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July 28, 2014

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Ruvo Center trial putting Parkinson’s patients on bikes

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Sam Morris

Exercise physiologist Mandy Penko shows Parkinson’s sufferer Dave Malcolm a therapy progress sheet at the Cleveland Clinic Lou Ruvo Center for Brain Health.

The latest hope for Parkinson’s patients is as simple as riding a bike.

That’s why 57-year-old Dave Malcolm, wearing shorts and a sleeveless T-shirt, spends mornings pedaling steadily on an exercise bike at the Cleveland Clinic Lou Ruvo Center for Brain Health.

Malcolm is in great shape. He exercises nearly every day and used to run races of up to 100 miles.

But now he has a hard time even walking. Parkinson’s makes him shuffle like an elderly man. He also struggles with fine motor skills such as writing and has suffered from a loss of his sense of smell. They are classic symptoms of the motor systems disorder that afflicts 1.5 million Americans, most famously actor Michael J. Fox.

Traditional Parkinson’s treatments include medication and deep brain stimulation. But in April, Malcolm came to the Ruvo Center for help and learned that riding a stationary bike could reverse the symptoms. Since May, the Ruvo Center has been an outpost for a clinical trial run by Cleveland Clinic researcher Jay Alberts.

Participating in the trial has given Malcolm new hope.

“I feel like the luckiest man in the world,” Malcolm says. “Who would believe in the middle of the desert that a brain clinic exists?”

On this morning, the Cleveland-based Alberts is in Las Vegas watching Malcolm work out on the bike. It is designed for “forced exercise,” meaning it will mechanically assist patients who, unlike Malcolm, cannot keep the revolutions going fast enough to be effective. The bike keeps patients pedaling at 90 revolutions per minute, a moderate but not blistering pace.

Alberts, who has a doctorate in biomedical research, made a serendipitous discovery in 2003 that Parkinson’s patients benefit from forced exercise. He was cycling with friends across his home state of Iowa when, by complete coincidence, a friend who suffered from Parkinson’s wound up on the back of his tandem bike. Alberts was able to assist the woman’s pedaling on the trip, and one night at camp they noticed something remarkable about a birthday card she had written for a friend. People with Parkinson’s suffer from a problem called micrographia — abnormally small, cramped handwriting. But in this case her handwriting was beautiful.

“It didn’t feel like I had Parkinson’s this week,” the woman said.

On a 2005 bike ride, again across Iowa, a friend who was a scientist suffering from Parkinson’s rode on the back of Alberts’ bike. Alberts keeps a video of the man’s Parkinson’s improvement on his laptop. Before the ride, the video shows the man’s hands shaking uncontrollably. Four hours after the ride, the man holds them up perfectly still.

Alberts needed to test his hypothesis with clinical research. The National Institutes of Health laughed at his initial grant request because many research plans include complex drug development, he said. He was merely suggesting that patients need to ride a bike.

“It’s a complete paradigm shift in the treatment of Parkinson’s,” Alberts says.

He came back to NIH with more research, which led to Alberts’ first clinical study, in 2008. The findings, published in the journal Neurorehabilitation and Neural Repair, found that Parkinson’s patients who engaged in forced exercise for eight weeks at a rate 30 percent greater than their preferred rate experienced a 35 percent improvement in their tremors, stooping and shuffling, difficulty moving and other symptoms. The improvements remained for four weeks after the forced exercise ended.

“It really looks like exercise is medicine,” he says.

The initial study was conducted with only 10 patients, and now Alberts is expanding it to 100 in Cleveland and Las Vegas. He’s looking for participants who are between ages 24 and 75, with a formal Parkinson’s diagnosis.

So far some of the 42 participants have seen improvement and some have not, Alberts says. But all have said it’s empowering, he says. Most studies have a dropout rate of at least 10 percent, he says, but no one has yet quit the forced-exercise study.

Malcolm has been participating in the program for about four weeks, and said he’s been able to reduce the amount of medication he takes to stave off the Parkinson’s symptoms. He is encouraged, but unsure he’ll see dramatic results, because he was already so active.

Malcolm takes a big-picture perspective on the study.

“Whether it helps me or not, maybe it’ll help my kids or someone else who has symptoms,” he says.

For more information about the Ruvo Center’s Pedaling for Parkinson’s program, call 483-6047.

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