range of benefits….but the relevant effect that was noted and acted upon would probably only be available on such exercise equipment. Or out on the road in the way that Alberts and his initial, inadvertent study subject were. Initially this was just intended as a charity ride to raise money for the Davis Phinney Foundation….and to introduce his friend (who had also been a keen cyclist prior to developing Parkinson’s) to the possibilities of continuing to exercise
The background story goes that they mostly trained separately for logistical reasons. So, whilst the woman with Parkinson’s had developed sufficient stamina and endurance to do this multi day event, she’d been training at a self selected cadence which was much lower than most roadies would use. Since he was riding captain to her stoker ( being more experienced and everything) he ended up having to make the compromise and pedal a bit slower and she was was forced to pedal a bit faster…..effectivelydragged up to a compromise speed (how tandems work) This is one reason why I doubt it would work quite so well in a regular IDC studio and, in fact, some of the early gyms trying this out used loaner tandems on modified cycle trainers (like Alberts’ early studies) and actually recruited the captains from a pool of experience regular class members. It thought that was a nice touch.
That’s what I wanted to try to introduce. Logistics and liability were the reasons given for why not. I did compromise and introduce a month of classes devoted to higher cadence pedaling during April (Parkinson’s Awareness Month) that used the protocol recommended for these programs …. so saw for myself that, even though most members there understood the assignment, the customary slow pedalers couldn’t up their cadence meaningfully for all the world as if they themselves had neurological issues.
I’m actually looking for an article from a Davis, CA local newspaper that featured a small gym close to my daughter’s little house. She sent me the link (she’s also an Emeritus Spinning and group fitness instructor) after one of my visits. It’d be on that old Cycling Fools board
There is a growing body of direct evidence from imaging studies of brains strengthening following meditation training. How mbsr reshapes the brain: (for those of us who exercised vigorously and ate all the right foods for decades but still struggled with anxiety and sleeplessness, this is the under appreciated third leg of the health and fitness stool)
A friend of my was recently diagnosed with Parkinson’s and I sent him this article. It doesn’t mention glymphatic but I suspect that system is involved.
The research suffers from only involving 10 individuals so it should be considered preliminary. These 10 were recently diagnosed with Parkinson’s and had only mild symptoms. The exercise program involved three 30min exercise sessions per week for 6 months (72 sessions total). The goal of each session was to reach and maintain 80% of maximum heart rate for the session. For me this would be about 140bpm that I typically reach running on level ground at a 12-13 minute mile pace. The investigators were only hoping for a slowing in the rate of dopamine neuron loss. Instead, after the 6 months they found that in 9 out of 10 subjects an increase in dopamine neurons, the brain seemed to be healing itself. https://www.nature.com/articles/s41531-024-00641-1
As far as I know this is the only indication of a treatment that might reverse Parkinson’s disease.
Just getting a dog to walk might have huge benefits.
Since we all die and many of us will get a form of dementia, when we mentally age matters. Those taking daily walks would be way ahead of the game. Remember, walking Fido is not just a once-a-day thing.
We do know dance is the ultimate exercise for seniors because the brain needs to learn each of the different steps. That supports your doubt.
My personal experience watching elderly family members walking is the foremost exercise for longevity and good health.
Hmmm…that might be my failure to explain properly. The excerpt you’re responding to was a bit unrepresentative of the phenom I was describing….which was the unexpected result of a very specific example of forced exercise. To channel Mencken a bit, the equivalent with walking a dog or seniors dancing would be to have the feet of the person who was already suffering noticeably from Parkinson’s Disease strapped to another walker or dancer so that they were compelled to move at a speed they couldn’t attain on their own. To the best of my knowledge (which means I haven’t bothered to look) this has not been attempted with reproducible results.
I’m going by recall now, but Jay Alberts’ stoker with Parkinson’s was at the point where her handwriting had become little more than chicken scratch. Regardless, she’d purchased postcards to send to family and friends at every stop along the way and, apparently, after a couple of days of riding at an uncomfortable cadence, they noticed that not only had her writing improved, her tremors were diminished and initiating volitional walking was easier. All these improved as the event progressed.
Now this is someone else’s story, mind, and it may or may not have been embellished with the passage of time …. but it certainly rings true, given the reproducibility of the data. I know that one or two companies marketed a mechanical exercise bike to do the same. Maybe a robot /exoskeleton type of set up could be developed to do the same for walking/dancing. I was trying to shoot for a tandem on something like a Saris/CycleOps trainer at the gym……I suspect the end result might be the same for this one objective measurement.
@VeeEnn thank you for sharing this interesting information!
This reminds me of the first chapter of the fascinating book, “The Brain That Changes Itself,” by Norman Doidge, a 2007 book about neuroplasticity. The book describes an elderly man who had a stroke and was unable to move. His loyal and determined son moved his limbs repeatedly through the pattern of walking, hundreds of times over months if I recall. Like your example, the elderly man was unable to move his own limbs so the movements were forced. Gradually, his brain used the feedback from the movements to re-route the neural networks around the stroke-caused damage. This was an early example of neuroplasticity in adults. (Until recently it was thought that neuroplasticity was only possible in young brains.)
Parkinson’s Disease is caused by the buildup of defective clumps of alpha-synuclein protein. These deposits don’t form uniformly throughout the brain. Rather, they begin in the olfactory bulb and trigger normal synuclein protein to misfold in a predictable stepwise pattern that is similar to a prion. (Braak staging hypothesis.) Eventually the misfolded synuclein reaches the substantia nigra, causing movement disorders.
It’s possible that forced movements might re-route motion patterns around damaged areas by neuroplasticity. There is even a program, Rock Steady Boxing, that uses high-intensity “forced intense exercise” to combat Parkinson’s symptoms. (I arranged for my mentee, Nicole, to volunteer with this program at the gym I attended when she was 16 years old. She enjoyed working with the participants so much that she went on to get a Ph.D. in Physical Therapy.)
But I do agree with @Leap1 that for most people the simple act of walking every day can help maintain functionality and health.
True enough, file under do not start to exercise in your 80s….most of the time.
I remember two years ago, the woman in her late 80s who discovered gymnastics. She was on the even bars at age 91 and in the news.
My 90 year old neighbor took up exercising with the seniors at age 65. She is fantastic for age 90. Amazing. She has done it all but the main thing was balancing exercises in the pool.
Colour me confused. I think it’s safe to say that neither of these women are likely to have had a diagnosis of Parkinson’s, right? That’s the only condition I was referring to in my previous posts…..and FWIW I fancy the woman who sparked the “Now that’s peculiar…” moment on that RAGBRAI ride wasn’t even 50. Additionally, from what I recall of the podcast and article I’m writing about, she’d been an avid exerciser and keen cyclist before her diagnosis.
I don’t think so, or at least I don’t think that is the main reason why improvements are seen with forced exercise. There are several studies indicating that forced (active) exercise increases and improves nervous system functioning in ways significantly different than passive (voluntary) exercise. A different and expanded set of neurons become active when exercise is pushed beyond what the subject would voluntarily choose. This is the best review on the subject that directly compares the impacts of forced vs voluntary exercise that I’ve found, though it is five years old. Therapeutic effects of forced exercise cycling in individuals with Parkinson's disease - ScienceDirect
Active participation and engagement in the exercise process allows for excitation of an increased number of peripheral sensory receptors compared to passive exercise participation. Passive exercise only activates joint receptors, cutaneous receptors and muscle spindles, whereas active-assisted exercise further engages the golgi tendon organs which help augment sensory afferent neural activity to stimulate central processing of information to enhance motor control and performance
It may be critical to push people beyond their comfort zone. I guess no one said reversing age-related neural degeneration was going to be easy. As definitions are important for clarity, here is how this review defines forced/active vs voluntary/passive exercise:
Forced exercise, which is defined as a “mode of aerobic exercise in which exercise rate is augmented mechanically to assist the participant in achieving and maintaining an exercise rate that is greater than their preferred voluntary rate of exercise,” is one mode of exercise that has been gaining traction in the research literature [1]. Forced exercise is more than simply passively augmenting the rate of exercise; it requires participants to be actively engaged in the exercise and their rate of exercise is further augmented mechanically to achieve an ideal exercise rate.
I interpret “actively engaged” as consciously pushing to maintain an uncomfortable level of performance rather than passively moving along at a comfortable pace. Note that previous studies linked to the glymphatic system pushed aerobic exercise to >80% of max heart rate. That is well above the Level 2 exertion that is recommended for fat loss, which is at about 65% of max, and is probably considered hard or uncomfortable for most people to maintain. I’m guessing that the key for significant improvements in neural functioning as one ages is high intensity training, not simply walking around the block. If you aren’t breathing hard and sweating hard, it is not enough to reverse Parkinson’s.
Good review choice, @btresist …. and I see the Jay Alberts original observation on that RAGBRAI ride I mentioned upstream has indeed led to more compelling evidence of the value of forced exercise.
Your interpretation is a bit off, though in that this forced exercise isn’t referring to individuals pushing themselves out of their intensity comfort zones and attempting to reach arbitrary heart rates.
Just a few sentences on from your quote is the clarification that this is exercise that involves augmenting the subjects best effort at pedal speed with either a mechanically assisted stationary bike (theracycle is one brand) or a tandem with a competent “captain” to the patient’s “stoker”……the setup I was trying to sell to gym management. A neuromuscular (especially the neuro part) rather than a cardiovascular or cardiorespiratory overload.
I’m going to bookmark this for my trainer…I mentioned this concept just last week and my efforts to get a “therapeutic “ class added to my gym’s roster.
I do recall articles by Alberts in the fitness press with titles like “From 65 to 85”…. which actually referred to cadence rather than %heart rates.
@btresist thank you for sharing this important information.
I have been diagnosed with early Parkinson’s and have a gene mutation that increases the risk.
When I work out with an instructor (whether doing Zumba to fast music or my Native American fitness instructor) I do push well beyond what I would “voluntarily” choose to do. My heart rate frequently goes over 135 beats per minute. Last week it went over 150 beats per minute when I did a “forced” exercise of lifting weights while also doing a step routine.
The issue is that I had open-heart surgery to replace my stenotic, calcified bicuspid aortic valve and ascending aorta last November. I’m finally (after several months of gradually increasing exercise including cardiac rehab class) feeling stronger. My heart seems to be settling into its new normal with a 25 mm bovine aortic valve instead of the resistance from the old calcified valve (which had only 1 square cm of opening when it was cut out).
My Fitbit says that I am in “excellent” cardiac fitness for my age based on the amount and intensity of aerobic exercise I do. But the Fitbit doesn’t know about the surgery. The maximum heart rate for vigorous exercise for a 71 year old woman is 104 to 127 beats per minute and I routinely go beyond that.
My level of exertion should not be enough to damage the prosthetics.
I have an appointment with my cardiologist next week. I will ask him but I don’t trust him 100% since he told me not to exercise after my open-heart surgery. I knew from experience that lack of exercise would cause deep de-conditioning. On the other hand, I was profoundly weak after the surgery since I had pleural effusion and partial lung collapse. I know how to gradually increase my exercise so that’s what I did. I figured the cardiologist must be talking about his other patients who haven’t worked out like I have for over 50 years.
So the question is: how do I thread the needle between the need to protect my heart and the need to exercise past my comfort zone to prevent progression of my Parkinson’s disease?
@WendyBG….re-read this concept of forced exercise in my posts. It’s absolutely not a cardiovascular challenge. You would be threading a different needle. For all I know there might be classes on just this concept near you….I know the Y and various JCC gyms embraced the Spinning (which, of course still isn’t quite it)
In your shoes and without access to a tandem on a trainer set up, I’d look at purchasing a used theracycle or the other make mentioned in the review. There might even be an enterprising gym owner with group ex classes on the contraptions
Inversions and gentle twists may enhance CSF and blood circulation, encouraging glymphatic flow.
Slow, deep breathing used in yoga promotes parasympathetic (rest-and-digest) activity, which is essential for glymphatic function.
Yoga reduces inflammation and cortisol levels, improving sleep quality — the core driver of glymphatic activity.
Benefits & Role in Glymphatic (Lymphatic) Function
1. Legs-Up-the-Wall (Viparita Karani)
Elevates lymphatic fluid and blood from the legs toward the core, reducing swelling and enhancing circulation.
Activates the parasympathetic (rest-and-digest) nervous system, promoting relaxation and improving sleep quality
2. Reclining Spinal Twist (Supta Matsyendrasana)
Gently compresses and releases lymphatic pathways in the abdomen, aiding detoxification and digestive function
3. Child’s Pose (Balasana)
Encourages diaphragmatic breathing and compression of the torso, which stimulates lymph flow around the chest and abdomen. Its calming effect also supports rest and sleep
4. Cat–Cow Flow (Marjaryasana–Bitilasana)
A dynamic movement that massages lymph nodes along the spine and chest, enhancing fluid circulation and easing tension
Bonus Poses for Enhanced Flow
Bridge Pose (Setu Bandhasana): Opens the chest and supports lymphatic movement in the upper body and groin area
Downward-Facing Dog (Adho Mukha Svanasana): An inversion that promotes lymph returns from the limbs to the core
Standing Forward Bend (Uttanasana): Uses gravity to assist lymph drainage and calms the nervous system
Twisting Poses (e.g., seated spinal twist): “Wrings out” lymph and enhances digestive and lymphatic flow in the abdomen
Quick Summary Table
Yoga Pose
How It Helps Glymphatic/Lymphatic Flow
Legs-Up-the-Wall
Drains fluid from legs, calms nervous system, improves sleep
Reclining Spinal Twist
Compresses & releases abdominal lymph pathways
Child’s Pose
Encourages diaphragmatic lymphatic movement, relaxes nervous system
Cat–Cow Flow
Stimulates lymph flow along spine & chest via rhythmic movement
Gravity-assisted lymphatic drainage & nervous system calming
Twisting Poses
Promotes abdominal lymphatic detox via compression
How to Sequence Them for a Pre-Sleep Routine
Try this gentle, restorative flow before bed (hold each pose 1–3 minutes unless noted):
Legs-Up-the-Wall – 5–10 min (deep breathing to unwind)
Supported Child’s Pose – 2–3 min
Cat–Cow Flow – 1–2 min (go slow and breathe deeply)
Reclining Spinal Twist – 1–2 min each side
Bridge Pose – 30–60 sec hold
Standing Forward Bend – 1–2 min to fold gently into stillness
This sequence helps facilitate lymphatic movement through gentle compression, inversion, and relaxation—supporting both physical detox and deep, restorative rest.
@thegreatdane thank you for these recommendations. I have done yoga for 34 years and start every morning with yoga. I haven’t done pre-sleep yoga but that’s a nice idea.
Please read carefully. It is not a well known or well studied topic.
AI Overview
No, collagen does not cause Parkinson’s disease
; in fact, alterations in collagen and other extracellular matrix (ECM) components are associated with the disease. Specific gene variants in collagen type VI have been linked to an increased aggregate burden in patients with Parkinson’s, suggesting a contributing role in the disease’s development or progression, not that collagen itself causes it.
How Collagen is Linked to Parkinson’s
Genetic risk:
Mutations in the gene for type VI collagen (COL6A3) have been identified in individuals with Parkinson’s disease, indicating a potential genetic link where certain collagen gene variants increase susceptibility.
Altered brain matrix:
The extracellular matrix, which includes collagen, is altered in Parkinson’s disease. Studies show differences in the expression of ECM components, including collagens, in the brains of people with PD compared to healthy individuals.
Role in brain repair:
Despite the association with the disease, collagen has therapeutic potential for Parkinson’s disease. It can be used to create scaffolds for cell delivery or to release therapeutic factors to help repair damaged brain tissue, suggesting its potential as a treatment rather than a cause, according to the National Institutes of Health (NIH).
In summary, while specific genetic mutations and overall alterations in the collagen-containing ECM are observed in people with Parkinson’s disease, collagen itself does not cause the condition. Instead, these findings highlight the important role of the brain’s ECM in neurodegenerative processes and suggest avenues for future therapeutic development.
My suggestion is to find an aerobic exercise that is easy to quantify. For example, I am a runner and I have a watch that gives me real-time heart rate. I will run at a pace that keeps my heart rate at about 140-150 bpm, outside my comfort zone, which I define as level 2 (120-130 bpm) and about 80% of max effort. Doing that for 3 miles will represent (for me) a 30-40 minute session. Do that three times a week and I meet the training criterium in the listed studies. If my running pace improves, then I have evidence of improved aerobic fitness.
I think you need to find an aerobic exercise that allows a similar level of quantification of effort and measurement of progress.
Zumba and weight lifting are fine exercises but strike me as difficult to measure consistent aerobic effort or aerobic improvement. Running or cycling may be a bit boring but they allow one to control the activity so one never needs to go above 150 bpm. That should mitigate the risk of overstressing your heart from too intense a physical effort.
