Effect of Training on Brain Volume in Ataxia

• ClinicalTrials.gov Identifier: NCT04837027
• Recruitment Status: Recruiting
• First Posted: April 8, 2021
• Last Update Posted: January 11, 2022
• Sponsor: Columbia University
• Information provided by (Responsible Party): Scott Barbuto, Columbia University

Study Description

Brief Summary:

The primary aim is to show balance training improves DCD individual's ability to compensate for their activity limitations, but does not impact disease progression.

The second aim is to demonstrate aerobic exercise improves balance and gait in DCD persons by affecting brain processes and slowing cerebellar atrophy.

Condition or disease	Intervention/treatment	Phase
Spinocerebellar Ataxias	Behavioral: Aerobic training; Behavioral: Balance training	Not Applicable

Detailed Description:

Individuals with degenerative cerebellar disease (DCD) exhibit gradual loss of coordination resulting in impaired balance, gait deviations, and severe, progressive disability. With no available disease-modifying medications, balance training is the primary treatment option to improve motor skills and functional performance. There is no evidence, however, that balance training impacts DCD at the tissue level.

Aerobic training, on the other hand, may modify DCD progression as evident from animal data. Compared to sedentary controls, aerobically trained DCD rats have enhanced lifespan, motor function, and cerebellar Purkinje cell survival. Numerous animal studies also document that aerobic training has a direct, favorable effect on the brain that includes production of neurotrophic hormones, enhancement of neuroplasticity mechanisms, and protection from neurotoxins.

The effects of aerobic training in humans with DCD are relatively unknown, despite these encouraging animal data. A single study to date has evaluated the benefits of aerobic exercise on DCD in humans, and this was a secondary outcome of the study. Although participants performed limited aerobic training during the study, modest functional benefits were still detected.

The main objective of this project will be to compare the benefits of aerobic versus balance training in DCD. We hypothesize that both aerobic and balance training will improve function in DCD subjects, but that the mechanisms in which these improvements occur differ. 1) Balance training improves DCD individual's ability to compensate for their activity limitations, but does not impact disease progression. 2) Aerobic exercise improves balance and gait in DCD persons by impacting the cerebellum

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 36 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Single blinded randomized controlled trial
• Masking: Single (Outcomes Assessor)
• Masking Description: The outcome assessor will know that the participant has received balance or aerobic training, but will not be aware of which group the participant belonged.
• Primary Purpose: Treatment
• Official Title: Balance Versus Aerobic Training in Degenerative Cerebellar Diseases
• Actual Study Start Date: September 1, 2021
• Estimated Primary Completion Date: June 2022
• Estimated Study Completion Date: July 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Aerobic training; Participants will be given a stationary exercise bike for home use. They will be instructed to use the exercise bike five times a week for thirty-minute sessions. The exercise intensity prescription will be based on the subject's VO2max determined on pre-test day. The exercise program will start at 60% of intensity per session, and then will be increased by steps of 5% intensity every 2 sessions until participants reach 30 minutes of training at 80% intensity. Participants will be contacted weekly by e-mail or phone to answer any questions about the exercise protocol and will be instructed to log each training session. Subjects will record duration of exercise, perceived exertion, average heart rate, maximum heart rate, and distance.	Behavioral: Aerobic training; Aerobic training on stationary bike 5x a week for 30 minutes a day
Active Comparator: Balance training; Balance Training A physical therapist will tailor a home balance training program for each participant based on pre- training capabilities. Subjects will be asked to perform exercises five times a week for thirty-minute sessions. Both dynamic and static exercises will be performed in sitting and standing positions. Exercises will start with stabilizing in a challenging static position and progress to dynamic arm and leg movements in the same or modified position. Participants will be contacted weekly by e-mail or phone to answer any questions about the exercise protocol and will be required to log their exercise effort in terms of frequency and level of balance challenge. Individuals will be instructed to perform more difficult exercises if balance	Behavioral: Balance training; Training 5x a week for 30 minutes. Standard of care

Outcome Measures

Primary Outcome Measures :

1. Cerebellar volume [ Time Frame: 6 months ]

   Cranial MRI will be performed in all participants using a 3-T scanner. Using each individual's T1-weighted image, structural imaging measures of cerebellar brain volume will be derived using the FreeSurfer software package (http:// surfer.nmr.mgh.harvard.edu/). FreeSurfer will automatically assign a neuroanatomic label to each voxel. From this labeling, a set of volumetric regions of interest is defined. The calculated volume within the cerebellar region is adjusted for variations in individual's intracranial brain volume (ICV) which is measured using BrainWash (an automatic

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   multi-atlas skull-striping software package). We will process the longitudinal T1-weighted images

Secondary Outcome Measures :

1. Cognition [ Time Frame: 6 months ]
   The NIH toolbox will be used before and after training to determine impact of training on cognition
2. Ataxia severity [ Time Frame: 6 months ]
   The Scale for the Assessment and Rating of Ataxia (SARA) will be done to before and after training. This scale ranges from 0 to 40 with higher scores indicating more ataxia
3. Gait speed [ Time Frame: 6 months ]
   Participants will walk 8 meters as fast as possible
4. Balance [ Time Frame: 6 months ]
   The dynamic gait index will be performed to test balance

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Diagnosed with spinocerebellar ataxia

  • Cerebellar atrophy on MRI
  • Prevalence of ataxia on clinical exam
  • Ability to safely ride a stationary exercise bike

Exclusion Criteria:

• Other neurologic conditions • Heart disease

  • Cognitive impairment
  • Medical instability

Contacts and Locations

Contacts

Contact: Scott Barbuto, MD PhD; 212-305-3535; Sb3779@cumc.Columbia.edu

Locations

United States, New York

Columbia University Medical Center; Recruiting

New York, New York, United States, 10032

Contact: Scott Barbuto

Sponsors and Collaborators

Columbia University

Investigators

• Principal Investigator: Scott Barbuto, MD PhD; Columbia University

More Information

• Responsible Party: Scott Barbuto, Primary investigator, Columbia University
• ClinicalTrials.gov Identifier: NCT04837027
• Other Study ID Numbers: AAAT1306
• First Posted: April 8, 2021
• Last Update Posted: January 11, 2022
• Last Verified: December 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Scott Barbuto, Columbia University:

Ataxia; Cerebellum; Cerebellar degeneration

Additional relevant MeSH terms:

Ataxia; Cerebellar Ataxia; Spinocerebellar Ataxias; Spinocerebellar Degenerations; Dyskinesias; Neurologic Manifestations; Nervous System Diseases; Cerebellar Diseases; Brain Diseases; Central Nervous System Diseases; Spinal Cord Diseases; Heredodegenerative Disorders, Nervous System; Neurodegenerative Diseases; Genetic Diseases, Inborn