Bicycling is an Effective Therapy

Grant Recipients Research the Benefits of Exercise on Parkinson’s Disease

At RSNA 2012, press conferences were held to highlight research findings that might be particularly interesting to the public. Grant recipient, Chintan Shah, B.S., was chosen to present the work he did with another R&E grantee, Michael D. Phillips, M.D., about the benefits of exercise on Parkinson’s disease.

The idea for this research originated with Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland. In 2003, Dr. Alberts rode a tandem bicycle across Iowa alongside a cyclist with Parkinson’s to raise awareness for the disease. The fellow cyclist 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, together with principal investigator Dr. Phillips, researcher Mr. Shah, and their Cleveland Clinic colleagues, recently used functional connectivity MR imaging (fcMRI) to study the effect of exercise on 26 patients with Parkinson’s disease.

“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 participated in 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 fc- MRI 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 while faster pedaling led to more significant results, not all people with Parkinson’s 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.”