What's Hot in PD? Cycling in Parkinson’s Disease in Those Who Can’t Walk: Is it Possible?

This month a report appeared in the New England Journal of Medicine by Snijders and Bloem about a patient they encountered in their Parkinson's Foundation Center of Excellence. The report was accompanied by a dramatic video revealing a late-stage Parkinson’s disease (PD) patient with severe ambulation difficulties and freezing of gait. The patient had Parkinson’s for many years, but his report of being able to ride a bicycle for six or more miles each day struck Dr. Bloem as “very interesting.” 

One thing I have personally learned over many years of caring for persons with Parkinson’s is that when they tell you something, even if it sounds improbable, it is likely true.  Bloem and colleagues did the right thing by following up this special case, and by documenting its occurrence by direct observation.  Their report follows in the wake of another observation by Dr. Jay Alberts who demonstrated that tandem biking and forced exercise may be beneficial in Parkinson’s disease.  Albert’s observation was made while tandem biking with a Parkinson’s disease patient in the back seat—all the way across the state of Iowa. As a trainee I witnessed a Parkinsonian woman who could not walk, but could dance for hours.  How many more of these cases are out there? Can these observations be extended to help others?  We hope the answer is yes.

The real question in this case is why does cycling improve symptoms?  Why could Bloem’s patient ride a bicycle, but not walk?  The answer remains a mystery, but many experts believe the answer may lie deep in the brain within a group of complex communicating structures (e.g. the basal ganglia). This network of structures aid in facilitating motor, mood and cognitive functions. How the basal ganglia works remains one of humankind’s greatest mysteries.  We believe that these systems act as advanced data processors modulating complex brain functions by filtering and sorting information.  Perhaps it was the basal ganglia itself that facilitated this man’s ability to ride the bike. Alternatively, the basal ganglia may have been bypassed by other brain systems in order to facilitate his complex riding movement. Basal ganglia diseases (e.g. Parkinson’s or other movement disorders) are known to be worsened by stress and anxiety (e.g. sleep deprivation or marital issues), but also are known to be improved by mood, exercise, visual/other cues, as well as many non-pharmacological/non-surgical modalities (e.g. Tai Chi). We need to learn more about how the basal ganglia work.

Dr. Bloem in a recent interview with the New York Times noted that he “was not advocating that Parkinson’s patients hop on bikes and go out on busy roads. They need help in mounting a bike and can get into trouble if they have to stop at traffic lights. They need to ride in safe areas.” He recommended that patients ride tricycles, or use stationary bikes or trainers — devices that turn road bikes into stationary ones. He also intimated that in select patients “bicycling offers an opportunity to be symptom-free, and to get some real cardiovascular exercise even when their disease is so far advanced that they cannot walk.” The Snijders/Bloem observation remains interesting, but we also want to caution all patients with PD not to run out and do it. Sudden offs, balance problems and many other complex issues could lead to crashes and severe injury. It is best to get the advice of a doctor and physical therapist, and if you choose to ride into the sunset on your bike, do it under careful supervision. Finally, in answer to the title of this article, “Is It Possible?” the answer is simple — almost anything is plausible and even possible in a Parkinson’s disease patient. This is the main reason why we as a Parkinson’s disease community are filled with hope and expectation about the future.

Link to New York Times article: http://www.nytimes.com/2010/04/01/health/01parkinsons.html

Selected References

Snijders AH, Bloem BR. Cycling for freezing of gait. N Engl J Med. 2010 Apr 1;362(13):e46. PubMed PMID: 20357278.

Ridgel AL, Vitek JL, Alberts JL. Forced, not voluntary, exercise improves motor function in Parkinson's disease patients. Neurorehabil Neural Repair. 2009 Jul-Aug;23(6):600-8. Epub 2009 Jan 8. PubMed PMID: 19131578.

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