Shah Chintan, Beall Erik B, Frankemolle Anneke M M, Penko Amanda, Phillips Michael D, Lowe Mark J, Alberts Jay L
1 Department of Radiology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania.
2 Imaging Institute , Cleveland Clinic, Cleveland, Ohio.
Brain Connect. 2016 Feb;6(1):25-36. doi: 10.1089/brain.2014.0328. Epub 2015 Oct 20.
Forced-rate lower-extremity exercise has recently emerged as a potential safe and low-cost therapy for Parkinson's disease (PD). The efficacy is believed to be dependent on pedaling rate, with rates above the subjects' voluntary exercise rates being most beneficial. In this study, we use functional connectivity magnetic resonance imaging (MRI) to further elucidate the mechanism underlying this effect. Twenty-seven PD patients were randomized to complete 8 weeks of forced-rate exercise (FE) or voluntary-rate exercise (VE). Exercise was delivered using a specialized stationary bicycle, which can augment patients' voluntary exercise rates. The FE group received assistance from the cycle. Imaging was conducted at baseline, end of therapy, and after 4 weeks of follow-up. Functional connectivity (FC) was determined via seed-based correlation analysis, using activation-based seeds in the primary motor cortex (M1). The change in FC after exercise was compared using linear correlation with pedaling rate. Results of the correlation analysis showed a strong positive correlation between pedaling rate and change in FC from the most affected M1 to the ipsilateral thalamus. This effect persisted after 4 weeks of follow-up. These results indicate that a plausible mechanism for the therapeutic efficacy of high-rate exercise in PD is that it improves thalamo-cortical connectivity.
强迫速率下肢运动最近已成为一种治疗帕金森病（PD）的潜在安全且低成本的疗法。其疗效被认为取决于蹬踏速率，高于受试者自主运动速率的速率最为有益。在本研究中，我们使用功能连接磁共振成像（MRI）来进一步阐明这种效应背后的机制。27名帕金森病患者被随机分为两组，分别完成8周的强迫速率运动（FE）或自主速率运动（VE）。运动通过一种专门的固定自行车进行，这种自行车可以提高患者的自主运动速率。强迫速率运动组接受来自自行车的助力。在基线、治疗结束时以及随访4周后进行成像。通过基于种子点的相关分析确定功能连接（FC），使用初级运动皮层（M1）中基于激活的种子点。将运动后功能连接的变化与蹬踏速率进行线性相关比较。相关分析结果显示，蹬踏速率与从受影响最严重的M1到同侧丘脑的功能连接变化之间存在强正相关。这种效应在随访4周后仍然存在。这些结果表明，高速运动对帕金森病治疗效果的一个合理机制是它改善了丘脑 - 皮质连接。
