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Exercise rate related to improvements in Parkinson’s disease


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#1 Kathrynne Holden, MS

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Posted 01 December 2012 - 06:51 PM

Public release date: 26-Nov-2012

Contact: Linda Brooks
lbrooks@rsna.org
630-590-7762
Radiological Society of North America

Exercise rate related to improvements in Parkinson’s disease

CHICAGO – People with Parkinson's disease benefit from exercise programs on stationary bicycles, with the greatest effect for those who pedal faster, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA). Functional connectivity magnetic resonance imaging (fcMRI) data showed that faster pedaling led to greater connectivity in brain areas associated with motor ability.

Parkinson's disease is a chronic, progressive disorder of the central nervous system. Early-stage symptoms like shaking and difficulty with walking eventually may progress to cognitive and behavioral problems such as dementia. An estimated 7 to 10 million people worldwide live with Parkinson's disease, according to the Parkinson's Disease Foundation, with most cases occurring after the age of 50.

As the disease progresses and the frequency of side effects increases, the therapeutic window begins to close. Deep brain stimulation is an effective therapy for late-stage Parkinson's disease, but is an invasive and costly procedure.

Exercise is thought to have beneficial effects on Parkinson's disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode 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.

"The finding was serendipitous," Dr. Alberts recalled. "I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function."

As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson's disease patients.

"By measuring changes in blood oxygenation levels in the brain, fcMRI allows us to look at the functional connectivity between different brain regions," Shah said.

The patients underwent 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. The researchers used a modified exercise bike to induce forced-rate activity.

"We developed an algorithm to control a motor on the bike and used a controller to sense the patient's rate of exertion and adjust the motor based on their input," Dr. Alberts said.

fcMRI was conducted before and after the eight weeks of exercise therapy and again as follow-up four weeks later. The research team calculated brain activation and connectivity levels from the fcMRI results and correlated the data with average pedaling rate. Results showed increases in task-related connectivity between the primary motor cortex and the posterior region of the brain's thalamus. Faster pedaling rate was the key factor related to these improvements, which were still evident at follow-up.

"The results show that forced-rate bicycle exercise is an effective, low-cost therapy for Parkinson's disease," Shah said.

Dr. Alberts noted that that while faster pedaling led to more significant results, not all Parkinson's patients need to do forced-rate exercise to see improvement.

"We're now looking at this phenomenon in patients with exercise bikes in their home," he said, "and other exercises like swimming and rowing on tandem machines may provide similar benefits."

###

Coauthors are Micheal D. Phillips, M.D. (principal investigator), Erik B. Beall, Ph.D., Anneke M.M. Frankemolle, B.S., Amanda Penko, M.A., and Mark J. Lowe, Ph.D.

Note: Copies of RSNA 2012 news releases and electronic images will be available online at RSNA.org/press12 beginning Monday, Nov. 26.

RSNA is an association of more than 50,000 radiologists, radiation oncologists, medical physicists and related scientists, promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill.

Editor's note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-949-3233.

For patient-friendly information on functional MRI, visit RadiologyInfo.org.

http://www.eurekaler...n-err111612.php
Best regards,

Kathrynne Holden, MS

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#2 christie

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Posted 02 December 2012 - 07:46 PM

Mrs Holden, this is exciting news. However, one might argue that tandem exercise is neither practical nor affordable for the overwhelming majority of PwP. What would be much more helpful for us to know, is the duration, frequency and type of routine exercise (such as biking, walking, running, swimming) needed for optimal benefits. Most importantly, should we exercise as often and hard as we can or is it possible that strenuous exercise may also do us some harm, especially when not optimally medicated ?
Thank you in advance for your valuable input, especially in regard to patients with young onset disease.
English is not my first language !

#3 DougZ

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Posted 03 December 2012 - 10:51 AM

My wife, 21 years with PD, recently turning 60, and I started tandem biking based on Jay's findings. We bought a recumbent tandem which is easier for someone with PD to get on and it feels a lot safer. As captain I use a cadence monitor to strive to achieve 80+ RPM. That's hard to achieve. As part of fitness, one can peddle faster, but peddling fast can be impacted by the PD, a ratcheting. The best results we got was going a full 45 minutes minimum, up to an hour three times a week. The length of time, speed of revolution combined with an elevated but controlled HR, produced the most consistent benefits of wakefulness, less meds, better walking, more stable, better sleep, improved outlook.

#4 Kathrynne Holden, MS

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Posted 03 December 2012 - 07:14 PM

Doug, thank you very much for the detailed information. There is very, very little published information regarding duration of intense exercise for people with PD, so your comments are much appreciated. Please continue to keep us informed and updated, I assure you others will be interested.
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#5 Kathrynne Holden, MS

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Posted 03 December 2012 - 07:18 PM

Dear Christie, your concerns are valid and to the point. I would be happy to help further, and am waiting and hoping for detailed guidelines with regard to exercise of this kind. I can't help thinking that there must be other types of intense exercise besides cycling that would not require investment in an expensive machine. But so far, we have research results without guidelines for the general population of people with PD.

Meantime, please read the post by DougZ. He is far more versed in the reality of exercise in general, and cycling in particular, as it pertains to PD, than I, and I am most grateful for his expertise and willingness to share their experience.
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