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Post of the Week: Cycling in PD in Those Who Can't Walk


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#1 Dr. Okun

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Posted 02 April 2010 - 10:30 AM

What’s Hot in Parkinson’s Disease
April 2010

Cycling in Parkinson’s Disease in Those Who Can’t Walk: Is it Possible?

Michael S. Okun, M.D.
National Medical Director, National Parkinson Foundation


This week a report appeared in the New England Journal of Medicine by Snijders and Bloem about a patient they encountered in their National Parkinson Foundation Center of Excellence Clinic. The report was accompanied by a dramatic video revealing a late stage Parkinson’s disease patient with severe ambulation difficulties and freezing of gait. The patient had Parkinson’s disease for many years, but his report of being able to ride a bicycle for six or more miles each day struck Dr. Bastian Bloem as “very interesting.”

One thing I have personally learned over many years of caring for persons with Parkinson’s disease is that when they tell you something, even if it sounds improbable, it is likely true. Bloem and colleagues did the right thing by following up this special case, and by documenting its occurrence by direct observation. Their report follows in the wake of another observation by Dr. Jay Alberts who demonstrated that tandem biking and forced exercise may be beneficial in Parkinson’s disease. Albert’s observation was made while tandem biking with a Parkinson’s disease patient in the back seat- all the way across the state of Iowa. As a trainee I witnessed a Parkinsonian woman who could not walk, but could dance-- for hours. How many more of these cases are out there? Can these observations be extended to help others? We hope the answer is yes.

The real question in this case is why does cycling improve symptoms? Why could Bloem’s patient ride a bicycle, but not walk? The answer remains a mystery, but many experts believe the answer may lie deep in the brain within a group of complex communicating structures (e.g. the basal ganglia). This network of structures aid in facilitating motor, mood and cognitive functions. How the basal ganglia works remains one of humankind’s greatest mysteries. We believe that these systems act as advanced data processors modulating complex brain functions by filtering and sorting information. Perhaps it was the basal ganglia itself that facilitated this man’s ability to ride the bike. Alternatively the basal ganglia may have been bypassed by other brain systems in order to facilitate his complex riding movement. Basal ganglia diseases (e.g. Parkinson’s or other movement disorders) are known to be worsened by stress and anxiety (e.g. sleep deprivation or marital issues), but also are known to be improved by mood, exercise, visual/other cues, as well as many non-pharmacological/non-surgical modalities (e.g. Tai Chi). We need to learn more about how the basal ganglia work.

Dr. Bloem in a recent interview with the NY Times noted that he “was not advocating that Parkinson’s patients hop on bikes and go out on busy roads. They need help in mounting a bike and can get into trouble if they have to stop at traffic lights. They need to ride in safe areas. He recommended that patients ride tricycles, or use stationary bikes or trainers — devices that turn road bikes into stationary ones. He also intimated that in select patients “bicycling offers an opportunity to be symptom-free, and to get some real cardiovascular exercise even when their disease is so far advanced that they cannot walk.” The Snijders/Bloem observation remains interesting, but we also want to caution all patients with PD not to run out and do it. Sudden offs, balance problems and many other complex issues could lead to crashes and severe injury. It is best to get the advice of a doctor and physical therapist, and if you choose to ride into the sunset on your bike, do it under careful supervision. Finally, in answer to the title of this article “is it possible,” the answer is simple- almost anything is plausible and even possible in a Parkinson’s disease patient. This is the main reason why we as a Parkinson’s disease community are filled with hope and expectation about the future.
Selected References-

Snijders AH, Bloem BR. Cycling for freezing of gait. N Engl J Med. 2010 Apr 1;362(13):e46. PubMed PMID: 20357278.

Ridgel AL, Vitek JL, Alberts JL. Forced, not voluntary, exercise improves motor function in Parkinson's disease patients. Neurorehabil Neural Repair. 2009 Jul-Aug;23(6):600-8. Epub 2009 Jan 8. PubMed PMID: 19131578.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#2 robin.griffin

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Posted 03 April 2010 - 07:22 AM

I too was amazed at the freedom that my tricycle gives me. I feel like I can go all over town--to the library, to the grocery store, post office, and the community park. My only concern was keeping my tires inflated so I did not get far away from home and have a flat tire. The owner of the bike shop where I purchased my trike said to weekly check the air pressure in my trike tires and then I should not have a problem. However, I have my cell phone handy just in case. I would not try to walk around town as my gait is subject to change; however, pedaling and being securely seated on my trike lets me experience the outdoors in a fun way. Regards, Robin

#3 Dr. Okun

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Posted 04 April 2010 - 02:02 PM

Thanks for the post!
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#4 lethe

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Posted 08 April 2010 - 05:20 AM

I ride a bike regularly and even when I can't walk well I ride my bike perfectly. Also, when I have trouble walking I often can walk better and faster backwards, or I can run better than walk at times. Sometimes when I have trouble walking I will try to "jump-start" by walking backwards a while and than switch to forward - sometimes this will "normalize" my walking.....

#5 Dr. Okun

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Posted 10 April 2010 - 08:17 AM

Thank you for the comment.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#6 Ljubica Lojan

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Posted 22 April 2010 - 11:40 AM

Although my husband, PD patient, can ride bycicle, but have problems walking, I am afraid he may lose the balance while on bike anytime. He is not as much motivated to ride stationary bycicle, however, I feel it is safer.
Emily

#7 Dr. Fernandez

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Posted 25 May 2010 - 03:54 PM

Great idea. Stationary bikes are good for patients with balance problems!
Hubert H. Fernandez




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