Angela L. Ridgel

Active-Assisted Cycling Improves Tremor and Bradykinesia in Parkinson's Disease

OBJECTIVES To develop a rapid cadence cycling intervention (active-assisted cycling [AAC]) using a motorized bike and to examine physiological perimeters during these sessions in individuals with Parkinsons disease (PD). A secondary goal was to examine whether a single session of AAC at a high cadence would promote improvements in tremor and bradykinesia similar to the on medication state. DESIGN Before-after pilot trial with cross-over. SETTING University research laboratory. PARTICIPANTS Individuals with idiopathic PD (N=10, age 45-74y) in Hoehn and Yahr stages 1 to 3. INTERVENTION Forty minutes of AAC. MAIN OUTCOME MEASURES Heart rate, pedaling power, and rating of perceived exertion were recorded before, during, and after a bout of AAC. Functional assessments included tremor score during resting, postural, and kinetic tremor. RESULTS This AAC paradigm was well tolerated by individuals with PD without excessive fatigue, and most participants showed improvements in tremor and bradykinesia immediately after a single bout of cycling. CONCLUSIONS This paradigm could be used to examine changes in motor function in individuals with PD after bouts of high-intensity exercise.

Enhanced Exercise Therapy in Parkinson's disease: A comparative effectiveness trial

Objectives Exercise can improve motor function in people with Parkinson’s disease but depression reduces the motivation to participate in regular exercise. The aim of this study was to develop a novel Enhanced Exercise Therapy program that uses manual-driven guided exercise and peer-facilitated psychoeducation for individuals with Parkinson’s disease and depression. Design 24 week randomized controlled design. Methods Thirty individuals were randomized to Enhanced Exercise Therapy or self-guided therapy, and evaluated at baseline, 12-weeks and at 24-weeks. Enhanced Exercise Therapy included group exercise and group psychoeducation for 12 weeks. Between 13–24 weeks, individuals had access to the fitness facility but group sessions were not held. Self-guided therapy included written guidelines for a self-paced exercise program and psychoeducation. Primary outcome measures included the number of exercise sessions and International Physical Activity Questionnaire score. Secondary measures included resting heart rate, supine blood pressure, estimated VO2max and incidence of orthostatic hypotension. Results Twenty four individuals completed the study (80% retention) and both groups attended similar number of exercise sessions. There were no significant changes in cardiovascular fitness measures but there was a significant increase in the amount of physical activity in the Enhanced Exercise Therapy group and a decrease in the self-guided therapy group during the post-intervention period. Conclusions Enhanced exercise therapy appears to promote engagement in an exercise program and more physical activity, even after group sessions were concluded in individuals with Parkinson’s disease and depression.

Dynamic High-Cadence Cycling Improves Motor Symptoms in Parkinson's Disease.

Rationale Individuals with Parkinson’s disease (PD) often have deficits in kinesthesia. There is a need for rehabilitation interventions that improve these kinesthetic deficits. Forced (tandem) cycling at a high cadence improves motor function. However, tandem cycling is difficult to implement in a rehabilitation setting. Objective To construct an instrumented, motored cycle and to examine if high cadence dynamic cycling promotes improvements in motor function. Method This motored cycle had two different modes: dynamic and static cycling. In dynamic mode, the motor maintained 75–85 rpm. In static mode, the rider determined the pedaling cadence. UPDRS Motor III and Timed Up and Go (TUG) were used to assess changes in motor function after three cycling sessions. Results Individuals in the static group showed a lower cadence but a higher power, torque and heart rate than the dynamic group. UPDRS score showed a significant 13.9% improvement in the dynamic group and only a 0.9% improvement in the static group. There was also a 16.5% improvement in TUG time in the dynamic group but only an 8% improvement in the static group. Conclusion These findings show that dynamic cycling can improve PD motor function and that activation of proprioceptors with a high cadence but variable pattern may be important for motor improvements in PD.

Design and Development of a Smart Exercise Bike for Motor Rehabilitation in Individuals With Parkinson's Disease

Recent studies in rehabilitation of Parkinsons disease (PD) have shown that cycling on a tandem bike at a high pedaling rate can reduce the symptoms of the disease. In this paper, a smart motorized bicycle has been designed and built for assisting Parkinsons patients with exercise to improve motor function. The exercise bike can accurately control the riders experience at an accelerated pedaling rate, while capturing real-time test data. Here, the design and development of the electronics and hardware as well as the software and control algorithms are presented. Two control algorithms have been developed for the bike: one that implements an inertia load (static mode) and one that implements a speed reference (dynamic mode). In static mode, the bike operates as a regular exercise bike with programmable resistance (load) that captures and records the required signals, such as heart rate, cadence, and power. In dynamic mode, the bike operates at a user-selected speed (cadence) with programmable variability in speed that has been shown to be essential to achieve the desired motor performance benefits for PD patients. In addition, the flexible and extensible design of the bike permits readily changing the control algorithm and incorporating additional I/O as needed to provide a wide range of riding experiences. Furthermore, the network-enabled controller provides remote access to bike dand one that implements a speed reference (dynamic mode). In static mode, the bike operates as a regular exercise bike with programmable resistance (load) that captures and records the required signals, such as heart rate, cadence, and power. In dynamic mode, the bike operates at a user-selected speed (cadence) with programmable variability in speed that has been shown to be essential to achieve the desired motor performance benefits for PD patients. In addition, the flexible and extensible design of the bike permits readily changing the control algorithm and incorporating additional I/O as needed to provide a wide range of riding experiences. Furthermore, the network-enabled controller provides remote access to bike data during a ridingata during a riding session.

Variability in Cadence During Forced Cycling Predicts Motor Improvement in Individuals With Parkinson's Disease

Variability in severity and progression of Parkinsons disease symptoms makes it challenging to design therapy interventions that provide maximal benefit. Previous studies showed that forced cycling, at greater pedaling rates, results in greater improvements in motor function than voluntary cycling. The precise mechanism for differences in function following exercise is unknown. We examined the complexity of biomechanical and physiological features of forced and voluntary cycling and correlated these features to improvements in motor function as measured by the Unified Parkinsons Disease Rating Scale (UPDRS). Heart rate, cadence, and power were analyzed using entropy signal processing techniques. Pattern variability in heart rate and power were greater in the voluntary group when compared to forced group. In contrast, variability in cadence was higher during forced cycling. UPDRS Motor III scores predicted from the pattern variability data were highly correlated to measured scores in the forced group. This study shows how time series analysis methods of biomechanical and physiological parameters of exercise can be used to predict improvements in motor function. This knowledge will be important in the development of optimal exercise-based rehabilitation programs for Parkinsons disease.

A randomized trial of individual versus group-format exercise and self-management in individuals with Parkinson’s disease and comorbid depression

Background Depression is common in people with Parkinson’s disease (PD), and exercise is known to improve depression and PD. However, lack of motivation and low self-efficacy can make exercise difficult for people with PD and comorbid depression (PD-Dep). A combined group exercise and chronic disease self-management (CDSM) program may improve the likeli-hood that individuals will engage in exercise and will show a reduction in depression symptoms. The purpose of this study was to compare changes in depression in PD-Dep between individual versus group exercise plus CDSM and to examine participant adherence and perception of the interventions. Methods Participants (N=30) were randomized to either Enhanced EXerCisE thErapy for PD (EXCEED; group CDSM and exercise) or self-guided CDSM plus exercise. Outcomes were change in depression assessed with the Montgomery–Asberg Depression Rating Scale (MADRS), cognition, apathy, anxiety, sleep, quality of life, motor function, self-efficacy, and patient satisfaction. Results Both groups showed significant improvement in MADRS (P<0.001) with no significant group difference. Individuals in EXCEED group enjoyed the group dynamics but noted difficulty with the fixed-time sessions. Conclusion Both group CDSM plus exercise and self-guided CDSM plus exercise can improve depression in PD-Dep. These findings suggest that development of a remotely delivered group-based CDSM format plus manualized exercise program could be useful for this population.

Test and Validation of a Smart Exercise Bike for Motor Rehabilitation in Individuals with Parkinson's Disease.

To assess and validate the Smart Exercise Bike designed for Parkinsons Disease (PD) rehabilitation, 47 individuals with PD were randomly assigned to either the static or dynamic cycling group, and completed three sessions of exercise. Heart rate, cadence and power data were captured and recorded for each patient during exercise. Motor function for each subject was assessed with the UPDRS Motor III test before and after the three exercise sessions to evaluate the effect of exercise on functional abilities. Individuals who completed three sessions of dynamic cycling showed an average of 13.8% improvement in the UPDRS, while individuals in the static cycling group worsened by 1.6% in UPDRS. To distinguish the static and dynamic cycling groups by biomechanical and physiological features, the complexity of the recorded signals (cadence, power, and heart rate) was examined using approximate entropy (ApEn), sample entropy (SaEn) and spectral entropy (SpEn) as measures of variability. A multiple linear regression (MLR) model was used to relate these features to changes in motor function as measured by the UPDRS Motor III scale. Pattern variability in cadence was greater in the dynamic group when compared to the static group. In contrast, variability in power was greater for the static group. UPDRS Motor III scores predicted from the pattern variability data were correlated to measured scores in both groups. These results support our previous study which explained how variability analysis results for biomechanical and physiological parameters of exercise can be used to predict improvements in motor function.

Effects of Repeated Bouts of Segmental Vibration Therapy on Balance in Parkinsons Disease

Background: One of the cardinal features of Parkinson’s disease is postural instability. This instability is believed to be due to abnormalities in processing afferent information from the vestibular, somatosensory and visual systems. Whole body vibration has been shown to improve balance in older adults. The goals of this study were to determine how sensory information affects balance and to examine if multiple sessions of segmental vibration therapy improved balance in individuals with Parkinson’s disease. Methods: Balance in healthy older adults and in individuals with Parkinson’s disease was assessed using the modified Clinical Test of Sensory Integration and Balance. After initial assessment, individuals with Parkinson’s disease were randomized into a control or segmental vibration therapy group. The segmental vibration therapy group completed twelve sessions, over four weeks, and was re-tested after that period. Results: Subjects with Parkinson’s disease showed the highest overall level of sway in the eyes closed soft surface condition, when compared to healthy older adults. However, repeated bouts of segmental vibration did not result in significant improvement in the sway scores. Conclusion: Although these individuals showed significant balance deficits, segmental vibration therapy did not promote improvements in balance, as measured with the modified Clinical Test of Sensory Integration and Balance test.

Effects of an Exercise Intervention on Body Composition in Older AdultMales Diagnosed with Parkinsons disease: A Brief Report

The investigation examined the value of a multifaceted exercise intervention on body composition and strength, in those diagnosed with Parkinson’s disease (PD). 8 males subjects diagnosed with PD (69.13 ± 6.20 years) completed a previously introduced, 8-week, 24-session exercise intervention. A repeated-measures analysis of variance (ANOVA) demonstrated improvements in body composition and muscular strength following the exercise intervention. The data suggests the multifaceted exercise intervention is an effective tool for improving strength and body composition in males diagnosed with PD.

Modeling and simulation of power sharing and interaction between riders on a tandem bicycle

Recent studies along with applied experiments have proved the relationship between forced or active-assisted exercise (tandem cycling) and improvement in motor function of Parkinsons decease (PD) patients. With the assistance of a trainer, patients pedaled at a rate 30% greater than their preferred voluntary rate. A good replacement for a trainer would be an automated smart bike that could assess patient conditions and dynamically change the exercise parameters to provide the best therapeutic experience to the PD patients. One important step in designing the optimize algorithms for smart bike is to study the interaction between the trainer and rider on the tandem bike, as well as the relationship between the load and the pedaling rate. In this paper, the relationship between the torque and cadence (RPM), as well as the interaction between riders on a stationary tandem bike have been studied. First, modeling and simulation of the power sharing and dynamical interaction on the tandem bike are discussed. Then, the model identification for the bike and power sharing between the riders based on the real data recorded from actual exercise sessions is presented.