October 22, 2018
Welcome friends. What have you been up to as summer transitions into fall? Here in Marin we have plenty of trees changing their colors and hills lit with warm, glowy, early autumn sun. Lisa and I went for an epic hike on Saturday and it felt so good to be out in beautiful nature.
At the beginning of this month, I completed a goal I've had for several years when I did a silent retreat that was 6 nights in duration. Back in the fall of 2017 I had done an 8 week course known as Mindfulness Based Stress Reduction (MBSR). MBSR is a course developed by John Kabat Zinn back in the 70s to help introduce mindful practices (which can include body scan meditations where you simply feel different parts of the body, walking meditation, simple yoga postures and seated quiet meditation) to the lay public. His program is extremely well evidenced (especially in the pain and cardiac communities).The 8 week course culminated in a day long silent retreat- we ate in silence, practiced walking in silence. For an introvert who needs to talk for up to 8 hours a day for work, I found the whole experience deeply restful.
Looking for some more experience, I dove into a 6 day silent retreat. I was inspired to do so since the focus of the talks were focused on western and eastern philosophies surrounding cognition and consciousness. Over the course of the 6 days we did silent and walking meditation, volunteered (I scrubbed pots in the retreat kitchen- something I’m notoriously bad at), and each night we listened to a different instructor speak.
There was very little conversation- meals were silent, volunteer work was done in silence- and so I noticed I had a lot of cognitive space and energy to think. I noticed so many more animals: hawks, lizards, bunnies- when I was out on my hikes. I felt the sunshine on my shoulders and noticed little details like nests in trees, the color of fallen leaves, the flavor of the sharp cheddar I had at dinner. And I had time to reflect on how the practice of mindfulness meditation may be helpful for attention and focus within the PD community.
We all know that there are non-motor aspects to Parkinson’s Disease. Among the list by the NIH of potential non-motor symptoms people with PD may develop you will find: anxiety, depression, pain and sensory dysfunction. Within the clinic one of the most common non-motor findings I observe is increased increased impulsivity (sometimes this is related to associated meds-pramipexole was notoriously tied to gambling and obesity in a study published in JAMA) and poor planning.
I see this when people are mid balance challenge and suddenly turn to look at me (while standing on one leg!) to ask for a drink of water. Within the clinic, I will sometimes set goals to practice focus and attention during activities. And people frequently say (when they are running through a BERG balance test or functional gait index) “I’m much better here than I am at home”. I wonder how much of that improvement has to do with focus and attention to the task at hand?
A study in Clinical Neurology and Neurosurgery 2013 noted improved grey matter density in MRIs (grey matter denotes areas of neuronal cell bodies within the cortex) in areas thought to be impacted by PD by a group of people with PD who participated in the classical 8 week MBSR training (please note the sample size was quite small- n= 27). There are certainly many research articles linking improved balance and stability in standardized tests when people with PD pursue mindful movement practices (such as thoughtfully applied yoga, tai chi and qi gong.
Some of the wonderful qualities about mindfulness practices, is that there are many free examples online, and there are little to no side effects. I must write- if you have any clinical behavioral health issues, please check with your therapist or doctor before attempting meditation.
Though we may not be able to speak to the efficacy solidly (like we can about forced exercise), you can start trying your hand at mindfulness today.
Here are some fun ideas you can try at home:
Body Scan with John Kabat Zinn (I give this to almost all of my patients) 30 minutes:
Noticing your breath 1-2 minutes:
When you are in a safe and comfortable position, close your eyes and notice your breath. When you inhale, notice you are inhaling. Notice your exhalation. Begin to count your breaths, labeling the inhalation and exhalation as one. When you get to 10, stop the practice or you can start back over at one. Notice when the mind wanders, and just gently bring it back to noticing the breath and count.
Mindfulness of food 5 minutes: (my favorite!)
I suggest trying this on a mid-full stomach- between meals-not super hungry or full. Decide what food you would like to do this with. Orange slices, apple slices, a small piece of cheese or chocolate if that is OK. It is nice to do it with something small, as you’ll see you won’t want to eat a lot of it. Begin by readying your food and take a small portion (one slice of orange). Place it in front of you. Notice the color, texture. Notice if you can smell the food (this is particularly tough when you have diminished olfactory senses but notice simply what is there- nothing is something too). Bring the food slowly to your mouth and put a small piece on your tongue (now I think this part is more rich if you take your vision out of it, so if you are in a safe spot, close your eyes). Notice the sweetness, acidity, sharpness. Notice if the taste changes as you continue to notice it. Notice how the textures feel as you chew. After swallowing your food, pause for a while. You can repeat with more bites, share with someone you love or save for later.
What are your thoughts on mindfulness and PD? Is this an area you would like to explore further?
Let us know!
Happy (mindful) Moving!