Parkinson’s Disease and Forced Exercise: A Preliminary Study

Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson’s disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson’s disease symptoms in a blinded, randomized, and controlled setting. Setting. Parkinson’s disease outpatient clinic, Veterans Administration Medical Center. Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson’s measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39. Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point. No other within group effects were noted. Results suggest that early enthusiasm for forced exercise may need tempering. Limitations of the study are discussed as well as numerous logistical challenges to this type of study. 1. Introduction Exercise therapy is well known to be beneficial for the elderly in general [1–4], and more recently the benefit of exercise for patients with Parkinson’s disease (PD) has been investigated [5–8]. The exact pathophysiological mechanism of exercise and types of specific exercises beneficial to persons with PD is still open to question [9]. Although there are limited exercise studies involving persons with Parkinson’s [10], some [11] postulate that the benefit of exercise is associated with synaptic plasticity, cascading effect of growth factors, and by reducing ancillary conditions (e.g., hypertension) that may adversely impact the brain. One limiting factor in studying the effect of exercise has been the ability of the patient with PD to maintain sufficient exercise intensity to produce appreciable benefit to the patient. Exercise intensity in this population can be limited by a number of factors to include bradykinesia and imbalance as well as general deconditioning. Recent studies [12, 13] have tried to overcome these limiting factors by the use of tandem bicycles (where the patient is placed in the rear seat and a fit trainer in the front seat maintains a strict cadence of at least 80 revolutions-per-minute (rpm)). Thus the person with