Former NBA player Brian Grant combats Parkinson’s with exercise

Brian Grant is used to being in control. As a power forward for the Portland Trail Blazers and four other National Basketball Association (NBA) teams—the Sacramento Kings, the Miami Heat, the Los Angeles Lakers, and the Phoenix Suns—from 1994 to 2006, he made life tough for opponents close to the basket, leaping for rebounds, denying positions, closing up passing lanes, blocking shots. His on-court confrontations with Hall of Fame power forward Karl Malone of the Utah Jazz were described as "one of the most physical and contentious one-on-one rivalries in the NBA," according to Trail Blazer video archives.

But sitting in a neurologist's office in Portland, OR, in 2008, as a doctor told him he had early-onset Parkinson's disease, he felt absolutely helpless. "I just stared out the window," recalls Grant, who was then 36. When Grant didn't respond, the neurologist asked him what he was thinking. "I joked, 'I think your scale must be off because it said I was eight or nine pounds heavier than I thought.'"

That eased the tension, and the conversation turned to how Grant would manage a permanent progressive motor disorder that had no cure. Facts and figures—that the disease affects about 1 million Americans and is caused by a loss of brain cells, or neurons, that produce dopamine, a chemical messenger that transmits signals in areas of the brain that control movement—washed past him.

His neurologist told him the disease, although chronic and progressive, was not fatal and could be managed with medication, but Grant couldn't process it. "I was used to being able to fix anything," he says. "But what I was hearing was, no matter how hard I fight or what I take, in the end I will lose to this disease."

Tremor and depression

At the outset, Grant despaired. In fact, he'd been depressed since retiring from the NBA two years earlier. "I saw a psychiatrist and started on antidepressants," Grant recalls, "but even the doctor thought it was odd to be so depressed just from retiring."

There was something else: a tremor in his left hand. It started as he was finishing his NBA career with the Phoenix Suns. "I was used to twitches and pains," Grant says. "The team neurologist said it was nothing to worry about." Parkinson's didn't spring to mind: Only 4 percent of people with the disease are diagnosed before age 50, according to the Parkinson's Disease Foundation.

What Grant didn't know then was that depression can be an early sign of Parkinson's disease, according to research. "People may be at increased risk of depression for five or 10 years before the illness," says Daniel Weintraub, MD, an associate professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. "Parkinson's disease can start in the brainstem and parts of the cortex, areas that are important for mood regulation, which may explain how depression can be an early sign," he says.

By the time motor symptoms such as tremors, stiffness, slow movement, or impaired coordination show up, "even in the earliest stages, there's already at least a 60 percent loss of dopaminergic [dopamine-producing] neurons," says Joseph Jankovic, MD, FAAN, distinguished chair in movement disorders and director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston. "So it's important to implement therapy as early in the course of the disease as possible."

Grant had noticed other signs—not being able to jump as high off his left leg and a vague sense of being uncoordinated—that, in retrospect, he pegs to Parkinson's disease. The series of blows—depression, the tremor, retirement, and a divorce—made Grant wonder, "What's next?" The Parkinson's diagnosis, for all its devastating implications, was motivating. "I was now in a position of seeing what I can do," Grant says.

Knowing he could be proactive shook him from the depths of his depression. With his position and visibility as an athlete, he knew he had much to offer as an advocate to help people with Parkinson's disease regain a sense of control over their lives.

Joining the fight

As word got out about his diagnosis, Grant started hearing from others who had the disease. The actor Michael J. Fox, founder of the Michael J. Fox Foundation for Parkinson's Research, called to discuss what challenges Grant could take on as an advocate. "He said, 'It's not a death sentence,'" Grant says. "'You can join the fight and use avenues available to you or keep it to yourself. There's no right or wrong way.'"

For Grant, sitting out wasn't an option. Growing up in rural southern Ohio, he relied on caring communities. "I did a lot of farm work in the summer to earn money—cutting and stripping tobacco, baling hay, digging potatoes," Grant says. When his family struggled, people in the area helped despite their own limited means. "We weren't destitute, but I've been on the receiving end of church dinners and funds that provide toys for kids at Christmas when their parents didn't have enough to give gifts," he says. "I've always wanted to give back."

His first thought: Start a foundation and website that would filter and reduce the flood of material on the Internet to a spigot of high-quality information about Parkinson's for those newly diagnosed. But he noticed something as he met more people with the disease and learned about their struggles: For many, the disease seemed to progress faster than his. Even today, seven-plus years after diagnosis, his main symptoms are a tremor in his non-dominant left hand, occasional tremors in his right hand, and a small amount of tremor in his left foot. Although he eventually started taking levodopa, a dopamine replacement drug, he's been on it for just three years. "My gait is pretty good," Grant says. "I consider myself lucky."

Grant credits that difference to his years as an athlete. Research suggests he may be on to something, says Mark A. Hirsch, PhD, a senior scientist in the department of physical medicine and rehabilitation at Carolinas Medical Center, part of Carolinas HealthCare System in Charlotte, NC. Dr. Hirsch is also the senior author of a 2016 research review in Parkinsonism and Related Disorders on how exercise affects the brain in people with Parkinson's.

"Walking or running on a treadmill, balance training, and interval training using a stationary bike triggered improvements in anatomy and function within key brain areas affected by Parkinson's disease," Dr. Hirsch says, summarizing the findings of eight studies involving 144 patients. "Also, scores on standardized tests of Parkinson's disease motor function improved." 

These findings are leading researchers and clinicians to think of exercise as therapeutic and potentially protective. "Many animal and well-designed human studies provide compelling evidence that exercise may slow the progression of the disease," says Dr. Jankovic.

Grant's experience got him thinking. "Exercise and nutrition are about the only things we can control," he says. With that in mind, he launched the Brian Grant Foundation in 2010 as a clearinghouse for information related to exercise and nutrition and a go-to destination for resources, including community programs and how-to workout videos tailored to people with Parkinson's disease. The organization works with a 12-member medical advisory board that includes several neurologists at Oregon Health & Science University (OHSU) in Portland, along with experts in physical therapy, exercise physiology, balance training, natural and nutritional medicine, and mental health, including a family physician who has Parkinson's. "We want to be the global leader for exercise—the one place you can find everything you need," says foundation director Cherise Bjornsgard. "Brian is joining the community just when it needs an inspiring person with fresh energy to champion that cause."

Getting physical

Grant's first experience in an exercise class for people with Parkinson's revealed how much work was needed. "The local courses I attended were for elderly people—things like getting up from chairs and changing your gait," he says.

That kind of experience can be devastating for high-functioning people with Parkinson's, says Dr. Jankovic. "You don't want to send someone who is just starting to experience symptoms to a class with people in wheelchairs," he says.

How to give high-functioning people the challenge they require? That was the question Kimberly Berg, a certified clinical exercise physiologist in Portland, pondered when she took over an exercise class for a group of 20 Parkinson's patients at a private health club. Berg had been working with researchers at OHSU to develop exercise protocols and a series of workout routines for people with Parkinson's disease. The class was a mix of low- and high-functioning people, which was great for support, Berg says, but because the class was always taught to the lower level, the high-functioning people seldom got a good workout. Grant could have joined a regular exercise program, but he wanted the support he would get from a class designed for people with Parkinson's, and he wanted an instructor who would be aware of the specific needs of people with Parkinson's.

Berg had an idea. She divided the class by functional level and began pushing participants in ways appropriate to their abilities. "I added stations, music, and drumming, and kept pushing. All of a sudden we had this group that just flourished." Grant got wind of Berg's efforts and approached her to do a pilot class that would kick up the intensity even higher.

Motivation to move

At Grant's urging, Berg set up stations on one of the basketball courts at Beaverton Hoop, a local all-court YMCA, for a trial Parkinson's program she called a boot camp. "I used weights, kettlebells, and different tools for participants," Berg says.

At one point, Berg told participants to take a water break—important for avoiding dehydration. Grant instead started shooting hoops. "I said, 'Get back here,'" Berg says, "and somebody said to me, 'No, don't stop him. Brian hasn't picked up a ball in years.' Something about that activity made him feel more capable. If you start sweating, something familiar inside comes alive."

Before starting an exercise program, Dr. Hirsch recommends seeing a physician who can rule out contraindications such as heart problems, then turning to a physical therapist who specializes in treating neurologic patients. "The physical therapist will do another evaluation and develop an exercise program that takes into consideration fatigue, depression, impairment, limited mobility, and cardiovascular problems," he says.

Berg signed on as the lead coach of the Brian Grant Foundation and developed the pilot class as a community program called the Powering Forward Boot Camp, which the foundation hopes to offer nationally. The foundation also launched a Powering Forward Wellness Retreat—a nine-hour program of nutrition education, cooking demonstrations, counseling, and community-building events like a wine and cheese hour.

All things exercise

Grant's foundation posts about a dozen exercises on its website that are adaptable to people of varying abilities and available in 10, 15, and 30-minute workouts. In a series of videos, Berg explains each move, demonstrates it, and has someone with the disease perform the workout while Berg provides coaching tips.

Other exercise protocols for Parkinson's disease exist, but exercise information tends to come in piecemeal, disjointed, or highly local ways, Bjornsgard says. "You'll find boxing programs in Texas and dance programs in New York. Our dream is to create a non-biased community where everyone can share what they're doing and put everything in one spot." What's striking about the Grant site is its patient focus and unfettered access to high-quality videos, says Michael J. Zigmond, PhD, a professor of neurology at the University of Pittsburgh. "They have a very mixed range of exercises, which I think is important, because we don't know which types of exercise are best," he says.

Tapping connections

Meanwhile, Grant has used his contacts as a professional athlete to raise awareness and funds. Even before starting his foundation, he organized a gala called Shake It Till We Make It. "That was a special night," Grant says. "Pat Riley [who coached the Miami Heat while Grant was on the team] made a speech. Retired and active NBA players attended, and even Michael J. Fox and Muhammad Ali [the boxing champ and fellow athlete with Parkinson's] showed up." The $350,000 in proceeds went to the Michael J. Fox Foundation that first year, but the event has since continued as an annual gala and golf event to raise funds for Brian Grant Foundation programs. At another Shake It Till We Make It gala, the top auction prize—which raised $36,000 of the event's $500,000 take—was an Alaskan fishing trip with Grant and his old on-court nemesis (and now friend) Karl Malone.

The foundation's next major initiative is the Parkinson Power Through Project, a partnership with the World Parkinson Coalition that encourages people to exercise individually or in teams (see "Powerful Partnership."). Thanks to Grant's connections with the NBA, the association will spotlight the project at the NBA All-Star game in Toronto on Valentine's Day.

Leading by example

Grant continues to model an active life in the hopes that exercise will help slow the progression of his disease. Grant's doctor, John Nutt, MD, a professor of neurology and emeritus director of the OHSU Parkinson Center of Oregon, encourages Grant to remain physically active but cautions him against pinning too much hope on exercise. "Everyone's Parkinson's follows its own course," he says. "Here is somebody who is a fabulous athlete and in very good condition, and yet saw symptoms of Parkinson's disease at age 36." So exercise didn't prevent the disease, but it may prevent it from being worse. "Moving your body through various forms of exercise, especially those that require balance and agility, is clearly better than not moving," Dr. Nutt says.

Motivating others has been an upside to Grant's diagnosis. "A lot of professional athletes see themselves as warriors who fight not only for themselves but for the team," Dr. Nutt says. "I think now Brian sees the Parkinson's community as part of his team, and he's fighting for them."

In Bjornsgard's view, Grant's athleticism, history of depression, and down-to-earth frankness give him power to effect change. "When Brian stands up in a room and says, 'This is hard for me, too, but you don't have to do this alone. Come join me. Come exercise,' there's such strong energy you can almost touch it. That's a huge contribution to the Parkinson's community."

Research has increasingly shown that exercise is key to treating Parkinson's in every stage.

Brian Grant's intuition about how exercise can help people with Parkinson's disease coincides with renewed scientific interest in the topic.

"When I started in the field 20 years ago, it was generally thought that exercise for people with Parkinson's was a waste of time and to be avoided," says Mark A. Hirsch, PhD, a senior scientist in the department of physical medicine and rehabilitation at Carolinas Medical Center, part of Carolinas HealthCare System in Charlotte, NC, and lead author of a 2016 review of exercise studies in the journal Parkinsonism and Related Disorders. "Scientific evidence now indicates that exercise affects the brain and can potentially slow progression of the disease in humans," he says.

Still, many caveats remain, says Michael J. Zigmond, PhD, a professor of neurology at the University of Pittsburgh. "In many human studies, the number of patients is small, the duration of the trial is short, and there's no real attempt to differentiate between relieving symptoms and slowing progression of the disease, which are both important but not the same," Dr. Zigmond says. "I'd put my money on exercise doing both, but we still need more research."

Dr. Hirsch contends that the research as a whole may provide stronger evidence than the outcome of any single small study. So far, the research shows that exercise causes changes in the brain that may positively affect Parkinson's. Among them are increases in gray matter and improved dopamine signaling in parts of the brain involved with motor movement, according to Dr. Hirsch's review and a 2007 study in the Journal of Neuroscience. Exercise may also boost levels of proteins called neurotrophic factors that seem to protect dopamine-producing neurons, Dr. Hirsch's 2016 review found.

"Several studies show that people with Parkinson's disease who exercise have more endurance and less rigidity, and their balance and gait difficulties progress more slowly than people who don't exercise," says Joseph Jankovic, MD, FAAN, of Baylor College of Medicine in Houston. In one 2013 study, in JAMA Neurology, led by Lisa M. Shulman, MD, FAAN, of the University of Maryland in Baltimore, three groups of people with Parkinson's disease tried three types of exercise—a combination of stretching and resistance training, low-intensity treadmill walking, and high-intensity treadmill walking—and all three groups were able to walk farther in a six-minute test after four months. Another small 2013 pilot study of four men with early Parkinson's disease published in the journal NeuroReport found that those who were randomized to do treadmill walking exhibited brain changes not seen in the patients who didn't exercise. (The work of the investigator who led the study, Beth Fisher, PhD, of the University of Southern California, is among the research that Dr. Hirsch highlights in his review of significant findings.) The exercisers improved both their walking performance and their ability to turn 90 degrees—significant because in people with Parkinson's disease, improving on one physical task doesn't necessarily translate to improving on a different task.

Research continues, but human studies are expensive and challenging. For example, given that Parkinson's disease manifests differently in every person, it's difficult to determine whether an intervention is causing someone to progress more slowly, since it's hard to say how that person might have progressed without it.

To learn more, a multicenter randomized controlled trial of 126 people with Parkinson's disease funded by the National Institutes of Health is underway. Called the Endurance Exercise in Parkinson's Disease trial, it will compare the effects of moderate and intense aerobic exercise to no exercise. Researchers are also exploring how to motivate people with Parkinson's disease to be active. One tool being investigated is a wearable, glasses-like device that provides visual cues, such as overlaying lines on the floor and auditory prompts similar to a metronome beat to help people initiate and continue movement. Smart glasses also let people make hands-free calls for help. A built-in GPS can also help caregivers or family members locate the wearer.

10 ways to get moving

Beginning and maintaining an exercise program is challenging even for healthy people. For people with Parkinson's disease, the difficulties are only magnified. "Apathy is the number one obstacle," says Joseph Jankovic, MD, FAAN, of Baylor College of Medicine in Houston. "Another is fatigue." But don't give up before you start. "Once people find out how great exercise makes them feel, they come back," says Kimberly Berg, MS, CEP, of the Brian Grant Foundation. These steps can help you start and stick with exercise.

1. Check with your doctor. Make sure you're healthy enough for exercise. Some people have Parkinson's-related heart problems they need to be vigilant about, for example. Exercise does have risks, says Dr. Jankovic, but for most people the benefits outweigh the risks.
2. Find a program. Most towns have a local Parkinson's disease organization that can refer you to exercise programs. You can also get leads from state organizations, neurologists with experience with Parkinson's disease, physical therapists, other people with the disease, and major medical centers. Ask for physical therapists or trainers who specialize in neurologic therapy and have worked with people with Parkinson's disease. Tell contacts about your functional level and ask for programs with others at that level, suggests Mark A. Hirsch, PhD, of the Carolinas Medical Center in Charlotte, NC.
3. Start slow. Respect your current abilities and level of fitness, no matter how athletic you were before. "If you're doing a balance exercise where you stand on one foot, for example, hold on to a stable object and just lift your heel at first," Berg says. Progress through raising your foot higher, then support yourself with two fingers before advancing to the full single-leg stance. When you introduce an aerobic activity, add intensity gradually. "You should feel invigorated and maybe a little sore the next day, but not exhausted," Berg says. "As your abilities improve, you can push yourself more and challenge your limits."
4. Don't be alarmed by increased tremors. It might seem like symptoms get worse right after exercise. That's because adrenaline released during a workout can increase tremors temporarily, says Dr. Jankovic. "It's a normal and transient response," he says. "It does not indicate Parkinson's is getting worse, and the long-term benefits of exercise outweigh the short-term effect."
5. Make exercise social. People tend to stick with exercise better when they work out with a group. "It builds community and holds you accountable to the team," Berg says, adding that many participants form their own support group. Socializing can also help relieve depression.
6. Do a variety of exercises. Aerobic conditioning, strength training, tai chi, and yoga have all been found to help with Parkinson's disease, but each may have distinct benefits, says Dr. Jankovic. "I encourage patients to combine exercises or do different things on different days," he says.
7. Aim for midmorning or early afternoon. In the morning, people with Parkinson's disease are often stiff. In the evening, they're often tired. Exercising around midday tends to be a sweet spot when the benefits of medication often peak.
8. Play music. People work harder and perceive exercise as less taxing when they listen to music, according to research published by the National Academy of Sciences. "Music is a motivator," Berg says. "I find people especially respond to music from their high school days."
9. Drink plenty of water. People with Parkinson's disease tend to be chronically dehydrated, in part because the disease affects brain cells that signal thirst. Medication for the disease can intensify the effect. "Carry a water bottle and sip from it the entire workout," Berg says.
10. Exercise your mind. Animal studies suggest that mice in "enriched" environments full of other mice and lots of toys need less exercise to protect their brains than mice that do a limited number of activities by themselves, according to Michael Zigmond, PhD, of the University of Pittsburgh. "Instead of walking on a treadmill, I'd go outside where you need to pay more attention to where you're going and where varying scenery stimulates your mind," Zigmond says. When not exercising, play cards or chess, read, socialize, or do other activities that make you think, he suggests.

Powerful partnership

Every three years, the World Parkinson Coalition, a nonprofit organization that highlights the latest research and advocacy work, along with caregiver initiatives and medical practices, hosts a weeklong World Parkinson Congress, where everyone from scientists to therapists and patients get together to share information, discuss practices, and establish connections.

In its search for ways to promote interest in the World Congress between the last gathering in 2013 in Montreal and the next one in September in Portland, OR, the coalition approached the Brian Grant Foundation. Seeing an opportunity to promote its mission, the foundation proposed the Parkinson Power Through Project, which invites people with Parkinson's and others to track exercise. An online calculator translates various forms of activity into miles. The goal is for each team of supporters to accumulate 100 hours of physical activity and cover 3,000 virtual miles from Montreal to Portland.

The project kicked off at the Grant Foundation's 2015 Shake It Till We Make It gala, but its major public push coincides with the NBA All-Star game in February. "It's the first global public initiative to bring people together around Parkinson's," says foundation director Cherise Bjornsgard. "We're crossing our fingers that we can do what Susan G. Komen did for breast cancer—become a household name that reaches the public in a call to action."