The Transformative Power of Exercise: Cycling Across Canada with Parkinson’s Disease

For most people, cycling across Canada is an unthinkable feat. For Steve Iseman, who was diagnosed with Parkinson’s disease eight years ago, it was that, and so much more.

Parkinson’s disease is a neurodegenerative condition in which gait and balance are impaired and fatigue can be debilitating. While exercise can help alleviate some of the disease’s symptoms, patients often struggle to hit recommended physical activity targets.

A group of scientists in Human Health and Nutritional Sciences has been conducting a large-scale clinical study into the effect of exercise on the disease — looking specifically at whether exercise intensity was an important determinant of clinical benefits. However, Steve Iseman was already much too fit to be eligible to participate. Instead, the researchers were presented with the chance to observe how intense, high-volume endurance exercise might affect a person living with Parkinson’s.

“It was a unique opportunity to see someone do an exercise regime that is far and above what would be prescribed or what normal people would do,” says Dr. Philip Millar, one of the lead investigators. “Iseman’s weekly exercise was through the roof — many times higher than what the Canadian guidelines recommend.”

Steve Iseman started his journey by dipping his bicycle in the Pacific Ocean in Victoria, BC. Eighty-five days and 7,850 kilometres later, he did the same in the Atlantic waters of St. John’s, Newfoundland. Before and after this epic trip, he was assessed by the research team for several markers of Parkinson’s disease, including motor symptoms, muscle strength, balance, gait, and cardiovascular responses to exercise.

Compared to his normal weekly regimen of around 300 minutes of exercise a week — already double the recommended guidelines — the trans-Canada trip had Steve cycling, on average, more than four hours over 100 kilometres per day.

While Millar cautions that this is a single case study, it nevertheless offers insight into whether there is a limit to how much exercise can help alleviate symptoms of Parkinson’s disease.

“It’s anecdotal, but it’s quite powerful to see the benefit of exercise and it offers us some insight into whether there’s a ceiling effect,” says Millar. “Normally, returns start to get smaller at a certain amount of time or intensity. Here, we saw profound improvements in motor symptoms in someone already doing high levels of exercise and going beyond that with this ride.”

Since Parkinson’s disease is caused by a loss of dopamine in the brain, patients usually take dopamine precursors several times throughout the day to alleviate their symptoms. To everyone’s surprise, Iseman’s condition improved to the point that he was able to periodically skip his evening dose.

His ability to generate power through knee extensions increased, as did his cardiovascular response to a standard hand-grip test.

“The grip test is used as a stimulus to raise blood pressure,” explains Millar. “There have been reports that patients with Parkinson’s have an impaired ability to increase their blood pressure during exercise.”

While the clinical trial has not found a change in patients’ cardiovascular response during the grip test, Millar was encouraged by the differences they measured in Iseman’s condition.

“We saw a profound change, going from almost no response to the hand-grip test to a more normal response post-trip. That gives us some indication that perhaps the high volume and intensity of exercise had an effect.”

Evaluations by a specially trained physiotherapist also showed a dramatic improvement in Iseman’s Parkinson’s motor symptoms.

“Iseman displayed a huge drop, the magnitude of which we weren’t expecting — almost a 50% reduction in his motor symptom score. There’s no study that shows such capacity,” says Millar.

The extent to which Iseman improved on his cross-Canada ride offers promising avenues of research. For example, studying the mechanistic pathways by which exercise caused those could offer potential strategies for developing therapeutics to target the same pathways.

Most importantly, though, Iseman’s adventure and improved quality of life offers hope to people with Parkinson’s disease.

“Iseman’s experience offers a motivating, forward-looking view of the improvements someone who’s newly diagnosed could experience,” says Millar.

Read the full study in the journal Physiological Reports.

Read about other  CBS Research Highlights.