A novel methodological approach to understanding the cortical and subcortical effects of aerobic exercise in Parkinson's disease

Mandy Miller KoopAnson B RosenfeldtVisar BerkiAndrew BazykSara DavidsonNitesh Singh MalanSean J NagelBenjamin L. WalterJames LiaoJay Alberts^*

• Cleveland Clinic, Cleveland, United States

Introduction: Aerobic exercise mitigates symptoms of Parkinson's disease and may slow the disease progression; however, the mechanism underlying these improvements is not well understood. Here, the methodology for simultaneously recording local field potentials from the subthalamic nucleus (STN-LFP), cortical recordings using scalp EEGs and exercise performance metrics during a 40-minute aerobic cycling session are detailed. Data from a single PD patient are provided to demonstrate the utility and data integrity of the experimental set up. Methods: The Medtronic Percept™ DBS system was used to record and stream bilateral STN-LFP in the off therapy (off-DBS and off-antiparkinson medications) condition during a 40-minute aerobic exercise session. A 64-channel mobile EEG recorded cortical data. The neural data streams were synchronized via a TENS device that injected a specified electrical signal into the EEG and LFP recordings. Exercise performance metrics, heart rate, cadence, and power were synchronized with neural data and collected during the exercise session. The study is registered on ClinicalTrials.gov, trial identifying number NCT05905302 and NCT05972759. Results: Initial data indicate that STN-LFP, EEG, and exercise performance data can be synchronized, recorded for greater than 40 minutes and analyzed to evaluate how aerobic exercise impacts patterns of cortical and subcortical neural activity. Discussion: While exercise positively impacts symptoms of PD, the precise effects of exercise on network activity are lacking. The utilized methods of data collection and analyses of neural, cortical and subcortical, and exercise outcomes during a typical bout of aerobic exercise suggests this approach can be adopted for larger and long-term exercise studies in patients with PD and DBS. The described protocol provides a roadmap for future projects seeking to combine STN-LFP and cortical data to understand how exercise may be impacting the PD brain.