title: Exercise Therapy for Parkinson's Disease: Pedaling Rate Is Related to Changes in Motor Connectivity.
abstract: Forced-rate lower-extremity exercise has recently emerged as a potential safe and low-cost therapy for Parkinson's disease (PD). The efficacy is believed to be dependent on pedaling rate, with rates above the subjects' voluntary exercise rates being most beneficial. In this study, we use functional connectivity magnetic resonance imaging (MRI) to further elucidate the mechanism underlying this effect. Twenty-seven PD patients were randomized to complete 8 weeks of forced-rate exercise (FE) or voluntary-rate exercise (VE). Exercise was delivered using a specialized stationary bicycle, which can augment patients' voluntary exercise rates. The FE group received assistance from the cycle. Imaging was conducted at baseline, end of therapy, and after 4 weeks of follow-up. Functional connectivity (FC) was determined via seed-based correlation analysis, using activation-based seeds in the primary motor cortex (M1). The change in FC after exercise was compared using linear correlation with pedaling rate. Results of the correlation analysis showed a strong positive correlation between pedaling rate and change in FC from the most affected M1 to the ipsilateral thalamus. This effect persisted after 4 weeks of follow-up. These results indicate that a plausible mechanism for the therapeutic efficacy of high-rate exercise in PD is that it improves thalamo-cortical connectivity.
authors.affiliation: 1 Department of Radiology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: Chintan
authors.initials: C
authors.lastname: Shah
authors.affiliation: 2 Imaging Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Beall
authors.affiliation: 3 Department of Biomedical Engineering, Case Western Reserve University , Cleveland, Ohio.
authors.forename: Anneke M M
authors.initials: AM
authors.lastname: Frankemolle
authors.affiliation: 4 Center for Neurological Restoration , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amanda
authors.initials: A
authors.lastname: Penko
authors.affiliation: 2 Imaging Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Phillips
authors.affiliation: 2 Imaging Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Lowe
authors.affiliation: 3 Department of Biomedical Engineering, Case Western Reserve University , Cleveland, Ohio.|4 Center for Neurological Restoration , Cleveland Clinic, Cleveland, Ohio.|5 Cleveland FES Center, L. Stokes Cleveland VA Medical Center , Cleveland, Ohio.
authors.forename: Jay L
authors.initials: JL
authors.lastname: Alberts
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009415:Nerve Net / Q000502:physiology / Q000503:physiopathology*; D009434:Neural Pathways / Q000503:physiopathology; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D013788:Thalamus / Q000503:physiopathology
keywords: Parkinson's disease; exercise; functional MRI; functional connectivity