Objective: Determine the feasibility and preliminary efficacy of an 8-week telehealth intervention of high intensity aerobic exercise prior to balance training (HIBT) compared to low intensity exercise prior to balance training (LIBT) in people with spinocerebellar ataxias (SCAs).

Background: Balance training (BT) and aerobic exercise (AE) improve motor function in SCA. Studies in stroke and Parkinson disease have evaluated AE prior to BT as a form of motor priming to enhance motor learning and functional outcomes but this has not been explored in SCA.

Method: Participants (n=20) were randomized to receive either HIBT, or LIBT for 60 minutes, twice weekly, for 8-weeks over telehealth. Outcomes were assessed at baseline, mid- and post-intervention and included Cerebellar Cognitive Affective Scale (CCAS), Scale for Assessment and Rating of Ataxia at Home (SARAHome)), functional measures of balance/gait, fatigue severity scale (FSS-49)) and metrics of feasibility. As a proxy for motor learning, participants completed a visuomotor adaptation test. Statistics were evaluated by mean difference and effect size.

Results: 93 people were referred, 20 people with early-mid stage SCA (1,2,3,6) enrolled (21.5% recruitment rate); mean(SD) age of 58.1(13.5) yrs; 6M/14F. 18 participants completed the post-intervention assessments (90% retention). The Intervention had high acceptance. There was 1 adverse event of low back pain which resolved. Both groups improved on the CCAS (HIBT: 4.10(4.38), d=1.10; LIBT: 15.13(7.4), d=1.8), SARAHome (HIBT: -0.61(0.74), d=0.83; LIBT: -1.0, d=0.51) however, statistically there were no differences between groups post-intervention. The LIBT showed greater mean changes on the FSS-49 4.63(6.98), d=.67, than the HIBT -0.11(4.88), d=0.02 who had decreased tolerability to BT after AE managing to complete only 8.5 BT exercises while LIBT completed 10. HIBT showed larger change in explicit motor adaptation (22.10(11.04), p=.04, R²=0.39) over LIBT (21.78(14.74), p=.15, R²=.22). For implicit motor adaptation, only the LIBT demonstrated improvements (8.83(4.26), p=.04, R²=.13).

Conclusion: Preliminary data supports a TH-delivered motor priming intervention in SCA, with improvements in disease-specific motor and cognitive measures. Fatigue after AE limited intervention tolerability for BT in the HIBT group and impacted potential for gains in implicit motor learning.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-fatigue-a-rate-limiting-factor-for-achieving-motor-learning-and-functional-gains-in-people-with-spinocerebellar-ataxia-prime-ataxia-rct/