Graded peak cycle ergometer test for cognitively impaired patients with Parkinson’s disease: a pilot study

André Hürlimann, Manuela Pastore-Wapp, Judith van Beek, Mark A. Hirsch, Erwin E. H. van Wegen, Tim Vanbellingen

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Background: Cognitive decline affects up to 50% of patients with Parkinson’s disease (PD) in the course of the disease and may be amenable to exercise interventions. To accurately set adequate training intensities, standardized exercise testing is required but such testing takes considerable time and effort. The aim of this pilot study was to investigate the feasibility of a graded peak cycle ergometer exercise test in cognitively impaired patients with Parkinson’s Disease (PD), and to define whether age-predicted maximal heart rate (HRmax) matched measured HRmax. Methods: A convenience sample of seven patients with PD (Hoehn and Yahr: 2–4, and cognitive impairment (Montreal Cognitive Assessment (MoCA) ≤ 26) completed a graded peak cycle ergometer test to voluntary exhaustion. Borg Rating of Perceived Exertion was used to record the individual’s perception of exertion. Pre-defined age-predicted HRmax (calculated as 208-(0.7 × age) was compared with the measured HRmax using Bland-Altman plot and a two-one-sided test. Results: All PD patients completed the graded exercise test between 8–12 minutes, showing therefore 100% compliance to the test protocol. No adverse events occurred. Predicted HRmax and measured HRmax did not differ. Conclusion: We demonstrate feasibility of graded peak cycle ergometer testing in PD patients with cognitive impairment. The good correspondence of age-predicted HRmax equation with measured HRmax, in this small sample, may in the future provide clinicians with a tool to define training intensities in cognitively impaired PD, without cardiac disease. However, further research is needed to confirm these results.
Original languageEnglish
JournalPhysiotherapy Theory and Practice
Early online date2022
Publication statusE-pub ahead of print - 2022


  • Bicycle ergometry test
  • Parkinson disease
  • cognitive symptom
  • heart rate

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