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Cited by 284Parkinson's Disease Mechanisms and TreatmentsStroke Rehabilitation and RecoveryNeurological disorders and treatments

Forced, not voluntary, exercise improves motor function in Parkinson's disease patients

Ridgel, Angela L., Vitek, Jerrold L., Alberts, Jay L.·2009·Neurorehabilitation and neural repair
DOI 10.1177/1545968308328726
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Abstract

BACKGROUND: Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients. OBJECTIVE: The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity. METHODS: Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate. RESULTS: Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. CONCLUSIONS: Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.

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  • Studies have reported similar improvements in aerobic capacity for high-intensity and low-intensity training programs.

    “Studies have reported similar improvements in gait speed and stride length (Pohl et al., 2003) and aerobic capacity (Ridgel et al., 2009; Shulman et al., 2013) for high-intensity (80% of maximum capacity) and low-intensity (50% of maximum capacity) training programs.”

    From Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease (2022) · cites this paper as Ridgel et al., 2009

  • Only a few studies have examined the effects of aerobic training alone that incorporate limited or no aspects of skill learning.

    “Only a few studies have examined the effects of aerobic training alone that incorporate limited or no aspects of skill learning 13, 22, 49.”

    From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [22]

  • Preliminary studies of aerobic training alone appear to demonstrate only modest gains in motor skill performance.

    “While preliminary, these studies appear to demonstrate only modest gains in motor skill performance.”

    From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [22]

  • Forced cycling led to improved automatic manual dexterity and increased connectivity between cortico-subcortical regions involved in automatic control using functional magnetic resonance imaging.

    “This led to central changes as evidenced by improved automatic manual dexterity as well as increased connectivity between cortico-subcortical regions involved in automatic control using functional magnetic resonance imaging (fMRI).”

    From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [22]

  • Alberts and colleagues forced individuals with Parkinson's disease to achieve pedaling rates 30% greater than their preferred rate, combining cognitive engagement with aerobic training.

    “Using a stationary tandem bicycle Alberts and colleagues “forced” individuals with PD to achieve pedaling rates that were 30% greater than their preferred rate thus combining aspects of cognitive engagement with aerobic training.21, 22”

    From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [22]

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Authors
Ridgel, A. L., Vitek, J. L., & Alberts, J. L.
Affiliations
Cleveland Clinic (US)
Corresponding author
Alberts, Jay L.
ORCID
Venue
Neurorehabilitation and neural repair
Publisher
SAGE Publications
Published
2009-01-08
Volume
23
Issue
6
Pages
600-608
ISSN
  • 0888-4390 (ISSN-L)
  • 1545-9683
  • 1552-6844
DOI
10.1177/1545968308328726
OpenAlex
W2156606713
Cited by
284
References
84
Citations by year
2026: 12 · 2025: 12 · 2024: 11 · 2023: 9 · 2022: 14 · 2021: 19 · 2020: 15 · 2019: 13 · 2018: 17 · 2017: 18 · 2016: 22 · 2015: 32 · 2014: 19 · 2013: 27 · 2012: 11
FWCI
8.95
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Neurorehabilitation and neural repair (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
Keywords
Parkinson's disease, forced exercise, voluntary exercise, motor function, bimanual dexterity, cardiorespiratory fitness, rigidity, bradykinesia, motor control strategies, feedforward control
MeSH terms
Aged, Disability Evaluation, Exercise Therapy, Female, Humans, Male, Middle Aged, Motor Activity, Parkinson Disease, Psychomotor Performance, Treatment Outcome, Recovery of Function

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