Aerobic exercise benefits individuals with cerebellar ataxia

High-intensity aerobic training appears to be a better way to manage cerebellar ataxia than balance training, with favourable effects on symptoms, fatigue, and cardiorespiratory fitness seen in a randomized clinical trial.

During the 12-month intervention, the primary outcome of ataxia symptoms, as measured using the Scale for the Assessment and Rating of Ataxia (SARA), improved with a greater magnitude in the aerobic vs the balance group (time-by-group interaction at 6 months: p=0.001; 9 months: p=0.006; 12 months: p=0.005).

At 6 months, SARA scores decreased by 2.4 points (95 percent confidence interval [CI], −3.1 to −1.80) with aerobic training and by only 0.9 points (95 percent CI, −1.5 to −0.2) with balance training. In the aerobic group specifically, participants who continued to train regularly through 12 months had their SARA score drop by 3.81 points (95 percent CI, −2.2 to −5.4), whereas those who limited their training saw their symptom improvements disappear, with their scores returning to near-baseline levels (0.4 points, 95 percent CI, −0.4 to 1.2).

Beyond symptoms, aerobic training also yielded better improvements in fatigue (6 months: p=0.001; 9 months: p=0.02; 12 months: p=0.005) and maximal oxygen uptake (Vo₂max) (6 months: p<0.001; 9 months: p=0.09; 12 months: p=0.07) compared with balance training.

Why aerobic training is superior

“These findings align with prior work demonstrating the potential for aerobic exercise to promote functional plasticity in individuals with cerebellar degeneration,” according to the investigators.

In preclinical and human studies, aerobic activity has been shown to enhance cerebellar output, modulate sensorimotor integration, and stall the progression of motor decline in ataxia syndromes. [Neurology 2009;73:1823-1830; J Neurosci 2006;26:9107-9116; Ageing Res Rev 2022;74:101543]

“Our trial suggests that even in the context of progressive neurodegeneration, individuals retain capacity for functional gains when appropriately challenged through high-intensity paradigm,” they pointed out.

Furthermore, the fact that the magnitude of improvement in ataxia symptoms was greater in the aerobic group than in the balance group supports the hypothesis that aerobic training may have broader systemic effects, potentially by improving cardiorespiratory fitness, neuromuscular coordination, or task endurance, the investigators said.

Balance training is commonly recommended for cerebellar ataxias, but its effects are thought to be due to compensation for deficits, they added. [Rehabil Res Pract 2018;doi:10.1155/2018/7172686; Biomed Res Int 2014;doi:10.1155/2014/583507; Lancet Neurol 2014;13:482-489]

Trial details

The trial included 62 individuals with various cerebellar ataxia types (mean age 54.4 years, 46.8 percent female, mean SARA score 12.1 points). These participants were randomly allocated to the aerobic group or the balance group.

Aerobic training was a home-based 30-min aerobic exercise session, performed five times per week. Training started with a heart rate goal of 65 percent of maximum, which progressively increased to 85 percent of maximum. Bi-weekly check-ins were conducted to adjust the exercise intensity to help participants achieve their heart rate goals. At 6 months, study support was withdrawn, and participants were encouraged to continue training on their own.

Balance training involved 30 min of balance exercises of varying difficulty, performed five times per week. Participants also received study support of biweekly phone calls for the first 6 months of the study.

Twelve-month outcome data showed improvements in balance, which was assessed using Dynamic Gait Index and Timed Up and Go, and gait speed in the aerobic group, but these changes did not significantly differ than that observed in the balance group. Quality of life showed no marked improvement in either group.

“Both interventions were safe and feasible, with high adherence to training at 6 months and no serious adverse events reported, suggesting that structured, remotely delivered exercise programs are implementable in this population,” the investigators said.

Overall, the findings support the inclusion of aerobic exercise in rehabilitation strategies for ataxia, they concluded.