Written by Jay L. Alberts, PhD
While many great scientific discoveries are rooted in rigorous laboratory or clinical environments, some are not. In 2003, I pedaled a tandem bike with my companion (a person with Parkinson’s disease) on a multi-day group bike tour through the corn and bean fields of Iowa. Little did I realize at the beginning of this trek that an important discovery about the effects of exercise on Parkinson’s motor function was about to be made.
A few days into the ride, my Parkinson’s companion noticed a dramatic improvement in her handwriting as she wrote out a birthday card – effortlessly and legibly. Initially, I thought that maybe our diet of pie and homemade ice cream was responsible for these improvements in motor function. Who wouldn’t feel better after indulging in such treats?
Turns out it was neither the pie nor ice cream; it was riding the tandem that was making the difference. What is special about tandem cycling? Couples without Parkinson’s jokingly call it a test of marriage, because of the coordination and communication that is required on a bicycle built for two. For us, the tandem enabled us to engage in a type of exercise called “forced-exercise.” Forced-exercise essentially means assisting a person in exercising at a rate that is greater than their preferred, voluntary, exercise rate. In this case, the Parkinson’s patient could pedal at a rate of approximately 55 revolutions per minute (RPMs) when she was exercising by herself. When she rode tandem with me, our pedaling rate or cadence was 80-90 RPMs. Thus, I was “forcing” her to pedal faster than she could by herself.
We have published an article in which we compared the effects of eight weeks of voluntary exercise to eight weeks of forced-exercise on Parkinson’s motor function, and most recently a review on aerobic exercise and Parkinson’s. Our results indicated that patients in the forced group exhibited substantial improvements in their overall motor functioning compared to the patients in the voluntary group, and the effects of the improvements lasted even after exercise was completed. This data, along with data from the animal studies, suggests that exercise rate or effort may be an important variable in improving motor function in people with Parkinson’s disease.
We are currently working to develop a paradigm that does not require the use of a tandem bike (I don’t want to be responsible for breaking up any marriages), and also learning more about how home exercises can help improve the lives of those with Parkinson’s disease. The Davis Phinney Foundation has greatly helped in funding this research with cycling and home therapy. Our most recent study allows us to give stationary bicycles to Parkinson’s patients where we can monitor their exercise with the use of telemedicine. In the meantime, you can ask your doctor or physical therapist how to safely integrate some of our approach into your own exercise. As with any exercise program, consistency and compliance are critical if the program is going to be effective. Hopefully, you will, through your own experience, be able to proclaim that exercise really is the best medicine.
Jay L. Alberts, PhD, is an Associate Staff Member within the Center for Neurological Restoration and Department of Biomedical Engineering at the Cleveland Clinic. Dr. Alberts shares his personal experience and expertise regarding exercise modification for people with Parkinson's.