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Cyclists with Parkinson’s Show Improved Brain Functions

Parkinson's disease patient in stationary cycling study (Stephen Travarca, Cleveland Clinic)

Parkinson’s disease patient in stationary cycling study (Stephen Travarca, Cleveland Clinic)

Researchers at the Cleveland Clinic in Ohio found Parkinson’s disease patients benefited from stationary cycling, with the greatest benefits experienced by patients who pedaled faster. The Cleveland Clinic team presents its findings today at a meeting in Chicago of the Radiological Society of North America.

Parkinson’s disease is a brain condition that leads to shaking, with difficulties in walking, movement, and coordination. The disorder occurs most often after age 50, but it can occur in younger people, including actor Michael J. Fox who started a foundation that funds research into a cure. Parkinson’s disease occurs when nerve cells in the brain that make the chemical dopamine are slowly destroyed, which impairs the ability of those cells to send signals, leading to a progressive loss of muscle function.

Cleveland Clinic neuroscientst and co-author Jay Alberts saw first-hand in 2003 the potential of cycling when he rode on a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride. “I was pedaling faster than her, which forced her to pedal faster,” says Alberts. “She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.”

In the study, Alberts and first author Chintan Shah used functional MRI to study the effect of exercise on 26 Parkinson’s disease patients. Functional MRI adapts magnetic resonance imaging to measure the metabolic changes that take place in an active part of the brain, which can help assess the effects of degenerative conditions such as Parkinson’s disease on brain functions.

The Parkinson’s patients took part in bicycle exercise sessions three times a week for eight weeks. Some patients exercised at a voluntary level and others underwent forced-rate exercise, pedaling at a speed above their voluntary rate. A modified exercise bike induced the higher cycling rates. “We developed an algorithm to control a motor on the bike,” says Alberts, “and used a controller to sense the patient’s rate of exertion and adjust the motor based on their input.”

Functional MRIs were taken before and after the eight weeks of exercise therapy, and four weeks later as follow-up. From the functional MRIs, the researchers calculated brain activation and connectivity levels, and correlated those data with the patients’ average pedaling rates.

The functional MRI findings show increases in task-related connectivity between the primary motor cortex and the posterior region of the thalamus, a part of the brain involved in the regulation of motor functions. A faster pedaling rate, say the researchers, was the key factor associated with these improvements, which were still evident at follow-up four weeks later. (The findings show a relationship between faster cycling and task-related connectivity in the brain, but not necessarily that the faster cycling caused the higher rate of improvements.)

“The results show that forced-rate bicycle exercise is an effective, low-cost therapy for Parkinson’s disease,” says Shah. Alberts adds that more research is planned to find other types of exercise for achieving these improvements. “We’re now looking at this phenomenon in patients with exercise bikes in their home,” says Alberts, “and other exercises like swimming and rowing on tandem machines may provide similar benefits.”

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