Health

Cycling with Parkinson’s disease

By The World ⋅ April 2, 2010 ⋅ Post a comment
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A doctor in the Netherlands has discovered that some people who suffer severe symptoms of Parkinson’s disease can ride a bicycle with relative ease. Marco Werman speaks with Dr. Bastiaan Bloem of the Radboud University Nijmegen Medical Center in Nijmegen.

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MARCO WERMAN:  Millions of people around the globe suffer from Parkinson’s disease, the neurological disorder affects a part of the brain that controls movement and leaves many of its victims trembling uncontrollably.  There is no known cure and doctors struggle to care for those afflicted.  Now, a Dutch patient with the disorder is offering doctors a new perspective on the disease.  Dr. Bastian Bloom has been treating that patient.  Dr. Bloom is professor of Neurology at Radboud University’s Nijmegen Medical Center in the Netherlands.  So this patient, Dr. Bloom, is 58 years old.  He came to you with the shakes that are so common to this disease.  Then tell us what happened next.

DR. BASTIAN BLOOM:   Well he was specifically referred to me because he had a very severe gait disorder.  He was nearly unable to walk.  During the examination, he incidentally told me that he just rode his bicycle for 10 or 20 miles just the day before.  And I said well that can’t be.  And he says yeah, sure, I can ride a bicycle.  And he really wanted to demonstrate this to me.  So we went outside.  We took one of the bicycles of one of my female residents, and it’s easier to mount on such a bicycle and we gave him a little push and there he went.  He just cycled completely normally and made a perfect U turn and came back to us.  Jumped off the bicycle and was immediately frozen again, very stunning.

WERMAN: It is absolutely stunning.  And there is an astonishing video of this that listeners can see at the world dot org.  So he attempts to walk, trembles uncontrollably, keels over, then you help him onto this bicycle and he’s smooth and balanced and as you say, he’s able to bike for many miles.  How do you explain this?

BLOOM: Well it’s still largely unexplained.  We do have some hypothesis.  One of the possibilities, that cycling is simply a different type of motor program.  So walking may be disturbed in Parkinson’s Disease because it’s stored in different parts of the brain.  But we also think there might be a role of the rhythmic pressure of the pedals of the bicycle that my help this patient to overcome his walking problem.  It’s a well known phenomenon in Parkinson’s Disease that people can benefit from so-called “external cues”.

WERMAN: Explain what you mean by those cues.  I mean, what were the cues, for example, that this 58 year old patient had that, for example, made him able to ride a bike?

BLOOM: Well we think it may have been the pressure of the rotating pedals on the bicycle.  But again, it’s a completely new observation.  We know that visual cues help, such as stripes on the floor.  We know that auditory cues help, for example rhythmic music.  But cycling is a completely new observation.  What was fascinating to us is I’ve interviewed 20 patients subsequently and it seems to be a consistent phenomenon.  So we’ve been missing out on something very important for many years.

WERMAN: Do you think that riding a bicycle might have permanent therapeutic impact on people with Parkinson’s?

BLOOM: Well absolutely.  The problem in Parkinson’s Disease is that because of their physical problems, patients tend to become immobilized and that’s very bad because it increases the risk of cardiovascular disease and stroke, and there is good evidence now from Rhett’s that exercise may actually help to slow down the progression of experimental Parkinson’s.  So we hope that by exercising patients with Parkinson’s Disease, we may be able to suppress symptoms and also perhaps slow down progression of the disease.

WERMAN: Is it the kind of thing that you would suggest to people with Parkinson’s, maybe starting on a stationery bike to kind of work it out a little bit?

BLOOM: Well that’s a very good point.  Of course the intervention needs to be safe.   So a tricycle, for increased stability, or maybe a home trainer.  And maybe very good ways of exercising patients in a very safe way.

WERMAN: Have you come across any other examples of Parkinson’s sufferers being able to do things you wouldn’t expect?

BLOOM: The interesting disease about Parkinson’s, is its been described since 1817 by James Parkinson and we’ve known ever since that Parkinson patients may be able to move paradoxically and unexpectedly well under particular circumstances.  A well known example is a patient in a nursing home.  The nursing home is caught on fire and the one to exit first is the patient who had been frozen in a nursing home for years, runs down the stairs, and drops down on the pavement unable to move again.

WERMAN: I’m wondering if there’s an analogy here.  I remember there was this country-western singer, I think it was Mel Tillis, who stuttered when he spoke, but once he got up on stage and performed, he didn’t stutter.

BLOOM: That is actually an interesting link because in the brain there are very tight links between speaking and walking.  They both depend on rhythm and patients with Parkinson’s Disease may develop a stutter in the course of their disease, so there are certainly links between the two.

WERMAN: Dr. Bloom, it sounds like meeting this 58 year old Parkinson’s patient taught you something entirely new about Parkinson’s that you didn’t know before.

BLOOM: That’s absolutely true and I think what is so interesting about this patient, it tells us that a particular area of the brain may be damaged and lead to incapacitating symptoms, but there are large areas of the brain still in tact in Parkinson’s Disease.  And I think it is patients such as these that really teach us that we should be looking at neurodegenerative disorder, such as Parkinson’s or maybe even Alzheimer’s or other diseases, not just as diseases where something goes wrong, but as people with brains that still offer opportunities for treatment.

WERMAN: Bastian Bloom is a professor of Neurology at Radboud University’s Nijmegen Medical Center in the Netherlands.  You can find the video of the man with advanced Parkinson’s riding a bike and professor Bloom’s article in the New England Journal of Medicine at the world dot org.


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Discussion

10 comments for “Cycling with Parkinson’s disease”

  • Barbara

    Parkinsonism and Related Disorders 15:644-648, 2009. PD and dance, specifically significant benefits with Argentine Tango dancing. Improvements in mobility, social support and the PDQ-39 (health-related quality of life assessment). Authors further suggest rhythmic tango steps activate putamen; it may engage problem solving and movement improvisation; also, Tango may improve axial impairment.

    • http://urbanharvestdesign.com Bill

      Barbara,

      Can you direct me to more information about tango and PD?

      Thanks.

      Bill

  • Kathleen McGuire

    I have been an occupational therapist for 18 years and have often had people with Parkinson’s Diesease on my caseload. I was doing a lot of things with them like: bouncing a tennis ball in sitting and standing, doing chain step paterns(like dancing, sometimes to music), tai chi, blow up a rubber glove and play volley ball, chair push ups, postural exercises, and jig saw puzzles to name a few things. I had a very good success rate with decreased falls, and a return to high level functional activites. I can document case studies and family recommendations.
    Everything I was doing, I basically made up in my head, on the job. I do home health therapy. All alone in someone’s home trying to help them be more independent.
    I had a strong interest in learning more about therapeutic methods to treat Parkinson’s disease so I took a course from a therapist from Clevland Clinic, Dorian Brown,OT. She developed the RKT 10 Step program. She taught all but two of my techniques and added about 5 of her own. I added everything of hers to mine. The strengthing exercises were a great addition.

    I heard your piece on The World about Dr. Broem who made this fantastic study about riding a bike and improving function with Parkinson’s patients. We therapists, a few of us who care, have known this for a long time. I am happy to here about his revelation, we need Doctor support.
    Most patients in the home do not have exercise bikes, although the ones who do, I teach them how to use it safely. I walk in the door with a tennis ball in hand. They think I’m crazy…something they can not do. Patients can hardly bounce it well at the beginning of my session. By the time we are through, they catch nine out of ten bounce to catch alternating hands. Maybe your good doctor would like to do some research on that, and come up with a new idea. I don’t kwow any other therapist who uses this idea,but I am sure there is someone like me out there somewhere, not speaking up. It also works on strokes, dementia, MS, most neurological disorders. That’s my protocol. When They can’t do something, think about how I do it works and teach it!

    • Marsha Nash

      I have a freind who suffers from parkinsons it has gotten worse since her depression and she now because of the two cannot take care of herself or do anything for herself anymore. I know depression is hard to deal with but i feel the parkinson’s has deepened the depresson not being able to do any thing for herself anymore She has to even be fed now. She was once a very active viberant women and i was just wondering what exactly you do with the tennis ball and the other things you were speaking of and how long of a period each day do you do thses things with your patients and how often. I really would like to find something to help her get active again All they do is give more and more meds and no one works with her to help her regain any of her life back I feel strongly that she needs some kind of pyhsical therapy to help her learn to live with the disease and function again in some way Could physical thearpy help teach her how to do that

    • http://www.bal-a-vis-x.com Bill Hubert

      Kathleen, please consider looking through my website. I suspect what you do with tennis balls is in keeping with what we do with racquetballs & sand-filled bags. I believe that the core dynamic here is automaticity of rhythm. All physical movement, certainly to include walking, CAN be done in markedly disjointed fashion, thereby CAN be random in expectation & execution of the next move–thus is systemically unpredictable & not automatic. But riding a bike requires rhythmic flow, not only in execution but in EXPECTATION of the NEXT move, hence would naturally be automatic. (This would apply, of course, only to those who already know how to ride a bike.) With modesty I urge you to read my book RESONANCE. I’d be glad to speak with you about any of this.

  • John Orsborn

    The fact that the Medtronics deep brain stimulator (DBS) can be positioned to control various parts of the body is evidence that the brain controls everything neurological in our human systems. Bike riding has been a form of therapy for many PD people. I use a set of pedals in a frame to get exercise for my legs. I find that pedaling from a higher chair is more beneficial than from a lower one – more like a bicycle when you push down. The brain is an amazing regulator. I also have Essential Tremor primarily in my right hand. Before I had a DBS, I could write very clearly by mentally transferring the tremor to my left hand. I kept it in a relaxed position in my lap. The main factor for people with PD is to take charge and use all of their faculties and other resources.

    • frank nicklason

      Dear John
      Thank you for your very interesting post.
      The description of transferring an essential tremor to the non dominant arm is fascinating, and it worked for you!
      Your last sentence is profound. Many, if not most, people with Parkinson’s disease have the ability to use unaffected parts of the brain. It is such a good message for people affected with a disability to bear in mind not just the disability but also the ability, so positive!
      People who wish to help those who have ability, whether they are health professionals or friends or family, really need to have this message clear.

      Best wishes.

  • John Henry Patterson

    Greetings from Marthas Vineyard! A close friend somehow came across your site and said i should have a look. I am 62 years old, male, 6-2,225#. I was diagnosed with Parkinson’s disease over 15 years ago and have the”freezing” type of this ailment.I went thru the drug therapy using sinemet(carbidopa/levidopa)as well as a myiad of agonists up until they were causing almost as much trouble as the dis-ease!I then had DBS surgery and that has been a welcome gift.I have been riding my bicycle for 4-5 years almost everyday that is nice out, in all seasons. I am lucky to live near a state forest with miles of asphalt bike trails.My walking gait is severely affected and I really have to focus on every step or falling is a very real thing. I guess I never thought about riding my bike as being special, only that I love the wind in my face, being an old biker(mtrcikle!)I agree with the caregivers advice about safety but I caution on how much restraint should be used. If a patient wants to do more, then it is a tuff call of safety versus progress!If i were asked to sum up the best advice in one word( and I have been asked..)MOVE!!!!!!!!! anyway you can.Prevention is worth much more than rehab!I never wrote in to any of these sites but if I can help with what I have learned ,I will try.
    Bst2ya! JNHNRY
    ps I dnt spl 2 gd!

    • Cindy Thomann PT

      I just think it is great to hear all of your stories, my input, would be to seek out the LSVT@BIG and LOUD program in your area, it is a great program, alot of evidence based research has proved its efficacey.. I teach it here in Flagstaff my clients have found it helpful, best to get doing it early in your diagnosis dont wait till movement is difficult, keep it from getting difficult. Learn the strategies early and yes, Keep active and Move BIG.

  • Anonymous

    My husband has vascular parkinson’s and can really not walk at all…He can cycle on our stationary cycle without problem and he rides a recumbent tricycle without problem..he is 82 years old.