Jeff: Nothing goes better with beer than neuroscience.
Although you might think they're at cross-purposes, we're going to find a balance in there, reducing brain cells and also stimulating cognition at the same time.
It's really an honor to have our guests this evening. Dr. Angela Ridgel with the Brain Health Research Institute at Kent State University and Dr. Aasef Shaikh, who is the Penni and Stephen Weinberg Chair in Brain Health, and the vice chair for research at the department of neurology at University Hospitals.
Aasef: Thank you. So what is Parkinson's disease?
It's a condition where brain cells are degenerated, particularly in a region of the brain called the substantia nigra.
Symptoms include tremor, and slowness, which can cause falls. It can also makes people think blurred. It can make people think dull. It can cause a cognitive problem, dementias. It can also lead to short term memory issues. It can lead to visual problems, balance problems, a number of different things.
10 million people in the world have Parkinson's disease. I always tell my patients, 'If everybody lives 110 years, they all get Parkinson's.' Only some unfortunate people get lots of cell damage at an earlier age and Parkinson's manifests in their lifetime.
We treat Parkinson's with medications, but everybody will have a different medical regimen, different combinations of different therapies, and sometimes deep brain stimulation or DBS. DBS is a cutting edge treatment that we do at University Hospitals and at the VA, where we implant the electrode in a patient's brain and reprogram their brain with a computer.
We can also do that remotely using Bluetooth. So you are sitting at your home, and I log in and you log in, and I can control your brain remotely. So it's really cool.
Science is going further and further, including Angela's discovery that when you bike, it actually helps moderate Parkinson's symptoms. It's not simple biking, but biking with certain variability improves Parkinson more than just simple motion.
So we put together a research program where we are coming up with a motorize bike that generates some variability. We tune the variability in the bike to suit the patient.
That's what Angela will talk about next.
Angela: Thank you. So we all know that exercise is good for cardiovascular health. We all know that exercise is good for muscle strength and also muscle endurance. What you may not know is that exercise can be very powerful for the brain itself, and it has a lot of mechanisms for improving the brain and improving brain function.
Exercise can decrease neuroinflammation. We also know that exercise can improve cognitive function. And lastly, exercise can improve motor function. In particular, we're looking at how exercise can improve the symptoms of Parkinson's that Dr. Shaikh already mentioned.
It's based on work that we did many years ago using a tandem bike in Parkinson's therapy. We had a tandem bike in the lab and we brought in patients paired with very strong cyclists. I actually participated as a trainer myself because I'm a cyclist, and we brought in some friends of mine that were good cyclists and we would train these people on the tandem bike. And we really showed that it was the cadence and the interaction between the two people on the bike that made the difference. That was an important feature. It's not just about how fast can you move the legs, but it's about the kind of the push and pull that you had between two people that are on a tandem bike. Because when you ride a tandem bike, there's a chain that's connecting the two positions, and if somebody does one thing, the other person's going to feel it.
So it was that variability, or that dynamic change, that was the important feature. And so we designed a motorized bike that mimicked the interaction between two people on a tandem bike. We showed that there was a 14% improvement in motor function after just three sessions on this motorized bike. That's compared to another group where they just pedaled on their own. Again, it was the high cadence and the variability that we programed into that bike that was the important feature.
However, as Dr. Shaikh mentioned, Parkinson's is not the same in everybody. Exercise is also not one size fits all. Specifically, we found that true in our dynamic cycling. So although the group as a whole showed 14% improvement, there was a decent variability in response. So how are we going to deal with that?
We developed what we call the SMART cycle. Speed Manipulating, Adapting, Rehabilitation-based Therapy. SMART cycling.
So just to give a little plug for the study: participants need to have been diagnosed with Parkinson's disease, we're looking at people 50 to 79 year's old, and free from cardiovascular disease, stroke or orthopedic issues.
What's involved? The cycle study is three times a week, (you should be exercising three times a week!) over four weeks. We're using technology developed by a company here in northeast Ohio to monitor motor symptoms, and we're also doing mobility assessments.
The study includes a bit of travel. We don't have it ready for the home at this point in time, but we're doing it at a site in Beachwood, and at Kent State.
Jeff: We have time for questions.
Question 1: So why cycling? I'm asking because when you think of tremor, you think primarily of the upper extremity. When I think of cycling, I think primarily of the lower extremity. So are there other kinds of exercise that would show an equal benefit?
Angela: Right. Great question. So we actually have shown, interestingly, that we are getting upper extremity improvements with lower extremity exercise, which is fascinating.
The upper and lower extremities in the nervous system are connected and they talk to each other. For example, high speed walking has also been shown to improve Parkinson's throughout the whole body, upper extremity and lower extremity. There are studies that have looked at dance, particularly tango, which obviously has an upper extremity component, which shows improvements in upper and lower extremities. So there's something about exercise of the legs that's promoting changes in the nervous system that's affecting the upper extremity too. Exercise of the legs shows a change throughout the entire nervous system. So that's what's really fascinating about it.
Aasef: In our intraoperative data that we had analyzed, we recorded from range of different neurons, and looked at the response of that single neuron activity in response to vibration of one muscle, the trapezius muscle of the shoulder. And what we find is that in certain patients, in certain generalized conditions, we find that effect of neck vibration was seen in other cells too. So every cell of the brain, especially the basal ganglia, the groups of cells, they are part of the network, when you change one node of the network, the effect is going to be network wide. So as a result, I vibrate neck and I see response in non-neck sensitive cells. So it is very possible that you change the tactile and vibratory in proprioceptive input of the lower limb. Are it that our sole lower limb hip trunk? Of course, because that is also involved, that effect is kind of system wide.
Question 2: So your data shows pretty well that it seems to help the symptoms of Parkinson's a lot. But do you know if it has any effect on the actual progression of Parkinson's?
Angela: We don't know that. And I will say that's a big piece of it.
We are doing another study that's actually looking at how exercise can slow progression. It's called SPARX3. It's a multi-site clinical trial including here at Kent State and at University Hospitals. It's using a treadmill based intervention to reach a high heart rate through walking. We have several patients in there right now, and it's a it's a huge clinical trial for 27 sites across the U.S. and Canada. So in the next couple of years, we're going to know a lot about how that slows Parkinson's progression. And in fact, it's in early Parkinson's unmedicated people. So we'll see how that goes.
We feel our study is similar in that a high heart rate and high leg speed are also indicative of pedaling. If you're pedaling at a fast rate, if you're walking at a fast rate, the same proprioceptive input is the same between those two behaviors. So stay tuned. You can look at Sparks three.
Question 3: So do you have one set of exercise for all patients or you have multiple ones? And do you start with at default exercise cycling for your patients? Second question, how much will the bike cost?
Angela: Yeah. So right now we've done two sets of studies. So the previous one that I showed you, we did just three sessions over a week period. So we had people do Monday, Wednesday, Friday, we had other studies where we did two weeks and we found that similar improvements. And we also saw that the improvements lasted about 72 hours afterwards.
This study we're doing now, it's 12 sessions over four weeks and they again come in three times a week. And we're actually monitoring them after every single exercise session. We are looking to see how they're improving not only over the whole time course, but also before and after each exercise session.
And then lastly, the price of the SMART bike... It's still in development. The only ones we have are in my lab right now. So we are working towards working with a company who wants to develop these. But, you know, this takes time, so I can't tell you how much it is now because we're not selling them at this point in time, but we are intending to.
Jeff: Well, I think that's it. Dr. Angela Ridgel, and Dr. Aasef Shaikh. Thank you so much.
