Dr. Scott A. Barbuto

In a growing trend, doctors across the country are writing exercise prescriptions for patients. But it’s not just for high blood pressure or diabetes. Exercise training shows great promise for patients with neurologic disorders. In fact, a recent literature search reveals an uptick of studies examining the relationship between exercise and neurologic disorders, specifically its ability to decrease symptoms and delay disease progression.

Scott A. Barbuto, MD, PhD, a physiatrist and clinical researcher in the Department of Rehabilitation and Regenerative Medicine at NewYork-Presbyterian/Columbia University Irving Medical Center, is leading an exercise training intervention for patients with spinocerebellar ataxia. Patients with this condition typically experience a gradual loss of coordination, impaired balance, gait deviations, and severe progressive disability. A prescribed exercise training intervention to prevent or delay cerebellar atrophy is welcome news for patients.

In their pilot study, Dr. Barbuto and colleagues randomized 20 patients with degenerative cerebellar disease to prescribed aerobic or balance training five days per week for four weeks. “When we compared aerobic training to balance training, we found that the two groups had similar benefits in terms of balance and gait speed but that the aerobic training group did better in terms of ataxia severity and fitness level,” says Dr. Barbuto. “The aerobic training group showed improvement in ataxia, which is the primary complaint of these patients.”

With no available disease-modifying medications, balance training to improve motor skills and functional performance has been the mainstay of treatment. However, there is little evidence that balance training can affect change on the molecular level in patients with degenerative cerebellar disease.

“There have been numerous studies that look at balance, but this is the first study indicating that these patients should be doing aerobic training,” says Dr. Barbuto who completed the pilot study in 2018 and is beginning a single blind randomized trial comparing the benefits of aerobic versus balance training in patients with cerebellar degeneration.

Exercise training interventions are gaining popularity as doctors embrace the “Exercise is Medicine” initiative, spearheaded by the American College of Sports Medicine, and the $170 million “Molecular Transducers of Physical Activity Consortium” initiative by the National Institutes of Health Common Fund, which targets the molecular mechanisms underlying exercise. Researchers like Dr. Barbuto are elucidating the relationship between exercise and the prevention or delay of neurodegenerative symptoms. Once thought of as adjunct therapy for patients with neurologic disorders, investigators are now examining the role of exercise training as frontline treatment (Allendorfer JB, Bamman MN. Getting the brain into shape: Exercise in neurological disorders. Clinical Therapeutics. 2018;40(1):6-7).

“We think that aerobic training may increase cerebellum volume, whereas balance training may be more of a compensatory mechanism, helping patients cope with a deficit as opposed to affecting anything in the brain.”

— Dr. Scott A. Barbuto

Currently Dr. Barbuto’s group is beginning recruitment for the larger (n=36), blind randomized study examining the effects of aerobic exercise versus balance training as measured by MRI and gait analysis. Study inclusion criteria include a genetic cause of cerebellar ataxia, cerebellar degradation, or cerebellar atrophy, as evidenced by MRI, age 18 years or older, and the ability to get on and off of a stationary bicycle safely.

Enhanced cerebellar atrophy

Changes in cerebellar volume are measured on MRI at baseline and six months. Additionally, patients are evaluated using the Scale for Assessment and Rating of Ataxia (SARA), gait parameters, and static balance at baseline and six months.

Dr. Barbuto’s team hypothesizes that although both aerobic and balance training will improve function, only aerobic exercise will affect disease progression and slow cerebellar atrophy. Animal studies show encouraging results, and the study at NewYork-Presbyterian/Columbia is the first of its kind to examine the benefits of aerobic exercise as a primary outcome in this patient population.

“We think that aerobic training may increase cerebellum volume whereas balance training may be more of a compensatory mechanism, helping patients cope with a deficit as opposed to affecting anything in the brain,” suggests Dr. Barbuto. “That’s our hypothesis, and it’s exploratory.”

The ataxia treatment team at NewYork-Presbyterian/Columbia includes neurologist and movement disorder specialist Sheng-Han Kuo, MD, and exercise specialist Dr. Barbuto. For patients, an opportunity to participate in a clinical trial that may decrease symptoms and delay disease progression is welcome news.