Cycle ergometer training improves gait in the elderly, but its effect in patients with Parkinson’s disease (PD) is not completely known.
Methods:
Twenty-nine PD inpatients were randomized to treadmill (n = 13, PD-T) or cycle ergometer (n = 16, PD-C) training for 3 weeks, 1 hour/day. Outcome measures were distance travelled during the 6-min walking test (6MWT), spatio-temporal variables of gait assessed by baropodometry, the Timed Up and Go (TUG) duration, the balance score through the Mini-BESTest, and the score of the Unified Parkinson’s Disease Rating Scale (UPDRS).
Results:
Sex, age, body mass index, disease duration, Hoehn-Yahr staging, comorbidity and medication did not differ between groups. At end of training, ANCOVA showed significant improvement, of similar degree, in both groups for 6MWT, speed, step length and cadence of gait, TUG, Mini-BESTest and UPDRS.
Conclusions:
This pilot study shows that cycle ergometer training improves walking parameters and reduces clinical signs of PD, as much as treadmill training does. Gait velocity is accompanied by step lengthening, making the gait pattern close to that of healthy subjects. Cycle ergometer is a valid alternative to treadmill for improving gait in short term in patients with PD.
AbbruzzeseG., MarcheseR., AvanzinoL., & PelosinE. (2015). Rehabilitation for Parkinson’s disease: Current outlook and future challenges. Parkinsonism & Related Disorders, 22(Suppl 1), S60–S64.
BayonaN.A., BitenskyJ., SalterK., & TeasellR. (2005). The role of task-specific training in rehabilitation therapies. Topics in Stroke Rehabilitation, 12, 58–65.
4.
BelloO., MarquezG., CamblorM., & Fernandez-Del-OlmoM. (2010). Mechanisms involved in treadmill walking improvements in Parkinson’s disease. Gait & Posture, 32, 118–123.
5.
BelloO., & Fernandez-Del-OlmoM. (2012). How does the treadmill affect gait in Parkinson’s disease?Current Aging Science, 5, 28–34.
6.
BelloO., SanchezJ.A., Lopez-AlonsoV., MárquezG., MorenillaL., CastroX., GiraldezM., Santos-GarcíaD., & Fernandez-del-OlmoM. (2013). The effects of treadmill or overground walking training program on gait in Parkinson’s disease. Gait & Posture, 38, 590–595.
7.
BorgG. (1982). Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise, 14, 377–381.
8.
BorgG., HassménP., & LagerströmM. (1987). Perceived exertion related to heart rate and blood actalte during arm and leg exercise. European Journal of Applied Physiology, 56, 679.
9.
BrownD.A., NagpalS., & ChiS. (2005). Limb-loaded cycling program for locomotor intervention following stroke. Physical Therapy, 85, 159–168.
10.
CakitB.D., SaracogluM., GencH., ErdemH.R., & InanL. (2007). The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson’s disease. Clinical Rehabilitation, 21, 698–705.
11.
CakitB.D., NacirB., GençH., SaraçoğluM., KaragözA., ErdemH.R., & ErgünU. (2010). Cycling progressive resistance training for people with multiple sclerosis: A randomized controlled study. American Journal of Physical Medicine & Rehabilitation, 89, 446–457.
12.
CoffmanK.A., DumR.P., & StrickP.L. (2011). Cerebellar vermis is a target of projections from the motor areas in the cerebral cortex. Proceedings of the National Academy of Sciences of the United States of America, 108, 16068–16073.
13.
CoquartJ.B., GarcinM., ParfittG., Tourny-CholletC., & EstonR.G. (2014). Prediction of maximal or peak oxygen uptake from ratings of perceived exertion. Sports Medicine, 44, 563–578.
14.
de GoedeC.J.T., KeusS.H.J., KwakkelG., & WagenaarR.C. (2001). The effects of physical therapy in Parkinson’s disease: A research synthesis. Archives of Physical Medicine and Rehabilitation, 82, 509–515.
15.
De NunzioA.M., ZanettiC., & SchieppatiM. (2009). Post-effect of forward and backward locomotion on body orientation in space during quiet stance. European Journal of Applied Physiology, 105, 297–307.
16.
FahnS., EltonR.L.The Unified Parkinson’s Disease Rating Scale. In FahnS., MarsdenC.D., CalneD.B., & GoldsteinM. (1987). Recent developments in Parkinson’s disease, Vol 2. Florham Park, NJ: Macmillan Healtcare Information, pp.. 153–163, 193–304.
17.
FalvoM.J., & EarhartG.M. (2009). Six-minute walk distance in persons with Parkinson disease: A hierarchical regression model. Archives of Physical Medicine and Rehabilitation, 90, 1004–1008.
18.
FertlE., DoppelbauerA., & AuffE. (1993). Physical activity and sports in patients suffering from Parkinson’s disease in comparison with healthy seniors. Journal of Neural Transmission, 5, 157–161.
19.
FontesE.B., OkanoA.H., De GuioF., SchabortE.J., MinL.L., BassetF.A., SteinD.J., & NoakesT.D. (2015). Brain activity and perceived exertion during cycling exercise: An fMRI study, bjsports-2012. British Journal of Sports Medicine, 49, 556–560.
20.
FranchignoniF., HorakF., GodiM., NardoneA., & GiordanoA. (2010). Using psychometric techniques to improve the Balance Evaluation Systems Test: The mini-BESTest. Journal of Rehabilitation Medicine, 42, 323–331.
21.
FranchignoniF., GodiM., GuglielmettiS., NardoneA., & GiordanoA. (2015). Enhancing the usefulness of the Mini-BESTest for measuring dynamic balance: A Rasch validation study. European Journal of Physical and Rehabilitation Medicine, 51, 429–437.
22.
FrazzittaG., BertottiG., RiboldazziG., TurlaM., UccelliniD., BoveriN., GuaglioG., PeriniM., ComiC., BalbiP., & MaestriR. (2012). Effectiveness of intensive inpatient rehabilitation treatment on disease progression in parkinsonian patients: A randomized controlled trial with 1-year follow-up. Neurorehabilitation and Neural Repair, 26, 144–150.
23.
FrazzittaG., BertottiG., UccelliniD., BoveriN., RovescalaR., PezzoliG., & MaestriR. (2013). Short-and long-term efficacy of intensive rehabilitation treatment on balance and gait in parkinsonian patients: A preliminary study with a 1-year follow up. Parkinson’s Disease, 2013, 583278
24.
Frenkel-ToledoS., GiladiN., PeretzC., HermanT., GruendlingerL., & HausdorffJ.M. (2005). Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson’s disease. Movement Disorders, 20, 1109–1114.
25.
GanesanM., SathyaprabhaT.N., GuptaA., & PalP.K. (2014). Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. PM&R, 6, 22–33.
26.
GodiM., FranchignoniF., CaligariM., GiordanoA., TurcatoA.M., & NardoneA. (2013). Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders. Physical Therapy, 93, 158–167.
27.
HarroC.C., ShoemakerM.J., FreyO.J., GambleA.C., HarringK.B., KarlK.L., McDonaldJ.D., MurrayC.J., TomassiE.M., Van DykeJ.M., & VanhaistmaR.J. (2014). The effects of speed-dependent treadmill training and rhythmic auditory-cued overground walking on gait function and fall risk in individuals with idiopathic Parkinson’s disease: A randomized controlled trial. NeuroRehabilitation, 34, 557–572.
28.
HermanT., GiladiN., GruendlingerL., & HausdorffJ.M. (2007). Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson’s disease: A pilot study. Archives of Physical Medicine and Rehabilitation, 88, 1154–1158.
29.
HorakF.B. (2010). Postural compensation for vestibular loss and implications for rehabilitation. Restorative Neurology and Neuroscience, 28, 57–68.
30.
HubbardI.J., ParsonsM.W., NeilsonC., & CareyL.M. (2009). Task-specific training: Evidence for and translation to clinical practice. Occupational Therapy International, 16, 175–189.
31.
HughesA.J., DanielS.E., KilfordL., & LeesA.J. (1992). Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: A clinico-pathological study of cases. Journal of Neurology, Neurosurgery & Psychiatry, 55, 181–184.
32.
JaegerL., Marchal-CrespoL., WolfP., RienerR., MichelsL., & KolliasS. (2014). Brain activation associated with active and passive lower limb stepping. Frontiers in Human Neuroscience, 8, 828.
33.
JahnK., DeutschländerA., StephanT., KallaR., WiesmannM., StruppM., & BrandtT. (2008). Imaging human supraspinal locomotor centers in brainstem and cerebellum. Neuroimage, 39, 786–792.
34.
JinH., JiangY., WeiQ., WangB., & MaG. (2012). Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: Discordance between improved cardiovascular fitness and walking ability. Disability & Rehabilitation, 34, 1665–1671.
35.
KadivarZ., CorcosD.M., FotoJ., & HondzinskiJ.M. (2011). Effect of step training and rhythmic auditory stimulation on functional performance in Parkinson patients. Neurorehabilitation and Neural Repair, 25, 626–635.
36.
LauhoffP., MurphyN., DohertyC., & HorganF. (2013). A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson’s disease. Disability & Rehabilitation, 35, 382–387.
37.
LeddyA.L., CrownerB.E., & EarhartG.M. (2011). Utility of the Mini-BESTest, BESTest, and BESTest sections for balance assessments in individuals with Parkinson disease. Journal of Neurologic Physical Therapy, 35, 90–97.
38.
LordS., GalnaB., VergheseJ., ColemanS., BurnD., & RochesterL. (2013). Independent domains of gait in older adults and associated motor and nonmotor attributes: Validation of a factor analysis approach. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68, 820–827.
39.
MackoR.F., IveyF.M., & ForresterL.W. (2005). Task-oriented aerobic exercise in chronic hemiparetic stroke: Training protocols and treatment effects. Topics in Stroke Rehabilitation, 12, 45–57.
40.
MakM.K., & PangM.Y. (2009). Fear of falling is independently associated with recurrent falls in patients with Parkinson’s disease: A 1-year prospective study. Journal of Neurology, 256, 1689–1695.
41.
MangioneK.K., McCullyK., GloviakA., LefebvreI., HofmannM., & CraikR. (1999). The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54, M184–M190.
42.
MatinolliM., KorpelainenJ.T., KorpelainenR., SotaniemiK.A., MatinolliV.M., & MyllyläV.V. (2009). Mobility and balance in Parkinson’s disease: A population-based study. European Journal of Neurology, 16, 105–111.
43.
McDanielJ., SubudhiA., & MartinJ.C. (2005). Torso stabilization reduces the metabolic cost of producing cycling power. Canadian Journal of Applied Physiology, 30, 433–441.
44.
McIntoshG.C., BrownS.H., RiceR.R., & ThautM.H. (1997). Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 62, 22–26.
45.
MehrholzJ., FriisR., KuglerJ., TworkS., StorchA., & PohlM. (2010). Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev, 1, CD007830.
46.
MorrisS., MorrisM.E., & IansekR. (2001). Reliability of measurements obtained with the timed “Up & Go” test in people with Parkinson disease. Physical Therapy, 81, 810–818.
47.
Movement Disorder Society. Task Force on Rating Scales for Parkinson’s Disease. (2003). The Unified Parkinson’s Disease Rating Scale (UPDRS): Status and recommendations. Movement Disorders, 18, 738–750.
48.
MuriasJ.M., KowalchukJ.M., & PatersonD.H. (2010). Time course and mechanisms of adaptations in cardiorespiratoryfitness with endurance training in older and young men. Journal of Applied Physiology, 108, 621–627.
49.
NadeauS., DuclosC., BouyerL., & RichardsC.L. (2011). Guiding task-oriented gait training after stroke or spinal cord injury by means of a biomechanical gait analysis. Progress in Brain Research, 192, 161–180.
50.
NelsonA.J., ZwickD., BrodyS., DoranC., PulverL., RoozG., SadownickM., NelsonR., & RothmanJ. (2002). The validity of the GaitRite and the Functional Ambulation Performance scoring system in the analysis of Parkinson gait. NeuroRehabilitation, 17, 255–262.
51.
PelosinE., FaelliE., LofranoF., AvanzinoL., MarinelliL., BoveM., RuggeriP., & AbbruzzeseG. (2009). Effects of treadmill training on walking economy in Parkinson’s disease: A pilot study. Neurological Sciences, 30, 499–504.
52.
PisanoF., MezzaniA., Del ConteC., GodiM., ArcolinI., & NardoneA. (2014). Three weeks of cycle ergometer versus treadmill training for patients with Parkinson’s disease: A randomized controlled pilot trial. Annals of Physical and Rehabilitation Medicine, 57, e362.
53.
PodsiadloD., & RichardsonS. (1991). The timed ‘Up & Go’: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148.
54.
PohlM., RockstrohG., RückriemS., MrassG., & MehrholzJ. (2003). Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 84, 1760–1766.
55.
RaaschC.C., & ZajacF.E. (1999). Locomotor strategy for pedaling: Muscle groups and biomechanical functions. Journal of Neurophysiology, 82, 515–525.
56.
RensinkM., SchuurmansM., & LindemanE., HafsteinsdóttirT. (2009). Task-oriented training in rehabilitation after stroke: Systematic review. Journal of Advanced Nursing, 65, 737–754.
57.
RidgelA.L., VitekJ.L., & AlbertsJ.L. (2009). Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. Neurorehabilitation and Neural Repair, 23, 600–608.
58.
RidgelA.L., PeacockC.A., FickesE.J., & KimC.H. (2012). Active-assisted cycling improves tremor and bradykinesia in Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 93, 2049–2054.
59.
RochesterL., BakerK., HetheringtonV., JonesD., WillemsA.M., KwakkelG., Van WegenE., LimI., & NieuwboerA. (2010). Evidence for motor learning in Parkinson’s disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues. Brain Research, 1319, 103–111.
60.
SageM.D., & AlmeidaQ.J. (2009). Symptom and gait changes after sensory attention focused exercise vs aerobic training in Parkinson’s disease. Movement Disorders, 24, 1132–1138.
61.
SchenkmanM., HallD.A., BarónA.E., SchwartzR.S., MettlerP., & KohrtW.M. (2012). Exercise for people in early- or mid-stage Parkinson disease: A 16-month randomized controlled trial. Physical Therapy, 92, 1395–1410.
62.
ShanahanJ., MorrisM.E., BhriainO.N., SaundersJ., & CliffordA.M. (2015). Dance for people with Parkinson disease: What is the evidence telling us?Archives of Physical Medicine and Rehabilitation, 96, 141–153.
63.
SiderowfA., McDermottM., KieburtzK., BlindauerK., PlumbS., & ShoulsonI. (2002). Parkinson Study GrouTest-retest reliability of the unified Parkinson’s disease rating scale in patients with early Parkinson’s disease: Results from a multicenter clinical trial. Movement Disorders, 17, 758–763.
64.
SkidmoreF.M., PattersonS.L., ShulmanL.M., SorkinJ.D., & MackoR.F. (2008). Pilot safety and feasibility study of treadmill aerobic exercise in Parkinson disease with gait impairment. Journal of Rehabilitation Research & Development, 45, 117–124.
65.
SnijdersA.H., ToniI., RužičkaE., & BloemB.R. (2011). Bycicling breaks the ice for freezers of gait. Movement Disorders, 26, 367–371.
66.
SteffenT., & SeneyM. (2008). Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the Unified Parkinson Disease Rating Scale in people with parkinsonism. Physical Therapy, 88, 733–746.
67.
TingL.H., KautzS.A., BrownD.A., & ZajacF.E. (1999). Phase reversal of biomechanical functions and muscle activity in backward pedaling. Journal of Neurophysiology, 81, 544–551.
68.
TomlinsonC.L., PatelS., MeekC., HerdC.P., ClarkeC.E., StoweR., ShahL., SackleyC.M., DeaneK.H., WheatleyK., & IvesN. (2013). Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev, 9, CD002817.
69.
Van de CrommertH.W., MulderT., & DuysensJ. (1998). Neural control of locomotion: Sensory control of the central pattern generator and its relation to treadmill training. Gait & Posture, 7, 251–263.
70.
WallJ.C., BellC., CampbellS., & DavisJ. (2000). The Timed Get-up-and-Go test revisited: Measurement of the component tasks. Journal of Rehabilitation Research & Development, 37, 109–113.
71.
WaltonC.C., ShineJ.M., MowszowskiL., NaismithS.L., & LewisS.J. (2014). Freezing of gait in Parkinson’s disease: Current treatments and the potential role for cognitive training. Restorative Neurology and Neuroscience, 32, 411–422.
72.
ZanettiC., & SchieppatiM. (2007). Quiet stance control is affected by prior treadmill but not overground locomotion. European Journal of Applied Physiology, 100, 331–339.
