Category: Allied Healthcare Professionals
Objective: Determine the feasibility and preliminary efficacy of an 8-week telehealth intervention of high intensity aerobic exercise prior to balance training (HIBT) compared to low intensity exercise prior to balance training (LIBT) in people with spinocerebellar ataxias (SCAs).
Background: Balance training (BT) and aerobic exercise (AE) improve motor function in SCA. Studies in stroke and Parkinson disease have evaluated AE prior to BT as a form of motor priming to enhance motor learning and functional outcomes but this has not been explored in SCA.
Method: Participants (n=20) were randomized to receive either HIBT, or LIBT for 60 minutes, twice weekly, for 8-weeks over telehealth. Outcomes were assessed at baseline, mid- and post-intervention and included Cerebellar Cognitive Affective Scale (CCAS), Scale for Assessment and Rating of Ataxia at Home (SARAHome)), functional measures of balance/gait, fatigue severity scale (FSS-49)) and metrics of feasibility. As a proxy for motor learning, participants completed a visuomotor adaptation test. Statistics were evaluated by mean difference and effect size.
Results: 93 people were referred, 20 people with early-mid stage SCA (1,2,3,6) enrolled (21.5% recruitment rate); mean(SD) age of 58.1(13.5) yrs; 6M/14F. 18 participants completed the post-intervention assessments (90% retention). The Intervention had high acceptance. There was 1 adverse event of low back pain which resolved. Both groups improved on the CCAS (HIBT: 4.10(4.38), d=1.10; LIBT: 15.13(7.4), d=1.8), SARAHome (HIBT: -0.61(0.74), d=0.83; LIBT: -1.0, d=0.51) however, statistically there were no differences between groups post-intervention. The LIBT showed greater mean changes on the FSS-49 4.63(6.98), d=.67, than the HIBT -0.11(4.88), d=0.02 who had decreased tolerability to BT after AE managing to complete only 8.5 BT exercises while LIBT completed 10. HIBT showed larger change in explicit motor adaptation (22.10(11.04), p=.04, R2=0.39) over LIBT (21.78(14.74), p=.15, R2=.22). For implicit motor adaptation, only the LIBT demonstrated improvements (8.83(4.26), p=.04, R2=.13).
Conclusion: Preliminary data supports a TH-delivered motor priming intervention in SCA, with improvements in disease-specific motor and cognitive measures. Fatigue after AE limited intervention tolerability for BT in the HIBT group and impacted potential for gains in implicit motor learning.
To cite this abstract in AMA style:
C. Macpherson, F. Awad, V. Rana, S. Kuo, L. Quinn. Is fatigue a rate limiting factor for achieving motor learning and functional gains in people with spinocerebellar ataxia? (PRIME-Ataxia RCT) [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/is-fatigue-a-rate-limiting-factor-for-achieving-motor-learning-and-functional-gains-in-people-with-spinocerebellar-ataxia-prime-ataxia-rct/. Accessed October 12, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/is-fatigue-a-rate-limiting-factor-for-achieving-motor-learning-and-functional-gains-in-people-with-spinocerebellar-ataxia-prime-ataxia-rct/