Theses Doctoral

Priming Motor Learning through Exercise in People with Spinocerebellar Ataxia (PRIME-Ataxia)

Macpherson, Chelsea Erin

Background. People with spinocerebellar ataxia (SCA) have symptoms that impact balance, gait, motor learning and control. Independently, balance training (BT) and aerobic exercise (AE) have improved motor function for people with SCA. Studies in stroke and Parkinson disease have evaluated the use of AE prior to BT as a form of motor priming to enhance motor learning. Motor priming has not been explored in SCA.

Introduction & Purpose. This was a pilot randomized controlled trial aimed to 1) determine the feasibility and efficacy of an 8-week telehealth intervention of high intensity AE prior to BT (HIBT) compared to low intensity exercise prior to BT (LIBT) on disease specific motor and cognitive outcomes, and 2) explore changes in patient reported outcomes as well as functional outcomes post exercise intervention in people with SCA.

Methods. Participants (n=20) were randomized to receive either HIBT, or LIBT, for 60 minutes, twice weekly, for 8-weeks over telehealth. The HIBT group underwent 30 minutes of High Intensity Interval Training (HIIT) prior to 30 minutes of BT, while the LIBT group underwent 30 minutes of low intensity warm up type exercises prior to 30 minutes of BT. Outcomes were assessed at baseline, mid- and post-intervention and included: disease specific measures (e.g., Cerebellar Cognitive Affective Scale (CCAS), Scale for Assessment and Rating of Ataxia at Home (SARAHome), functional measures of balance and gait (e.g., Timed Up and Go test (TUG), 30 second Sit to Stand Test (30secSTS)), patient reported measures (e.g., fatigue severity scale (FSS-49)) and metrics of feasibility. Data for disease specific, and functional outcomes were not normally distributed. Data for patient reported outcomes was normally distributed. Statistical significance of findings are reported as p-value.

Results. A total of 93 people were referred to this intervention, and 20 were enrolled (21.5% enrollment). Eighteen participants completed the intervention and post-intervention outcome assessments (90% retention). Both the HIBT and LIBT interventions had high acceptance from on the post-intervention questionnaire. Enrolled participants had a mean (SD) age of 58.1(13.5) yrs; 6M/14F. Diagnoses were early-mid stage SCA types 1, 2, 3, and 6. Participants showed 100% adherence to the intervention, with 1 adverse event of low back pain exacerbation which resolved. Both groups improved on disease specific measures of the CCAS, and SARAHome where outcomes for the SARAHome surpassed the established group minimal detectable change score of 0.3 points. At post-intervention however, there were no between group differences identified on the SARAHome (p > .05), however for the CCAS the LIBT group demonstrated significant improvements at post intervention over the HIBT group (p < .01). There were no differences observed at post-intervention between groups for functional measures such as the TUG test, 30secSTS test, or in any static stance position. The LIBT group showed greater changes in fatigue post-intervention, (p < .05). The HIBT group showed no significant change in fatigue, however they displayed decreased tolerability to engage in BT after engagement in AE. The HIBT group managing to complete an average of only 8.50 BT exercises per session while LIBT completed 10.04.

Conclusions. Results from this pilot randomized controlled trial support a telehealth-delivered exercise intervention for people with SCA 1, 2, 3, and 6, with low overall attrition, and high rates of intervention adherence, and acceptability. However, effect estimates do not support the hypothesis of motor priming in people with SCA. Fatigue after engagement in AE limited intervention tolerability for BT in the HIBT group, and this suggests that fatigue may stand as a potential barrier for not only exercise engagement and functional improvement, but also neuroplastic growth and motor learning potential. Future research should aim to optimize exercise prescription to mitigate fatigue in this population.


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More About This Work

Academic Units
Thesis Advisors
Quinn, Lori
Ph.D., Columbia University
Published Here
June 26, 2024