You can find out more
about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting
the NPF Center of Excellence, University of Florida Center for Movement Disorders
& Neurorestoration.
This month a report appeared
in the New England Journal of Medicine by Snijders and Bloem about a
patient they encountered in their National Parkinson Foundation Center of
Excellence Clinic. The report was accompanied by a dramatic video revealing a
late stage Parkinson’s disease patient with severe ambulation difficulties and freezing
of gait. The patient had Parkinson’s disease 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 disease 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 NY 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.
Read the full New York
Times article here: "Cycling Provides a Break for Some with
Parkinson's."
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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