Former NBA Player Brian Grant Combats Parkinson's with Exercise
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EXERCISE FEBRUARY/MARCH 2016 BY RICHARD LALIBERTE Former NBA Player Brian Grant Combats Parkinson’s with Exercise Azer a 12-year career with the NBA, Grant was diagnosed with Parkinson's disease. Today, he's a leading proponent of exercise for people with his condition. 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. Brian Grant at home in Portland, OR, with his dog. NBA: GETTY IMAGES/AFP PHOTO/ROBERT SULLIVAN 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." Brian Grant as a Portland Trail Blazer, competing against Karl There was something else: a tremor in his Malone, in 1999. 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 From top: Grant at his Shake It Till We Make It gala in 2010; and with Michael J. Fox and at Oregon Health & Science Muhammad Ali, at the Michael J. Fox University (OHSU) in Portland, Foundation's 2010 benefit, A Funny Thing Happened on the Way to Cure Parkinson's. along with experts in physical TOP: COURTESY BRIAN GRANT; FOX AND therapy, exercise physiology, ALI: GETTY IMAGES/STEPHEN LOVEKIN/MJF 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." Geing 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.