Pulse
Bicycle Therapy
Dramatic images of a bicycling Parkinson’s patient in the Netherlands posted online by the New England Journal of Medicine have caught the attention of journalists and medical experts alike. In its April 1 edition, the journal posted video of a 58-year-old Dutch man standing before a wheelchair with his arms shaking uncontrollably, first unable to walk and then shuffling briefly until he falls to the floor. In a second clip, the man is shown riding a bicycle (without tremors) down a cobblestone street. When he comes to a stop, he hops off the bike but then resumes his frozen posture. Bastiaan Bloem, M.D., a professor of neurology at the Radboud University Nijmegen Medical Center in the Netherlands who filmed the patient, said in a New York Times story that he was shocked to discover that the man regularly bicycled for miles a day.
The man’s story wasn’t surprising to University of Minnesota Parkinson’s expert Paul Tuite, M.D., who says he’s long known that patients with Parkinson’s and other movement disorders can ride bicycles. “I’ve had a lot of patients make the comment that they can bicycle normally when they have walking problems,” he says. Some claim their tremors are less severe after they get off the bike.
Yet neither Tuite nor anyone else completely understands why otherwise debilitated individuals might do so well on a bike. Bloem speculated in the Times article that it might be because different parts of the brain and different sets of muscles are used for cycling and walking or that the rhythm of cycling and pressure of the pedal on the foot might serve as a cue to the rider. The more interesting issue, Tuite says, is whether cycling produces special and lasting benefits in Parkinson’s patients.
He points to the research of Jay Alberts, Ph.D., a biomechanical engineer and kinesiologist from the Cleveland Clinic who recently spoke in Minnesota about his hypothesis that forced, high-intensity exercise might lead to sustained improvement in Parkinson’s patients. Alberts came up with the idea after cycling across Iowa on a tandem bike with a friend who has the disease. The friend’s tremors were not only stilled while on the bike but were increasingly more controlled off the bike as the week progressed. Alberts has since conducted a trial comparing Parkinson’s patients who bicycled solo on a stationary bike with those who were on a tandem bike with a trainer pushing them to cycle at 80 to 90 cycles per minute. Those who did the high-intensity cycling with the trainer showed more improvement than those who did not, and their improved function lasted as long as four weeks.
Although Tuite is intrigued by such findings, he says there are many unanswered questions about the relationship between bicycling and Parkinson’s: Is it the rhythm of cycling that provides benefit or is cycling one of many types of exercise that lead to improvements in function? Does the rate of cycling matter? Did the presence of the trainer affect the outcomes in Alberts’ study? “There are all these subtle questions that have to be addressed,” he says.
Sixty-eight-year-old Britt Downs of Circle Pines, whose Parkinson’s was diagnosed in 1995, has fewer questions about why bicycling helps him. “Once I’m up and balanced and going, it’s the rhythm of it that is helpful,” he says.
Downs, who had a deep-brain stimulator implanted three years ago, has been an avid cyclist for years and now estimates he bicycles 600 miles a year plus the miles he logs on a stationary bike in his basement. Downs says that although he has trouble getting on a bike and has fallen while walking, he’s never fallen while riding. He’s a passionate promoter of the benefits of bicycling. “It’s been great for my attitude and mental sharpness,” he says.
His doctor, Tuite, is cautious about recommending bicycling to his patients, however. “I often talk about exercise in general,” he says, explaining that he thinks biking could be dangerous for some people with Parkinson’s. He notes one of his patients recently fell while riding to a golf course. But for Downs and the man in the Netherlands, riding a two-wheeler is transformational. As Downs puts it: “My tremors disappear, my attitude improves, and I’ve got a smile on my face.”—Carmen Peota
To see the video images of the bicycling Parkinson’s patient, go to http://content.nejm.org/cgi/content/full/362/13/e46.
Exertion Aids Cognition
Moderate physical activity done regularly in midlife and beyond can stave off mild cognitive impairment. That’s the finding of new research led by Mayo Clinic neuropsychiatrist Yonas Geda, M.D.
Geda and his colleagues set out to test the often-touted idea that exercise not only benefits the body but aids the brain as well. To do so, they compared the frequency of physical exercise among 198 individuals with mild cognitive impairment with that of 1,126 subjects with normal cognition. They found that any frequency of moderate exercise performed in midlife or later was associated with a reduced chance of having mild cognitive impairment. Moderate exercise was defined as brisk walking, hiking, aerobics, strength training, golfing without a cart, swimming, playing doubles tennis, use of exercise machines, yoga, martial arts, or other activities.
Geda said in an online interview that people should view the findings as one more reason to exercise. “Certainly, it’s motivated me a little more to keep exercising,” he said.
The study was published in the January issue of the Archives of Neurology.