An interview with Author Kristine Meldrum on the importance of structured, high intensity exercise to manage and reduce Parkinson’s disease symptoms on January 8, 2024 by George Ackerman, Ph.D, J.D.
Parkinson’s Place Iowa, Founder & President
Davis Phinney Foundation for Parkinson’s, Ambassador
Exercise Professional who works with people with Parkinson’s
& Neuro Diseases
- ACE Certified Group Fitness Instructor
- ACE Senior Fitness Specialist
- Certified Rock Steady Boxing Parkinson’s Head Coach
- Certified Mad Dogg SPINNING® Advanced Cycle Instructor
- Certified Mad Dogg SPINPower® Instructor
- ACE Approved Parkinson’s Cycling Coach
- Total Health Works Total Parkinson’s Instructor
- SCW Certified Aquatic Instructor
- APDA Parkinson’s Training for Fitness Professionals
Parkinson’s: How to Reduce Symptoms Through Exercise is the name of my just-released book, with Dr. Jay Alberts, Vice Chair of Innovations at the Neurological Institute of The Cleveland Clinic, and Professor Daniel M. Corcos, Professor of Neuroscience at the Feinberg School of Medicine and Northwestern. The book is currently the Number One new release in Parkinson’s Disease (PD) books on Amazon. The book is a comprehensive review of the science and scientists who have helped to build the evidence that proves that exercise is a real therapy for PD. It also has more than 20 interviews with people with Parkinson’s Disease (PWPD) who have implemented the research and protocols by these scientists into their exercise programs and experienced life-changing results.
The book title is also the title of the talk I give when speaking to PWPD across the country. The book contains a crucial message that needs to be delivered to all PWPD or Parkinsonism because exercise can help manage PD symptoms and is the one therapy that can potentially slow the progression of the disease.
Professor Bastiaan Bloem, cycling in the hills of The Netherlands, puts into practice what he tells his patients to do—exercise at 80% of maximum heart rate at least three days a week. However, he tells them to plan on exercising daily. His rationale is that if they plan on only working out three days a week, they will only get in one workout when life gets in the way. So, it’s better to plan on working out daily and get in three days.
Professor Bastiaan Bloem, MD, PhD, FRCPE, wrote the foreword of your book.
Professor Bloem was so excited about this book that the first thing he said to me was, “Why didn’t you write this with me?” I laughed and told him that Dr. Jay Alberts and I had been working on it for a long time, but that I would love for him to write the foreword—which he did.
Professor Bloem titled his foreword “Why Every Person with Parkinson’s Disease or Parkinsonism Should Read this Book.” In Professor Bloem’s words, “This new book, Parkinson’s: How to Reduce Symptoms Through Exercise, is long overdue. Written by recognized experts in the field, this highly readable book comprehensively summarizes the state-of-the-art evidence in the field of exercise and Parkinson’s disease. The book is richly filled with personal stories, both of individuals living with Parkinson’s and the scientists who have helped build the evidence to support the merits of exercise as a genuine therapy. Make no mistake, as this book nicely summarizes, there is now a rigorous scientific underpinning to demonstrate that exercise helps to alleviate the symptoms of Parkinson’s disease, just as you would expect from a drug that corrects the dopamine deficiency in the brain. In fact, some of the effects of exercise equal that of a moderately effective antiparkinson drug. The evidence is strongest for the suppression of motor symptoms, such as slowness, stiffness, or tremor, but there is also a steadily increasing body of work that points to improvements in a wide range of so-called non-motor symptoms, including mood and sleep.
And what is even more exciting, there is now emerging evidence to suggest that exercise is not merely helping to alleviate disability, but it may also help to slow the otherwise relentless progression of Parkinson’s disease. . . . We are now in an area where physicians should literally write a prescription for exercise in addition to prescribing more traditional medical interventions such as drugs or surgical interventions.”
Dr. Jay Alberts, left, takes his research to heart and is an avid cyclist. In 2022, he and his son, Grant, rode the famed Stelvio Pass through the Italian Alps with a group of cyclists from the Davis Phinney Foundation for Parkinson’s. During the week of this photo, they rode between 40 and 60 miles a day at 6000 ft. Wearing Dr. Albert’s non-profit organization Pedaling for Parkinson’s apparel, they rode daily in their PFP gear.
Please tell me a little about your background.
I am an exercise professional who works with PWPD and other neurological clients. I have spent fifteen years in the fitness industry and worked for a decade in the medical fitness industry. Implementing science-based PD protocols has always been the basis of my neuro-wellness classes. I followed Dr. Albert’s research and methodologies for designing my neuro-cycling classes with great success. My clients began experiencing life-changing results in reducing their PD symptoms. I decided to publish educational PD exercise articles (my former career was in Marketing and Marketing Communications) about the PWPD successes I had witnessed. I sent those articles to Dr. Alberts to have them reviewed by an expert in PD exercise. Bringing PD research directly to PWPD and watching it work in the “real world” instead of the lab was essential for both Dr. Alberts and I. It showed us that the PD exercise prescription Dr. Alberts was researching in the lab was working wonders for PWPD in the community.
What made you write the book?
Far too many PWPD still don’t know that exercise can help manage PD symptoms and can potentially delay disease progression, especially if started at the point of diagnosis. Neurologists, family doctors, PD articles, and other resources generally encourage PWPD simply to “be active and exercise.” However, when PWPD are “active” and get no results, and their symptoms get worse, they quit exercising, and the disease has free rein to progress faster.
The critical reason for this disconnects between general advice and positive results is that few PWPD understand that there is a specific way to work out that will stabilize or reduce PD symptoms. So, I decided to start educating PWPD and others interested in improving PD treatments. Along with publishing articles, I also expanded my certifications to include seven other PD exercise programs in addition to cycling. I created a complete neuro-wellness program with neuro-cycling, Rock Steady Boxing, neuro-aqua, Total HealthWorks’ Total Parkinson’s, Tai Chi, neuro-Pilates, and strength training.
Jay and I had been talking for years about writing the book. Daniel [Daniel Corcos, PhD, Professor in the Department of Physical Therapy and Human Movement Sciences as the Feinberg School of Medicine and a Professor in the McCormick School of Engineering at Northwestern University] joined us as we got into the actual process of writing the book. This occurred after a Davis Phinney Leadership Conference in 2022, where the focus of the conference was what each of us, as Ambassadors, would try to accomplish in the next year to help PWPD. I left the conference Saturday and wrote the outline of the book that same by Sunday evening. I spent the next year and four months dedicated to writing and publishing the book. Parkinson’s: How to Reduce Symptoms Through Exercise is a PD-exercise education book that teaches people with PD how to manage their symptoms through exercise so they can live happier and healthier lives.
What do you consider the most pivotal events in Parkinson’s exercise history?
Hundreds of scientists have contributed to establishing PD exercise as a valid therapy for Parkinson’s. However, the most dramatic impact points in modern PD exercise research are Jay Alberts’ 2003 Discovery Ride and his 2007-09 CYCLE Forced vs. Voluntary Landmark Study, Daniel Corcos’ 2012-2015 SPARX2 Study, and Bastiaan Bloem’s 2015-2019 Park and Shape Cycle Study. These three scientists I consider the three pillars of PD exercise. They have devoted their lives to helping PWPD to find a way to manage their symptoms through exercise and to find the promise of slowing disease progression.
Professor Daniel Corcos, cycling on Lake Shore Drive in Chicago. To keep up with his demanding schedule. He bikes and strength-trains daily. His patients know that he religiously “walks the talk.”
Again, implementing their research into my community-based programs has proven to bring life-changing results for PWPD. Professor Corcos also has substantial research in progressive strength training for PWPD (Two-Year Randomized Controlled Trial of Progressive Resistance Exercise Training for PD) and has worked with the Resistance Training with Instability for Patients Study (Silva Batista et al. 1678–87), which showed that progressive strength training improves motor, non-motor, and cognitive function for PWPD.
PD exercise opens the door for fun events! Our Parkinson’s group designed a “Live to Tri” triathlon—a twenty-minute walk/run on the track, a thirty-minute cycle ride, and a ten-minute walk/swim in the pool. Everyone had a great time and a big celebration was held afterward, complete with tri-goodie bags and fun prizes. Some of the Live to Tri PD crew: (l to r) Chantelle Smith, Ray Paul Pietig, Jim Best, Kristine Meldrum, Cristina Bucksbaum, Jane Collison and Pat Ferring, Sandy Trent, Mary Fran Pietig, and Jen Voorhees.
How did their research impact your PWPD’s quality of life?
When using the research methods and protocols by these scientists in the daily exercise program plans, I saw the following results with my own clients:
- A man initially diagnosed with Parkinson’s (it was later confirmed as Progressive Nuclear Palsy (PSP) Parkinsonism), for whom medication did not work, was still cycling, boxing, and strength training at year 17 after diagnosis; most individuals are in dependent care by year three to four and don’t live past years six to nine with PSP. A man with MS came into our program relying on a cane. Four months later he no longer needed it.
- A woman with PD had the personal goal of keeping her medications low through exercise. She is still at about the same dosage as when she was diagnosed eight years ago. Keeping medications low helps to avoid the side effects that may come with higher medication dosages.
- For over forty years, a woman who is paralyzed on one side of her body has kept herself from being in a wheelchair through her participation in our neuro exercise program.
- Many PWPD almost immediately feel the benefits of symptom management after starting their PD exercise program.
Rhonda Foulds takes a photo with the Michael J. Fox Parkinson’s support team cheering on the runners at the 2022 New York City Marathon. Rhonda was diagnosed at age 35 with young-onset Parkinson’s disease and the symptoms rapidly took her to a wheelchair. Following deep brain stimulation surgery Rhonda started walking, then jogging, and ultimately running. Her first official race was as a PWPD. Rhonda has run over 100 marathons.
The book relates more than 20 inspirational stories/case studies of PWPD, about half in Iowa and other case studies from people across the United States who have used the methodologies outlined in the book and had life changing results.
Can you tell me more about your organization?
I am the founder and president of Parkinson’s Place Iowa, in West Des Moines, Iowa. Our mission is to educate people with Parkinson’s in Iowa on the power of exercise in managing symptoms to give them a better quality of life and help them access Parkinson’s information, resources, tools, and events that will enrich their lives. Parkinson’s Place Iowa is in the state capital, where most PWPDs have access to exercise programs and information. However, that isn’t the case for those living with PD in rural parts of Iowa, where many have no access to support. This is one of the reasons I wrote the book—to get this critical information out to those who do not have access to current science-based support. Our next goal is to get the book in all libraries in the 99 counties of Iowa and then help create access to PD exercise programs for all PWPD throughout Iowa.
I recently received an email from a physical therapist in a small community in Iowa. She wrote that she works with a small group of Parkinson’s clients and is very excited to get a copy of the book for everyone in her group. Her response reinforces the mission of my non-profit; to inform everyone with PD and professionals working with PWPD about the benefits of exercise for PD—particularly in our small communities and rural areas in Iowa with little access to information.
MaryFran Pietig with Kristine Meldrum during a neuro-cycling class. MaryFran loves to cycle, and she was surprised how great she feels after a cycling class.
What is your passion and how did you get involved in Parkinson’s awareness and hope for a cure?
“You give me hope” is the phrase I hear most when I explain what exercise can do for a person with PD. After decades of research, high-intensity exercise has been shown to reduce symptoms in PWPD. My passion is working with my clients and watching how exercise can dramatically change their life for the better. For example, I had a man with PD who came to me in despair after falling 56 times in eight months. He came to our first session wearing a helmet and covered with bumps and bruises. When he started exercising with the proper PD exercise protocols over the next two months, he fell only one time.
People often ask me how I got started working with people with Parkinson’s disease, since I have no one in my family with the disease. I tell them that over a decade ago, after I finished teaching my afternoon cycling class, I would often help my cycle mentor, Bill Roach, with his Parkinson’s cycle class, which followed mine. His class was large, and getting everyone fitted on their stationary bikes took time. I found that I loved talking to the people with Parkinson’s, and I admired their bravery and perseverance in fighting their disease.
In striking contrast, I had watched my mother suffer several debilitating strokes. She lost functionality on one side of her body and later went blind. She stayed in her room and seldom came out for the rest of her life. As I watched in admiration the people in Bill’s class, they inspired me to change the direction of my fitness education goals and turn to a Parkinson’s neuro-wellness path. It has been a blessing for me as I have the opportunity to work with and learn from such courageous and inspirational people every day.
After an intense Rock Steady Boxing class everyone is smiling and feeling strong. Pictured left to right is Bill Brown, Joe Johll, Kristine Meldrum, Linda O’Hair, Ed Maahs, Mike Thorson and Jane Collison.
What type of goals do individuals with Parkinson’s have when working with you?
Most PWPD want to manage their symptoms and improve their quality of life. When building a PD Exercise Cocktail Plan™ (see below), I first determine the PWPD’s balance, walking, rotation, and movement abilities through formal assessments. After assessments, I find out what they want to work on, symptom-wise, and what exercise they like. We figure out what cardio or strength program will work best for them, and we discuss how to tackle symptoms as they appear or change throughout their PD journey. Then, I perform monthly assessments to see where they are in their progress.
Building a PD Exercise Cocktail Plan™. First, make sure you have fun creating a name for your cocktail to motivate you. The steps in the graphic show what takes place in building a PD Exercise Cocktail Plan™. Level 1 is the most critical layer. You will start with Level 1 and add layers 2 through 4, depending upon the stage of disease, motivation, and goals. Level 5 is doing what you love—the “olive or maraschino cherry” on top, making it complete.
What type of training and how long are the programs?
In the book, the reader will learn about building a custom PD Exercise Cocktail Plan.™ I call it a cocktail because each one is a plan that combines a different balance of exercise ingredients that are best suited to the particular client’s abilities and preferences. And, like a person’s favorite cocktail, it makes the patient feel better. The plans are highly individualized, just like their beverages of choice.
The book goes into detail for how to build the plans for each level of the cocktail. Level 1 explains science-proven endurance exercises like treadmill training for PD, cycling for PD, and progressive strength training for PD that have more than twenty years of research behind them. Level 2 lists PD-specific resources and what they provide as a choice for PWPD. The same goes for Level 3, Level 4 and Level 5.
What effect can it have on an individual with Parkinson’s?
Exercise has a profound effect on an individual with PD. The message that PWPD need to hear is that:
- After decades of research, high-intensity exercise has been shown to reduce symptoms in PWPD.
- Exercise is also the most promising approach to slow the progression of the disease—particularly if initiated at diagnosis.
What would you like to see as a future goal for your programs?
Dr. Alberts, Professor Bloem, Professor Corcos and I have a shared vision—one where everyone on an individual’s PD care team (neurologists, PD exercise professionals, family doctors, physical therapists, care partners, family members and so forth) and of course, the PWPD agrees that exercise is, in fact, medicine for the treatment of PD, and that exercise needs to be done proactively so that PWPD can reduce their symptoms and feel better.
What events do you participate in?
As the Ambassador for Iowa for The Davis Phinney Foundation for Parkinson’s my non-profit aligns with Davis Phinney’s core philosophy for his foundation. Davis became acutely aware that people would live a very long time with the disease; therefore, it became his organization’s mission to “help PWPD live well TODAY” with Parkinson’s. The most significant part of his message is helping people understand how crucial exercise is to their ability to live well in their journey with PD.
Kristine Meldrum, Daniel M. Corcos and Jay Alberts during the book signing portion of the Parkinson’s: How to Reduce Symptoms book launch, Dec 14, 2022, in West Des Moines, Iowa.
At Parkinson’s Place Iowa we hold joint events for PWPD that promote exercise with the Davis Phinney Foundation. We have had Davis Phinney Victory Events and of course, our latest event was the Parkinson’s: How to Reduce Symptoms book launch on Dec 14, 2022, in West Des Moines, Iowa.
How does this also assist the caregivers?
Parkinson’s: How to Reduce Symptoms Through Exercise is not only a road map for PWPD on how to exercise to manage symptoms, but a resource for the entire PD care team. The PWPD, care partner, neurologist, physical therapist, exercise professional, and so on. The book’s recommendations, while geared toward Parkinson’s applies to any neurological disease or anyone who is aging—which is everyone. It also provides important resources on how to find a qualified exercise professional, what programs have been accredited through the Parkinson’s Foundation, how to create a PD Exercise Cocktail Plan™, as well as additional resources.
How can someone get in touch? What is your website?
How can others also become advocates for awareness?
There are many ways to advocate for awareness. And it doesn’t have to be on a big scale. Volunteering in your community is one simple but impactful way of helping PWPD. So many PWPD can’t get to and from a PD exercise program. Check with different PD organizations or non-profits to see how you can volunteer your time for PD events and contribute to the PD community.
How focused does an effective PD exercise program have to be?
One of the most important messages for the entire PD care team is that there is a particular way you need to work out to get results for PD symptoms. The “PD exercise prescription” that the scientists talk about in the book and how to build a custom PD Exercise Cocktail Plan™ are based on the latest research by top Parkinson’s experts. As Dr. Jay Alberts says, “Too often, people with Parkinson’s are told that exercise is good without being given any sense of what type or how much exercise.” He further explains, “Patients are given advice like, ‘If you like to garden, then you should garden.’ Now gardening is a nice physical activity, but it’s not exercising at a high enough intensity level to be neuroprotective. If we want to treat exercise as medicine for this disease, we need to provide patients with an actual prescription that specifies frequency, duration, intensity, and heart rate.”
John Cullen is about to squat 425 lbs at his first powerlifting competition as a PWPD. John discovered that powerlifting at a high intensity relieved many of his PD symptoms. Not only did he go to the competition, but also attempted to beat the state record.
In your opinion what is the key to effective advocacy?
Everyone has a unique way of contributing to areas of life where they feel an inner compulsion to help. When their action comes from a place of personal passion, then it will be effective. If you had told me the first time I went in to help Bill Roach with his Parkinson’s cycle class that 15 years later I would write a book on Parkinson’s exercise, I wouldn’t have believed you. But one thing led to another, and each experience built on top of the other over many years. It’s like the incredible inspirational stories you will read about in the book. These are PWPDs who show up each day to work out. Over time, they achieve what seems like incredible feats simply by showing up every day. For both the PWPD and the advocate it’s the day-by-day commitment that allows the opportunity to achieve what others view as unachievable. The truth is, anyone can create the same opportunity for themselves in whatever the “challenge” they choose to tackle. They just have to start and never stop.
Why should people who don’t have Parkinson’s care about this?
PD is an age-related degenerative brain condition, meaning it causes parts of the brain to deteriorate. It is also a movement disorder. Currently, nearly a million people have PD in the United States. A “gray tsunami” is headed our way when, in 2030, “all Baby Boomers will be age 65 and over—78 million people” (Gibson “Age 65”). It’s projected that by 2040, our country will see an increase in the number of people with neurodegenerative diseases of a magnitude not previously encountered. More alarming news—PD is now the fastest growing neurological disease. “Neurological disorders are now the leading source of disability globally, and the fastest growing neurological disorder in the world is Parkinson’s disease. From 1990 to 2015, the number of people with Parkinson’s disease doubled to over six million. Driven principally by aging, this number is projected to double again to over 12 million by 2040” (Dorsey et al. S4). These statistics should be a wake-up call to everyone. People who don’t have PD should be very concerned by what is happening, because eventually Parkinson’s or other neurological diseases will touch someone in their lives, if not themselves. Even for those few blessed enough not to be directly affected by the disease, their support for Parkinson’s care and research will help to reduce the level of suffering in a troubled world.
If you had one song that would tell us more about you or represent your life which song, would it be?
When I work on projects, I have a song or album that shows up when I need inspiration, help, or encouragement. When writing this book, I often thought I wouldn’t finish it. Writing a book is hard work. You find that out once you are knee-deep in it. My book was 360 pages, which got edited down to 220—lots of research. I interviewed over 30 people across the US and around the globe. I had a tough-as-nails development editor with weekly deadlines early in the process. I had to deliver. I could go on, but I will spare all my book challenges. However, when I felt like I wasn’t going to make it one particular morning, on my playlist the song, The Climb, sung by Zach Seabaugh, (lyrics by Miley Cyrus), played, and these words struck me the most. Whenever I felt like I wouldn’t finish the book, I listened to this song. The message is also one that I share with my clients fighting every day against Parkinson’s. It truly is about the journey, the daily climb, and the ability to keep moving through challenges when you think you can’t anymore. “Keep on moving, keep climbing.”
Section of Lyrics from The Climb
I may not know it
But these are the moments, that
I’m gonna remember most, yeah
Just gotta keep going
And I, I gotta be strong
Just keep pushing on, ’cause
There’s always gonna be another mountain
I’m always gonna wanna make it move
Always gonna be an uphill battle
Sometimes I’m gonna have to lose
Ain’t about how fast I get there
Ain’t about what’s waiting on the other side
It’s the climb
Keep on moving, keep climbing.
If you had one final statement or quote you could leave for the Parkinson’s community, what would it be?
Currently, medicine and surgery cannot slow the progression of this disease. However, medicine and surgery are vital to managing disease and enabling PWPD to exercise. Professor Bloem says in the book, “Don’t be afraid of the medication either. And if you are severely debilitated by Parkinson’s, medication can bring you up to the next level where you can then begin to exercise. So, it’s the interaction between the medication and the exercise that gives you the greatest benefit. The time has come for doctors like myself to no longer just prescribe medication; we need to prescribe exercise as well and, indeed, lifestyle interventions in general.”
Note: MLA9 adds a period after the web or doi address
Dorsey, E Ray, et al. “The Emerging Evidence of the Parkinson Pandemic.” Journal of Parkinson’s Disease, vol. 8, no. s1, 18 Dec. 2018, pp. S3–S8. https://doi:10.3233/JPD-181474.
Dorsey, Ray, et al. Ending Parkinson’s Disease. 1st ed., PublicAffairs, Mar 2020.
Gibson, William R. “Age 65+ Adults Are Projected to Outnumber Children by 2030.” AARP, 14 Mar. 2018, www.aarp.org/home-family/friends-family/info-2018/census-baby-boomers-fd.html. Accessed 2 Oct. 2022
Johansson, Martin E., et al. “Aerobic Exercise Alters Brain Function and Structure in Parkinson’s Disease: A Randomized Controlled Trial.” Annals of Neurology, vol. 91, no. 2, Feb. 2022, pp. 203–216. https://doi:10.1002/ana.2629.
Ridgel, Angela, et al. “Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson’s Disease Patients.” Neurorehabilitation and Neural Repair, vol. 23, no. 6, 8 Jan. 2009, pp. 600–608. https://doi:10.1177/1545968308328726.
Schenkman, Margaret, et al. “Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial.” JAMA Neurology, vol. 75, no. 2, Feb. 2018, pp. 219–226. https://doi:10.1001/jamaneurol.2017.3.
Silva-Batista, Carla, et al. “Resistance Training with Instability for Patients with Parkinson’s Disease.” Medicine and Science in Sports and Exercise, vol. 48, no. 9, Sept. 2016, pp. 1678–1687. https://doi: 10.1249/MSS.0000000000000945.