Researchers at university hospitals and the Cleveland VA say long-term exercise programs may restore neural connections in Parkinson’s patients

CLEVELAND – It was the early 2000s when researchers first showed that exercise can help relieve the tremors that are common with Parkinson’s Disease. So far, researchers haven’t been able to explain how exercise helps. But they may be getting closer to an answer.

A novel study conducted at University Hospitals and the VA Northeast Ohio Healthcare System, through its Cleveland Functional Electrical Stimulation (FES) Center, provides clues, as it shows that long-term dynamic exercise programs might have wider restorative effects on the brain signals of Parkinson’s Disease (PD) patients than researchers previously thought.

Researchers used recordings from participants’ deep brain stimulation devices to try to assess how long-term exercise programs might be re-activating connections damaged by Parkinson’s Disease.

Unlike previous studies, this investigation sought to decode the brain changes linked to motor symptom relief; both with the help of second-generation DBS devices and a long-term dynamic cycling exercise regimen in Parkinson’s patients.

Details on the study are published in the June 2025 issue of Clinical Neurophysiology. The pilot investigation, funded by a VA Merit Award from the Department of Veterans Affairs along with philanthropic funds to the Department of Neurology at University Hospitals (Penni and Stephen Weinberg Chair in Brain Health) was led by UH & VA neurologist Aasef Shaikh MD, PhD, who is also Vice Chair for Research at University Hospitals, Professor of Neurology, and Associate Medical Director of the Cleveland FES Center. Prajakta Joshi, lead author of the article, is a PhD candidate in biomedical engineering at the Shaikh Lab that is part of University Hospitals and Cleveland FES Center at the Louis Stokes Cleveland VA Medical Center.

“We’ve already established over years of study that dynamic cycling regimens are beneficial for treating Parkinson’s tremor,” said Dr. Shaikh. “The latest study adds the use of deep brain stimulation and an ongoing exercise program to visualize how long-term exercise might be rewiring neural connections in the brain.”

Another unique and critical part of the study, Dr. Shaikh added, was the collaboration between the two medical systems, which provided a larger pool of potential participants for recruiting purposes.

About the Study

Participants with Parkinson’s Disease – including military Veterans – were required to take part in 12 dynamic cycling sessions over a four-week period. All study participants had previously been implanted with deep brain stimulation devices to treat their motor symptoms; while simultaneously measuring the brain signals in the region where the electrodes are implanted.

Another critical aspect of the study was the adaptive cycling regimen investigators used. This technology empowers the bike to learn how patients perform while biking.

For example, viewing the connected game screen, riders are instructed to pedal up to 80 rpm, and to maintain that speed for about 30 minutes. Meanwhile, their pedaling intensity is shown by an on-screen balloon, and riders have to keep the balloon aloft over water but within specific parameters on screen.

However, the adaptive quality of the bike keeps riders guessing as to how much effort to apply. The bike’s motor assists them in attaining 80 rpm, but also adds and reduces resistance depending on the rider’s level of effort. Researchers believe this push and pull mechanism is particularly beneficial in treating Parkinson’s symptoms.

Kent State University PhD candidate Lara Shigo, a co-author of the study, acknowledges 80 RPMs is faster than a person would naturally choose to ride, but says the level doesn’t cause fatigue because the bike’s motor assists the rider in attaining that level.

Exciting Findings

Brain signal recordings were captured from participants’ implanted DBS electrodes to assess participants’ brain signals before and after each exercise session.

“Our goal was to understand the immediate and long-term effects of the exercise in that region of the brain where the electrodes are implanted, which is also the same area where Parkinson’s pathology is evident,” Dr. Shaikh said.

Researchers did not observe immediate brain signal changes, but after 12 sessions, they saw a measurable change in the brain signals responsible for motor control and movement.

Joshi and the team observed that while modern DBS systems offer a novel window into brain activity, they are limited to capturing signals only from the regions where the electrodes are implanted. As a result, other brain areas that may also contribute to the observed patterns could remain unmonitored.                               

The key insight, Joshi explains: “There may be a broader circuit involved. Numerous upstream and downstream pathways could be influenced by exercise, and it's possible that we’re inducing a network-level change that drives the improvement in motor symptoms.” Additional work could help provide answers, Joshi adds. “The good news is that our next investigations could bring us closer to revolutionary and personalized treatments for PD.”

Patient Success

Amanda “Mandy” Ensman, 59, was diagnosed with PD 12 years ago and participated in the study. “I knew I needed to start exercising. It really does make a difference,” she explained. “Biking helped me with a variety of symptoms I was struggling with, including my gait, walking and increased my energy levels.”

Mandy now regularly participates in physical therapy regularly at InMotion, where the study took place. The gym holds workout classes and programs that are geared specifically towards PD patients.

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Joshi, P., Shaikh, A., et. al. Electrophysiological correlates of dynamic cycling in Parkinson’s disease. Clinical Neurophysiology, Volume 174, 2025, Pages 17-27; https://doi.org/10.1016/j.clinph.2025.03.018.

About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of more than 20 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, Taiwan National University College of Medicine and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.

About Cleveland FES Center
The Cleveland FES Center is a neuromodulation and neurostimulation research consortium of six nationally recognized institutions: VA Northeast Ohio Healthcare System, Syracuse VA Medical Center, MetroHealth System, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Clinic Neurological Institute. The Cleveland FES Center is at the forefront of academic and clinical research to further the advancement of neural technology; thereby accelerating the translation of innovation into clinical practice and improving the quality of life for people with neural disorders and their families. Visit FEScenter.org to learn more