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Parkinson’s: An Athlete’s Journey is for athletes navigating Parkinson’s, the coaches and clinicians who train them, and anyone who wants real-world strategies for performance and longevity. Hosted by Eric Von Frohlich and Todd Vogt, the show focuses on tactical takeaways: how to train, recover, manage symptoms, and stay consistent when the rules keep changing. Expect honest conversations, tested routines, and guest experts who go deeper on what works.
Eric Von Frohlich (00:31)
Well,
thank you so much for joining us. It's kind of exciting. I've been looking forward to talking to you on this topic since the first day I met you, as you know.
honored to have Dr. Julie Hirschberg, founder and owner of Reactive in
El Segundo and California. She's a neurologic PT, which is different than a regular PT, I take it. And ⁓ overall, just a super special person. I'm super excited not only to work with her, but to be able to spend some little time outside of work
⁓ Julie, why don't you do a better job than I just did introducing yourself and we'll kick it off from there.
Julie Hershberg (01:14)
yeah, you did a great job. I'm a neuro PT. It is my like a thousand percent passion to ⁓ work with neurologic disorders, do research in that area. I teach at the University of Southern California. So I get to like work with hundreds of
DPT students and teach them these very things too. So ⁓ it's really my honor though. say, although I've been a part of research, I've read so many textbooks, I've written textbooks, nothing is like learning from people who are living with a diagnosis. This is my favorite way to learn. So ⁓ I've learned more from you, I think Eric, than...
Eric Von Frohlich (01:44)
Thank you.
Julie Hershberg (02:00)
They went the other way and so I'm really thankful that you asked me to do this
TODD VOGT (02:05)
How long have you guys worked together?
Julie Hershberg (02:08)
It's about a year. Yeah, it's been a very, Eric doesn't need a lot of physical therapy. So it's a very infrequent journey that we've been on ⁓ every few months. And I always look forward to it. It's always so fun. We both get a workout, ⁓ but we're both learning things the whole time.
Eric Von Frohlich (02:30)
Yeah, it is amazing your approach to it. ⁓ It's really fun and doesn't feel like we're learning or training at all. It's ⁓ just enjoying accompanying your to the diagnosis. And it's kind of remarkable that we've come to appreciate each other as much as we do.
Julie Hershberg (02:51)
Yeah, yeah, I feel very lucky to have just met, honestly, Eric. And you're right, it ⁓ should be fun, right? Like, I believe that about any kind of rehabilitation, not just in Parkinson's, but there is a certain something in the nervous system that happens when you're experiencing joy. ⁓
Gosh, if you can get joy with aerobic exercise, with strength training, with motor learning all at once, that's kind of the sweet spot when it comes to changing the brain.
TODD VOGT (03:30)
What drew you to working with Parkinson's and guess other people with other sort of neurodegenerative issues?
Julie Hershberg (03:36)
Yeah, gosh, I like, I was like, love it for sight. ⁓ When I was in grad school, we had to dissect the brain and the spinal cord and all of that. And I was just fascinated. It wasn't as straightforward as just like a joint, right? Just the knee or the shoulder and things like that. ⁓ It had a lot of things that were unknown. And so I fell in love in grad school, I started teaching it and I did a residency program at
USC. And that was actually my first foray into movement disorders is I got to work with some of the best of the best neurologists. Like I was the physical therapist in the neurology clinic. So Giselle Petzinger, who is a premier leader in exercise research in Parkinson's was my mentor and Mark Liu and Alan Wu all at USC.
and I got to hang out with them in clinic and they would literally write prescriptions for exercise. And while I was in clinic with them, I got to talk with patients about the benefit of exercise, how they could exercise in their body, with their injuries, with what they loved and the power of exercise and activity in Parkinson's, but actually in just...
humans in general, you appreciate that because you're athletes, like it's pretty incredible. So that was 20, 24 years ago ⁓ that I started on that journey and then just kept going. we got to collaborate on exercise research with Beth Fisher and Giselle Petzinger and exercise physiologists. And that really changed my view about how
Eric Von Frohlich (05:00)
I think it's pretty natural to have social media. I think we're going to have have a very different kind of We're going to need a lot of social media, a of social lot And I think going to be
Julie Hershberg (05:24)
how plastic the brain was. Like I learned that in general, but I really hadn't
Eric Von Frohlich (05:25)
I think it's great. I think that's be a great come together and talk
Julie Hershberg (05:30)
dove in until I was surrounded by the researchers and clinicians like really doing it on a day-to-day basis.
Eric Von Frohlich (05:35)
Thank
TODD VOGT (05:38)
what is like the range of clients that you typically see within the Parkinson's community like age and how far along are they or not along, not very far along or I don't know.
Julie Hershberg (05:46)
Yeah, all ends of it, Todd. Yeah, from people who just got diagnosed yesterday, ⁓ people that have young onset, Parkinson's, ⁓ people that were diagnosed much later in life in their 80s even, ⁓ people with Parkinsonisms or Parkinson's Plus syndrome. So I've seen a lot of folks with many different
types of the Parkinsonisms. And so that's just over my practice as reactive when I started with almost entirely movement disorders. So it was it was primarily Parkinson's and the Parkinsonism. So really have seen it all. I would say like my passion is for really getting connected with somebody early on.
from a prevention standpoint because I'd rather them not have to see me later on
Eric Von Frohlich (06:47)
I
Julie Hershberg (06:48)
because they have an exercise or they have developed balance difficulties in their following. I'd rather prevent that from happening. that's my that's my current passion. ⁓ But honestly, like I just kind of love everybody. So ⁓ yeah, it's all fun for me.
TODD VOGT (07:09)
Nice. What does?
Eric Von Frohlich (07:09)
Yeah, you keep
trying to fire me, Julie.
Julie Hershberg (07:15)
I do, Eric. You're so, I mean, you're so active, both of you, so active. And I can really appreciate the role of PT and keeping you at your like utmost activity level. But also I can really appreciate like, you don't have to do rehab all the time, right? Like life is better living and doing things in your athletic endeavors. And so as long as you're doing that.
I'm stoked. I'm really happy and you don't need me. ⁓ But if you're getting stuck in that, like, yeah, let's figure it out together.
Eric Von Frohlich (07:51)
So how do you decide where you're going to start? Because Parkinson's has such a wide range of symptoms. so where do you jump in when you have someone in front of you and decide what the lead domino is going to be?
Julie Hershberg (08:05)
Yeah, yeah. Well, it starts with you, right? It starts with the person in front of me. I've never started the same way twice. And that's, I mean, that's the fun of being a physical therapist, of being a clinician is that you center the person that shows up. What is the thing holding you back? What are you not doing that you so want to do? Or you're doing it, but it's painful, or you're doing it and it's hard.
⁓ I actually remember Eric, when we met, we created a list. Like you said, well, I got this thumb issue happening. We got the shoulder thing. I want to do this. I want to do that. I wish I was faster with basketball with my son. ⁓ All of these things. And we literally made a list. I think it had about 12 things on it. And we went through them. So you told
Eric Von Frohlich (08:46)
I'm
Julie Hershberg (08:57)
me, like you told me precisely. Now from that,
like this is where I get to bring in my creativity or my understanding of the brain. I'm looking for commonalities, right? So you have this, this and this, or you have difficulty with like this shirt and this shoe and these shoelaces and those things. I can put those things together and go, okay, there's some commonalities here. There's a motor control part. There's a sensory part. Maybe there's a non-anomic part. I...
kind of take what you say and I started like hypothesizing, what is the real issue contributing to difficulty with this? And then like we work together to examine that. We test speed, we test coordination, we look at if we change the sensory input, does that change? What happens with motor control? mean, Eric, you are like the prime motor control example of like
your...
Eric Von Frohlich (09:55)
I'm going with question, and then we'll to the second question. So, with the first question. actually heard you say that you were part of the page for a few minutes. So, I'm to start with the first question. So, I'm with second So, I'm to the So, going first question. So, with question.
Julie Hershberg (09:55)
Performance skyrockets with just little bits of motor control input. We had you predict things and your performance changed, for example. So we put those in, test them out, and kind of come up with a formulation of like, you're having difficulty with these things because of XYZ. Here's where we can intervene and really.
not just impacted in the moment, but like change the brain. That would be the ultimate goal.
Like how do we change this movement, change this pattern, improve this function, but really overall change the brain, prevent this from occurring and have it carry over to other activities too. So we do all of that together and then we bring in the fun, right? This is where you get to tell me all the things that you love and how can we make this
Eric Von Frohlich (10:25)
Okay. Thank you.
Julie Hershberg (10:47)
a day-to-day practice that's engaging for you and
incorporates what you love already. like jujitsu, right? Like that was my number one thing. Playing basketball with your son, that was a big thing. Taking in your inner competitor, right? So you could compete against yourself and perform better. where, again, going back to the beginning, getting to know you and your motivations and your why helps us put together
a plan together.
Eric Von Frohlich (11:17)
It is amazing to me how stacking
different modalities and different ⁓ requirements lends to a more progressive program. it's balance, it's coordination, it's rotation, it's plyometric, it's, you know, there's layers after layers that you keep adding to the load that keep it engaging and challenging. And ⁓ apparently that's the magic that you're formulating.
Julie Hershberg (11:28)
Mm-hmm.
Yeah, or reformulating together, right? Like it's a bit of a dance. We try some things, we modify, ⁓ but really it's you. You're leading the way.
Eric Von Frohlich (12:02)
Well, I'm glad you haven't included dancing yet.
Julie Hershberg (12:05)
⁓ in my ideal world area, we're dancing every single time. And that includes facial expressions, right? A little musical theater.
Eric Von Frohlich (12:06)
You
Yeah, that's for sure.
Todd, do you do facial expressions or like a program like VST?
TODD VOGT (12:23)
No, not really. try to be conscious of things like my facial expressions and my voice, but the only thing I do that maybe is something, this is not too weird, but I just try to sing a lot when I'm driving in the car. Cause like singing is like, find great for like my vocal strength and like my diction and things like that. I'm being purposeful now. yeah. Yeah, exactly. I don't know what they think.
Eric Von Frohlich (12:43)
How is it for the passengers in your car?
Julie Hershberg (12:49)
love that. So, I mean, this is the perfect example of like you've incorporated that into like your everyday activity. I'm just going to sing along in the car. It also has this really lovely autonomic side effect too, ⁓ which is like another like current area I'm like obsessed with in Parkinson's. So, and like both of you have really like beautiful commanding voices.
TODD VOGT (12:58)
Yeah.
Julie Hershberg (13:16)
So I think that's a lot for your singing in the car therapy.
TODD VOGT (13:20)
Yeah, I put a lot of effort into it. Even still, can feel, even having said that, I feel as like my voice is not as strong as it used to be. And it's not, know, it's, I can sense that it's not what it once was. You know, I tried to do what I can to hang on to what I got, it's not, you know, I can still sense that it's not the same. I guess you gotta stick, I guess you gotta keep, you know, stick with it, I guess.
Eric Von Frohlich (13:23)
Okay.
Okay.
Julie Hershberg (13:28)
and
Keep singing and you know what Todd, is ⁓ not that you were asking for any advice at all, but our speech therapist introduced me to this cool app that gives a lot of feedback
on your singing or your voice. And ⁓ one of the things I loved about it, just read, I'm part of this working group to write a paper and I just read one part of the paper about
interoception in Parkinson's, which was really like how you can notice some of the like internal sensations in the body and that part of the brain can have less less robust responses in Parkinson's. And I never thought about this before, but it really relates to speech a lot because you're getting getting a lot of internal feedback. And I actually really love that you said like, I noticed this because noticing
is like half the battle. If you didn't notice it, you wouldn't know, right? So love the noticing and I love that that can like kind of motivate you to keep like pushing, keep working on it.
Eric Von Frohlich (14:52)
So Julie, when you say internal feedback, does embarrassing count?
Julie Hershberg (14:57)
Embarrassment? It is! It's... Why? Am I embarrassing you, Eric?
TODD VOGT (14:58)
Sure.
Eric Von Frohlich (15:02)
No, I'm
TODD VOGT (15:03)
You're saying
like you're embarrassed for yourself, I'm guessing.
Eric Von Frohlich (15:04)
picturing Todd singing and if I was in the same position with my voice, I'm not sure that I would be quite as bold.
Julie Hershberg (15:13)
⁓ got it, yeah.
Eric Von Frohlich (15:14)
So stuff
for me to work on. Embarassment is an underexplored emotion that you should probably embrace as much as you can in life.
Julie Hershberg (15:20)
Hahaha!
You can explore embarrassment. Yes, indeed. I think we've explored embarrassment, Eric, when we are doing things much bigger, louder, and obnoxiously than you might want to.
Eric Von Frohlich (15:41)
Well, that's a good tip for Todd, not that he's looking for tips, but turning up the volume is probably a solution for his voice not being as strong as it used to be.
TODD VOGT (15:52)
Yeah, yeah, it's like a, it's a little bit of a workaround. can, yeah, you can overcome it with just speaking louder.
Julie Hershberg (15:58)
Mm-hmm.
Eric Von Frohlich (15:58)
Exactly.
TODD VOGT (15:59)
what are some other examples of things? Say you have somebody who was a runner and now has dystonia in their feet and they can't run, for example, or their feet are dragging along, one of their feet are dragging along.
Julie Hershberg (16:11)
Yeah, yeah, that's very, very common. I actually love working with dystonia. I don't love for people to have dystonia, but it is it is one of those other enigmas of the the brain that occurs in Parkinson's. And it's very treatable. So and whether this is dystonia or even some other
movement difficulties a person has, one of the biggest pieces that gets under explored is the sensory system. And in dystonia, the sensory system is a really big piece where the body part, so let's say the foot, the leg, especially if they're attempting with running and walking, it's not giving correct or appropriate sensory feedback to the brain about where it is in space.
And you get abnormal involuntary contractions. Oftentimes it's like a turning in or a plantar flexion of the foot. It's really disabling for running or biking or walking or any of those things. It can be very painful too. And so we'll actually first test that out. We'll map out the sensory map of the foot through testing and train it.
train it with weight, for example. This is why I love weightlifting in Perkinsons in general, because it's a sensory input. But especially variable weight in the limb can be very helpful. So we'll trial that. We'll trial it in like pre-running activities
Eric Von Frohlich (17:29)
Okay.
Julie Hershberg (17:43)
and plyometric activities, and then take it into running. A lot of motor control training overlaps with that sensory training. One of my favorites actually is to use
point of view videos and what's nice compared to like 24 years ago, like you could go on YouTube and find a point of view video for anything now. So it's a first person point of view of an activity that that person is doing and they're watching it as they're doing the movement. that like sometimes their dystonia goes completely away with that visual feedback. And you know, as an athlete how
Eric Von Frohlich (17:59)
Okay. .
Julie Hershberg (18:23)
powerful mental imagery is, it's super powerful for things like dystonia. ⁓ But even just for movement in general, I love using some of those pieces and especially if you've used them before, it's really powerful.
TODD VOGT (18:41)
Okay, slight tangent One of the things I like is when I'm in a boat behind, I'm in like the middle of a boat, person in the stroke seat furthest in the back, one that nobody can see, they're the one who sets the rhythm and everybody else is just forced to follow the rhythm. So I don't know, I find that it's like much more easy to follow somebody else's rhythm than it is to sort of create my own rhythm.
find when I'm rowing by myself, my tempo, my stroke rate just keeps dropping and dropping and dropping. But when I'm rowing a team boat, it's like you're forced to follow the rhythm exactly of the stroke brute force is your brain and body to sort of follow a rhythm that you might not otherwise take.
Julie Hershberg (19:17)
forced use all the way, we should all be rowing Todd, like that. Everybody should be rowing like that, but in
Eric Von Frohlich (19:21)
Thank you.
Julie Hershberg (19:27)
a way that they have to match, like as you said with Bradykinesia, your natural pace is just gonna be slower. that forced, I mean, we were part of the cycling studies with forced exercise, which came from.
TODD VOGT (19:44)
Yeah, yeah, it's in situation.
Yeah.
Julie Hershberg (19:46)
Yeah,
same situation, tandem bike, rowing. don't care what it, this is Eric, why I love dancing, like the tango studies in Parkinson's. All of those are paired activities where your brain is and your body are being forced to match and meet the rhythm of the other. mean, Todd rowing forever, if you can. And the rest of, mean, you.
TODD VOGT (20:11)
That's not Florida.
Julie Hershberg (20:14)
You like rowing too, right? Like I think that's the other thing is like, if you love it, you're gonna do it. If it's social, like that's the other piece, right? You're rowing with a group, right? Like, it's fun. You're gonna keep doing it.
TODD VOGT (20:16)
Yeah, absolutely.
That's fun.
It feels beneficial to row in the team boat, you know, with, like I said, to match somebody else's rhythm.
Julie Hershberg (20:38)
Yeah, we should be studying this. We should study it. I mean, the cool thing in those Tanna bike studies is like people would Tanna bike, get off the bike and it looks like they had taken their meds, but they hadn't, right? And I'm curious for you, if you would go and row in the setting, like you leave that, do you feel different? Do you feel better?
Eric Von Frohlich (20:41)
and I'm to talking the different ways that we help you this. So, going be talking ways that to the different ways that can help get So, ways through
TODD VOGT (21:01)
Yeah, yeah, absolutely. 100%, that's one thing I've said ever for a long time whenever I've done interviews and podcasts is rowing is very, I mean, it's enjoyable and therapeutic on the water and has all the strength and cardiovascular benefits, but yeah, the other thing too is, yeah, using all four limbs independently. So when I get done pointing, speaking to your point, when I get done rowing, particularly on the water, there's like, I don't know, it lasts for, there's like an after effect, I guess you would say, where I feel all my symptoms are sort of gone for anywhere from.
I don't know, 30 minutes to an hour depending on the day, you know, so.
Julie Hershberg (21:32)
Yeah. So you just need to row every hour, Todd. No big deal.
Eric Von Frohlich (21:37)
Apparently I need to find someone to run with because my running I can't for a pace for more than a couple minutes. A part of that may be some of my heart condition that I've been dealing with, but it's weird. I'm constantly conflating what's just deconditioned in aging versus what's Parkinson's and don't want to credit one.
Julie Hershberg (21:50)
Yeah.
Right.
Eric Von Frohlich (22:01)
too much and not look at the other.
Julie Hershberg (22:04)
Yeah. And you're, I mean, I think the good news there is you're taking care of the hard stuff so that you can keep exercising. But to your point, you know, they've done studies and exercise like running or biking, walking, and having a matched pace. And now I would prefer that pace with music myself.
Eric Von Frohlich (22:12)
Right.
Julie Hershberg (22:29)
⁓ to like run at a certain cadence and beats per minute, right? So similar to Todd's rowing, it would be like, I have to run at this pace. ⁓ But doing it in a group is like, is a really great way to do that. Now, the benefit of rowing, mean, Todd, now I need to go rowing with you. This sounds so good. Like I'm not a rower. Now I'm just like, I think we should all row. ⁓ Is that like, you have
to keep it up, right? And when you're running, unless you're attached to somebody else, which I did see when I last ran the Super Bowl 10K, there was a group of people attached as like a worm. So they all had to keep up, right? ⁓ So in a group, would still, or if you can't do a group, I would consider like music and tempo and cadence being your driver because it's externally.
TODD VOGT (23:00)
Yeah, absolutely.
Julie Hershberg (23:27)
focused, right? So you might not have the capacity for the internal drive at that speed, but if you can externally focus it, you, got a good, good way.
TODD VOGT (23:40)
a couple random things. We interviewed a couple weeks ago one of my friends here in Portland, this guy Jay. One of the hacks that he's, I guess you would call it a hack, is runs with ankle weights takes them on and off and he's like, and that seems to provide a lot of benefit to him as far as improving his running. So, don't know, speaking along the same lines, like it just gives you more feedback, I guess you would say.
Eric Von Frohlich (23:43)
I'm I'm not sure if that's what I'm I'm not sure that's what I'm hearing. that's what I'm that's what I'm I'm that's hearing. I'm what I'm
Julie Hershberg (23:53)
Yeah. Yeah.
It's sensory feedback, yeah. And research shows a lack of sensory feedback in Parkinson's. So adding the weights, we actually did this, Eric,
Eric Von Frohlich (24:00)
I'm if that's what not that's hearing. I'm not not what hearing.
Julie Hershberg (24:09)
in therapy. It's also a really nice motor learning principle to kind of load and then unload. And like I like that idea, like your friend said, like loading during running and taking it off and loading and taking it off. There's some variability there.
Eric Von Frohlich (24:11)
All right.
Julie Hershberg (24:25)
But also like you respond, like when you take it off, it's like, ⁓ this might be easier, right? And so that gives a wind to the brain, that gives a little boost of dopamine and like anything that we can get a little extra dopamine is like 100 % in my book.
Eric Von Frohlich (24:43)
that was idea about jujitsu. It just made sitting on the floor look easy. As opposed to having someone trying to push me into the floor.
Julie Hershberg (24:50)
Yeah
Eric Von Frohlich (24:52)
it's definitely sensory feedback and just checked a lot of boxes for me from a social perspective as well from a ⁓ clinical perspective. I'm going to start that back up again in about a week or two. So.
Julie Hershberg (25:05)
I was going
to ask. I love rolling on the floor and there's not a lot of things where people are like, yeah, I want to roll on the floor. Except for Eric and Jujitsu. He's like, yes. But the floor gives so much good feedback. So it's a great sensory activity.
Eric Von Frohlich (25:13)
Right.
and I just have to add some music to it.
TODD VOGT (25:22)
Okay, yeah,
exactly. That kind of leads me to the question I was gonna ask next, but what are some modalities or things you think, know, well, everybody in general, or guess people with Parkinson's should be doing, whether it's juggling or yoga or whatever, rolling on the ground or playing soccer, I don't know, whatever.
Julie Hershberg (25:25)
Yeah! ⁓
I would definitely answer that in a couple of ways. One, I think people should do what is fun, what they will stick with and what they like, because we know that it's hard to exercise in general, and especially if you start to lose some of your intrinsic motivation. So,
fun and what you like is number one. I don't really care what that is, like find the thing. ⁓ But Todd, it can include play. If it can include learning or trying a new skill, like that ramps up some of that like brain engagement in it versus a really passive task. ⁓ And so if somebody said, okay, well,
TODD VOGT (26:11)
Okay.
Julie Hershberg (26:34)
love everything, everything's fun, I can play everything. Then I would say, okay, well then let's find the thing that is gonna be like max protective capacity for the brain, right? And so that would include some aerobic activity, that would include some forced use and speed and coordination involved in it. It would enjoy play and joy and fun as a part of it.
For some person that might be yoga or dance or musicals and for the other person that's like throwing a baseball and running around the bases or picking up snowboarding or surfing or something like that. ⁓ So I think it will be different for everybody. But starting with what they would do is the number one.
TODD VOGT (27:21)
Okay.
Okay, that makes sense, okay. Yeah, or if somebody's a runner, then running, I guess, know, and throwing some speed burst in or whatever.
Julie Hershberg (27:33)
Yes, I would throw in speed burst, would throw in, I mean, I'm a runner, so I love like a fartlek and I love all of the different variables that you can add into running. I would do it socially, I'd sign up for races, I would train with other people ⁓ so you could get some of that like mirror neuron activity and some modeling and changes in your own speed that way. Most runners are pretty...
Eric Von Frohlich (27:36)
Thank you.
I I
Julie Hershberg (28:01)
solo, ⁓ which myself included, right? So I would like maybe make some little shifts to change it up. if that's what people love, like, let's keep you doing it as long as possible.
TODD VOGT (28:16)
Nice. There's a one, I don't know if you've ever been to Portland, but there's like, I think they call it, it's a park called Forest Park. I think it technically it's the largest park in the city limits. It's right outside of downtown, but there's probably 40 miles of trails. in one of the trails is 22 miles in a straight shot. And so if you can do out and backs, but you can do 40 miles of out and back if you want on the trail, there are a lot of them are single track. And so in there,
Eric Von Frohlich (28:32)
Thank you.
TODD VOGT (28:39)
They're not all flat. A lot of them are just like the elevation is constant and they're turning and they're turning it up and down so I used to love running on there because it forced me to be like this pre Parkinson's but I can think now it's like it forced me to be like a billy goat like I had to really be conscious of my steps and Because it was it was muddy a lot and you're so you're like, know, like you're clipping your steps or you're jumping onto a log or Where you going uphill or you're going downhill or you're going down the motor? So it made the runs like really fun. I thought
Julie Hershberg (28:43)
Nice.
Yeah
TODD VOGT (29:08)
because it kept you focused. As opposed to one of my own coaching colleagues, he was hardcore. He was a hardcore fitness dude, but he ran the same route every day, four miles out, four miles back on a road, on a sidewalk. And was all about how hardy and fast he could run, but running in the trail just kept you in the moment. anyways.
Julie Hershberg (29:08)
Yeah.
Yeah. Yeah.
Yeah, I love
that. The four miles in and out, same exact thing, same shoes, same pace. That is a recipe for dystonia, if I ever heard one. ⁓ Whereas yours in the mud with the logs. I mean, and let's just talk about the nature. Let's talk about the smells that you're getting there. Let's talk about the whole entire experience. It's so variable.
TODD VOGT (29:42)
Yeah.
Julie Hershberg (29:57)
Yeah, see, this is why, Todd, if I wasn't living in Southern California, I would be in Portland in a heartbeat. I sure would. I sure would. I'd be outdoors every day.
Eric Von Frohlich (30:04)
You'd be rowing in Portland with Todd.
TODD VOGT (30:11)
I suppose you could run on the beach though, I mean, at some point or near the beach or
Julie Hershberg (30:15)
I ran four miles on the beach this morning. Yeah, and yesterday. I'm pretty darn lucky around here. I'm not going to complain. ⁓ And it's 70 degrees and sunny in February, so no complaints at all.
TODD VOGT (30:18)
⁓ alright, so just, you know... We're rubbing in. We're rubbing in.
Yeah. Yeah,
that's rough. That's a burden you have to bear, I suppose, you know? Speaking of rowing, like lot of the big rowing hub in the United States, like where we train is in Boston. My point is like all my friends, all my rowing friends still live in Boston. So right now they're buried under three feet of snow or whatever. yeah.
Julie Hershberg (30:32)
That is my burden to bear.
Totally. Yeah, yeah. Many
of my colleagues are at Mass General in Boston and we're working on a paper and they're like, stop sending us pictures, Julie. Like, this isn't fair.
Eric Von Frohlich (31:00)
this is basically all just updating your software and your brain to do new challenges and new modalities and that seems to be the essence of neuroplasty is constantly challenging yourself with a new environment or new stimuli, right?
Julie Hershberg (31:17)
Exactly. Yeah. And it's updating software. with practice and repetition, you're going to change the volume of your hippocampus. You're going to improve your memory and cognition. So not only is it updating software, but it has long-term changes for you. mean, this is like for both of you, for many athletes with Parkinson's, all they've done for their entire life has really protected
their brain in many ways so that you can live well and live long ⁓ with Parkinson's because you're actually changing some of the hardware too.
Eric Von Frohlich (31:58)
Yeah, it was just a couple days ago I jump started my brain by writing the alphabet and number line with my non dominant hand. And it's the same hand that has the tremor. So I was shocked at the consistency of the lettering and the spacing. It wasn't any like micrographia and it turned out to be.
TODD VOGT (31:58)
Okay.
Wow. Thanks.
Julie Hershberg (32:08)
Wow.
Wow
Eric Von Frohlich (32:21)
And I got done doing it. It was hard to do. I was surprised at how challenging it was. But my brain was like on fire by the time I got done with 10 minutes of it. It kind of jump started my whole day and made me think like I need to find neurologically to to jumpstart my day. So you have any other examples like that?
Julie Hershberg (32:42)
Yeah, I love
that. That is great. I just imagining your brain kind of tingling with things like that. I mean, I think this would be very specific to each person. Erica, I'm thinking like, I want to try that. What would that feel like? Right? And so for you, that kind of cognitive opposite limb,
Eric Von Frohlich (33:03)
Yeah.
Julie Hershberg (33:10)
challenge was like a nice like brain wake up. ⁓ For another person, it might just be like stepping outside barefoot, right? Getting some sensory like cold grass, sensory input on their feet. ⁓ Listening to birds, right? Like that might be maybe not the challenge that you had, but it might actually be
shift in input. Like, so if you're normally a person that kind of gets up in your inside and you're not outside until later in the day, like that could be the input that you need. Another person, it might be like getting up and hopping on a bike, right? And like speed, doing some sprints, right? Todd, was listening to podcast where you were like 17th in the world in the, yes, yes.
TODD VOGT (33:58)
I've been
Julie Hershberg (34:01)
Yeah.
TODD VOGT (34:02)
doing that the last couple of times, I've been like fifth or sixth. yeah. So, yeah.
Julie Hershberg (34:05)
Okay, you're moving up. So like that
might be the thing for you to kind of kickstart your brain. ⁓ So it's very person specific.
TODD VOGT (34:18)
Yeah, with this, okay, I should mention a little more, give it little bit more context, I think it's relevant. nearly healed, but I had some rotator cuff injury. I was stuck in this cycle where, it started last fall, I training for Head of the Charles, which is a big rowing race in Boston every fall. And I gerotated my shoulder, and I was stuck in this cycle where I'd take a few days off, it would get a little better, then I'd row, and it would be terrible for a couple days. So I finally said I'm not gonna row. This is maybe a month ago, I'm just gonna let this thing fully heal.
Julie Hershberg (34:26)
Mm-hmm.
TODD VOGT (34:45)
and slowly increase my volume back up. So to do that, keep, that's why the concept to work out of the day thing came. That was like my thing that was keeping me motivated. that was my like thing that made it fun. That's first part, that doing the bike workouts made it fun and made me want to work, made me want to go hard on the bike. The second part to it is that ⁓ the first time when I was talking about 15th or 16th,
Julie Hershberg (34:59)
Mm-hmm. Great. Yeah.
TODD VOGT (35:10)
Yeah, I was in the altitude room. The gym that I go to has an altitude room. So I did that at like 10 or 11,000 feet. So, which is incredible. Like I was just in there earlier today. I love it. Yeah, the altitude room is a real challenge. And I don't know what it's doing neurologically, hopefully it's got some sort of benefit too.
Eric Von Frohlich (35:14)
Ha
Julie Hershberg (35:28)
Whoa, what's?
Eric Von Frohlich (35:28)
⁓
I can add to your training by choking you out while you're riding a bike.
Julie Hershberg (35:35)
I don't even
think I could get on the bike at the 11,000 foot altitude. that, well, and what's good for the heart is good for the brain. So like that I think is incredible. And it tapped, you know, I hate cycling with a passion, except if I'm on like a beach cruiser along, you know, along the beach, but like that might get me in like knowing where I am because I'm competitive. Like
TODD VOGT (35:45)
Sure.
Sure.
Julie Hershberg (36:04)
that would get me on the bike. And if I had to rest, you I got a stress fracture when I was training for the New York Marathon and I had to rest. I had to swim, I had to bike. And it was like so mentally hard for me. I love that you found this like external goal of like, how, how, like, how can I beat the best person in the world today? Right? Like that is so motivating. And that I think
You know, we hear so much about exercise, exercise, exercise in Parkinson's, but like we need more about what's actually motivating because we need to keep it up when we get sick, when we hurt our shoulders, when we hurt our knee, when we hurt our back, like how are we going to find ways to do that? And I think every athlete has gone through that because they've had injuries and such and that keeps you going, but it's like.
Eric Von Frohlich (36:54)
.
Julie Hershberg (37:00)
Let's get that for everybody. Let's really find ways to keep people motivated. You are so motivated. You're motivating me.
TODD VOGT (37:06)
Yeah.
Well, this, we Eric and I have mentioned this before, but I think the thing that helps for Eric, I'm speaking for you a little bit Eric as well, is that we're both like gym rats, right? Basically. So it's been like, we've been doing, know, going to the gym and doing, sports since we were kids. So it's like heavily ingrained in us already to go to the gym and, know, go to the effing gym as the one dude on Instagram says, you know, have you ever seen that guy? I'm sure you have.
Eric Von Frohlich (37:16)
Go for it Todd.
Yeah.
Julie Hershberg (37:36)
But
I can hear that voice in my head, yes. ⁓
TODD VOGT (37:37)
He's like this huge
dude, huge dude with long blonde hair. He's always got a tank top on it. He's always got like a coffee mug and he's to the effing gym. This is whole everything he posts on every Instagram reel. Go to the effing gym. Go to the effing gym. You've seen it Eric, right? I'm sure. Yeah.
Julie Hershberg (37:50)
Pfft!
Eric Von Frohlich (37:55)
Yep, yeah,
it answers a lot of problems going to the gym. you know, the heaviest weight's the front door. So, you know, if you show up, it's, all you gotta do is walk in the front door and the rest of it kinda happens.
TODD VOGT (38:04)
Yeah, that's
Julie Hershberg (38:05)
This is so true.
TODD VOGT (38:10)
I, my natural inclination is to, you know, exercise is a part of our life, my life. I'm, you know, I'm speaking of, I said, for Eric. we, a, you know, an advantage that we have, I guess
Julie Hershberg (38:19)
Yeah, yeah, it's definitely an advantage. I think that I work with many other folks that have never exercised in their entire life. And so then then we're actually like, well, maybe it's not exercise. Sometimes it's just like, let's get you gardening. Let's get you like doing an activity that's engaging in your life. and let's ⁓
TODD VOGT (38:29)
Yeah.
Julie Hershberg (38:42)
you know, let's throw a heavy pail with that to get you some weight, right? So we get creative to find ways to introduce this to a person that maybe hasn't had that you know, great background that you have.
TODD VOGT (38:57)
Yeah, I can understand that from the sort of counter perspective. I can understand. Say you've never gone to the gym. You go to the gym, you're like, what do I do? Okay, maybe I'll just on the elliptical for 15 minutes, get on the treadmill for five minutes or 10 minutes, and go use the bicep curl machine and then like stare at some of other machines and I don't know what they are. Then I'm out of here. Then I'll go hit the sauna and call it a day, you know, so.
Julie Hershberg (39:13)
you
Yeah, it's pretty intimidating to the non-gym But, know, once you, like Eric said, once you're in the door, once you start building that practice and then reaping the benefits, you know, like you said, Todd, 30 minutes to an hour after your road, like you feel incredible. that's the kind of stuff that we need.
on the daily and even multiple times a day to really counter what is happening in the brain. So it's building
Eric Von Frohlich (39:51)
.
Julie Hershberg (39:52)
those little habits, even if they start with like a five minute thing that, you know, I'm kind of a a big firm believer of habit stacking, right? So building tiny habits that build up over the course of the day that, that protect your brain.
TODD VOGT (40:10)
Okay, I got another question for you. This might be hard to answer, exercise and lifestyle and all these things, how does it help the slow degeneration of the brain
how is it good for you with Parkinson's, guess?
Julie Hershberg (40:23)
now most of this work has been thoroughly studied in animals, right? And we've got some evidence in humans as well, but neurogenesis, so yes, actually new neurons. ⁓ Dendritic sprouting, that's probably one of the biggest pieces where we're making connections between different areas.
Eric Von Frohlich (40:26)
.
Julie Hershberg (40:45)
And we know that in Parkinson's, it's a connection problem too between multiple areas of the brain. that dendritic
sprouting and making new connections is super, super So we've got neurogenesis, we've got dendritic sprouting, just angiogenesis. So like I said, what's good for the heart is good for the brain. So blood flow to the brain, this is massive, especially when we know some of the
of Parkinson's with the autonomic nervous system actually decrease blood flow to the brain. So exercise, really reversing some of that, preventing some of that, really beneficial because blood flow is kind of what we need for the brain to function, especially cognitively, but really for everything. So those big three are what happens in the brain. ⁓ And then some of the things that I talked about, like
Yeah, we can increase the volume of particular areas, right? So ⁓ preventing things like cognitive decline and dementia by plumping up the hippocampus. So we can get some structural changes through those other mechanisms that happen in the brain. mean, exercise is kind of a miracle drug, ⁓ better than a lot of our drugs really.
TODD VOGT (42:04)
Yeah.
Eric Von Frohlich (42:07)
I recently was able to cut my medication % and didn't suffer any any effects from it and I was excited because of all know, I'm using exercise as a bridge for a couple of those hours and it seems to have worked really really effectively for me. So
Julie Hershberg (42:22)
Mm-hmm.
Eric Von Frohlich (42:26)
just one person's story on the benefits of exercise.
TODD VOGT (42:30)
Does exercise also have the same sort of positive effects with other neurodegenerative diseases, guess? Like Alzheimer's specifically is what I'm thinking of, but any others like ALS or Huntington's disease or dystonia, Parkinson's,
Julie Hershberg (42:30)
Yeah, that's you.
Yeah.
Yeah.
like pretty much all of the above. Now I will say, cause you mentioned ALS, not as much. Now aerobic exercise, yes, but purely muscle strengthening may actually have some detrimental effects. And this is the case in most disorders. If you've denervated, like taken away the nerve from the muscle, you probably shouldn't try to keep working that muscle. It's actually not going to recover.
⁓ But that's not the case in the majority of neurologic disorders. Stroke, the same forced exercise that was found to be effective in Parkinson's is effective post-stroke. We were a part of a large study in Huntington's disease that looked at improving people's activity level. This is also effective in Huntington's disease. ⁓ In Alzheimer's, like you said, ⁓ pretty much across
across the gamut of all humans. ⁓ granted that they have intact neuromuscular units, exercise has changes and a lot of those changes are actually coming at the brain level. And that's great for us and our like longevity and our health span and ⁓ our thinking and our memory and all of those things over our life.
And this is why I love being a physical therapist. Because I get to find ways to do
Eric Von Frohlich (44:06)
So.
So what gives you hope? Because you're on the cutting edge and you're the tip of the spear also. So you have like a unique perspective. What gives you hope on solving this Parkinson's issue? Or what do you feel like? What direction are we going with it?
Julie Hershberg (44:27)
Yeah, that's good question. A lot of things give me hope. And honestly, think hope is really important. This was a while back, but I hadn't seen it. There was this really cool article on, it was called Hopamine instead of Dopamine. And it was the importance of hope in Parkinson's. And I want to say it was maybe from the early, maybe it was 2020, I had missed it. And I was like, how did I miss this? Because I...
I I feel like, in the world of hope because I primarily work with people with a neurodegenerative disease that oftentimes have been told there is no hope. And that alone is crushing to the soul and it's not helpful for the brain either. What people should be told, and this was kind of the point of that Hope Amine article, is that like you have this.
TODD VOGT (45:08)
Yeah. ⁓
Julie Hershberg (45:25)
And there is hope. And here are those areas. mean, and frankly, exercise, lifestyle, all of those pieces give me a lot of hope. And research catching up to things that I've seen for a long time, I would say, in the realm of exercise and lifestyle. Even things like mindfulness and meditation, like these have been researched a whole lot more and they give me hope.
for any condition that is affecting the brain.
Eric Von Frohlich (45:56)
Yeah, I completely agree. When you get the diagnosis that you're not going to outlive this or solve it, it really does, you know, it's like fuel for depression and apathy. And ⁓ it doesn't take long for the body to follow suit once you're in that mental frame of mind. So Todd and I talk about mindset all the time and the importance of, you know, having having your mind determined that you're impacting this disease in a positive way.
Julie Hershberg (46:18)
Yeah.
Yeah. Yeah. Mindset is massive. which, which is why I love that you're doing this podcast. Cause I think you talk about that a lot. You're living examples of it. And that's not different than like being an athlete, right? Like we heard a lot about mindset in the winter Olympics, right? Like it's, it's such, it's such a difference maker and, actually in Parkinson's there's been these interesting
Eric Von Frohlich (46:45)
Yeah.
Julie Hershberg (46:54)
studies that show the Parkinsonian brain might even be more sensitive to that. More sensitive, Eric, you and I talked about the placebo effect, right? Like they're more sensitive to that. And to me, that is our thoughts and our mindset in regards to what's possible for us. Even our mindset about exercise is important. ⁓ So I think both of you are living, breathing,
Eric Von Frohlich (47:06)
Yeah.
Julie Hershberg (47:23)
examples of that.
TODD VOGT (47:26)
Thank you. Yeah, it's easy to go dark. mean, with your thought process, for example, know, say you're having a bad day with your, I don't know, say you're having dystonia in your left It's really easy to say like, well, I'm struggling to walk now. How am I gonna feel in, how is this gonna be in 10 years? Am I just gonna be in a wheelchair altogether, you know? So it's easy to like, sort of, know, spiral
Julie Hershberg (47:42)
Right. Right.
And of course, like, and I'm not saying you shouldn't in a way, like it's actually quite natural to do that. And you know, to be, to have some days where you're just like, this sucks. Like, I don't want to be doing this and being realistic, not shoving down some of that stuff and ignoring it, but having a counter to it and going, okay, this sucks. I'm going through this.
And I know, and sometimes you need external reminders, whether that's like a friend, a social group, like working with a psychologist, like whatever that is, sometimes you need some help to pull out of the hole too. And that's just as important than the physical exercise. You can't do the physical exercise ⁓ if you're stuck in the hole.
TODD VOGT (48:34)
Yeah, I think that's a good point, absolutely. if I start to spiral out of control and think about the future, what it might entail, I try to tell myself, you don't know, this is like one half of my brain speaking to the other half, I guess you'd say, it's like, you don't know what the future really looks like. Who knows, I mean, maybe your symptoms won't progress quite as fast as you think, or who knows what the future will hold.
And then on the flip problem that have myself especially, is it's real easy to be nostalgic and be like, oh, and say to yourself, three, four years ago I was able to do X, but now I can't do X because my foot won't let me, my foot has too much dystonia and I can't do that anymore, or whatever it is, I can't climb anymore, because I don't have the balance anymore. So it's really easy to be, be,
Julie Hershberg (49:12)
Yeah.
TODD VOGT (49:19)
I'm upset about the loss of what you had and who you were.
Julie Hershberg (49:21)
Mm-hmm. Yeah. Yeah. Yeah, I think that's natural, right? To look back and as an athlete to go back to like early days and go, oh my gosh, I used to do this for hours and it was no problem. And yeah, I think that's really, really common and like expected, I would say. then you like, then there's a counter to that, right?
what's possible today? What can I do here? What can I envision? Because we kind of know we are what we think we are too, right? And so this is part of neuroplasticity is that if we have in mind that we are ending up in a wheelchair and disabled in the next five years, we start plotting the trajectory right there.
⁓ But if instead we're looking up to people like you and going, I'm going to stay active. I'm going to pick up rowing. Todd, I hope people like start messaging you how much they're going to pick up rowing after this episode. Because I like literally, I've wanted to do this for my whole life, Todd. So I like really think this is my time I'm inspired. But like, so if they're looking at you, they're looking at other examples of people that are living really well with Parkinson's.
That's the picture in their mind, right? That's what you're striving to be and that's what you're believing. And I think that really sets a very strong trajectory for your path.
TODD VOGT (51:02)
Yeah, we just interviewed Jimmy Choi a couple weeks ago, know Jimmy, right? Yeah, he's inspired. mean, the stuff that he does is amazing.
Eric Von Frohlich (51:02)
Yeah.
Julie Hershberg (51:05)
⁓ I knew Jimmy. Yeah, yeah, yeah.
It's incredible. Again, I'm inspired by Jimmy. would never, he was at our clinic the other day just like showing off, but we filmed him like doing this crazy maneuver with walkers. And I was just like, I would never even attempt anything like that. But yeah, like if that is your picture of Parkinson's, how much like,
TODD VOGT (51:15)
Absolutely.
Julie Hershberg (51:38)
better are you angled toward activity to hope, to being fully engaged in life versus a picture that, you know, a neurologist might have painted for you early on that kind of like maybe they gave you a flyer that kind of showed this progression and like you're in a wheelchair. Like that's going to take you down a different pathway if that's what you believe is going to happen.
Eric Von Frohlich (52:03)
agree. I think you have a very binary choice. You can either change the thing that you're dealing with or you can accept it. And it's pretty cut and dry if you don't want to create a problem. You just accept it or you change it and then you're busier taking control of the situation than just up and saying, well, there's nothing I can do.
Julie Hershberg (52:24)
Yeah. And I think Eric, to your point, it's kind of, you know, what I love about this podcast too, it's like accepting, I have Parkinson's and, and then going, and here's what I'm going to do. Right. Because I think I work with a lot of people early on, it's a hard, heavy thing to accept and the denial and the lack of acceptance actually will keep
people out of taking some proactive steps for a while. And actually I'm curious for the two of you, like how do you think you got where you are now in this kind of radical acceptance of it and like really, you know, sharing messages of like hope and like positivity and like staying active, all of those things.
Eric Von Frohlich (52:57)
Yep.
I think the serenity prayer is a good place to start. You know, God grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference between the two. You know, that kind of everything you need to, you know, to take responsibility for the things you can change and then get busy doing And the things you can't, you just accept and you put it in God's hands.
Julie Hershberg (53:20)
Hmm
Eric Von Frohlich (53:41)
And trust that you'll have the strength that you need for whatever challenge you overcome at whatever point you get there. So it's something that you really don't have to worry about. You just need to be proactive in doing what you can to impact it for yourself in any, you know, in any positive direction. What about you, Todd?
TODD VOGT (53:58)
I don't know, this is something I struggle with. So I'd say it's a daily battle. It's a moment by moment battle. To sort of be self accepting of who you are and then trying to still have a positive frame of mind going forward. I try to do the best I can. I don't think I do the best job always in my own head, but yeah, I try to like.
Eric Von Frohlich (54:18)
Yeah,
there's definitely good days and bad days. That's that's as Julie brought up earlier. But then there's a time where you just kind of have to put on your big boy pants and get get after the problem and, you know, start dealing with it. It's ⁓ it's not a we've talked about Parkinson's being a accelerated aging process in a lot of ways. And.
You know, every athlete comes to a point where he can't do what he used to do, or can't do it as quickly as he used to do it. And so, everyone, given enough time, comes across these same challenges that we're getting at an earlier age and maybe a little bit of accelerated pace. So, no one's getting through life without that challenge at some point or another if you live long enough.
Julie Hershberg (55:04)
Yeah, I love the honesty of it is a daily like battle or challenge. I think that's like really real for both of you to share that. And here you are a podcast on athletes with Parkinson's and spreading the word. ⁓ And I think that says a lot
Eric Von Frohlich (55:23)
Yeah, and thanks to people like yourself, Julia, who dedicated a lifetime to understanding this disease and working with people like us. And we can't say enough that you guys have given us a tremendous amount of insight and a tremendous amount of hope. So we thank you for your dedication to improving people's neurological challenges.
Julie Hershberg (55:44)
thank you. mean, I wouldn't know anything that I know without you. I, this as like the people that I've seen have shaped me as a person, but shaped my career and what I love and learn. And, you know, even this conversation today, I'm gonna be taking to the clinic tomorrow. So thank you.