MDS 2009: Forced Exercise Provides Benefit Similar to Levodopa in Parkinson's Disease

MedScape Medical News, by Pauline Anderson
http://www.medscape.com/viewarticle/704397?src=rss

June 15, 2009 (Paris, France) — Patients with Parkinson’s disease (PD) who exercise on a stationary tandem bicycle with a healthy partner during a single 40-minute session experience a 35% improvement in motor function and increased brain activation similar to that found with levodopa treatment, new research shows.

The study, by researchers at the Cleveland Clinic in Ohio, found that maintaining a steady rate of 80 to 90 revolutions per minute (rpm) on the bicycle not only improved function in lower extremities but also in upper extremities.

The improvement was dramatic and similar to that achieved by levodopa therapy, said 1 of the researchers, Jay L. Alberts, PhD, from the Center for Neurological Restoration at the Lerner Research Institute, in Cleveland.

"It looks like there are global effects in terms of the improvement in motor function," he told Medscape Neurology. "It suggests to us that maybe we're changing central motor function or maybe we're actually changing brain function through something very noninvasive."

The study was presented during the Movement Disorder Society's 13th International Congress of Parkinson's Disease and Movement Disorders.

A previous published study by this Cleveland research group found that the same forced exercise intervention administered 3 times a week for 8 weeks provided a similar 35% improvement in motor function.

"Couple these new findings with our longer-term data, and for us it's very encouraging," said Dr. Alberts. "Maybe if we can alter brain function, we can potentially alter the course and potentially slow the progression of this disease."

I find that riding my trike for 30-60 minutes each morning really helps my symptoms - and that the period of time before I need to take meds is longer.

hmm, what I'm wondering is whether it's the speed of the movement or activity, or the fact that the person was having another person's motor impulses imposed on their own that helped?

I was wondering the same ..

Is a partner is required for this or if they did tests with & with out a partner??
and tandem vs a single ??
-- is it the motions/movements alone or is the the partnership--

oh, maybe the tandem bike use would be for those that aren't able to pedal on their own..

Aren't we talking about passive exercise??

We are building muscle strength w/out the work /energy expenditure . Same as EECP benefits.

Some form of passive exercise should be REQUIRED for alll pd'ers. Will medicare pay for our Theracycles? $5,500 each!

ibby

Is this the study? I don't understand why, if they're both working at 60 - 80% of their training hear rate, why it makes a difference if someone else is on the bike with them. Interesting.

1: Neurorehabil Neural Repair. 2009 Jan 8. [Epub ahead of print]Click here to read Links
Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients.
Ridgel AL, Vitek JL, Alberts JL.

BACKGROUND: Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients. OBJECTIVE: The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity. METHODS: Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate. RESULTS: Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. CONCLUSIONS: Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.

Does street riding make a difference?

I don't get out every day due to work and weather, but I do go riding on the days off and on weekends whent the weather is nice. I feel better after the ride initially, but then it's downhill from there.

Too much of a good thing?

John

I think street riding is probably good. Gets your spirits up, its great to be out in the open...

In Norman Doidge's book on the plasticity of the brain, he says that the best thing to preserve one's cognition and abilities as we age, is to learn new dances. "Force" ourselves to do motor patterns that are unfamiliar. I took an African dance class the other night, which I thought was a great step in that direction....

Exercise, Movement and cadence

I believe from reading that 3 items are involved ...

1) Exercise is good so any kind of bike anywhere is a help....

2) Controlled movement - guidance from the pedal movement rather than freeform makes it easieir for us and is a help in rebuilding nuero pathways

3) Cadence - most of these articles on tandem bikes or powered machines have mentioned a HIGH CADENCE - higher than in normal riding or comfortable for a PD patient to maintain on their own - magnifies the benefit from 1 & 2.

take care ,,, ken