Phase I Single-Blinded Randomized Controlled Trial Comparing Balance and Aerobic Training in Degenerative Cerebellar Disease

Introduction: Primary deficits in individuals with cerebellar degeneration include ataxia, unstable gait, and incoordination. Balance training is routinely recommended to improve function whereas little is known regarding aerobic training.

Objective: To determine the feasibility of conducting a randomized trial comparing balance and aerobic training in individuals with cerebellar degeneration.

Design: Assessor blinded randomized control phase I trial.

Setting: Assessments in medical center, home training.

Participants: Twenty participants with cerebellar degeneration were randomized to home balance or aerobic training.

Intervention: Aerobic training consisted of 4 weeks of stationary bicycle training, five times per week for 30-minute sessions. Home balance training consisted of performing the same duration of easy, moderate, and/or hard exercises.

Outcome measures: Scale for the Assessment and Rating of Ataxia (SARA), maximal oxygen consumption (VO₂ max), Dynamic Gait Index, Timed Up and Go, gait speed.

Results: All 20 participants completed assigned training with no major adverse events. Seven of each group attained target training duration, frequency, and intensity. Although both groups had significant improvements in ataxia severity, balance, and gait measures, there were greater improvements in individuals who performed aerobic training in ataxia severity and maximal oxygen consumption when compared to balance training. The effect size for these outcome measures was determined to be large, indicating a phase II trial comparing the benefits of aerobic and balance training was feasible and required 26 participants per group. Improvements in SARA score and VO₂ max remained in the aerobic training group at 3 months posttraining, but these improvements were trending back to baseline. In contrast, all balance group measures for pretraining and 3 months posttraining were statistically similar.

Conclusions: A phase II trial comparing balance and aerobic training in individuals with cerebellar degeneration is feasible. Benefits trended back toward baseline after training stopped, although benefits of longer duration exercise programs still need to be determined.