Implementation of high‐cadence cycling for Parkinson’s disease in the community setting: A pragmatic feasibility study

Abstract

Background Efficacy of exercise to improve motor symptoms in Parkinson's Disease (PD) has been established in multiple clinical trials. The Pedaling for Parkinson's ™ (PFP) program is an existing community‐based cycling intervention for individuals with PD. Although PFP program design was informed by in‐laboratory efficacy studies, the implementation and effectiveness of the program in the community have not been studied. This feasibility study explores implementation and effectiveness of PFP utilizing the RE‐AIM implementation evaluation framework. Methods This was a pragmatic open‐label multi‐site study. First, community‐based gyms were recruited to implement the PFP protocol with enhanced multi‐modal training and support. Second individuals with Hoehn and Yahr stage I‐III idiopathic PD were recruited to participate. Reach, effectiveness (both clinical scores and participant enjoyment), adoption, implementation (gym and participant fidelity, cost), and maintenance (sustainability) were assessed. Tracking of adverse events was used to monitor safety of the intervention. Results Reach was moderate: 59% of participants who expressed interest opted to participate. No effectiveness outcomes demonstrated a significant change from pre to post; however, the program was highly enjoyable (96% of participants who started classes enjoyed the program and 87% wished to continue). Adoption was poor with only four out of 34 gyms participating. The program had poor gym and moderate participant fidelity. The program was maintained for at least 4 months across all sites. The program was implemented safely. Conclusion Barriers to implementation of nonpharmacologic interventions such as exercise protocols limit reach and availability of these interventions to patients. Pilot studies are needed to inform and direct further implementation efforts. Our pilot study suggests the PFP cycling intervention should be modified prior to attempts at widespread implementation. Modifications made by gyms in this study suggest adaptations to the protocol that may increase fidelity and effectiveness.

Individuals With Parkinson Disease Are Adherent to a High-Intensity Community-Based Cycling Exercise Program

“…Participants' self-reported exercise was 5.4 ± 1.3 days per week, suggesting that participation in the PFP program is part of well-balanced approach to exercise in this PD cohort. The high level of self-reported physical activity reported by participants in this study is consistent with those reported by McKee and colleagues,43 who reported that PwPD who elect to participate in a PFP program tend to have a moderate to high level of self-reported physical activity prior to joining the class. Attending more than 50% of annual available cycling classes, fairly evenly distributed throughout the 12-month period, suggests that the exercise behavior was in the maintenance phase of adopted behavior44 and habitual in nature 45.…”

Bicycling for Rehabilitation of Persons With Parkinson Disease: A Scoping Review

“…While this question has been investigated to some extent, it merits further study. 57 The studies reported in this review were conducted in different settings. The most common was a laboratory setting, but several investigators used group approaches 28,36,38 that were in some instances community based and did not always require specialized bicycles.…”

Active and Passive Cycling Decrease Subthalamic β Oscillations in Parkinson's Disease

“…Many studies have contributed to the growing body of literature on the potential benefits of cycling as a therapeutic intervention for PD. [17][18][19] In this study, we investigated STN β (13-30 Hz) and high γ (60-100 Hz) power during both active and passive cycling with different cadences, and compared patients with and without FOG. The passive cycling experiment, where a motor provided a fixed cadence, allowed us to study the effect of isolated sensory information without motor activity.…”

“…Many studies have contributed to the growing body of literature on the potential benefits of cycling as a therapeutic intervention for PD 17‐19 . In this study, we investigated STN β (13–30 Hz) and high γ (60–100 Hz) power during both active and passive cycling with different cadences, and compared patients with and without FOG.…”