World’s Toughest Row with Brendan Cusick and Pat Morrissey: Part One

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain & Life Podcast.

Dr. Correa:
Welcome back, or welcome to the Brain & Life Podcast. Katy, I'm so glad to be starting this new year, at least together, and just enjoying our community and helping spread more word about living with neurologic conditions.

Dr. Peters:
Happy New Year, Daniel. Absolutely, right back at you. Happy to be here. Happy to be here with you.

Dr. Correa:
And sorry to our listeners. I know we're probably well past the window of being able to even say Happy New Year, but we're just enjoying the beginning of the year together. So Katy, we talk about lots of different kinds of adventures and experiences in our community. Do you get seasick? Do you like boating and going out on the water?

Dr. Peters:
It depends. So cruising on the river on a float boat, I'm fine. That was similar to what, we were in St. Paul, slash, Minneapolis, the Twin Cities for AAN.

Dr. Correa:
That's right.

Dr. Peters:
That sailboat, or I guess it was a float boat, was fine. But if you have me on a sailboat with those big mass sails or deep sea fishing, not fine. I turn green, I'm seasick. I was fine on a high-speed boat in Hawaii for snorkeling, but I've not tried my sea legs on something bumpier or choppy waters. How about you?

Dr. Correa:
I mean, I love whenever I get a chance on vacation to go on a boat, out on the water, have a picnic, like a boat that takes you somewhere to go snorkeling. And occasionally when it's moving a little faster and you get those extra bumps, you get that little bit of excitement. But also, you're also like, "Ooh, yeah, I'm right at the edge." I'm going to relax. I'm going to make sure not to eat anything for a bit, but I can notice that challenge. I've never even tried sailing with a mast and a sail on my own before. It'd be really interesting to learn, but it doesn't seem like something that would be the place where I would do it, be testing the edges of my possibilities. How about something like going out into nature for multi-day adventures, whether you're camping or anything else?

Dr. Peters:
I'm game for that. I think I could do that. I have done it before, but I guess where I'm at now, the idea of glamping over camping seems a lot more fun to me and a little bit more reasonable.

Dr. Correa:
Yeah, I do remember growing up both with Boy Scouts and friends, just going out camping. I found I loved the campfires, I like the cooking, being out for the hikes, but I also really like having a comfortable place to sleep. And even if I'm going to be cooking and we're hanging out together, having at least a little bit easier of a kitchen or a place to cook is great because I enjoy really the food. And yes, I probably would categorize it as glamping because if I have the option and a choice, I'd pick a place with a hot tub.

Dr. Peters:
I totally agree and a shower.

Dr. Correa:
Yeah, there's that. Imagine our two guests today, Brendan Cusick and Pat Morrissey, they're friends that came together in a wild situation. They were not only targeting a long distance boating or rowing voyage on open ocean-

Dr. Peters:
Oh my gosh.

Dr. Correa:
... the Pacific of all, but aiming to spend over a month at sea alternating rowing in groups of two, in a group of four guys.

Dr. Peters:
That's amazing.

Dr. Correa:
And you know what? By the way, being that we're on the Brain & Life Podcast, one of the team members you'll get to meet in a moment was living with Parkinson's and had never rowed before in his life.

Dr. Peters:
Oh my gosh.

Dr. Correa:
I mean, truly impressed with the dedication to a goal and the idea of potentially fundraising so much to benefit research and those living with a neurologic condition and what to me is practically a moonshot. I can't imagine. And it's so amazing to hear their success and that they ended up actually setting a world record.

Dr. Peters:
That is just amazing.

Dr. Correa:
So quickly, before we get to the episode, I wanted to say after we've spent some time with the discussion with Brendan and Pat and our medical expert, Dr. Fleisher, we found we had enough great content for two episodes. So this week, you'll hear part one of our discussion with Brendan and Patrick, and then some follow-up discussion with Dr. Fleisher in this week's episode. Then stay tuned next week and make sure you don't miss part two where we will continue with more information from Brendan and Patrick about their experience and taking their lessons into daily life, whether it's living with Parkinson's disease or in any situation. And we'll continue that again with Dr. Fleisher, stay tuned.
Welcome back to the Brain & Life Podcast. I'm really excited this week to bring you two guests, a team or members of a team who have come together really to bring greater attention and awareness to our community of those living with neurologic disorders. Brendan Cusick and Patrick Morrissey are two of four members of a team called Team Human Powered Potential, who in July 2024 completed what is considered the world's toughest row.
This route requires rowing with their hands, rowing across the Pacific Ocean from Monterey, California to Kauai, Hawaii for a total of 2,800 miles without any help, no motor power, no one coming along with them. That alone sounds amazing, but they did it in 41 days after rowing in teams of two for 24 hours straight. They did this together as friends and to fundraise to increase research for Parkinson's disease in collaboration with the Michael J. Fox Foundation's Team Fox.
Patrick himself lives with an early Parkinson's disease diagnosis and still found his way to manage his own symptoms, join the team, become the first person with Parkinson's to complete this challenge, and together they raised $42.8 million for research. I'm just amazed by all of it, guys. Thank you Brendan and Patrick for joining us.

Brendan Cusick:
Happy to be here. Thank you for having us.

Pat Morrissey:
Happy to be here. Yes, thank you very much for having us.

Dr. Correa:
So before the 2,800 miles, I'd like to go back even before that. What's your history for each of you with exercise and sports and endurance challenges? I imagine you didn't wake up in June and just go and start this effort. What was your previous experience with these kinds of things?

Brendan Cusick:
So for myself personally, I come from a background of professional mountain guiding and climbing. I have a deep history in climbing in the Himalaya, Alaska, South America. I found a great interest in single push climbs especially in Alaska where it stays light 24 hours a day, where you're able to steadily, take a rest every 12 hours, and then continue on. Also had a certain knack and enjoyment in ultra-endurance-related events, whether it was trail running or ski mountaineering and then bike racing as well. And I've been doing that since my late teens and then really getting serious about it into my early 20s. And I'm 50 now, just for perspective.

Dr. Correa:
All of that sounds very serious. And for our listeners, they won't see that you're not calling in and joining us from the top of a mountain somewhere. So it looks like you have another job that you do other than taking yourself to all these other places in the world. What do you do day to day?

Brendan Cusick:
Day to day, I work for an oil and gas company that's owned by the Southern Ute Indian Tribe and I work in reclamation and sustainability. So on the environmental front of reclaiming old oil and gas wells and putting them back to their natural state. And then on the sustainability front, reducing our methane emissions and other toxic emissions into the environment.

Dr. Correa:
All right, well, thank you for all that you're doing to hopefully improve our environment as we move forward.

Brendan Cusick:
Absolutely.

Dr. Correa:
And Patrick, I mean were you spending all of your time rowing at home or what was your previous experience with doing these kinds of sports challenges?

Pat Morrissey:
Well, thank you. So going back, in college, I was a Division I wrestler. I wrestled in college, so that was the start of my career in intense athletics. But after I got out of college, I dabbled in mountain biking, did some 24 hour racing through my younger years. And then really just all different sports, hockey, skiing, road biking, a little bit of everything, nothing to the level of Brendan and Peter and Scott, but I dabbled in a lot of different things leading up to this adventure.
But talking about rowing, I did not do any rowing until this adventure started. So I don't have any background on that. I started about two years ago and Brendan can maybe give you the little bit of the history of how the whole team got together and started, then I can finish on that. So yeah, this is a new one for me, especially being landlocked. We're both from Colorado. Brendan's got some history back in younger days rowing, but me, I'm a mountain boy.

Dr. Correa:
Brendan, so tell me, how did this team of four come together? You have your own experience with these endurance challenges, but how did the idea come together and why each of the four of you?

Brendan Cusick:
So I had been following ocean rowing for a little while. I found it to be a fairly fascinating sport and taking that endurance level to another step. It really kind of shatters the ceiling. And as you mentioned, what's unique about it is that we row two hours on, two hours off, 24 hours a day for really the entirety of the crossing. So it does take a special person who wants to embark on such an endeavor.
And it all kind of started when our teammate, Scott Forman, he and I have been friends since the early '90s, just about 30 years guiding together climbing. And then we've stayed in close contact and he lives near to Pat and I in New Mexico, we're in Colorado. And I had found out about the event and I texted him because, well, for his 50th birthday, we ran the Grand Canyon rim to rim to rim, so to the North Rim and then back to the South Rim. And I said, "Well, we're doing this for your 50th, we'll have to do what I choose for my 50th." And he says, "Whatever it is, I'm all in," which is a typical Scotty response.
So I found out about the event and they were having an info call and he and I jumped on that call and we were learning about it. And at the same time, four women, American women had just completed the row, but they went from San Francisco to Oahu. And we found out that the boat that they had crossed on was available, and that's probably one of the hardest things to get a hold of. These boats are very unique and specialized for this particular type of crossing. While we were on the call, he messages me and says, "Why don't we buy the boat?" And here we're just finding out about the event and all of a sudden we're considering purchasing this boat, which is no small endeavor.
So fast-forward a couple of months and we did buy the boat, American Spirit. She has four world records and just an amazing history in her own right. And from there, we started to evaluate folks who might be interested and that's where Scott reached out to Pete Durso, who's our other teammate. And Pete's not one to say no to much of anything. He's a triathlete and former competitive swimmer. He reached out to him and he said, "Absolutely, I'm in."
And then at the same time, all teams pick a cause to row for and each team has their own. And in a roundabout way, we became affiliated with Team Fox and the Michael J. Fox Foundation and really wanted to focus our efforts in on raising funds for them and also recognized it was a unique opportunity to actually have them as effectively our sponsor. And when that happened, I personally have a number of close friends and family that live with Parkinson's along with Pat, who he and I are neighbors and worked together for a number of years. I reached out to Pat and said, "I'd really love to have you involved perhaps as a spokesperson or in some capacity." Well, it didn't take long before Pat called me one evening and said, "I think I'd actually like to row."
And so that was an easy ask of us knowing Pat, knowing that he was fully capable of embarking on this endeavor. And this is all in early 2023 that this transpired and started to form as a team. So that's how it all came together. And from there, we had the four of us and we officially kicked off our training about a year before the actual crossing.

Dr. Correa:
Pat, what did you have to ask yourself and explore for yourself to answer the question, can I do this? Do I want to do it? What is going to fill my brain for 12 hours a day of this rowing for 30 to 40 days, or who knows how long it's going to take? You're out there on your own. There's one direction, you got to finish.

Pat Morrissey:
Yes, yes, great question. So I'm going to add a little bit to what Brendan talked about there of where I was at. He talked to me about being a spokesperson at first, just with me, knowing that I had Parkinson's. We were working together at that time. I just end up retiring at the beginning of this year from my past job. Our offices were pretty close and Brendan and I used to go to coffee and talk about this.
So it was about two months while they were putting the team together that they didn't have a third. And I was watching them go through the process and they started going, I think they went one or two training rows out in California before I started. And through that whole time, I've been kind of searching for what's next and there's a couple things is the challenge of doing this with Parkinson's was definitely one of the big ones. But also getting involved with the Michael J. Fox Foundation and knowing that they were involved was also a big part of it. It was my way of being able to give back a little bit to the community in a fundraising society and also get to know the foundation and everything they do, have done, or continue to do.
And so, one night, it was about two months into it, I was just talking to my wife and I said, "What do you think about me doing this?" And she just looked, it was more of a, I knew this was coming. And I said, "I think I'm going to call Brendan and talk to him about it." Well, that call turned into I was doing it. She pretty much knew where that call was going.
And we decided for that first couple months just to make sure that let's just ease into this and see how my body handles the training because it was very intense. We had a coach who really defined everything for us on a daily basis to get us ready for about a year and a half before we started. And after a couple months, I was able to basically keep up with the training and it was history from that point. So it's just been a great, great endeavor and the guys are just great teammates. I don't know if I answered the question, but it was a long, long answer there.

Dr. Correa:
No. Now the one thing I didn't hear and I was wondering was before you had that conversation with your wife and then called Brendan, had you actually gone on a rowing machine?

Pat Morrissey:
No. No. So when we talked about it, I had to buy a rowing machine after we committed. So that was the first thing we did after that phone call was get online and bought myself a Concept2. I have a video of the very first row. It was not pretty at all. The technique was a little bit off, but luckily we have a world-class coach that helped.

Dr. Correa:
What were in your thoughts that night, the first night after you had been on the rowing machine and started your training?

Pat Morrissey:
Kind of twofold. It was excitement. There was really an excitement because it really gave me a very large goal to go after and I knew I could do this. Well, I really knew I could do it back in my younger days. With Parkinson's, I just didn't know how it was going to react. But also a little bit of nervousness because of that, of how my Parkinson's was going to ... I didn't want to let the guys down, one of those, at the beginning. So I was like, "Oh man, I hope I committed and I can be able to continue to do this." But we were able to put it together, so it was pretty good.

Dr. Correa:
You had years of doing different types of exercise and I imagine even after your diagnosis, you were probably still incorporating exercise into your daily routine. How did you feel your body responded to exercise after Parkinson's?

Pat Morrissey:
So a little story of when I was diagnosed. The day I was diagnosed, I got a call from the doctor and I tell the story because there were two things that she told me when I asked her, "Okay, well what do I do from here?" And the two things she told me were, "Go find a movement specialist, the best movement specialist you can find out there, a neurologist, and get involved with them. They're usually on the front line of everything so they know what's coming up on trials, et cetera. And work out every day for the rest of your life." Those were the two things she mentioned to me and I've taken that very seriously. I did work out every single day from that point until after the row. I did take a couple days off after the row.

Dr. Correa:
Well, I'm glad.

Pat Morrissey:
Yeah, there were a few days. I think we just slept for a few days, literally after we got off the row. But it has been instrumental in my life, the exercise portion, and the row just continued that, took it to another level. But you don't have to row an ocean to be able to, and I just heard this statement the other day, but try to do some kind of exercise every day to keep moving forward and to keep your body moving. So it's been almost a non-negotiable item in my life, which has really helped.

Dr. Correa:
And we've seen evidence from studies, really the benefit of exercise for many conditions, but particularly including Parkinson's disease. But a lot of that has been with stationary bike and with other coordinated activities of both sides of the body, particularly different types of dance. Once you started rowing, did you feel there was a difference in how your body responded either positively or differently with your tremor and with your symptoms from the rowing compared to other physical activity you had been doing?

Pat Morrissey:
Yes. So it was incredible. When I rode at the beginning, my tremor would totally go away. So it was a part of the training that was, I think the repetitive motion and it's almost like calming or a little bit almost like meditation where I could get in a groove and everything would just stop. And that, just as you may understand, when that tremor stops, it's nice. So it was great, and it still is. I still row right now after the journey because of that rhythmic motion and trying to keep everything in coordination and working together. I think it's a great exercise for Parkinson's.

Dr. Correa:
And Brendan, as Pat's friend and teammate, what was your perspective with him participating and did that change or any concerns change as you trained together?

Brendan Cusick:
I really wasn't too concerned and especially as Pat mentioned as the training progressed, we really saw this shift in how his body performed on the boat, having that ability to coordinate with the oars and everything else. And of course, I mean the first couple of rows we're just kind of sussing it out, especially when you've never rode before. And as that progressed, we really just saw a lot of remarkable positive outcomes during our training.
Interestingly and kind of in a small world, our friend Barry Hayes, who's a British Ocean rower, he crossed the Indian Ocean with the only other person to row an ocean with Parkinson's other than Pat. And Robin's success out of that row was kind of a little carrot of that it's possible. They were out there for 70 something days. And so it was nice to have those conversations and to know maybe what could be expected when we're out there.
I'd say if anything, our confidence was boosted by all of our training and just seeing how Pat was doing. The other thing I will mention is Pat's mentally very tough. I don't know if it's the years of wrestling and football and just that really focused training, but that really came alive in such an amazing way that I think just he was able to really bring that focus and talent forward in the training and into the row that it made it much better and it just enhanced the whole team in a great way.

Dr. Correa:
And team rowing on a boat particularly, in my very limited understanding just from watching the Olympics, requires a lot of coordination and really having a sense of each other's flow. Was that something that each of you had to train together with Pat? And how was it the difference between rowing together with Pat as opposed to one of the other team members?

Brendan Cusick:
I didn't really notice much of a difference. And so what would happen is Pete and I would switch, he and I are both the tall guys on the boat, so we shared a long cabin, and so he and I would switch, and then Scott and Pat were in the alternate cabin, and so they're a little shorter. So I think favorably in a lot of ways is that Pat was behind Peter and I, and so we were able to set the stroke. We were basically the stroke seat.
And I think that helped Pat, maybe mine didn't so much at times. I was a little faster cadence than Pete, so obviously. And then we're switching off every hour, so you have to readjust a little bit. But I think, and correct me if I'm wrong, Pat, but I think that really helped a lot in terms of being able to set the cadence for him so that he wasn't, one, nervous about having to do so, and two, could just kind of follow our lead. And I think that helped a lot.

Pat Morrissey:
Yes, I'll add to that. So originally on the training rows, I mean they were training rows out in the Bay of Ventura and near San Francisco in the Bay. And it was nice because I could just follow Brendan's cadence. What I would do is literally follow his right arm with my right arm. My right side is the tremor and my Parkinson's comes out in my right side much more than my left. So I was able to follow that cadence really nice.
I will add when we got out into the ocean, the ocean brought a whole nother level of stress and exhaustion to our rows, which we never got into on our training rows. We'd go out for 24, 48 hours, but nothing for 41 days. And also the level of what the ocean just kept bringing to us. So there were times that my right side didn't work as well through the row. And it is just, I would say from total exhaustion and the mental stress. Mental stress is something that really hits me and it starts up my tremors, really one of my big catalysts, I guess what I would say, or triggers, and the ocean brought that out.
So there were times throughout the row that I ended up having to take a little bit of time off and reset my right side and try to get that coordination back from my right and left side. And these guys just kept rowing. So it was incredible what they were able to do. And ultimately, it would come back and what we ended up having to do is figuring out that fine line of how much I could push it. We figured it out as a team and continued to endure and get through the race and finish strong.

Dr. Correa:
I mean, many of us get thrown off and stressed and anxious and have all kinds of other things triggered by some turbulence on a plane when we're riding on those comfy seats, or not so comfy. But I can't imagine on the rowing seats, on the ocean, isolated, 30-foot waves. I would just be worried about holding onto the oar just so we don't lose it.

Pat Morrissey:
There were a few of those times also. Yeah.

Dr. Correa:
Yeah, yeah. Truly a thank you to Brendan and Pat. I can't wait to finish this conversation in part two next week. Just wanted to remind you, make sure you subscribe, you're on it so that you get the next follow-up for this episode.
Want to learn more about the conditions discussed in this episode and other factors that could impact your brain health? For the latest on causes, symptoms, diagnosis, treatment, and management of more than 250 of some of the most common and rare neurologic conditions, please visit brainandlife.org/disorders.
Welcome back to the show. I still can't imagine rowing 2,800 miles. I'm just so impressed with their dedication and effort and I'm really excited now to continue our discussion today. We have with us Dr. Jori Fleisher. She's a movement disorder specialist at Rush University Medical Center in Chicago, and a passionate advocate for people and families living with advanced Parkinson's disease and related conditions.
Jori is the co-director of clinical centers there at Rush University dedicated to improving the care for Lewy body dementia, progressive supranuclear palsy, Parkinson's disease, and another center called the AIMS Clinic. Her work emphasizes that there is always something that can be done to help those with Parkinson's and their families. Dr. Fleisher's research highlights the importance of human connection to combat social isolation and to support family givers. She's developed programs for home visits, mentors other doctors with the hopes of improving quality of life for the community that she serves, and is dedicated to patient care and research and has been recognized by many of the organizations, both patient advocacy organizations and professional organizations. Join me in welcoming, Jori. Thank you so much for joining us here today.

Dr. Fleisher:
Oh, thank you so much for having me, Daniel. It's a pleasure.

Dr. Correa:
So I wanted to just, one thing that I mentioned there, I'm not even really sure how you're wearing so many hats. We're always impressed by each other in terms of our colleagues and particularly all the different work that you're doing, not just in patient care, but supporting the community and juggling the various conditions that are considered movement disorders. One of the things we mentioned is the AIMS clinic or the AIMS center. What is that?

Dr. Fleisher:
The AIMS clinic stands for Advanced Interdisciplinary Movement Disorders Supportive Care Clinic. The acronym doesn't quite work, but we stretch it. The way I think that I'm able to juggle so many different roles is because I am not doing it on my own at all by a long stretch. So the AIMS clinic is an incredible team of, we have a neuro-palliative care doc, Dr. Neha Kramer, we have a social worker, Sarah Mitchell Chen, we have an amazing dietician, Kristin Gustashaw, and our nurse, Grace Hong, and then our movement disorder fellows.
And it's really a place where my colleagues, as other movement disorder neurologists, and folks in the community can say, "I have a person living with a movement disorder who is really challenged by some of the more complex symptoms," or, "The number of symptoms is really starting to increase," or, "I'm just not sure what to do," or, "Their care partners, their family members are feeling really overwhelmed and I'm not sure how to point them in the right direction in terms of community resources," or, "Someone is losing weight unintentionally."
And as neurologists, that's not usually part of what we do. We don't necessarily have a ton of background in nutrition. But being able to pull in all of these brilliant specialists and we're actually in the room together all at the same time. So instead of the patient family sitting in one room and sort of that rotating carousel of different specialists, we describe it as the clown car of women that dumps out into the room and we're seeing people all together.
But being able to hear directly from our folks living with neurologic disease and their family members and really target as a team, we can tag team into the conversation. So it's nice. It's a way to bridge all of those different conditions, Lewy body, Parkinson's, PSP, and some of the atypical Parkinsonism. So it's incredibly fulfilling.

Dr. Correa:
I mean it sounds particularly unique, but then it also raises the question for me, do you think that everyone with one of these movement disorders should be seen at a clinic doing a similar approach or is their general neurologist a good start? How do you juggle that kind of recommendation?

Dr. Fleisher:
It's such a good and important question, and I think there are a lot of different answers to it. There is the idealistic answer of everyone should know the different specialties that are out there and should have access. I think it's unrealistic. I know that the clinic that we've built is a product of the location and having the right people at the right time and the right funding, and that doesn't exist most places. And so I don't want to tell people, you must go and find a clinic like this.
You can have an amazing neurologist who's taking care of you, whether in the community, a general neurologist, a movement disorder specialist. They may not have a social worker affiliated with them, but hopefully they can point you towards one. They can recommend a dietician. They can connect you with a gastrointestinal specialist if you need it. They can explain what palliative care is and why that is a specialty that really is relevant throughout the entire journey with any neurologic illness because it's all about quality of life.
And so I think empowering people living with neurologic disease to know what's out there, recognizing which of their symptoms could be related to their neurologic illness, and bringing that to the neurologist and saying they may not be able to treat their urinary issues, but do you know a urologist that you can point me to who is familiar with neurologic conditions? So building your team, even if it's asynchronous, even if it's not in the same place, you deserve a team. You just may have to do a little bit of legwork to build that.

Dr. Correa:
I like that. So we all deserve, I think, a team that help us and push us forward in improving our quality of life. In this situation, you're saying if you like the neurologist that you're working with and it's starting well, then you can stick with them, but seek these other services. And it sounds like to me that you would also then welcome the suggestion that if you're not sure, then you always are welcome and deserve a second opinion.
And we just heard from Patrick and Brendan about this amazing adventure they went on, that Patrick joined Brendan and a few other adventurers out there basically on this idea of rowing from California to Kauai, Hawaii. I mean, not exactly even like a road trip. There's no out. Once you're out there, you're in the middle of the ocean.

Dr. Fleisher:
I mean that's bigger than just buying your gym membership on January 1 and saying, "I'm going to do this." They really did it.

Dr. Correa:
Yeah, seriously. And then this idea, I think Brendan, an adventurer really, had this idea where he was really interested in this effort and had been talking about it with friends. And Patrick got involved as just a friend and they were talking about ideas. And then Patrick was interested in actually joining it and raising the question, what if he could do it? And if he could do it, what if they could fundraise for Parkinson's with the Michael J. Fox Foundation? An amazing feat, raising over $42 million.

Dr. Fleisher:
That's incredible.

Dr. Correa:
I'm so impressed with the story and incredible that they were able to make such a contribution to move research and the effort forward. But it raises a lot of questions for me. He talked about how he found over time exercise helped with some of his symptoms. He really had to talk about nutrition and some aspects about managing his day with his neurologist. And I wanted to start there with you. What do we know about the mechanism of how exercise, different things about nutrition, or other types of movement and the time of day impacts someone living with Parkinson's?

Dr. Fleisher:
So I think it's a really complex area, and I'll start from the broad perspective, which is that right now none of our medications, none of the pills that we have, none of the interventions that we have for Parkinson's are slowing down the course of the disease. We all want a cure. There are thousands of researchers out there day and night working to find cures and to find treatments. But right now, all of the medicines that we have to offer are covering up the symptoms, helping people live better, function better, but they're not changing what's happening underneath.
However, exercise seems to be the thing that has the most evidence that it is slowing things down and changing the brain underneath, which is incredibly powerful. And there are many different mechanisms that have been proposed for this. It's hard to study it in people, so a lot of the data that we have comes from animal studies where they take a little mouse and by very scientific ways, you can have a mouse mimic having Parkinson's and you make them do different kinds of exercise.
And they see that the mice who exercise more, the dopamine cells, which are the brain cells that die off early because of Parkinson's, the heavy exercising mice, their dopamine cells stick around for longer. They seem to connect better with the neighboring brain cells. So they strengthen their connections, they strengthen their synapses. We see that there is a decrease in some of the toxins that can happen in the brain, some of these reactive oxygen species. Those seem to be decreased with more exercise.
And so we have good, basic science data that tells us, all right, in an animal model, there's all kinds of reasons why we know that this is helping the brain. In people, it's harder to quantify things like that. But what we do know is that in clinical trials where they randomly assign people and say, "You do this exercise and you sit around, don't change your routine," the folks who exercise do tend to do better. They do better on their Parkinson's exam in terms of their mobility, their stiffness, their slowness.
Many studies have reported that activities of daily living, how easy or difficult is to get dressed to go about your daily life, that tends to improve and people's quality of life improves. Some studies have found improvements in mood. So there are a lot of different ways that we think this is working.

Dr. Correa:
Yeah, I mean Patrick had a background of athletics and doing exercise growing up and later in life, but had been noticing a decline. And amazingly enough, even though he did this effort, hadn't actually done any rowing on the ocean, let alone on a rowing machine before this.

Dr. Fleisher:
It's pretty mind-blowing.

Dr. Correa:
So it must have been also, I can imagine after doing it that he really found enjoyment, he found a benefit. And that's another aspect that you were just talking about. And I was going to ask you because whether it's us reading journals, whether it's our listeners and magazine readers taking a look at articles in the magazine or all kinds of different things online, there's been studies described showing martial arts improve Parkinson's, dancing improves Parkinson's, riding on a stationary bike improves Parkinson's, using a rowing machine.
And so you started to mention it already there, I am not aware, I haven't seen any actually comparing types of exercise or even the type of movement, if it's a coordinated movement of both sides of the body, or if it's a single movement, or if it's weightlifting compared to more balance and coordinated movements. Do you know, is any attempt right now being done to take a look and compare?

Dr. Fleisher:
Yeah, it's a really interesting question. There are some small studies where they've compared one type of exercise to another. The challenge is these studies are often pretty small, and some of them, people are choosing which exercise they do and that introduces a bias because people are going to do better presumably if it's something that they've chosen and enjoy. But it doesn't tell us as much about the exercise that we're studying. It tells us the persons doing something, they're actually sticking with it. They're doing the movement.
From several different studies, we know that there is benefit to aerobic exercise. So things that get people's heart rate up, that get them sweating, not pushing themselves to the point of oblivion where they can't move the next day, but where they feel like they're really getting a workout. We know that there is strong benefit to aerobic exercise and there's actually kind of a prescription.
So based on some of these studies, the prescription that we give people is aiming for 150 minutes per week, which could be 30 minutes five times a week, you can split the math however you'd like, but of aerobic exercise where your heart rate is increased, you're sweating, you feel like you're pushing yourself. So for some people, if they're just starting out, that might just be walking around the block. But for someone who's rowing across the ocean, they're going to have to work a lot harder to get their heart rate up. So it's really tailoring that to the individual person.
But there are also studies not comparing head-to-head, but there are studies showing us that resistance exercise, so weight training, even body weight strength is really, really helpful. We know our folks with Parkinson's are prone to falls and can break bones. We want to strengthen bones, we want to strengthen muscles to protect from falls and to cushion if there's a fall. So weight training, things like that. But people have also studied swimming, which can be aerobic. That's very helpful. Dance is very helpful. Several different forms of dance and things like yoga and tai chi for flexibility have also been shown to be beneficial. So ideally people are choosing more than one thing and they're getting all those different benefits to the extent that they can.

Dr. Correa:
So in a way, almost picking an activity that seems very approachable and increasing the amount of time that you can do, somewhere near that 150 minutes. And then I like the idea of maybe picking one other, the future exercise, the thing that you'd like to be doing in the future that seems appealing to you. But maybe starting off at 150 minutes seems like a lot and seeing if you can incorporate that some more into your week or maybe a little bit each day, and the walking to and from can be the first challenge.

Dr. Fleisher:
Absolutely. And I think maybe some of the secret sauce, as Brendan noted, all of this is having an accountability partner, not trying to do this on your own. This is why some people really like just going and walking around the mall or they like going for a walk in their neighborhood with a friend. It's not just that it helps with social connection and prevents social isolation and loneliness, but there's accountability because anyone's going to have a morning where it feels too cold or you just don't feel like doing it, the motivation isn't there. It happens to all of us.
And Parkinson's particularly can cause a lot of apathy, this loss of motivation to do things that used to bring us joy. And so someone who was fine before and would get up and bike 10 miles and go about their day, maybe losing that motivation to do that. But if instead of doing it on a stationary bike at home, they meet a friend and they go for that bike ride together, they know someone's expecting them to be there. They're often more willing to show up for someone else than just to do it on their own. And so I think that there's tremendous power in social connection, especially when it comes to exercise.

Dr. Correa:
I think a great message and something for us to learn, for everyone to learn from this. Well, I wanted to come back to that team idea that was so important for Patrick, Brendan and the other two guys that joined them. And as we wrap up, we often talk about and think about, oh, what more can the family or the caregivers do? But let's think about the person living with Parkinson's. How can they support their family and partners, whether it's in communication and in other ways so that everyone's quality of life is improved?

Dr. Fleisher:
I mean, I think reminding people. Sometimes, especially in the first couple of months after a diagnosis, it can feel very much like the spotlight of life has just shifted to just focusing on this disease. And in whatever way you can, remembering first as the person living with neurologic illness that you are a person. You are every bit of the person that you were before this diagnosis was made and you will still always be that person, and reminding your family. If there are times where the conversation is always about the diagnosis, you can stop the line and say, "I'd rather not talk about this anymore. Let's talk about the game. Let's go do this. I just saw the craziest movie."
You have every right to control that conversation and bring it up when you want to, but also say, "I appreciate it. It's likely coming from a place of concern and love, but with all due respect, stop sending me 15 articles a day. I don't want to read them. I will talk with my neurologist. You can hang onto them if that's helpful for you, family member, to learn more about Parkinson's and for you to cope with a loved one having that diagnosis, cool, cool. But right now that is not helpful to me because I want to continue being who I am."
When I make a diagnosis of Parkinson's, I always tell my folks that this is something that gets added to your list, but this should never be the center of your life. You are you and you happen to have Parkinson's. And if it ever feels like Parkinson's is the center, then I'm not doing my job because it should never eclipse who the person is. That person didn't disappear with the diagnosis. That person is not going to disappear. You may adapt and change just like everyone does with time and with challenges and with aging. But you should not feel like you are disappearing and you can feel free to remind your loved ones that you are still you.

Dr. Correa:
Such great attention to really something that's important for all of us. Thank you so much, Jori, for everything that you're doing to support and work alongside that team at the AIMS clinic and everything that you're doing to learn more about improving quality of life.

Dr. Fleisher:
Oh, you're so welcome. It's my pleasure. And I do it because I'm so inspired by our community and my patients are the ones that come to me with ideas and say, "What if?" And that's what drives all of us, I think. So please, if you have an idea, if you have a thought about what if I tried X, Y, Z exercise, what if I did this? I had a patient who came to me and said, what about karate for Parkinson's? And it started a whole line of research and we've got people that have now been practicing karate alongside other adults who don't have Parkinson's. And some of our folks have gotten their black belts over the course of the last several years, and it is astonishing. I mean, they could kick all of our butts and it's amazing.
And I think more impressive than what they're able to achieve and a board that they can break, which they can, is the community that they formed with each other. So that sense of camaraderie and the importance of that social connection, they taught me that. We can read any paper that we want, but find what you love, find the people that you enjoy doing it with and go to.

Dr. Correa:
I agree and thank you. And now we can all go out and find our own way to kick butt.

Dr. Fleisher:
Please do. Thanks so much for the opportunity.

Dr. Correa:
And that was just a snippet, a portion of the great conversation we had with Dr. Fleisher. Tune in to hear more about treatment options and the future of Parkinson's next week with Dr. Fleisher.
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org.

Dr. Peters:
Also for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain & Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online, @neurodrcorrea.

Dr. Peters:
And Dr. Katy Peters joining you from Durham, North Carolina and online, @katypetersmdphd.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
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