GUELPH – A man living with Parkinson’s disease who completed an 85-day cross-country cycling trip, saw significant reduction in his disease symptoms, say University of Guelph researchers who assessed the man’s condition for new research.
Their findings appear in the journal Physiological Reports and offer important insight into the role intense aerobic exercise can play in relieving symptoms of Parkinson’s disease, also known as PD.
Steve Iseman, 57, of Toronto, was diagnosed eight years ago with PD and has worked to stay active since physical exercise has long been recommended to help reduce PD symptoms of tremors, stiffness and difficulty with balance.
But it’s never been clear how much exercise is enough to see benefits, nor whether there is a limit to the benefits of exercise on PD symptoms.
Cycling trip turned study
To understand these questions better, researchers in the U of G’s Human Health and Nutritional Sciences (HHNS) department teamed up with Iseman as he embarked on a nearly 8,000-kilometre cycling trip across Canada from Victoria, B.C. to St. John’s, Newfoundland, riding for an average of 100 kilometres per day.
Lead researcher Dr. Philip Millar, an HHNS professor who researches cardiovascular physiology, said following Iseman’s journey was “a unique opportunity to see someone do an exercise regime that is far and above what would be prescribed or what the average person would do.”
In an interview, Millar said researchers could never get someone with PD to do the volume and intensity of exercise in a clinical trial that Iseman was training to do.
“He cycled a tremendous volume and high intensity,” Millar said, adding that even during his training, Iseman was cycling about 300km a week.
Steve Iseman, second from left, saw a significant reduction in Parkinson’s disease symptoms during a cross-Canada cycling trip. Submitted photo
Millar’s team assessed Iseman’s PD symptoms before and after the trip using a standard Parkinson’s evaluation scale, as well as his muscle strength, balance, gait and cardiovascular responses to exercise.
They found a dramatic improvement in his motor symptoms.
Iseman’s ratings on the Unified Parkinson Disease Rating Scale (UPDRS) Part III motor score decreased 43 per cent, from a score of 46 to 26.
Iseman’s ability to generate power through knee extensions increased 12% over the trip, and his score on a standard test to measure Parkinson’s fatigue, the PFS-16, decreased 32%, from a score of 3.4 to 2.3.
“Iseman displayed a huge drop,” Millar says. “There is no study that shows such capacity.”
‘Powerful’ impact on symptoms
No major changes were observed in Iseman’s gait or static balance. But many of his other symptoms improved so much during the trip that Iseman periodically skipped his evening dose of PD medications.
Millar describes the changes in Iseman’s abilities as “profound.”
“We didn’t know if he would get extra benefit from the trip but what we saw was that with more exercise, there were more improvements,” Millar said.
While he cautions this is a single-case study, it nevertheless offers insight as to how much exercise can help alleviate symptoms of Parkinson’s disease.
“It’s anecdotal, but it’s quite powerful to see the benefit of exercise,” he said.
“Typically, returns start to decrease at a certain amount of time or intensity, but in Iseman’s case, there were profound improvements in motor symptoms in a person already doing high levels of exercise.”
Millar said that suggests there is no “upper end” to the benefits of exercise. He added the extent to which Iseman’s symptoms improved on his cross-Canada ride offers promising avenues of research.
“Iseman’s experience offers a motivating, forward-looking view of the improvements someone who’s newly diagnosed could experience.”
Millar said doctors often prescribe exercise to PD patients, “but we don’t know how much to prescribe. What is the optimal dose?”
The clinical trial he oversaw had some PD patients do interval training and others do 45 to 60 minutes of continuous moderate exercise.
Interval training is high intensity exercise for one minute followed by one minute of rest, repeating the cycle over 20 minutes.
Millar said he thought they would see more benefit from interval training, “but there was no difference in improvement,” between the two methods he said.
Millar and his team will next examine perceived fatigue.
Many patients with PD self-report extreme fatigue, but muscle tests indicate the patient could physically do more.
“That suggests mental fatigue prevents people from getting started at exercise,” he said.
“We want to target that notion of mental fatigue versus neuromuscular fatigue. Then it becomes about motivating people [to exercise].”
