Levels of riders

The Parkinson’s Cycling Program typically sees 3 types of riders. These are:
1. Beginner level
2. Transitional Level
3. Athlete

Level 1 rider
The Beginner or level 1 rider is usually a novice rider at the beginning of the program.

• He/She Requires assistance with seat and handlebar placement

• Requires assistance mounting and dismounting the bike

• Maintains a voluntary RPM unless coached to increase cadence

• Maintains a lower intensity heart rate unless coached to increase

• Continues a work interval of less than 3 minutes

This rider is typically a rider who is just beginning the Parkinson’s Cycling Program.  However, approximately 15% of riders who begin the Parkinson’s Cycling Program will not achieve the Rpm or heart rate goals at the end of 12 weeks.  As coaches, the continued encouragement and support is paramount.

Level 2 rider
The Transitional level 2 rider is usually a rider who has been in the Program for approximately 4 weeks.

• Able to set own seat and handlebar placement

• Able to mount and dismount with bike without assistance

• Can increase Rpm or cadence to required levels when instructed

• Can bring heart rate into appropriate training heart rate zones

• Can maintain work intervals 3-5 minutes when coached

• This rider is able to feel and see some symptom management changes.
• His/Her flexibility is improving.

Level 3 rider
The Athlete or Level 3 rider is seeing the results from building an aerobic base.

• Able to adjust seat and handlebar placement

• Able to mount and dismount the bike without assistance

• Achieves the 80-90 RPM or cadence when coached

• Successfully uses the correct heart rate zone parameters during interval training

• Maintains work intervals 5-9 minutes when coached

• This rider is able to feel and see positive symptom management changes.
• Flexibility is improving, everyday activities might become easier.

Utilizing these Levels to categorize participants in the Parkinson’s Cycling Program is helpful to the coach.

This information is helpful in grouping participants together with the same skills.        

  Or:

                                                                                                                  
Consider placing a Beginner (Level 1) rider with a Transitional (Level 2) for helpful peer encouragement.

Be mindful of “pigeonholing” these levels of riders. Moving from one level to another can and does occur.
After several class sessions, the Parkinson’s Cycling Coach gets to really know the riders or participants. The Parkinson’s participants can have good and bad days. Observing the participants as they enter the cycling room can reveal a lot of information to the coach. If a rider comes into the room off balance and holding onto the wall and bike, the coach should always offer help to mount and dismount the bike even though that rider has consistently been a Transitional rider. The instructor might be more mindful of that rider’s other abilities during that particular class. It might be necessary to curb the intensity of the intervals for that particular class. Record that information for a reminder review for the next class.
Sample post:
Larry had a good day today. But when he came into the room, his balance was a little off. He was shuffling his feet. After he left the class, he was taking larger steps and balance was improved.

Continue to encourage eating a good breakfast, taking medications on time, and hydration before coming to class. Always, always, always, monitor individual intensity levels appropriately.

Goal setting for riders

These classes can be heterogeneous. This means that each individual can control his or her intensity level to best suit ability and fitness level. Active and dynamic encouragement will help all riders achieve their level of success. Coaches will use the practical and technical advice learned in the Parkinson’s Cycle Coach Program for improving aerobic base and increasing RPMs.

Most of these riders will be de-conditioned or aerobically challenged. RPMs are voluntary usually riding at 55-60 RPMs. Working with these participants to increase RPMs is priority here. The results of this program are driven with RPMs between 80-90. This rider and coach will work on increasing the participant’s RPMs during the first 3 months of the class.
For example:
The instructor separates the goals into smaller goals.

1. RPMs or cadence building
The rider has 3 months to get to 80RPMs.
1st month or 1st 4 weeks – the rider gets to 60Rpms during the work intervals
2nd month or 8 weeks- the rider pedals at 70 Rpms during the work intervals
3rd month or 12 weeks- the rider pedals at 80 Rpms during the work intervals
In conclusion, start this rider at 60 Rpms and encourage the rider to pedal up to 80 Rpms by the end of 12 weeks.
2. Measuring Heart rate /Aerobic base building
Use the initial heart rate parameters as the guideline for exertion level. It is a good idea to keep the heart rate at the lower end of the zone as the rider builds cadence. After 4 weeks, add 5% points to the heart rate. This will encourage aerobic base building.
For example:
Katie’s initial assessment test shows a heart rate of 90. After 4 weeks encourage the rider to bring the heart rate to approximately 95 bpm during the ride intervals. Add 5% to the heart rate after 8 weeks, 12 weeks, etc.

3. Time in work intervals
This goal is achieved at a faster rate than the 2 previous goals.
Example:
The rider can maintain the work effort for 1 minute to start with. Keep that work effort at 1 minute for the first 2 weeks. During the 3rd week increase that work effort to 90 seconds or 1-½ minutes. The instructor sets new goals every 2 weeks depending on the rider’s progress and success.

4. Wattage or power
Wattage is a little more difficult to work with because of the participants age. Small increments are possible but no more that 10 or 15% at a time.
Example:
If the initial wattage or power is 50, do not expect more that 5-7 increases in power or wattage every week.

Review progress of the rider every 2 weeks. Encourage and support this rider.

Approximately 15% of riders will not achieve these goals at the end of 12 weeks. The coach continues to encourage and support this rider. Remember that part of the success of this program is the group or peer support. It is also helpful for building aerobic base. The rider may not get everything we want them to from the program to help with symptomatic management, but they will get peer support and a more conditioned cardiovascular system.

Individual rider Bike set up

The set up for this special class will be different than a regular indoor cycling class.  The riders can have issues with balance, flexibility, and core strength. To accomodate some of these issues the seat height and handlebar placement are important for a good pedal stroke as well has shoulder and neck comfort.
1. Adjusting the seat height
A rough estimate of the seat height can be obtained by asking the rider to stand next to the bike with the seat at hip bone level.
Allow the rider to mount the bike if they are capable (sometimes they need a step up) but we must realize that most will need help.
Drop the seat height lower then the hip.
The rider straddles the bike.
The rider slides back onto the saddle standing with help holding onto the handlebars.

The Parkinson’s Cycling Coach can then adjust the seat height to the appropriate level without asking the rider to dismount. Remember, most of these riders have muscle stiffness and limited flexibility. Adjusting the seat lower than normal riding level will provide a more efficient pedal stroke at the beginning. After a few classes, he/she might need their seat elevated to a normal riding level.

Specialty seats or using gel padded a seat cover might be more comfortable for the riders. We all know how we can experience “saddle soreness” when we sit on our saddles for 50 mins. Can you imagine someone with limited core strength and limited flexibility?
Here is an example of a specialty seat that might work for you and your participants.

Speciality wide cushioned seat/ Typical indoor cycling seat

Please inform the rider that he/she will experience some soreness at the beginning of their riding experience. Products like Glide or other chamois products can help prevent that soreness. Also cushioned padded bike shorts are also a good recommendation.

Some riders experience a feeling of “sliding forward” on the seat. Using an adjustable wrench, tip the front of the saddle up slightly. This will encourage a ride that feels more stable.

If the rider has used a step to mount the bike be sure to pull the step away after the rider is on the bike.

After safely mounting the bike, help him/her to place feet into the cages and secure the straps. Have the rider take a few pedal strokes around. Then ask him/her to stop pedaling keeping the pedal at the bottom of the pedal stroke. There should be a slight bend in the knee of about 25-35 degrees.

Keep adjusting the saddle up or down until the correct angle has been achieved.

2. Handlebar placement

Handlebar are set in the highest position. This helps keep the riders upright with proper hand placement. If the rider feels that they are still leaning too far forward, offer a few towels to be stacked on the handlebars for more of a “lift” through the chest and core. Shoulders remain down, elbows slightly bent, chest open to allow for a full breath.

3. Fore and aft position

The horizontal placement of the saddle, or forward and backward, should keep the knee tracking behind the toes. The knee is placed over the center of the pedal. Adjust the horizontal saddle position until the proper position has been found.

Recheck all seat positions and then record of all seat adjustments. We want he or she to be as comfortable and as secure as possible.

4. Explain the knob that controls resistance. Clockwise provides more resistance and counterclockwise takes that resistance away. Usually the same knob will be the emergency break. Let the rider know that the flywheel is weighted and heavy. Explain that the flywheel will continue to circle even though his or her foot has come out of the cage. Have them pedal and then press down on the emergency break so they understand how to stop the flywheel if necessary.

5. Have the rider begin pedaling lightly with little or no resistance. Show the rider the RPM number and what it means. Next, help them place the heart rate transmitter strap adjusting and placing it correctly on the rider. Explain that the transmitter has a sensor which will pick up the heart rate and transmit to the bike’s computer.  Make sure the transmitter is moist. Using a few drops of water should be sufficient to create the transmission. If the heart rate monitor strap does not make a good connection with the rider’s  chest, consider sliding the transmitter to the middle of the upper back. The connection at that point should be better for riders with a slight hollowing of the front of the chest due to the forward slumping of the shoulders. This alternative could also be for a rider who has an abundant amount of chest hair.

A quick review of the individual’s heart rate parameters is appropriate at this time.

Most riders will be able to correctly set their handlebars and seat placement after a few weeks of coming to class. This is encouraged but not required. If the riders are able to set their own handlebars and seats, it seems to give them a bit of ownership and control over their bodies and the Parkinson’s Cycling class.

Other factors to consider

1. Encourage the riders to eat a balanced breakfast –  In some people with Parkinson’s Disease, amino acids (from dietary protein) can interfere with the uptake of levodopa into the brain.  This means eating high-protein food (such as meat, fish, poultry and dairy products) can decrease the effectiveness of levodopa.  The doctor should encourage the participant to balance his protein intake with his dosage of medication.

2.  Hydration- Our older participants have a tendency to lose their drink mechanism.  Coaches should recommend drinking 8-16 ounces of water at least 30 minutes before attending class. Coaches also need to encourage and remind the riders to drink frequently throughout the class. Drink during exercise!!  American College of Sports Medicine recommends drinking 20 oz of water for 30 minutes of exercise.

3. Take their medications as prescribed by their doctor.

4. Needing to visit the restroom prior to coming to class is encouraged. Sometimes it is needed during class. That is ok too.

Most riders will be able to correctly set their handlebars and seat placement after a few weeks of coming to class. This is encouraged but not required. If the riders are able to set their own handlebars and seats, it seems to give them a bit of ownership and control over their bodies and the Parkinson’s Cycling class.

What should the riders wear during the Parkinson’s Cycling Class?

Encourage the riders to wear active wear that can remain comfortable during exercise. Short sleeved “dri-fit” tops are helpful. But with some Parkinson’s individuals thermo-regulation is an issue due to age, medication side effects, or disease. If the rider is usually cold, ask them to wear a long sleeved shirt or jacket to wear until the body can warm. At that time it is important to remove that so the rider can ride comfortably. Some individuals will perspire a lot from exercise or disease issues. Always encourage appropriate hydration.
Ladies can wear shorts or capris and men should wear shorts so not to interfere with the pedal stroke. Shorts or capris are also helpful when setting the correct position of the riders. You are able to see the correct placement of the foot on the pedal as well as the rotation of the pedal stroke.
Athletic shoes are a good choice for footwear. Most participants will find that Velcro straps are convenient and allow for a good fit. Some riders will eventually decide to purchase cycling shoes with clips.