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The aim of this study was to compare the effects of VE and FE on PD symptoms, 
motor function, and bimanual dexterity.  Ten patients with mild to moderate PD 
were randomly assigned to complete 8 weeks of FE or VE. With the assistance of 
a trainer, patients in the FE group pedaled at a rate 30% greater than their 
preferred voluntary rate, whereas patients in the VE group pedaled at their 
preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of 
their individualized training heart rate.  Aerobic fitness improved for both 
groups. Following FE, Unified Parkinson′s Disease Rating Scale (UPDRS) motor 
scores improved 35%, whereas patients completing VE did not exhibit any 
improvement. The control and coordination of grasping forces during the 
performance of a functional bimanual dexterity task improved significantly for 
patients in the FE group, whereas no changes in motor performance were 
observed following VE. Improvements in clinical measures of rigidity and 
bradykinesia and biomechanical measures of bimanual dexterity were maintained 
4 weeks after FE cessation.

Aerobic fitness can be improved in PD patients following both VE and FE 
interventions. However, only FE results in significant improvements in motor 
function and bimanual dexterity. Biomechanical data indicate that FE leads to 
a shift in motor control strategy, from feedback to a greater reliance on 
feedforward processes, which suggests FE may be altering central motor control 
processes.

Ridgel AL, Vitek JL, Alberts JL. Forced, not voluntary, exercise improves 
motor function in Parkinson′s disease patients. Neurorehabil Neural Repair. 
2009 Jul-Aug;23(6):600-8

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