Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients

Ridgel, Angela L.; Vitek, Jerrold L.; Alberts, Jay L.

doi:10.1177/1545968308328726

Cited by 228 publications

(276 citation statements)

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“…In animal studies, the subject is forced to exercise at a rate greater than its voluntary exercise rate, whereas in human studies, the subjects exercise at their voluntary rate. The ensuing hypothesis raised in a subsequent study was that FE would improve motor symptoms compared to voluntary-rate exercise (VE) (Ridgel et al, 2009). FE is defined as exercise at a rate above a subject's voluntary (preferred) rate, maintained using an external system (Ridgel et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…The ensuing hypothesis raised in a subsequent study was that FE would improve motor symptoms compared to voluntary-rate exercise (VE) (Ridgel et al, 2009). FE is defined as exercise at a rate above a subject's voluntary (preferred) rate, maintained using an external system (Ridgel et al, 2009). In this initial study, FE was delivered via tandem bicycle with the patient behind a personal trainer (Ridgel et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…The average pedaling rate in the FE group was 43% greater than that in the VE group, and aerobic intensity was matched between groups. After completing 8 weeks of bicycle exercise, those patients randomized to FE showed 35% improvement in clinical motor ratings, while patients randomized to VE did not show improvement (Ridgel et al, 2009). Other studies have found that improvements in corticomotor excitability and motor performance may be related to the intensity of exercise (Fisher et al, 2008), and that patients undergoing intensive exercise showed increases in striatal dopamine D2 receptor binding potential measured with positron emission tomography (PET) imaging .…”

Section: Introductionmentioning

confidence: 99%

“…FE is defined as exercise at a rate above a subject's voluntary (preferred) rate, maintained using an external system (Ridgel et al, 2009). In this initial study, FE was delivered via tandem bicycle with the patient behind a personal trainer (Ridgel et al, 2009). For further study of FE, our laboratory developed a motor driven stationary cycle that can augment the rider's pedaling rate (see Methods section) (Beall et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Deep brain stimulation is an effective therapy for late stage PD, but carries significant cost as well as risks due to the invasive procedure for placement of the device. This study focuses on forced-rate exercise (FE), a potential new, low-cost, and noninvasive therapy for PD, which has been shown to improve motor symptoms (Alberts et al, 2011;Ridgel et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

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Exercise Therapy for Parkinson's Disease: Pedaling Rate Is Related to Changes in Motor Connectivity

et al. 2016

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Forced-rate lower-extremity exercise has recently emerged as a potential safe and low-cost therapy for Parkinson's disease (PD). The efficacy is believed to be dependent on pedaling rate, with rates above the subjects' voluntary exercise rates being most beneficial. In this study, we use functional connectivity magnetic resonance imaging (MRI) to further elucidate the mechanism underlying this effect. Twenty-seven PD patients were randomized to complete 8 weeks of forced-rate exercise (FE) or voluntary-rate exercise (VE). Exercise was delivered using a specialized stationary bicycle, which can augment patients' voluntary exercise rates. The FE group received assistance from the cycle. Imaging was conducted at baseline, end of therapy, and after 4 weeks of follow-up. Functional connectivity (FC) was determined via seed-based correlation analysis, using activationbased seeds in the primary motor cortex (M1). The change in FC after exercise was compared using linear correlation with pedaling rate. Results of the correlation analysis showed a strong positive correlation between pedaling rate and change in FC from the most affected M1 to the ipsilateral thalamus. This effect persisted after 4 weeks of follow-up. These results indicate that a plausible mechanism for the therapeutic efficacy of high-rate exercise in PD is that it improves thalamo-cortical connectivity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exercise Therapy for Parkinson's Disease: Pedaling Rate Is Related to Changes in Motor Connectivity

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Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease

Shulman

Katzel²,

Ivey³

et al. 2013

JAMA Neurol

340

309

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Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease

et al. 2018

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IMPORTANCEParkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise.OBJECTIVES To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial. DESIGN, SETTING, AND PARTICIPANTSThe Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control). INTERVENTIONS High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months. MAIN OUTCOMES AND MEASURES Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson's Disease Rating Scale motor score.RESULTS A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson's Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, −1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe.CONCLUSIONS AND RELEVANCE High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease.

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Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients

Cited by 228 publications

References 45 publications

Exercise Therapy for Parkinson's Disease: Pedaling Rate Is Related to Changes in Motor Connectivity

Exercise Therapy for Parkinson's Disease: Pedaling Rate Is Related to Changes in Motor Connectivity

Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease

Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease

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