A backward cycling programme for people with Parkinson’s disease: a feasibility and preliminary results study
DOI:
https://doi.org/10.2340/jrm.v56.17738Keywords:
Parkinson Disease, Exercise, Balance, Gait, CyclingAbstract
Objective: To assess the feasibility of backward cycling for people with Parkinson’s disease. Secondary objectives were to assess changes in gait and balance following a 6-week program.
Design: A single-group prospective pre-test, post-test study with 1-month follow-up.
Subjects/Patients: Twenty-six people with Parkinson’s disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years).
Methods: Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test.
Results: There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest.
Conclusion: Backward cycling was a feasible intervention for people with Parkinson’s disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.
Downloads
References
Goodman CC, Fuller KS. Pathology: Implications for the physical therapist. 4th ed. St. Louis, MO: Elsevier; 2015.
Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis 2013; 2013: 1–17.
https://doi.org/10.1155/2013/906274 DOI: https://doi.org/10.1155/2013/906274
Grimbergen YA, Munneke M, Bloem BR. Falls in Parkinson’s disease. Curr Opin Neurol 2004; 17: 405–415.
https://doi.org/10.1097/01.wco.0000137530.68867.93 DOI: https://doi.org/10.1097/01.wco.0000137530.68867.93
Hackney ME, Earhart GM. The effects of a secondary task on forward and backward walking in Parkinson’s disease. Neurorehabil Neural Repair 2010; 24: 97–106.
https://doi.org/10.1177/1545968309341061 DOI: https://doi.org/10.1177/1545968309341061
Kellaher GK, Baudendistel ST, Roemmich RT, Terza MJ, Hass CJ. Persons with Parkinson’s disease show impaired interlimb coor-dination during backward walking. Parkinsonism Relat Disord 2022; 94: 25–29.
https://doi.org/10.1016/j.parkreldis.2021.11.029 DOI: https://doi.org/10.1016/j.parkreldis.2021.11.029
Maritz CA, Silbernagel KG, Pohlig R. Relationship of backward walking to clinical outcome measures used to predict falls in the older population: a factor analysis. Phys Ther Rehabil 2017; 4: 1–7.
https://doi.org/10.7243/2055-2386-4-14 DOI: https://doi.org/10.7243/2055-2386-4-14
Horak FB, Dimitrova D, Nutt JG. Direction-specific postural instability in subjects with Parkinson’s disease. Exp Neurol 2005; 193: 504–521.
https://doi.org/10.1016/j.expneurol.2004.12.008 DOI: https://doi.org/10.1016/j.expneurol.2004.12.008
Carpenter MG, Allum JH, Honegger F, Adkin AL, Bloem BR. Postural abnormalities to multidirectional stance perturbations in Park-inson’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 1245–1254.
https://doi.org/10.1136/jnnp.2003.021147 DOI: https://doi.org/10.1136/jnnp.2003.021147
Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C. The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disabil Rehabil 2008; 30: 1205–1212.
https://doi.org/10.1080/09638280701828930 DOI: https://doi.org/10.1080/09638280701828930
Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson’s disease. Mov Disord 2013; 28: 1474–1482.
https://doi.org/10.1002/mds.25613 DOI: https://doi.org/10.1002/mds.25613
de Kam D, Nonnekes J, Oude Nijhuis LB, Geurts AC, Bloem BR, Weerdesteyn V. Dopaminergic medication does not improve step-ping responses following backward and forward balance perturbations in patients with Parkinson’s disease. J Neurol 2014; 261: 2330–2337.
https://doi.org/10.1007/s00415-014-7496-3 DOI: https://doi.org/10.1007/s00415-014-7496-3
Shen X, Mak MK. Repetitive step training with preparatory signals improves stability limits in patients with Parkinson’s disease. J Rehabil Med 2012; 44: 944–949.
https://doi.org/10.2340/16501977-1056 DOI: https://doi.org/10.2340/16501977-1056
Tseng IJ, Yuan RY, Jeng C. Treadmill training improves forward and backward gait in early Parkinson disease. Am J Phys Med Rehabil 2015; 94: 811–819.
https://doi.org/10.1097/PHM.0000000000000273 DOI: https://doi.org/10.1097/PHM.0000000000000273
Jöbges M, Heuschkel G, Pretzel C, Illhardt C, Renner C, Hummelsheim H. Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 1682–1687.
https://doi.org/10.1136/jnnp.2003.016550 DOI: https://doi.org/10.1136/jnnp.2003.016550
Rawson KS, McNeely ME, Duncan RP, Pickett KA, Perlmutter JS, Earhart GM. Exercise and Parkinson disease: comparing tango, treadmill, and stretching. J Neurol Phys Ther 2019; 43: 26–32.
https://doi.org/10.1097/NPT.0000000000000245 DOI: https://doi.org/10.1097/NPT.0000000000000245
Hackney ME, Earhart GM. Tai Chi improves balance and mobility in people with Parkinson disease. Gait Posture 2008; 28: 456–460.
https://doi.org/10.1016/j.gaitpost.2008.02.005 DOI: https://doi.org/10.1016/j.gaitpost.2008.02.005
McGough EL, Robinson CA, Nelson MD, Houle R, Fraser G, Handley L, et al. A tandem cycling program: feasibility and physical per-formance outcomes in people with Parkinson disease. J Neurol Phys Ther 2016; 40: 223–229.
https://doi.org/10.1097/NPT.0000000000000146 DOI: https://doi.org/10.1097/NPT.0000000000000146
Barroso FO, Torricelli D, Moreno JC, Taylor J, Gomez-Soeriano J, Bravo-Esteban E, et al. Shared muscle synergies in human walking and cycling. J Neurophysiol 2014; 112: 1984–1998.
https://doi.org/10.1152/jn.00220.2014 DOI: https://doi.org/10.1152/jn.00220.2014
Chvatal SA, Torres-Oviedo G, Safavynia SA, Ting LH. Common muscle synergies for control of center of mass and force in nonstepping and stepping postural behaviors. J Neurophysiol 2011; 106: 999–1015.
https://doi.org/10.1152/jn.00549.2010 DOI: https://doi.org/10.1152/jn.00549.2010
Bressel E, Heise GD, Bachman G. A neuromuscular and metabolic comparison between forward and reverse pedaling. J Appl Bio-mech 1998; 14: 401–411.
https://doi.org/10.1123/jab.14.4.401 DOI: https://doi.org/10.1123/jab.14.4.401
Dalrymple-Alford JC, MacAskill MR, Nakas CT, Livingston L, Graham C, Crucian GP, et al. The MoCA: well-suited screen for cogni-tive impairment in Parkinson disease. Neurology 2010; 75: 1717–1725.
https://doi.org/10.1212/WNL.0b013e3181fc29c9 DOI: https://doi.org/10.1212/WNL.0b013e3181fc29c9
Herzog, MA. Considerations in determining sample size for pilot studies. Res Nurs Health 2008; 31: 180–191.
https://doi.org/10.1002/nur.20247 DOI: https://doi.org/10.1002/nur.20247
Gill DJ, Freshman A, Blender JA, Ravina B. The Montreal Cognitive Assessment as a screening tool for cognitive impairments in Parkinson’s disease. Mov Disord 2008; 23: 1043–1046.
https://doi.org/10.1002/mds.22017 DOI: https://doi.org/10.1002/mds.22017
Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008; 23: 2129–2170.
https://doi.org/10.1002/mds.22340 DOI: https://doi.org/10.1002/mds.22340
Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 2004; 19: 1020–1028.
https://doi.org/10.1002/mds.20213 DOI: https://doi.org/10.1002/mds.20213
Jacobs JV, Horak FB, Van Tran K, Nutt JG. An alternative clinical postural stability test for patients with Parkinson’s disease. J Neu-rol 2006; 253: 1404–1413.
https://doi.org/10.1007/s00415-006-0224-x DOI: https://doi.org/10.1007/s00415-006-0224-x
Bilney B, Morris M, Webster K. Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture 2003; 17: 68–74.
https://doi.org/10.1016/s0966-6362(02)00053-x DOI: https://doi.org/10.1016/S0966-6362(02)00053-X
Van Uden CJ, Besser MP. Test–retest reliability of temporal and spatial gait characteristics measured with an instrumented walkway system (GAITRite®). BMC Musculoskelet Disord 2004; 5: 13.
https://doi.org/10.1186/1471–2474-5-13 DOI: https://doi.org/10.1186/1471-2474-5-13
McDonough AL, Batavia M, Chen FC, Kwon S, Ziai J. The validity and reliability of the GAITRite system’s measurements: a prelimi-nary evaluation. Arch Phys Med Rehabil 2001; 82: 419–425.
https://doi.org/10.1053/apmr.2001.19778 DOI: https://doi.org/10.1053/apmr.2001.19778
Di Carlo S, Bravini E, Vercelli S, Massazza G, Ferriero G. The Mini-BESTest: a review of psychometric properties. Int J Rehabil Res 2016; 39: 97–105.
https://doi.org/10.1097/MRR.0000000000000153 DOI: https://doi.org/10.1097/MRR.0000000000000153
Steffen T, Seney M. Test–retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008; 88: 733–746.
https://doi.org/10.2522/ptj.20070214 DOI: https://doi.org/10.2522/ptj.20070214
ATS Committee on Proficiency Standards for CLinical Pulmonary Function Laboratories. ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117.
https://doi.org/10.1164/ajrccm.166.1.at1102 DOI: https://doi.org/10.1164/ajrccm.166.1.at1102
Sartor-Glittenberg C, Brickner L. A multidimensional physical therapy program for individuals with cerebellar ataxia secondary to traumatic brain injury: a case series. Physiother Theory Pract 2014; 30: 138–148.
https://doi.org/10.3109/09593985.2013.819952 DOI: https://doi.org/10.3109/09593985.2013.819952
Beier M, Bombardier CH, Hartoonian N, Motl RW, Kraft GH. Improved physical fitness correlates with improved cognition in multiple sclerosis. Arch Phys Med Rehabil 2014; 95: 1328–1334.
https://doi.org/10.1016/j.apmr.2014.02.017 DOI: https://doi.org/10.1016/j.apmr.2014.02.017
Asplund C, St Pierre P. Knee pain and bicycling: fitting concepts for clinicians. Phys Sportsmed 2004; 32: 23–30.
https://doi.org/10.3810/psm.2004.04.201 DOI: https://doi.org/10.3810/psm.2004.04.201
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381. DOI: https://doi.org/10.1249/00005768-198205000-00012
Penko AL, Barkley JE, Koop MM, Alberts JL. Borg scale is valid for ratings of perceived exertion for individuals with Parkinson’s dise-ase. Int J Exerc Sci 2017; 10: 76–86.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 1988.
Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141: 2–18.
https://doi.org/10.1037/a0024338 DOI: https://doi.org/10.1037/a0024338
Gray P, Hildebrand K. Fall risk factors in Parkinson’s disease. J Neurosci Nurs 2000; 32: 222–228.
https://doi.org/10.1097/01376517-200008000-00006 DOI: https://doi.org/10.1097/01376517-200008000-00006
Zaman A, Ellingson L, Sunken A, Gibson E, Stegemöller EL. Determinants of exercise behaviour in persons with Parkinson’s disease. Disabil Rehabil 2021; 43: 696–702.
https://doi.org/10.1080/09638288.2019.1638975 DOI: https://doi.org/10.1080/09638288.2019.1638975
Prakash P, Scott TF, Baser SM, Leichliter T, Schramke CJ. Self-reported barriers to exercise and factors impacting participation in exercise in patients with Parkinson’s disease. Mov Disord Clin Pract 2021; 8: 631–633.
https://doi.org/10.1002/mdc3.13197 DOI: https://doi.org/10.1002/mdc3.13197
Pickering RM, Fitton C, Ballinger C, Fazakarley L, Ashburn A. Self reported adherence to a home-based exercise programme among people with Parkinson’s disease. Parkinsonism Relat Disord 2013; 19: 66–71.
https://doi.org/10.1016/j.parkreldis.2012.07.006 DOI: https://doi.org/10.1016/j.parkreldis.2012.07.006
Quinn L, Busse M, Khalil H, Richardson S, Rosser A, Morris H. Client and therapist views on exercise programmes for early-mid stage Parkinson’s disease and Huntington’s disease. Disabil Rehabil 2010; 32: 917–928.
https://doi.org/10.3109/09638280903362712 DOI: https://doi.org/10.3109/09638280903362712
McVey MA, Amundsen S, Barnds A, Lyons KE, Pahwa R, Mahnken JD, Luchies CW. The effect of moderate Parkinson’s disease on compensatory backwards stepping. Gait Posture 2013; 38: 800–805.
https://doi.org/10.1016/j.gaitpost.2013.03.028 DOI: https://doi.org/10.1016/j.gaitpost.2013.03.028
Lindholm B, Hagell P, Hansson O, Nilsson MH. Prediction of falls and/or near falls in people with mild Parkinson’s disease. PLoS One 2015; 10: e0117018.
https://doi.org/10.1371/journal.pone.0117018 DOI: https://doi.org/10.1371/journal.pone.0117018
Uygur M, Bellumori M, Knight CA. Effects of a low-resistance, interval bicycling intervention in Parkinson’s disease. Physiother Theory Pract 2017; 33: 897–904.
https://doi.org/10.1080/09593985.2017.1359868 DOI: https://doi.org/10.1080/09593985.2017.1359868
Bryant MS, Rintala DH, Hou JG, Lai EC, Protas EJ. Effects of levodopa on forward and backward gait patterns in persons with Parkin-son’s disease. NeuroRehabilitation 2011; 29: 247–252.
https://doi.org/10.3233/NRE-2011-0700 DOI: https://doi.org/10.3233/NRE-2011-0700
Herman T, Giladi N, Hausdorff JM. Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: a mini-review. J Neural Transm 2009; 116: 307–318.
https://doi.org/10.1007/s00702-008-0139-z DOI: https://doi.org/10.1007/s00702-008-0139-z
Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. Responsiveness and minimal clinically important difference of the Mini-BESTest in patients with Parkinson’s disease. Gait Posture 2020; 80: 14–19.
https://doi.org/10.1016/j.gaitpost.2020.05.004 DOI: https://doi.org/10.1016/j.gaitpost.2020.05.004
Liguori G, Feito Y, Fountaine C, Roy BA, editors. ACSM’s Guidelines for exercise testing and prescription. Philadelphia, PA: Wolters Kluwer; 2022.
van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkin-son’s disease: a double-blind, randomised controlled trial. Lancet Neurol 2019; 18: 998–1008.
https://doi.org/10.1016/S1474-4422(19)30285-6 DOI: https://doi.org/10.1016/S1474-4422(19)30285-6
Barajas JS, Peterson DS. First-trial protective step performance before and after short-term perturbation practice in people with Parkinson’s disease. J Neurol 2018; 265: 1138–1144.
https://doi.org/10.1007/s00415-018-8821-z DOI: https://doi.org/10.1007/s00415-018-8821-z
Protas EJ, Mitchell K, Williams A, Qureshy H, Caroline K, Lai EC. Gait and step training to reduce falls in Parkinson’s disease. NeuroRehabilitation 2005; 20: 183–190.
https://doi.org/10.3233/NRE-2005-20305 DOI: https://doi.org/10.3233/NRE-2005-20305
Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2008; 23: 631–640.
https://doi.org/10.1002/mds.21922 DOI: https://doi.org/10.1002/mds.21922
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Suzanne K. O'Neal, Stephanie A. Miller, Megan S. Eikenberry, Elizabeth S. Moore
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.