Non-Motor Symptoms after One Week of High Cadence Cycling in Parkinson’s Disease

Harper, Sara A.; Dowdell, Bryan; Kim, Jin Hyun; Pollock, Brandon S.; Ridgel, Angela L.

doi:10.3390/ijerph16122104

Cited by 11 publications

(13 citation statements)

References 54 publications

(68 reference statements)

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“…One study (157) reported that a sedentary program may be more beneficial to boys' moods than exercise. Another study (158) reported that 1-week high cadence cycling failed to improve depression symptoms. Methodological weaknesses, excessively severe depressive symptoms in participants, discrepancies in the mean age of the sample, imperfect exercise programs, and bias would affect the results.…”

Section: The Therapeutic Effect Of Exercise On Depressionmentioning

confidence: 99%

The Effects and Mechanisms of Exercise on the Treatment of Depression

Xie

Sun

et al. 2021

Front. Psychiatry

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Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles.Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations.Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized.Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18–65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions.Recommendations: Aerobic exercise/mind-body exercise (3–5 sessions per week with moderate intensity lasting for 4–16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.

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Section: The Therapeutic Effect Of Exercise On Depressionmentioning

confidence: 99%

The Effects and Mechanisms of Exercise on the Treatment of Depression

Xie

Sun

et al. 2021

Front. Psychiatry

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“…Multiple small controlled trials have demonstrated that forced high cadence cycling (FHCC) can ameliorate motor symptoms in individuals with PD as measured by the Unified Parkinson's Disease Rating Scale‐Part III and Timed up and Go (Alberts et al., 2011; Beall et al., 2013; Harper et al., 2019; McGough et al., 2016; Miller Koop et al., 2019; Ridgel et al., 2009, 2011, 2013, 2015; Uygur et al., 2015). In FHCC, individuals with PD pedal with either a tandem corider or a motor providing external augmentation at a cadence of 80–90 revolutions per minute (rpm)—which is faster than most individuals would pedal on their own.…”

Section: Introductionmentioning

confidence: 99%

“…Although the rate is augmented, cycling on either device is an active, not passive, activity. In comparing FHCC versus cycling at a self‐selected cadence on a stationary indoor bicycle, most of the published literature has found that, despite similar cardiovascular exertion in the two modes, improved motor symptoms are only observed in the forced‐cadence modality (Harper et al., 2019; Ridgel et al., 2009, 2015; Uygur et al., 2015). One recent study did demonstrate gains in both forced and voluntary groups, but it was noted that the voluntary group self‐selected to pedal at a cadence near the target achieved by the forced group (Miller Koop et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Implementation of high‐cadence cycling for Parkinson’s disease in the community setting: A pragmatic feasibility study

et al. 2021

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Background Efficacy of exercise to improve motor symptoms in Parkinson's Disease (PD) has been established in multiple clinical trials. The Pedaling for Parkinson's ™ (PFP) program is an existing community‐based cycling intervention for individuals with PD. Although PFP program design was informed by in‐laboratory efficacy studies, the implementation and effectiveness of the program in the community have not been studied. This feasibility study explores implementation and effectiveness of PFP utilizing the RE‐AIM implementation evaluation framework. Methods This was a pragmatic open‐label multi‐site study. First, community‐based gyms were recruited to implement the PFP protocol with enhanced multi‐modal training and support. Second individuals with Hoehn and Yahr stage I‐III idiopathic PD were recruited to participate. Reach, effectiveness (both clinical scores and participant enjoyment), adoption, implementation (gym and participant fidelity, cost), and maintenance (sustainability) were assessed. Tracking of adverse events was used to monitor safety of the intervention. Results Reach was moderate: 59% of participants who expressed interest opted to participate. No effectiveness outcomes demonstrated a significant change from pre to post; however, the program was highly enjoyable (96% of participants who started classes enjoyed the program and 87% wished to continue). Adoption was poor with only four out of 34 gyms participating. The program had poor gym and moderate participant fidelity. The program was maintained for at least 4 months across all sites. The program was implemented safely. Conclusion Barriers to implementation of nonpharmacologic interventions such as exercise protocols limit reach and availability of these interventions to patients. Pilot studies are needed to inform and direct further implementation efforts. Our pilot study suggests the PFP cycling intervention should be modified prior to attempts at widespread implementation. Modifications made by gyms in this study suggest adaptations to the protocol that may increase fidelity and effectiveness.

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“…Multiple small controlled trials have demonstrated that FHCC can ameliorate motor symptoms in individuals with PD as measured by the Uni ed Parkinson's Disease Rating Scale-Part III and Timed up and Go. [22][23][24][25][26][27][28][29][30][31] In FHCC, individuals with PD pedal with either a tandem co-rider or a motor providing external augmentation at a cadence of 80-90 revolutions per minute (rpm)-which is faster than most individuals would pedal on their own. Although the rate is augmented, cycling on either device is an active, not passive, activity.…”

Section: Introductionmentioning

confidence: 99%

High-Cadence Cycling for Parkinson Disease: A Single-Arm Hybrid Implementation and Effectiveness Clinical Trial in the Community Setting

McKee¹,

Johnson²,

Chan³

et al. 2020

Preprint

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BACKGROUND Efficacy of exercise to improve motor symptoms in Parkinson Disease (PD) has been established in multiple clinical trials. The Pedaling for Parkinson’s ™ (PFP) program is an existing community-based cycling intervention for individuals with PD. Although the program design was informed by efficacy studies, the implementation and effectiveness of the program have not been studied. We used a hybrid trial, which blends the study of implementation and effectiveness, to study the implementation of PFP in community gyms in the greater Boston area. METHODS This was a single-arm open-label pragmatic hybrid type 3 clinical trial designed to test implementation and observe clinical effectiveness. The implementation strategy consisted of enhanced multi-modal training and support for community-based gyms to implement the PFP protocol. Individuals with Hoehn and Yahr stage I-III idiopathic PD were recruited to participate. Primary implementation outcomes included adoption, gym fidelity, participant adherence, implementation cost, sustainability, acceptability, and safety. Secondary effectiveness outcomes included disease and quality of life measures. RESULTS 34 gyms were invited to participate. 4 gyms agreed to participate and implemented the PFP protocol. 24 individuals with idiopathic PD agreed to participate in the study and started classes. The program was implemented safely and sustainably across all sites but with high fidelity at only one of four gyms. 58% of individuals who started classes completed at least 80% of classes. 96% of participants who started classes enjoyed the program and 87% wished to continue. No effectiveness outcomes demonstrated a significant change from pre to post. CONCLUSION Our implementation strategy of additional multi-modal training and support in starting a PFP class was insufficient to achieve wide adoption of and high fidelity and adherence to the PFP protocol. However, participating gyms’ modifications of the PFP protocol in this study suggests such protocol modification may be necessary for effective implementation in the community setting. Future studies should first establish effectiveness of a revised PFP protocol. Implementation could then be achieved through a participatory approach in which barriers to gym participation are identified and mitigated early in the implementation process.

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Non-Motor Symptoms after One Week of High Cadence Cycling in Parkinson’s Disease

Cited by 11 publications

References 54 publications

The Effects and Mechanisms of Exercise on the Treatment of Depression

The Effects and Mechanisms of Exercise on the Treatment of Depression

Implementation of high‐cadence cycling for Parkinson’s disease in the community setting: A pragmatic feasibility study

High-Cadence Cycling for Parkinson Disease: A Single-Arm Hybrid Implementation and Effectiveness Clinical Trial in the Community Setting

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