Category: Neurodegenerative Disease (e.g. MS, Parkinson's disease); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Technology (e.g. robotics, assistive technology, mHealth)
Objective : To assess whether technology-enhanced cycling forcing a prescribed fast rate is feasible and efficacious in individuals with Parkinson’s disease (PD).
Design : Single-blind, randomized controlled pilot trial
Setting : Urban rehabilitation outpatient facility
Participants (or Animals, Specimens, Cadavers) : Twelve subjects with idiopathic Parkinson’s disease, Hoehn and Yahr Stage II were enrolled (from 16 screened). 50% were female, with mean age 65.2 years.
Participants were randomized to an 8-week exercise program (3 sessions/week, 50 minutes/session) using a commercially-available stationary bike with pedal-assist at a forced-pace of 90 revolutions per minute or a self-selected pace. Both groups targeted 60-65% maximal heart rate (rating of perceived exertion 13-16).
Main Outcome Measure(s) : Unified Parkinson’s Disease Rating Score motor subscale (UPDRS-m), GaitRite-measured self-selected gait velocity, and Mini-BESTest were measured at baseline, immediate post-exercise, and follow-up 8 weeks after completion.
Results : Eight participants completed the study: two forced-paced and six self-paced. Subjects exited early from the forced-paced due to: reported inconvenience (n=2), worsening symptoms (n=1), and lost to follow-up (n=1). The forced-paced group maintained rates of 13-15 mph versus 7-9 mph in the self-paced group. At baseline, immediate and follow-up assessments, the forced-paced group UPDRS-m scores were 21.3±14.0 (SD), 24.0±2.8, and 22.5±6.4; self-selected gait velocity was 1.3±0.2 meters/second, 1.4±0.2, and 1.6±0.3; Mini-BESTest 21.8±3.9, 23.0±1.4 and 24.0±1.4. The self-paced group means were: UPDRS-m 29.2±9.9, 27.3±12.6 and 31.3±14.6; self-selected gait velocity 1.2±0.2, 1.3±0.2, and 1.3(±0.2); Mini-BESTest 21.3±2.9, 23.0±2.4, and 22.0±1.7.
A high drop-out rate of participants assigned to forced-paced cycling limited feasibility in this urban community. Exercise type maximizing long-term adherence should be considered when prescribing exercise interventions for individuals with PD.
Alison Scarpa– Occupational Therapist, Shirley Ryan AbilityLab, Chicago, Illinois
Patrick Sung– Research Associate, Shirley Ryan AbilityLab, Chicago, Illinois
Miriam Rafferty– Research Scientist, Shirley Ryan AbilityLab, Chicago, Illinois
Laura Doyle– physical therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Elizabeth Kliver– Physical Therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Kelcey Bines– Occupational Therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Jennifer Traines– Physical Therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Christina Marciniak– Professor and Attending Physician, Department of Physician Medicine and Rehabilitation and Department of Neurology, Northwestern University. Shirley Ryan AbilityLab, Chicago, Illinois
Sneha Solanki– Clinical Research Quality Manager, Shirley Ryan AbilityLab, Chicago, Illinois
Allison Todd– Research Administrator, Rehabilitation Institute of Chicago dba Shirley Ryan AbilityLab, Chicago, Illinois