Currently, no medications exist to combat spinocerebellar ataxias, debilitating neurodegenerative diseases that cause loss of balance and coordination. Physicians recommend balance training to improve symptoms, but a new study suggests that rigorous aerobic exercise may provide greater benefit for adults with cerebellar ataxia. Patients were able to safely undergo six months of aerobic training five times a week. Their ataxia symptoms improved significantly, by an average of 1.9 points on the Scale for Assessment and Rating of Ataxia, compared with control patients who did balance training (who saw improvement of 0.6 SARA points). Although some balance-specific measures showed better results with balance training and studies of less-rigorous aerobic training showed little benefit, intense aerobic activity appears to be a promising therapeutic avenue for ataxia, and demonstrates important connections between nervous system health and aerobic activity.
Full abstract, to be presented at the American Neurological Association 2022 Annual Meeting, October 22-25, 2022 in Chicago, and published in Annals of Neurology:
Home Aerobic Versus Balance Training In Cerebellar Ataxias
Scott Barbuto, MD, PhD, Columbia University Medical Center
Coauthors: Sheng-Han Kuo, MD, Lauren Winterbottom, OTR, Yaakov Stern, PhD, Joel Stein, MD
Spinocerebellar ataxias are a group of disorders that result from cerebellar degeneration and cause balance and coordination loss. The diseases are devastatingly debilitating with many individuals requiring wheelchairs for mobility within ten years from initial diagnoses. With no disease modifying medications currently available, most guidelines recommend individuals with cerebellar ataxia to perform balance training to maintain functional abilities. Although conflicting results have been reported, most studies indicate that balance training can help improve symptoms of ataxia if the training is adequately challenging. The benefits of aerobic training for cerebellar ataxia have been less well-studied. After promising results in animals, the first study examining aerobic training in humans with cerebellar degeneration showed minimal benefits. However, participants were not provided a structured exercise program, and the training was limited to three, fifteen-minute sessions per week for one month. Hypothesizing that a larger dose of training could be beneficial, our research group conducted a pilot study having individuals with cerebellar degeneration perform one month of rigorous aerobic training, defined as thirty-minutes sessions, five times per week at 65–80% of their maximum heart rate. Our results indicated that individuals with cerebellar ataxias were able to safely perform rigorous aerobic exercise and that a phase II study comparing balance and aerobic training was feasible. After completion of the pilot study, we conducted a single center, assessor-blinded, randomized controlled phase II trial. Individuals with cerebellar ataxia were assigned (1:1) to either home aerobic or balance training for 6-months. The primary outcome was improvement in ataxia severity as measured by the Scale for the Assessment and Rating of Ataxia (SARA). Secondary outcomes included safety, training adherence, and balance improvements. Nineteen subjects were randomized to aerobic training and 17 subjects to balance training. There were no differences between groups at baseline. Thirty-one participants completed the trial, and there were no training-related serious adverse events. Compliance to training was over 70%. There was a mean improvement in ataxia severity of 1.9 SARA points (SD 1.62) in the aerobic group compared to an improvement of 0.6 points (SD 1.34) in the balance group. Although two other measures of balance were equivocal between groups, one measure of balance showed greater improvement with balance training compared to aerobic training.
Overall, this 6-month trial comparing home aerobic versus balance training in individuals with cerebellar ataxia had excellent retention and adherence to training. There was a significant improvement in ataxia severity with aerobic training compared to balance training, and a phase III trial will be conducted.
All abstracts from ANA2022 will be available in Annals of Neurology starting at 3:01 p.m. U.S. Eastern Time on October 14. This research is under embargo until that time. Contact Katherine Pflaumer (kpflaumer@steegethomson.com) for additional highlighted abstracts, full meeting abstracts, and call-in information for the ANA2022 Media Roundtable (Oct. 25, 11 a.m. U.S. Central).
