Functional and Cognitive Benefits of a Community Tandem Cycling Exercise Intervention on Patients with Parkinson’s Disease and Their Care Partners 
Ryan Reyes1, Alia Sadek1, Leila Djerdjour1, Greggory Adams1, Margaret Smith1, Cara Logan1, Sara Biddle2, Enrique Urrea-Mendoza2, Tracie McConnell2, Fredy Revilla2, Jennifer Trilk2
1University of South Carolina School of Medicine Greenville, 2Prisma Health-Upstate
Objective:
To investigate the feasibility, limited efficacy, therapeutic partnerships, and physical effects of a VR tandem cycling program on Parkinson’s Disease PD dyads.
Background:
Aerobic exercise programs demonstrate symptom improvements in PD patients; however, incorporating care partners (“PD dyads”) into a community-based, virtual reality (VR) cycling program with PD patients remains uninvestigated.  
Design/Methods:
Upon Prisma Health Institutional Review Board approval, PD dyads were screened for eligibility by neurologists. Pre-testing measures for PD dyads (N=9) involved emotional and cognitive status questionnaires including the Brief Resiliency Scale (BRS) and the Parkinson’s Disease Questionnaire (PDQ-39). The Unified Parkinson’s Disease Rating Scale (UDPRS) and 10-meter gait speed test were administered to assess PD patients’ physical function. PD dyads tandem cycled for 8 weeks, 2x/week, 15 to 45 minutes/session. Post-testing measures occurred 48 hours after the last session. Paired t-tests were conducted for statistical significance at p<0.05. Due to the research design being a pilot of a small sample size, changes from pre-testing are reported using the standard error of the mean (SEM).  
Results:
Post-intervention, care partners demonstrated individual improvements in overall resiliency via the BRS. PD patients demonstrated a minimum clinically important difference in the overall PDQ-39 score (-4.71, SEM=3.93, 95% CI=(-14.02, 4.59), p=0.27) post-intervention, with a significant improvement in the mobility dimension (-13.61, SEM=4.49, 95% CI= (-23.96,-3.26), p=0.02). Functionally, PD patients’ total UDPRS scores suggested a clinically relevant trend for a decrease (-8.00) from pre-testing to post-testing. PD patients’ 10-meter gait speeds suggested improvement (+0.27 m/s, SEM=0.06, 95% CI= (0.14,0.4), p=<0.01) post-intervention. 
Conclusions:
The findings from this pilot study suggest that a PD dyad tandem cycling program may improve the overall health and well being of both PD patients and their care partners. Future studies should be conducted with larger cohorts of participants to further explore the effectiveness of a tandem cycling intervention in PD dyads.  
10.1212/WNL.0000000000206004