Home-based high-intensity aerobic training was associated with greater improvement in cerebellar ataxia symptoms, fitness, and fatigue compared with guidelines-recommended balance training in a randomized controlled trial.

The balance training group experienced modest improvements in ataxia symptoms, but the magnitude of change was smaller than in the aerobic training group.

“These findings support the hypothesis that aerobic training may have broader systemic effects, potentially by improving cardiorespiratory fitness, neuromuscular coordination, or task endurance,” the investigators wrote.

Indeed, aerobic training has been shown to enhance neuroplasticity mechanisms in animals and slow progression of various neurodegenerative disorders in people, including Parkinson’s disease, Huntington disease, and Alzheimer’s disease, lead author Scott Barbuto, MD, PhD, Columbia University Irving Medical Center, New York City, told Medscape Medical News.

“Aerobic exercise may actually affect disease progression,” Barbuto said.

The study was published online on September 14 in JAMA Neurology to coincide with presentation at the American Neurological Association annual meeting in Baltimore.

Aerobic or Balance Training?

Clinical practice guidelines currently advise balance training for cerebellar ataxia, but less is known about the value of aerobic training.

To investigate, Barbuto and colleagues randomly assigned 62 adults (mean age, 54 years; 47% women) with cerebellar ataxia (most commonly spinocerebellar ataxia) to home-based high-intensity aerobic training using a stationary bicycle or to home structured balance training.

The aerobic group cycled for 30 minutes, five times a week, at up to 85% predicted maximum heart rate. The balance training group performed 30 minutes of structured balance exercises of varying difficulty five times per week. All participants were supported with biweekly phone calls only for the first 6 months of this 12-month study.

The primary outcome was the Scale for the Assessment and Rating of Ataxia (SARA) score (range, 0-40 points; with higher scores indicating more ataxia).

At 6 months, those in the aerobic group showed an average SARA score improvement of 2.4 points compared with an improvement of 0.9 points in the balance group. Improvements of 1 point on this measure are considered clinically meaningful.

Aerobic training also led to significantly greater improvements at 6 months in fatigue (beta coefficient, -9.38; P = .001) and respiratory fitness (VO₂ max: beta coefficient, 4.26; P < .001). There were no significant between-group differences in balance and gait, gait speed, and timed up and go test.

Improvements in ataxia symptoms, fitness, fatigue, balance, and gait were maintained in individuals in the aerobic group who continued to hit training goals at 1 year but trended back to baseline for those who did not, the authors reported.

Poor Long-Term Adherence

However, adherence to assigned regimen fell off after study support ended at 6 months, with only about 39% of aerobic participants and 24% of balance participants meeting training goals at 12 months.

Both home-based high-intensity aerobic training and balance training were safe, with no serious adverse events reported. Minor complaints included mild pain in the aerobic group and occasional falls without injury in the balance group.

Barbuto said further studies are needed before changes to current clinical practice guidelines can be made.

“I personally believe that aerobic training can be done at home. You don’t need someone to watch you pedal on a bicycle,” he said.

Balance training, on the other hand, “which can be very difficult to do, should be supervised at a clinic. Being able to challenge their balance without risk of falling, which is really beneficial,” he added.

Although small, there was a higher dropout rate in the balance group than in the aerobic group, which may indicate lower acceptability, reduce power, and impact the interpretability of efficacy, the authors noted.

Mounting Support for Aerobic Exercise

Commenting on the findings for Medscape Medical News, Estelle C. Gallo, DPT, neurorehabilitation expert and clinical specialist at Rusk Rehabilitation, NYU Langone Health in New York City, said there is a “paucity of evidence to guide the clinician on what to do with this patient population so this study is valuable.”

Traditionally, rehabilitation for ataxias has largely focused on balance training, Gallo noted.

“That’s what’s recommended because these patients have so much balance and coordination deficits,” she said.

“However, there has been a huge push and a building of evidence that moderate-to-high intensity aerobic exercise actually is very beneficial for the neurological population. If you could combine both that would be the best,” Gallo added.

This study was supported by a grant from the National Institute of Neurological Disorders and Stroke. Barbuto and Gallo reported having no relevant disclosures.