‘Exergaming’ on Stationary Bicycle Eased Parkinson’s Motor Problems

Exercising at home with a stationary bicycle — using a motivational app and remote supervision to increase compliance — eases motor complications in patients with mild Parkinson’s disease and improves their cardiovascular health, according to results from a clinical trial.

Findings from the study, “Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial,” were published in the journal The Lancet Neurology.

Though high-intensity aerobic exercise has shown motor benefits in people with Parkinson’s, the effectiveness of home-based programs in a broader patient population has not been determined.

A team from Radboud University Medical Center, The Netherlands, designed the “Park-in-Shape” intervention that incorporates virtual reality software and real-life videos — a so-called “exergaming” approach — to make exercising on a stationary bicycle at home more engaging.

Overall, the single-center, randomized trial (NTR4743) tested whether this type of aerobic exercise would improve motor function in patients with mild disease severity (a Hoehn and Yahr stage 2 or less) who were on stable dopaminergic treatment or not yet started on such therapies.

To be included, the patients (ages 30–75) had to exercise less than is recommended for older adults, meaning vigorous exercise over 20 minutes up to two times per week, or moderate exercise over 30 minutes up to four weekly sessions.

The study compared two groups, in which all 130 patients exercised three times per week over six months and were on stable dopaminergic medication (stable dose for at least one month), or were still without treatment and expected not to start treatment within the next month.

But while 65 patients performed stretching, flexibility and relaxation exercises in 30-minute sessions (control group), the other 65 patients exercised for 30 to 45 minutes on the stationary bicycle at home (intervention group). The patients were instructed to cycle at a target heart rate zone, which was gradually increased as the participants became fitter.

All participants had a motivational app with tips for optimal training, support from loved ones, and information to track progress. All were supervised once at home and also remotely every two weeks.

Patients were evaluated during their “on” and “off” states — when dopaminergic medication is still effective, or when it wears off.

Results showed that the patients exercising on the stationary bicycle had  significantly better motor function after six months. Specifically, in their “off” state, the increase in their Movement Disorders Society—Unified Parkinson’s Disease Rating Scale score was 4.2 points lower than that of the controls. Also, unlike the controls, patients on aerobic exercise experienced improvements in cardiovascular fitness by the end of the study.

“Aerobic exercise can be done at home by patients with Parkinson’s disease with mild disease severity and it attenuates [lessens] off-state motor signs,” the scientists wrote.

In contrast, no benefits were seen in non-motor complications such as fatigue, anxiety, depression, or cognitive function, which the researchers attribute to the short duration of the intervention.

Over the span of the study, the mean number of aerobic exercise sessions was 54, while that of the control sessions was 60. This corresponds to 75% and 83% of the expected 72 sessions for each group, respectively.

“We were pleasantly surprised that people with Parkinson’s disease were able to adhere to their exercise regimes so well,” Nicolien van der Kolk, the study’s lead author, said in a press release. “The beneficial effect on their motor disability was also large enough to be clinically relevant. As such, exercise is a very useful addition to the medication.”

Five patients were lost to follow-up, four of whom were in the cycling group. Ten patients in each group did not complete their assigned intervention, with technical issues being the main reason for discontinuation in the cycling group. However, as they attended the follow-up visit, these patients were included in the analysis.

Eleven patients experienced adverse events (AEs, or side effects) potentially related to the intervention, seven of whom were in the cycling group. These included back or joint pain and palpitations. Three patients discontinued exercise due to AEs.

In turn, the seven serious AEs observed (three in the cycling group) were all unrelated to the program. They included knee and fall-related injuries, hip fracture, and severe dyskinesias, which refer to involuntary, jerky movements.

“This study is very important,” said Bas Bloem, MD, PhD, the study’s principal investigator. “We can now start researching whether much more long-term cycling can also slow the disease progression.”

“Also, this new ‘exergaming’ approach that we have developed is very suitable to achieve long-term improvements in exercise behavior for patients with a range of other disorders that could also benefit from regular exercise,” Bloem said.

“Future studies should establish long-term effectiveness and possible disease-modifying effects,” the researchers concluded.