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Pedaling Back Against Ataxia

Written by Jacen Emerson
Edited by Pragya Goel, PhD

Regular stationary bike training improves ataxia symptoms within months according to a clinical trial.

Home cardio may outperform traditional balance training

A new clinical trial has identified daily aerobic exercise as an effective home treatment for reducing ataxia symptoms. With a lack of FDA approved treatments for cerebellar ataxias, researchers are working tirelessly to find ways to improve quality of life and delay symptom onset in patients. Because developing new treatments takes time, a smart approach is to test interventions known to successfully manage similar conditions. Regular cardio is a cheap and accessible form of exercise that has been shown to slow functional decline in other major neurodegenerative disorders, such as Huntington’s and Parkinson’s disease. It is cheap, accessible and can be practiced at home. Building on this foundation, Barbuto’s team at Columbia University performed a clinical trial to investigate if high-intensity home exercise could improve symptoms for people living with ataxia.

Balance training verses Cardio exercise for Ataxia

To fully comprehend the study’s impact, it is important to note the two types of exercise researchers compared in this study- balance training and cardiovascular exercise using a stationary bike. Historically, specialized balance training is recommended to ataxia patients to help manage day-to-day stability and compensate for coordination loss. However, experts overall agree that balance drills alone do not slow disease progression. This trial tests intense cardio as an exercise routine to assess if it offers a greater benefit compared with balance training. Participants were divided into two groups. Those assigned to the control group performed 30 minutes of balance training of varying difficulty, five times a week. Participants in the experimental group were subjected to an at-home cardio routine. Cardio group patients were given a stationary bike which they rode for 30 minutes, five times a week, at home. To ensure participants were performing aerobic exercise at the proper intensity they wore heart rate monitors. At the start of the study their goal was to reach 65% of their maximum heart rate while biking. This goal was slowly increased to 85% as participants got used to biking.

Clear benefits of aerobic exercise in ataxia

During the first six months of this study, patients received coaching calls every other week to support their routines, resulting in ~75% of participants in each group hitting their exercise goals. At the 6-month mark, researchers used the Scale for Assessment and Rating of Ataxia (SARA), to objectively measure motor coordination.

Authors found that the aerobic exercise group achieved significantly larger improvements in their SARA scores compared to the balance training group. Additionally, the aerobic group reported a reduction in daily fatigue– a typical ataxia associated symptom that lowers the quality of life and limits independence in patients. Finally, bicycle pedaling also boosted the participant’s VO2Max, a core measurement of aerobic fitness and oxygen usage, which clinically correlates with a decreased long-term risk of cardiovascular disease. Unsurprisingly, balance training did not impact VO2Max.

The importance of consistency in exercise as a treatment

In this 12-month study, the final 6 months provided a critical clinical insight: aerobic exercise benefits are entirely reversible if the routine stops. After the first 6-months of consistent check-ins, investigators intentionally stopped coaching calls to see if patients continued with their exercise routine. In the absence of check-ins, sticking to the routine was drastically reduced: for cyclists this dropped from 70% to 38%, for the balance group from 70% to 24% by the 1-year mark.

This decrease allowed the investigators to determine if the benefits obtained from aerobic exercise at six months were maintained at twelve months if exercise was stopped. Patients who maintained their bike routine successfully showed improved coordination and lower SARA score at 1-year. Conversely, participants who lessened or stopped cycling altogether saw fatigue levels, movement symptoms and aerobic fitness marks moving back to baseline levels. This critical finding shows that while cardio and intense cycling is a powerful tool to improve ataxia symptoms, it requires long-term commitment to remain effective. Practically, aerobic exercise has limited potential given enhanced baseline fatigue and mobility in patients with ataxia.

The take away

Altogether, this landmark randomized clinical trial provides evidence that home-based, high intensity aerobic cycling can actively fight fatigue and improve ataxia symptoms in a matter of months. However, maintaining an intense exercise routine is challenging. Thus, researchers note that future clinical programs will need to incorporate continuous coaching and structured remote support to help patients maintain long-term benefits

Key Words

Aerobic Exercise: Often referred to as “cardio”. This is a type of exercise that elevates your heart rate and breathing for a prolonged period of time. Examples include biking, running, and swimming.

SARA Score: A clinical scale used to measure the severity of symptoms experienced by a patient with ataxia. A higher score indicates more symptoms present.

Conflict of Interest Statement

The author and editor have no conflicts of interest to declare.

Citation of Article Reviewed

Barbuto, S., Lee, S., Stein, J., Kuo, S., Quinn, L., Spinner, M., Stern, Y. Home Training for Cerebellar Ataxias: A Randomized Clinical Trial. JAMA Neurol, 2025. 1;82(11):1162-1170. (https://pubmed.ncbi.nlm.nih.gov/40946705/)