J Clin Neurol.  2018 Apr;14(2):225-233. 10.3988/jcn.2018.14.2.225.

An 8-Week Low-Intensity Progressive Cycling Training Improves Motor Functions in Patients with Early-Stage Parkinson's Disease

• Chang HC
• Lu CS
• Chiou WD
• Chen CC
• Weng YH
• Chang YJ

• KMID: 2407951
• DOI: http://doi.org/10.3988/jcn.2018.14.2.225

Abstract

BACKGROUND AND PURPOSE
The effects of high-intensity cycling as an adjuvant therapy for early-stage Parkinson's disease (PD) were highlighted recently. However, patients experience difficulties in maintaining these cycling training programs. The present study investigated the efficacy of cycling at a mild-to-moderate intensity in early-stage PD.
METHODS
Thirteen PD patients were enrolled for 16 serial cycling sessions over a 2-month period. Motor function was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III) and Timed Up and Go (TUG) test as primary outcomes. The Montreal Cognitive Assessment (MoCA), modified Hoehn and Yahr Stage (mHYS), total UPDRS, Falls Efficacy Scale, New Freezing of Gait Questionnaire, Schwab and England Activities of Daily Living, 39-item Parkinson's Disease Questionnaire, Patient Global Impression of Change, and gait performance were assessed as secondary outcomes.
RESULTS
The age and the age at onset were 59.67±7.24 and 53.23±10.26 years (mean±SD), respectively. The cycling cadence was 53.27±8.92 revolutions per minute. The UPDRS III score improved significantly after 8 training sessions (p=0.011) and 16 training sessions (T2) (p=0.001) in the off-state, and at T2 (p=0.004) in the on-state compared to pretraining (T0). The TUG duration was significantly shorter at T2 than at T0 (p < 0.05). The findings of MoCA, total UPDRS, double limb support time, and mHYS (in both the off- and on-states) also improved significantly at T2.
CONCLUSIONS
Our pioneer study has demonstrated that a low-intensity progressive cycling exercise can improve motor function in PD, especially akinesia. The beneficial effects were similar to those of high-intensity rehabilitation programs.

Keyword

Parkinson's disease; exercise; cycling; gait

MeSH Terms

Accidental Falls
Activities of Daily Living
Age of Onset
Education
England
Extremities
Freezing
Gait
Humans
Methylenebis(chloroaniline)
Parkinson Disease*
Rehabilitation
Methylenebis(chloroaniline)

Figure

• 

  Fig. 1 Study flow diagram and outcome measures. T0: baseline test, T1: midterm test, T2: posttraining test. *Off-state assessment, 12 hours overnight withdrawal of all antiparkinsonian agents (24 hours withdrawal for extended-released dopaminergic agents), †Off-state assessment, 2–3 days later off cycling and 12 hours overnight withdrawal of all antiparkinsonian agents (24 hours withdrawal for extended-released dopaminergic agents), ‡Each session contained a 5-min warm up, main cycling setting, and a 5-min cool down. ADL: Activities of Daily Living, FES: Falls Efficacy Scale, mHYS: modified Hoehn and Yahr Stage, MoCA: Montreal Cognitive Assessment, NFOGQ: New Freezing of Gait Questionnaire, PDQ-39: 39-item Parkinson's Disease Questionnaire, PGI-C: Patient Global Impression of Change, TUG: Timed Up and Go, UPDRS: Unified Parkinson's Disease Rating Scale.

• 

  Fig. 2 Changes in cycling cadence during 16 training sessions of training (S1–S16).

• 

  Fig. 3 The improvement of akinesia subscores differed between the MAS and the LAS in both the on- and off-states after 16 sessions of cycling training. LAS: less-affected side, MAS: most-affected side.

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