This is my first post. I've read all the previous posts in this thread and would firstly like to say thanks to everyone who contributed all the valuable information contained in these posts. A special thanks to all the major contributors, especially Nan Cyclist, Conductor71, and soccertese.

In the early years of this thread, the pioneering work of Jay Alberts and Angela Ridgel was a topic of discussion, in particular their "formula" of keeping cadence between 80 and 90 RPM and heart rate between 60% and 80% of HRmax. Three sessions per week of 40mins duration each session.

What I would like to focus on in this post is one of their more recent papers (May 2013) titled "Variability in cadence during forced cycling predicts motor improvement in individuals with Parkinson's disease". What this paper seems to me to be saying is that the participants who experienced the greatest improvement in motor symptoms were those whose cadence varied the most.

With this in mind, (i.e. in order to get some "variability" into my own exercise bike routine), I have recently adopted an 8s/12s duty cycle. I set the resistance to a fairly low level (I'm currently using the 2nd lowest level on my exercise bike). I pedal very fast for 8 seconds and then pedal slower for 12 seconds. I then repeat 120 times (i.e. a total of 40 mins). My revolution count during the 8 second period averages 14 (i.e. 105 RPM) and my revolution count during the 12 second period averages 16 (i.e. 80 RPM), for an overall average of 90 RPM.

The originator of the 8s/12s duty cycle is Prof. Stephen Boutcher. I learnt about his work from an (Australian) ABC Catalyst program titled "Fit in 6 minutes a week". If you would like to Google it and have a look, the program goes for about 27 minutes and the segment covering his work starts at about the 18:25 mark. Note that his work targets aerobic health and glycemic health (i.e. he is not working in the PD field).

I've only been using the 8s/12s duty cycle for about 2 weeks but the results seem very promising. My symptoms seem to have diminished somewhat and are now more in the background rather then being "front and centre". However, I'm not really sure if an 8s/12s duty cycle matches the Parkinsons researchers criteria for "variability".

Does anyone here have any insights into this issue (i.e. the relative importance of "variability" in the Alberts/Ridgel formula), or can someone point me in the right direction to discover where this issue has been discussed?

Jeff

While I was waiting for a response to my first post, and to my emails to Jay Alberts and Angela Ridgel, I did some more "research" and realised that the answer to my main question was obvious. And the answer is ... it's too soon to tell !

Similarly, if the Parkinsons researchers haven't (yet) studied the application of interval training techniques to high-cadence cycling, they can't (yet) know much about the comparative effectiveness of this combination.

The penny dropped while I was reading a relevant (and recent) paper. I've summarized it by extracting a couple of key paragraphs.

Ridgel AL, Phillips RS, Walter BL, Discenzo FM, Loparo KA. Dynamic high-cadence cycling improves motor symptoms in Parkinson’s disease. Frontiers in Neurology 6:194 (2015) doi: 10.3389/fneur.2015.00194

"The dynamic cycling paradigm that we developed uses a motorized stationary cycle to assist individuals with PD to pedal at a cadence faster than they can (or would) pedal on their own. In addition, this rehabilitation paradigm is unique because the motor rotates the pedals at a high speed with a slight, but prescribed, variation. These dynamic changes in cadence appear to be an important component of tandem cycling. [A]" [B]
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"CONCLUSION: These findings show that dynamic cycling can improve PD motor function and that activation of proprioceptors(1) with a high cadence but variable pattern may be important for motor improvements in PD."
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"Funding: This work was funded by a National Institutes of Health Grant R21 HD068846 to Angela L. Ridgel."
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"Conflict of Interest Statement: Provisional patent filed through KSU on 12/2014; full application has not yet been submitted; no royalties have been distributed."

[A] Ridgel et al. Variability in cadence during forced cycling predicts motor improvement in individuals with Parkinson's disease. (2013)
[B] Ridgel et al. Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. (2009)

(1) In the limbs, the proprioceptors are sensors that provide information about joint angle, muscle length, and muscle tension, which is integrated to give information about the position of the limb in space.

Prior to my interest in "variability of cadence" (see previous posts), I had an existing interest in the application of interval training techniques (ITT) to high-cadence cycling for the benefit of PWPs.

My interest in this combination was triggered by a post from Conductor71 (the originator of this thread) in which she said: "Researchers keep looking at vigorous vs. moderate; maybe a combo like interval training is even better for us?" (post #137 on 11-08-2011). I was further inspired by a post from TexasTom (post #325 on 06-26-2015) in which he described his adoption of a 30s/30s duty cycle for use with his motorized Exercycle.

I've been searching for papers which consider this combination but have so far found only three.

The first paper is titled "Immediate effects of high-speed cycling intervals on bradykinesia in Parkinson's disease" (Oct 2014). The exercise session involved participants cycling at a self-selected fast pedaling cadence for the first 15 seconds of every minute for 20 minutes.

The second paper is titled "Interval training-induced alleviation of rigidity and hypertonia in patients with Parkinson's disease is accompanied by increased basal serum brain-derived neurotrophic factor" (2015). The exercise session comprised eight 5-minute duty cycles. Each duty cycle consisted of 3 minutes cycling at >= 60 rpm (preferably at 80-90 rpm) and 2 minutes at =< 60 rpm.

The third paper is titled "Enhanced Exercise Therapy in Parkinson’s disease: A comparative effectiveness trial" (2016). The exercise session involved participants being encouraged to increase their cadence up to 80 rpm (with music) for 1 minute bouts, followed by 2-3 minutes of easy spinning, for a total of 20 minutes.

Is anyone aware of any other papers which consider the combination of ITT, high-cadence cycling, and PD?

Hi Jeff, Thanks for your welcome additions to this thread. I'm impressed with your commitment to define and maintain such specific workout protocols. Of course, riding on roads or trails restricts my ability to maintain such precise intervals. I do note, for what it's worth, that I feel stronger and more affected by my cycling when I ride outside. Jay has told me informally that it appears that a higher cadence (still maintaining the hr parameters), provides stronger results. I have also found for me that riding four or more days/week is better than three one hour slots. I can't imagine restricting myself to a tandem. Just organizing the people to help would use up my resources. As long as I can ride on my own, inside or out, I am in charge of my program and that sense of self efficacy means a great deal to my continued success, which brings me to the point of emphasizing two other points: the power of the placebo effect and the fact that movement is just one part of Parkinson's: emotion and cognition play equally important roles.

Could you tell us a bit more about yourself?

Hi Nan, thanks for the detailed response and the words of encouragement. I'll try to respond to each of the issues and questions which you've raised.

"I'm impressed with your commitment to define and maintain such specific workout protocols."
I don't think that the changeover times have to be that precise. I haven't asked Stephen Boutcher about this yet, but I get the impression from the Catalyst video segment that they used pre-recorded music to distinguish the fast and the slow segments. In my first post I included the information about my own RPMs just to show that if you double the Boutcher session duration to 40 minutes, you pretty much satisfy the Alberts/Ridgel formula, plus you get some "variability" thrown in for free.

"Of course, riding on roads or trails restricts my ability to maintain such precise intervals. I do note, for what it's worth, that I feel stronger and more affected by my cycling when I ride outside."
This is where I think you and I differ significantly. Cycling is only a very small part of my life. I do it only because I believe that high-cadence cycling is a very effective way to lessen symptoms and to possibly slow the progression of PD. I do my 40 minute session (plus 5 minutes warm up plus 5 minutes cool down) first thing in the morning before breakfast, after I take my medication. That way it's done with and I'm free for the whole day.

"Jay has told me informally that it appears that a higher cadence (still maintaining the hr parameters), provides stronger results."
Informal is nice, but as you know, it carries no weight in the scientific community. Jay Alberts is one of the authors of the "variability in cadence" paper which I referred to in my first two posts. As I reported in my second post, one of the conclusions from this research is that "dynamic changes in cadence appear to be an important component of tandem cycling."

As I hinted at in my second post, it seems to me that Ridgel el al. plan to use their "tested and validated" motorized smart exercise bike [A] as a "research vehicle" to further investigate how "variability of cadence" (and other factors) impact motor symptom improvements. I would imagine that this could take a few years.

"I have also found for me that riding four or more days/week is better than three one hour slots."
I agree. I do my session 6 days a week (I have a day off on Sunday).

"I can't imagine restricting myself to a tandem. Just organizing the people to help would use up my resources. As long as I can ride on my own, inside or out, I am in charge of my program and that sense of self efficacy means a great deal to my continued success..."
I agree. I must also add though, that I can't see a strong connection to anything I said in my first three posts.

"which brings me to the point of emphasizing two other points: the power of the placebo effect"
post #81 by Nan Cyclist, 03-08-2011: After his talk I asked if he knew about Pedaling for Parkinson's and Jay Alberts' work. He was very familiar with that. I asked if the results were due to the placebo effect and he stated "absolutely not The changes due to cycling are real."
I'm confused. Perhaps I've misunderstood you.

"and the fact that movement is just one part of Parkinson's: emotion and cognition play equally important roles."
I'm not sure if I've heard this before, and I'm not sure that I'd put it that way. Do you have a reference which you could share with us?

"Could you tell us a bit more about yourself?"
Sure. I was born in 1956 and diagnosed with idiopathic PD in June 2015. Like you, I think I have "PD lite" as you once called it. My main symptom is tremor (on the right side). My ambition is to replicate your success at remaining at stage 1 for 10 years, and to share with others what I learn along the way.

I'm sorry if I've been a bit blunt in some of my replies. It's not the PD - it's the way I am (according to my wife).



[A] H. M. Abdar, A. L. Ridgel, F. M. Discenzo, R. S. Phillips, B. Walter, K. A. Loparo, "Test and Validation of a Smart Exercise Bike for Motor Rehabilitation in Individuals with Parkinson’s Disease", IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2016. DOI:10.1109/TNSRE.2016.2549030

This is my last post (probably - at least for a while anyway, barring any unexpected developments).

So just to summarize:

For my 40-minute (six days per week) exercise bike session I've recently adopted the Boutcher protocol. My overage average RPM is 90, which seems to pretty much satisfy the Alberts/Ridgel formula (see first post).

I've found that the variability inherent in an 8s/12s duty cycle seems to help the time pass quickly. Whether this type of variability also contributes to motor symptom improvement seems to be unknown at this point in time. My reading of recent research outputs leads me to believe that the role played by "variability-of-cadence" (and other factors) will be studied more over the next few years, most likely by Ridgel et al. at KSU (see second post).

More generally, it seems that few papers have been published which consider the combination of interval training techniques, high-cadence cycling, and PD (see third post).

I've sent an email message Jay Alberts, Angela Ridgel and Stephen Boutcher, and included a link to this webpage. If I get any significant response, and I have their permission, I'll post the information to this thread.

And Nan, I've dug up a reference for you.

"The nonmotor impairments are wide ranging and include cognitive and emotional impairments, autonomic dysfunction, sleep disorders and sensory abnormalities, including pain..." [A]

If you had said "also play important roles" rather than "play equally important roles", I think I might not have had a problem with it. It's not my bluntness this time, it's probably OCD. I'm sorry.

[A] Allen NE, Moloney N, van Vliet V, Canning CG (2015) The rationale for exercise in the management of pain in Parkinson's disease. Journal of Parkinson's Disease 5 (2015) 229-239 DOI 10.3233/JPD-140508

I still think emotion and cognition are equally important in PD. But each of us has our own experience. As we progress the non-motor symptoms become more important and more debilitating unfortunately. That said, yesterday I rode my bike 31 miles around the U British Columbia campus and up and down hills and I feel better on all fronts today.

I think your attitude will carry you a long way, hopefully the ten years or more you're aiming for.

Just a short note to clarify something. When I said "This is my last post", what I actually meant to say was "This is my last post on this topic (for now)". Sorry for any confusion.

A few years ago Nan did a post (post #184 on 12-10-2012) to inform everyone that: "A group of Dr. Alberts' staff gave a poster recently covering results of a cycling trial that included 26 patients." Nan's post includes a link (now broken) to the corresponding press release on the RSNA website, titled "Exercise Rate Related to Improvements in Parkinson's Disease."

This post of mine is to inform everyone that the November 2012 "poster" has now evolved into a published research paper:

Shah C, Beall EB, Frankemolle AM, Penko A, Phillips MD, Lowe MJ, Alberts JL. (2016) Exercise Therapy for Parkinson's Disease: Pedaling Rate is Related to Changes in Motor Connectivity. BRAIN CONNECTIVITY, Volume 6, Number 1, 2016 DOI: 10.1089/brain.2014.0328

Here is a link to the paper's abstract:

http://www.ncbi.nlm.nih.gov/pubmed/26414696

Reading through the paper, it seems to me that the essence is still very similar to that of the poster. So if you are interested in reading the paper, but are unable to access a copy of it, I think you can still learn quite a lot from the information associated with the poster, and this is still available on the RSNA website.

To replace the broken link in Nan's post, here is a new link to the poster's press release on the RSNA website:

https://www2.rsna.org/timssnet/Media...get.cfm?id=633

The press release contains a link called "Press conference video" (just below the "Abstract:" box). The 16 minute video is essentially Chintan Shah (the lead author) talking you through a set of charts/slides describing the project.

The press release also contains a link (now broken) to the poster abstract, titled "Exercise Therapy for Parkinson’s Disease: Faster Pedaling is Related to Greater Improvement in Motor Connectivity." To replace this broken link, here is a new link to the poster abstract on the RSNA website:

http://archive.rsna.org/2012/12043477.html

I have made a change to my exercise bike routine, taking to heart the message from the researchers that higher cadences give better results. I still pedal very fast for 8 seconds and then pedal slower for 12 seconds, and still repeat that 120 times (i.e. a total of 40 minutes). The change I have made is that I now have the resistance level set to the lowest level (previously it was set to the second lowest level). My revolution count during the 8 second period now averages 15 (i.e. 112.5 RPM) and my revolution count during the 12 second period now averages 17 (i.e. 85 RPM), for an overall average of 96 RPM (previously it was 90 RPM). I still do one 40-minute session 6 days per week (plus 5 minutes warm up, plus 5 minutes cool down).

Note that in my adaptation of the Boutcher protocol, the "slow" phase (i.e. the 12s phase) is not really slow at all (i.e. 85 RPM on average). But it feels significantly slower than the fast phase, and I seem to just coast right through it. I guess it's partly due to the momentum generated during the fast phase.

One thing I like about the 8s/12s duty cycle is that the time seems to pass quickly, maybe because I'm always concentrating. To signal the changeover points between the 8s and 12s segments, I use the digital timer that came with my exercise bike, and I also count my revolutions during each 20 second duty cycle. Since I already know that my average revolution counts are 15 and 17 respectively, I count my revolutions until I get to 32 (on average), and then start counting from one again. I look at the timer when my count gets to about 15, to end the 8s phase at the correct time (i.e. at 8, 28, and 48 seconds of each minute). I look at the timer again when my count gets to about 32, to end the 12s phase at the correct time (i.e. at 20, 40, and 60 seconds of each minute). It's very convenient that the duty cycle is 20 seconds long, as 20 divides into 60 evenly (i.e. 3 duty cycles per minute, repeated 40 times).

There has been a definite improvement in my tremor (my main symptom). I remember that when my tremor first appeared ( approx. 2 years ago) it was just an internal tremor (i.e. I felt it but it was not visible). Since starting high-cadence cycling my tremor has weakened, and it has become internal again some of the time. I also feel I have more energy now and am thinking more clearly.

Thank you Nan, for inspiring me, and so many others, to try high-cadence cycling, using our own bikes.