Pushing the Pedals: Is Outdoor Cycling a Feasible Activity for People with Parkinson’s Disease?

Purpose: Physical activity levels tend to be lower in Parkinson’s disease (PD) than in healthy age-matched controls, largely because of substantial gait impairment. Remarkably, individuals with PD often retain a remarkable ability to cycle. However, so far, no evidence exists regarding the safety of patients when cycling outdoors in daily life. Therefore, the aim of this review is threefold: 1) to compare the mechanisms of cycling to those of walking, 2) to examine the symptomatic effects of stationary cycling, and 3) to highlight the challenges and opportunities to ensure safe outdoor cycling in PD.Major findings: Compared to walking, making cycling movements likely engages alternative neural circuits that largely bypass the most affected parts of the striatum in PD. Stationary cycling programs are therefore feasible and consistently improve physical fitness and motor symptom severity. Outdoor cycling may further increase physical activity levels, social participation and mobility in PD. However, its feasibility and safety are poorly studied, while there exist significant safety concerns linked primarily to poor balance, but also axial rotation, motor initiation and cognitive impairments. The present review discusses these challenges and considers which may be modifiable through future cycling-rehabilitation interventions.Conclusion: The relatively preserved ability to make cycling movements in PD makes outdoor cycling an attractive form of physical activity and promising strategy to enhance quality of life. However, further research is needed to assess outdoor cycling skills and inform rehabilitation interventions to ensure safe participation in a population for whom maintaining physical activity is essential.