Battling Parkinson’s - Cleveland Clinic Doctor Discovers That Intense Bicycling Can Reduce Symptoms Of This Neurological Disorder

Allen Karger works with his physical therapists to reduce his Parkinson’s symptoms through intense bicycling.

We could all benefit from being forced to exercise, but for those with Parkinson’s disease, a new program at Lakewood Hospital is providing clear evidence of just how beneficial strenuous exercise can be.

Parkinson’s, the second most common neurodegenerative disorder after Alzheimer’s disease, affects about 1 million people in the U.S. It is a disorder of the central nervous system that limits the brain’s ability to produce dopamine, which helps control movement. Decreased dopamine results in symptoms that include tremor, rigidity, slowness of movement, and walking and balance problems.

In 2003, while riding a tandem bike across Iowa with a friend who had Parkinson’s, Cleveland Clinic researcher Jay Alberts, PhD, serendipitously discovered how intense exercise could improve the symptoms associated with Parkinson’s disease. After just one day of rigorous exercise, his friend’s symptoms—inability to write legibly, difficulty moving, problems with balance—improved.

Since that ride 10 years ago, Dr. Alberts has continued to research the effects of “forced” cycling on patients, and has identified positive results.

When Exercise Presents Special Challenges

Cleveland Clinic Rehabilitation and Sports Therapy at Lakewood Hospital purchased a prototype motorized stationary bicycle last winter with a gift from Lakewood Hospital’s Children’s Board and assistance from the Lakewood Hospital Foundation. The rehabilitation program is just one element of the multidisciplinary neurological care available at Lakewood Hospital.

Allen Karger of Broadview Heights is one of many people putting that bike to good use. Diagnosed with Parkinson’s 20 years ago, the 66-year-old actively fights the disease. When Mr. Karger was first diagnosed, medication helped. In 2004, as the disease progressed and his symptoms worsened, he underwent deep brain stimulation (DBS) surgery, in which electrodes implanted in his brain send electrical impulses to the area affected by Parkinson’s in order to control his symptoms. Today, a combination of medication, effects of DBS, exercise at a fast pace, (called “forced exercise”) and physical therapy help keep him moving.

There’s a difference between voluntary exercise—or going at your own pace—and forced exercise, in which something else sets a pace higher than your voluntary rate, says physical therapist Joyce Geib, PT.

“It’s very difficult for those with Parkinson’s to increase the force needed to move at a rate higher than what they can comfortably do on their own,” Ms. Geib says. “While the average person can pedal a bike comfortably at between 60 and 90 revolutions per minute, Dr. Alberts’ research has shown optimum impact on brain function and movement comes from exercising at a minimum rate of 80 RPMs. This is very challenging for an individual with Parkinson’s to achieve.”

Working with Physical Therapists

Mr. Karger has worked up to riding the bike twice a week for 12 minutes at 80 RPMs, and is striving to do more. “It is a workout to be sure, but such a simple exercise can do so much good,” he says.

Those in the forced exercise program typically have therapy two or three times each week, spending up to 45 minutes on the bicycle under the supervision of a physical therapist.

The operation of the bike is controlled by an iPad, which monitors the effort the patient is exerting vs. what the bike is controlling to maintain the 80 RPM rate. The goal is for patients to learn, over time, how much exertion is required to reach and maintain that pace so they can do the same level of exercise at home on a standard stationary bike. This helps to improve brain circulation, increase mobility, and possibly even reduce the amount of medications needed.

Remarkable Results

“At the time Allen was diagnosed, we never thought he’d be able to walk our daughter down the aisle—but he did,” says his wife, Cynthia Karger. “Thanks to the incredible support of his physicians and the therapists at Lakewood Hospital, and Allen’s own determination to fight every single day to keep going, he’s doing great,” Mrs. Karger says. “In January, when we went to Disney World with our son, daughter-in-law and two beautiful granddaughters, he was able to walk the park with the rest of us—never once needing a wheelchair.”

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Volume 10, Issue 1, Posted 1:48 AM, 01.08.2014