Cycling with Parkinson's disease

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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.

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.