Effect of a High-Intensity Tandem Bicycle Exercise Program on Clinical Severity, Functional Magnetic Resonance Imaging, and Plasma Biomarkers in Parkinson's Disease

Abstract

Rationale: The optimal modality, intensity, duration, frequency, and dose–response of exercise as a therapy for Parkinson's Disease (PD) are insufficiently understood. Objective: To assess the impact of a high-intensity tandem bicycle program on clinical severity, biomarkers, and functional MRI (fMRI) in PD. Methods: A single-center, parallel-group clinical trial was conducted. Thirteen PD patients aged 65 or younger were divided in two groups: a control group and an intervention group that incorporated a cycling program at 80% of each individual's maximum heart rate (HR) (≥80 rpm), three times a week, for 16 weeks. Both groups continued their conventional medications for PD. At baseline and at the end of follow-up, we determined in all participants the Unified Parkinson's Disease Rating Scale, anthropometry, VO 2 max, PD biomarkers, and fMRI. Results: VO 2 max improved in the intervention group (IG) (+5.7 ml/kg/min), while it slightly deteriorated in the control group (CG) (−1.6 ml/kg/min) ( p = 0.041). Mean Unified Parkinson's Disease Rating Scale (UPDRS) went down by 5.7 points in the IG and showed a small 0.9-point increase in the CG ( p = 0.11). fMRI showed activation of the right fusiform gyrus during the motor task and functional connectivity between the cingulum and areas of the frontal cortex, and between the cerebellar vermis and the thalamus and posterior temporal gyrus. Plasma brain-derived neurotrophic factor (BDNF) levels increased more than 10-fold in the IG and decreased in the CG ( p = 0.028). Larger increases in plasma BDNF correlated with greater decreases in UPDRS ( r = −0.58, p = 0.04). Conclusions: Our findings suggest that high-intensity tandem bicycle improves motor function and biochemical and functional neuroimaging variables in PD patients. Trial registration number: ISRCTN 13047118, Registered on February 8, 2018.

Boxing vs Sensory Exercise for Parkinson’s Disease: A Double-Blinded Randomized Controlled Trial

“…11,14,29,34,41,42 In comparison to sensory exercise, boxing did not have a lasting effect on disease severity. This is contrary to recent rehabilitation literature that have stated high-intensity exercise (e.g., treadmill training, 43 tandem cycling, 44 multidisciplinary intensive rehabilitation treatments, 45 and aerobic exercise 46 ) can greatly improve disease severity as well as potentially have a neuroprotective effect. One difference between these studies and the current one is that intensity was not quantified.…”

Does Exercise Attenuate Disease Progression in People With Parkinson’s Disease? A Systematic Review With Meta-Analyses

“…4 It has been suggested to possibly have a disease-modifying effect on PD, with some evidence that exercise can lead to neurorestoration and neuroplasticity in people with PD. 5…”

“…4 It has been suggested to possibly have a disease-modifying effect on PD, with some evidence that exercise can lead to neurorestoration and neuroplasticity in people with PD. 5 Evidence from small randomized controlled trials (RCTs) and single group studies suggest that moderate to high intensity aerobic exercise or multimodal training including aerobic components can improve cortical inhibition, 6 dopamine receptor function, 7 and neurotrophic factor concentration, 8,9 as well as reduce inflammation. 9 One meta-analysis showed that exercise interventions increased plasma brain-derived neurotrophic factor (BDNF) among people with PD.…”

Effects of Exercise on Parkinson’s Disease: A Meta-Analysis of Brain Imaging Studies

“…A total of 2,874 publications were selected through databases for initial screening, and among them, 1,201 duplicates were removed, and 1,651 articles were excluded as they did not satisfy the inclusion criteria. As a result, through the full text of 22 screened studies, only seven fully satisfied all the criteria for inclusion in the meta-analysis ( Shine et al, 2013 ; Duchesne et al, 2016 ; Agosta et al, 2017 ; Kelly et al, 2017 ; Messa et al, 2019 ; Segura et al, 2020 ; Silva-Batista et al, 2020 ). A flowchart of this process is shown in Figure 1 .…”