Improvements after patient-specific adaptive dynamic cycling in parkinson's disease

BACKGROUND Parkinson's disease (PD) is a progressive neurological disorder characterized by symptoms of bradykinesia, tremor, and muscle rigidity. Previous studies have shown that high cadence dynamic cycling promotes significant improvement in PD motor symptoms. This improvement is attributed to a higher entropy (variability) of cadence during dynamic cycling. However, it is not clear how entropy of cadence and level of effort can be utilized to develop individualized exercise prescriptions for individuals with PD, as well as how patient specific adaptive dynamic cycling impacts motor function and mobility in individuals with PD. Therefore, the purpose of this study was to develop an individualized exercise paradigm by manipulating entropy of cadence and level of effort and also examine the effects on motor function and mobility in PD. METHODS/DESIGN 11 individuals diagnosed with idiopathic PD were randomized into either the patient-specific adaptive dynamic cycling (PSADC) or an active control (AC) group. The dynamic cycle resistance settings were optimized for each individual in the PSADC group, while settings remained constant in the AC group. Each group completed 12 sessions over the course of 4 weeks. Motor function and mobility were measured at baseline and after 12 exercise sessions using the clinical and Kinesia One Unified Parkinson's Disease Rating Scale Motor III (UPDRS Motor III) and the Timed Up and Go (TUG). The UPDRS Motor III is the gold standard measurement of PD symptom severity. TUG is a mobility assessment that is highly correlated to overall functional mobility. Outcome measures were compared using repeated measures ANOVA, as well as paired samples and independent samples t-tests. RESULTS Individuals in the PSADC group saw significant improvements UPDRS Motor III score (Pre: 43.33, Post: 36.67; p=0.040), Kinesia One UPDRS Motor III score (Pre: 25.142, Post 23.833; p = 0.017), and TUG completion time (Pre: 12.37s, Post: 9.99s; p=0.036) from baseline to follow up. Individuals in the AC group did not significantly improve motor function (Pre: 28.60, Post: 29.60) or mobility (Pre: 11.23s, Post: 10.85s). CONCLUSIONS PSADC is associated with significant improvements in motor function and mobility in individuals with PD. Future studies will consider developing machine learning or artificial intelligence algorithms to provide accurate and valid exercise prescriptions to be utilized in the clinical rehabilitation for individuals with PD.