Rapid Cadence Cycling for Parkinson's Disease: A Study of Implementation and Efficacy in the Community Setting

Study Overview
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Brief Summary
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Forced cadence cycling (FCC) in which individuals with Parkinson's Disease (PD) pedal with external augmentation at 80-90 revolutions per minute (rpm) has demonstrated significant motor improvement in prior clinical trials. These studies required either a tandem bicycle with second rider or an expensive motorized bicycle, making this therapy inaccessible to most patients. In this pragmatic open-label before and after pilot study investigators examine implementation and effectiveness of (RCC) without tandem or motor augmentation and in a community-based setting. Approximately 30 participants will be recruited to participate in 24 one-hour rapid-cadence spin classes in YMCAs over 8 weeks. Primary outcomes will examine implementation of the intervention and secondary outcomes will examine effectiveness against a historical comparison group.

Official Title
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Rapid Cadence Cycling for Parkinson's Disease: A Study of Implementation and Efficacy in the Community Setting

Conditions
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Parkinson Disease

Intervention / Treatment
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* Other: Rapid Cadence Cycling on a Solo-Rider Spin Bicycle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults age 18 or older. Clinically confirmed diagnosis of idiopathic PD by a movement disorder specialist. Hoehn and Yahr stage I-III while ON anti-parkinsonian medication. Stable or absent MAO-B inhibitors (Selegiline, Rasagiline, Zydis selegiline HCL Oral disintegrating) for at least 60 days prior to enrollment; stable or absent other medications for PD motor symptoms (Levodopa, Dopamine agonists, Anticholinergics, Amantadine, COMT-Inhibitors) for at least 30 days prior to enrollment; stable or absent medications for the following PD-non-motor symptoms: depression, anxiety, cognition, sleep, orthostatic hypotension. Agreement to defer any medication changes until after completion of 8-week program and post-test measurements. Written permission by a physician to participate in the program. English language proficiency sufficient to understand and participate in a cycling class taught in English. Exclusion Criteria: Clinically significant medical disease that would increase the risk of exercise-related complications (eg: cardiac or pulmonary disease, uncontrolled diabetes mellitus, uncontrolled hypertension or stroke) as determined by a treating physician through letter obtained by YMCA or the study investigator. Dementia as evidenced by a score of less than 116 on the Mattis Dementia Rating Scale or dementia in the opinion of the study investigator that would prohibit subject from complying with all study activities. Other medical or musculoskeletal contraindication to exercise. Concurrent participation in another trial of exercise therapy for PD or initiation of a new structured exercise plan during the duration of the study. Note: participants may continue any pre-existing exercise routine (including group-based classes) during the study but will be asked not to start anything new.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cycling Intervention<br>Single-arm trial. All participants will receive the same intervention of Rapid Cadence Cycling on a Solo-Rider Spin Bicycle | Other: Rapid Cadence Cycling on a Solo-Rider Spin Bicycle<br>* Individuals with Parkinson's Disease will participate in 60 minute spin-classes during which they will follow the Pedaling for Parkinson's(TM) Foundation recommended protocol to achieve a cadence of 80-90 during the 40 minute main set.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of individuals who complete at least 80% of offered cycling sessions [Tolerability] | Investigators will consider those who do not withdraw from the study, are not lost to follow up, and complete at least 80% of the cycling sessions to demonstrate tolerability of the study. | assessed at conclusion of the 8 week intervention | 
| Proportion of subjects reporting an adverse event during class [Safety] | Safety will be reported descriptively and include the proportion of subjects reporting any adverse event. | assessed at each class by study staff and weekly by PI for duration of 8 week intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Unified Parkinson's Disease Rating Scale-section III Motor | The Unified Parkinson's Disease Rating Scale (UPDRS) section III measures severity of motor symptoms of Parkinson's disease with scores ranging from 0 to 199 with higher scores indicating more severe motor symptoms. This study utilizes a modified version of the UPDRS without rigidity which will be recorded on video and rated remotely by a movement disorder neurologist blinded to intervention status of the participant. This modified version has been shown to be reliable and valid, both at cross-sectional time points and longitudinally (Abdolahi, 2013). | Assessed within two weeks prior to start of intervention and within one week after completion of intervention | 
| Timed Up and Go | The Timed Up and Go test is measured in seconds with a range of 5-25 seconds (longer is worse) | Assessed within two weeks prior to start of intervention and within one week after completion of intervention | 
| Trail Making Test A& B | This cognitive test is measured in seconds with a range (part B) of 60-240 seconds (longer is worse). | Assessed within two weeks prior to start of intervention and within one week after completion of intervention | 
| PROMIS sf v1.0 Global Health | A 10-item patient reported outcomes scale measuring five domains (physical function, fatigue, pain, emotional distress, social health) and general health perceptions that cut across domains. Scores can range from 0-100 where higher is better. | Assessed within two weeks prior to start of intervention and within one week after completion of intervention | 
| Assessment of Intelligibility of Dysarthria (AIDS) | The Assessment of Intelligibility of Dysarthric Speech is a tool for quantifying single-word intelligibility, sentence intelligibility, and speaking rate. The outcome is measured as the percent of words that are intelligible, with higher scores being better. | Assessed within two weeks prior to start of intervention and within one week after completion of intervention |