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Bicycling Ability May be Unaffected by Freezing of Gait in Parkinsonís

People with Parkinson’s disease (PD) who have trouble walking due to freezing of their gait — the sudden inability to move while walking — may retain the ability to ride a bicycle.  The new research, published in the September 20 online edition of the Journal of Neurology, Neurosurgery, and Psychiatry, could provide a realistic exercise option for people who find it difficult to perform other activities.

Freezing of the gait is a common symptom among people living with Parkinson’s. It often impacts ability to perform activities of daily living.  Freezing of gait arises because Parkinson’s affects brain regions related to motor function; however, this symptom does not respond well to current Parkinson’s medications such as levodopa.  Anecdotal evidence and small studies have previously suggested that bicycling may be unaffected or less affected than other activities, by the progression of PD.

In this study, researchers from Radboud University Nijmegen Medical Center in the Netherlands led by Bastiaan R. Bloem, M.D., Ph.D., conducted a semi structured interview of 45 people with Parkinson’s who were consecutively seen in their outpatient clinic to discover whether they demonstrated freezing of gait and whether they retained the ability to bicycle. 

Results

  • Of the 45 people studied, 25 had regular freezing of their gait.
  • Of these 25 people, 19 were still cycling. Of these 19, 14 reported no difficulties on the bicycle, such as the ability to start cycling normally.  Only one of 19 reported freezing while bicycling. 
  • Those who had difficulty cycling reported problems with uneven pedal pressure, balancing issues, mounting/dismounting and fitness.
  • Of the 20 people with no freezing of gait, 18 were still cycling and none had freezing instances on the bicycle.

What Does it Mean?

Freezing of gait is a debilitating medical condition, most often seen in people with Parkinson’s or diseases similar to PD such as progressive supranuclear palsy (PSP). 

This study reinforces the idea that when freezing affects gait, it does not impact all forms of movement equally.  It demonstrates that many people with PD retain the ability to cycle despite issues such as freezing of gait.  The biological mechanism of freezing of gait is unknown, and there are no treatments for freezing for people who experience it in spite of adequate treatment with levodopa. Therefore, it is encouraging to find out that at least in some cases, bicycling may be an alternative means of exercise and transportation for people whose gait is affected by freezing but whose ability to bicycle is not.  

The authors recommend that people with Parkinson’s who want to cycle outdoors do so only if they can safely mount and dismount; otherwise, it is recommended that those individuals use controlled conditions such as stationary bicycles or even tricycles.  People with Parkinson’s should check with their doctor before beginning this or any exercise program.

This study does not clarify why bicycling and walking impact people with Parkinson’s differently.  One hypothesis is that moving pedals provide a tactile input that helps stimulate leg movement; however, this area remains a topic for continued research.  In addition, this study’s interpretation is limited by its methodology.  By asking people whether they bicycle or have problems bicycling rather than observing it in person, the study leaves itself open to error, such as underreporting of problems.  It also remains unclear how severely the other, more commonly reported problems — such as difficulty balancing and irregular pressure on the pedals — affect a person’s ability to bicycle. 

Despite its small size and limited interpretation, this study demonstrates a positive way for people living with PD to exercise and increase their mobility while fighting a sedentary lifestyle. 

Reference: Snijders, A. H., van Kesteren, M., & Bloem, B. R. (2012). Cycling is less affected than walking in freezers of gait. Journal of neurology, neurosurgery, and psychiatry, 83(5), 575–576. doi:10.1136/jnnp-2011-300375

 

Source Date: May 03 2012