Objective: To investigate the current status of riding bicycle and the reasons for cessation of cycling in patients with Parkinson disease (PD).

Background: The “bicycle sign” is well-known to offer good diagnostic value for separating PD from atypical parkinsonism after disease onset (Aerts MB et al, 2011). However, little is known about the status of riding bicycle and the reasons for cessation of cycling through the progression of PD.

Methods: A single center cross-sectional survey on outpatients. Patients; clinically probable PD patients diagnosed by MDS clinical diagnostic criteria with cardiac sympathetic denervation on MIBG scintigraphy. Consecutive PD patients received a structured interview, including current cycling status, cycling difficulties under specific situations (e.g. narrow cycling space, crowded road) and reasons for cessation of cycling (if applicable), with assessment of ten-consecutive tandem gait ability.

Results: In fifty-seven PD patients, the number of “non-riders” who had stopped riding bicycle long before PD onset was twenty-eight. The total number of PD patients exposed to analysis was twenty-nine (age, 70.3 ± 8.8 years old; PD duration, 5.9 ± 3.4 years; mean ± SD). Nineteen patients currently ride on bicycle (PD duration, 4.5 ± 2.9 years; Hoehn & Yahr staging (H&Y), 1.9 ± 0.7; daily levodopa equivalent dose (LED), 337 ± 351 mg). On the other hand, ten “ex-riders” who ceased cycling at 6.1 ± 2.8 years after PD onset, presented significantly longer disease duration with higher H&Y staging (3.4 ± 0.7), and LED (576 ± 161 mg) was also significantly higher, compared to the current riders (p<0.05, respectively). The reasons of cessation of cycling were related not only to motor symptoms (difficulty of handlebar operation and balance), but also to nonmotor symptoms (visuospatial processing problem, anxiety and hallucination). Tandem gait ability was maintained at seventeen patients with current cycling (17/19, 89.5%), as opposed to only two patients of ex-riders who stopped cycling after PD onset (2/10, 20%).

Conclusions: We revealed that the reasons of cessation of cycling in PD patients were related not only to motor symptoms, but also to various nonmotor symptoms. Tandem gait ability was maintained at about 90% of current riders, but only at 20% of ex-riders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/status-of-riding-bicycle-and-reasons-for-cessation-of-cycling-in-patients-with-parkinson-disease-a-japanese-single-center-cross-sectional-survey/