Objective: To evaluate the efficacy of a 12-month, home-based, high-intensity aerobic exercise intervention in slowing the progression of Parkinson’s disease (PD) using rate-focused cycling.

Background: PD is a progressive neurodegenerative disorder with no current disease-modifying treatment.  Epidemiologic and clinical trial evidence suggest that long-term aerobic exercise may be ideally suited as an intervention to alter the progression of the motor sign severity of PD. Few studies have been specifically designed to deliver high-rate aerobic exercise in a home environment.  The Cyclical Lower Extremity Exercise for Parkinson’s Disease II (CYCLE-II) trial investigated whether or not a structured, home-based high-rate aerobic exercise program was effective in slowing PD motor sign progression.

Method: In this multi-site randomized controlled trial, 256 individuals with mild-to-moderate PD were assigned to either an aerobic exercise (AE) group (stationary cycling at ≥75 RPMs, 60-80% AAPMHR, 3x/week, 45 minutes) or a usual and customary care (UCC) group. Home based cycling with virtual coaching was utilized to optimize engagement with others engaged in the same activity. Home based exercise on a stationary cycle removed common transportation and mobility barriers to exercise, while regular goal setting, the social support provided by the virtual community, and shared decision between the participant and the monitoring physical therapist regarding the progression of exercise were used to promote exercise self-efficacy.  The primary outcome was the change in Movement Disorder Society Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III) scores over 12 months.

Results: The AE group demonstrated a significantly lower rate of MDS-UPDRS III progression (0.2 points/year) compared to the UCC group (3.9 points/year, p<0.0001). Cluster analysis revealed that individuals who maintained a cadence ≥75 RPMs and increased their power-to-weight ratio experienced the most benefit. Adherence was high (93%), with AE participants completing 92.4 minutes of exercise per week on average.

Conclusion: Long-term, high-intensity aerobic exercise with a focus on cadence significantly slowed motor sign progression in PD. These findings support the use of structured, rate-focused aerobic exercise as a viable disease-modifying intervention.

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Rosenfeldt AB, Lopez-Lennon C, Suttman E, et al. Use of a Home-Based, Commercial Exercise Platform to Remotely Monitor Aerobic Exercise Adherence and Intensity in People With Parkinson Disease. Phys Ther. Feb 1 2024;104(2)doi:10.1093/ptj/pzad174

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