Deep Brain Stimulation, Parkinson's Disease
Conditions
Keywords
Parkinson, Deep Brain Stimulation, Parkinson's disease, Deep Brain Stimulation Surgery, DBS, Exercise, exercise training, Parkinson disease, Parkinson's, Parkinson's Disease with Deep Brain Stimulation, Percept, Cycling, Aerobic
Brief summary
This study is focused on people with Parkinson's disease who already have deep brain stimulation devices. The goal is to understand how aerobic exercise, specifically forced vs voluntary cycling, affects movement, thinking, and brain activity in these individuals. Parkinson's disease is a progressive condition that impacts both movement and cognitive function. Previous research suggests aerobic exercise can improve PD symptoms, but the mechanisms underlying the improvement are not fully understood. This study aims to evaluate the neural (brain) mechanisms underlying exercise.
Detailed description
This study is investigating how aerobic exercise, specifically forced exercise (FE) and voluntary exercise (VE), affects movement, thinking, and brain activity in people with advanced Parkinson's disease who have deep brain stimulation (DBS). Over eight weeks, 36 participants will complete either a forced cycling program (where a motor helps them pedal faster than they could on their own) or a voluntary cycling program at a self-driven pace. Participants will complete an 8-week delayed start period to serve as a comparison before starting an exercise program. The study will measure motor symptoms, cognitive performance, and brain activity from both the cortex (via EEG) and the subthalamic nucleus (via DBS device recordings) at several time points, including before treatment, after the 8-week exercise period, and again four weeks later. By analyzing how neural signals change at rest and during tasks, the study will evaluate the neural mechanisms that make exercise beneficial. This research could ultimately guide more effective, personalized exercise therapies to support people with advanced Parkinson's disease with DBS.
Interventions
BEHAVIORALExercise
Participants will complete an eight-week control period followed by an eight-week cycling program. They will complete 3 sessions per week in-person with a member of the study team, for a total of 24 exercise sessions.
Sponsors
The Cleveland Clinic
National Institute on Aging (NIA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of Parkinson's disease * Previous placement of bilateral Medtronic Percept DBS as standard of care treatment for PD * Clinically optimized DBS parameters for one month prior to enrollment * Ability to ambulate with or without an assistive device for 5 continuous minutes * Willingness to withhold antiparkinsonian medication and DBS stimulation for outcomes assessments
Exclusion criteria
* Neurocognitive impairment that compromises the ability to provide informed consent * Neurological disease other than Parkinson's disease (i.e. multiple sclerosis, stroke) * Recommendation for medical clearance using the American College of Sports Medicine (ACSM) Preparticipation Health Screen: 1. If the ACSM screen recommends medical clearance, the subject must obtain medical clearance by their health care provided prior to participation. 2. Those who choose not to obtain physician clearance will not be eligible for participation. Those who do not receive physician clearance for high intensity exercise will not be eligible. * A musculoskeletal issue (arthritis, osteoporosis, back problem) that would limit one's ability to engage in exercise * Current cardiac arrhythmia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Movement Disorder Society-Unified Parkinson's Disease Rating Scale (Motor Examination) | Baseline to EOT and Baseline to EOT+4 weeks | Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III: Motor Examination score, measured off medication. Range of scores is 0 to 132, with lower score indicating better motor function. Change in MDS-UPDRS III score from baseline to end-of-treatment (EOT) and baseline to EOT+4 weeks. |
| Relative Root Mean Square Error of a Grip Force Tracking Task | Baseline to EOT and Baseline to EOT+4 weeks | Participants are required to modulate the precision grip force of their dominant hand to match a target trajectory on a computer screen. Relative root mean squared error quantifies deviation from the target force trajectory. Values are normalized for maximum target amplitude, with lower values indicating decreased error. |
| Local Field Potential Subthalamic Nucleus Beta at Rest | Baseline to EOT and Baseline to EOT+4 weeks | Normalized beta band activity is reported as the change in resting-state STN beta band (13-30Hz) power. Higher beta band suggests increased pathological electrical synchrony. |
Countries
United States
Contacts
CONTACTMacKenzie Dunlap
PRINCIPAL_INVESTIGATORJay L Alberts, PhD
The Cleveland Clinic
Outcome results
None listed