By Evelyn Ooi, MD
Synopsis: In this randomized clinical trial comparing home high-intensity aerobic training to home balance training among individuals with cerebellar ataxias, investigators found that home high-intensity aerobic training improved ataxia symptoms, fatigue, and aerobic fitness more than dose-matched home balance training.
Source: Barbuto S, Lee S, Stein J, et al. Home training for cerebellar ataxias: A randomized clinical trial. JAMA Neurol. 2025;82(11):1162-1170.
Cerebellar ataxias are a heterogeneous group of disorders marked by progressive loss of coordination and balance, affecting approximately 150,000 individuals in the United States and imposing substantial healthcare costs in the absence of any definitive cure. Although balance training has shown modest benefits in symptom control, prior evidence suggests that aerobic exercise can promote neuroplasticity and slow neurodegeneration in other neurodegenerative diseases such as Parkinson’s and Alzheimer’s. Animal studies also have shown that aerobic activity can enlarge cerebellar structures and improve survival in ataxic mice. Building on these findings, the authors hypothesized that aerobic training could yield superior functional improvements over balance training in people with cerebellar ataxia.
To this end, researchers conducted a randomized clinical trial investigating the effects of home-based, high-intensity aerobic training compared with balance training in individuals with cerebellar ataxia. Conducted at Columbia University Medical Center between 2021 and 2023, the study enrolled 62 participants with varying ataxia types, all capable of performing stationary cycling and balance exercises. Participants were randomly assigned to either a home aerobic training program or a balance training regimen, both performed five times per week over six months, with follow-up assessments at nine and 12 months. The primary outcome was change in the Scale for the Assessment and Rating of Ataxia (SARA) score, while secondary measures included aerobic fitness (assessed via Vo2max), fatigue, gait, balance, and quality of life. Results demonstrated that participants in the aerobic training group experienced significantly greater improvements in ataxia symptoms compared to the balance group.
After six months, mean SARA scores improved by -2.4 points in the aerobic group vs. -0.9 points in the balance group, a clinically meaningful difference that persisted at nine and 12 months for those who maintained exercise adherence. The aerobic group also showed notable gains in fatigue reduction and cardiorespiratory fitness, with modest but non-significant improvements in gait and balance performance. Both interventions were well tolerated with no serious adverse events. The most common issues were mild pain in the aerobic group and minor falls in the balance group. Adherence to both regimens exceeded 70% during the supported phase but declined sharply after six months when formal monitoring ended, a trend that likely contributed to gradual reduction of benefits over time. Despite this limitation, the study provides compelling evidence that structured, high-intensity aerobic training, implemented at home and tracked through wearable devices, is safe, feasible, and more effective than balance training in improving motor symptoms, endurance, and fatigue in people with cerebellar ataxia.
Commentary
This study offers a valuable and timely contribution by showing that aerobic exercise significantly can improve functional outcomes in people with cerebellar ataxia, which currently has limited effective treatments. Rehabilitation for ataxia traditionally has focused on balance exercise and compensatory techniques, but the finding that aerobic training produced greater improvements in symptom severity and fatigue suggests that cardiovascular conditioning may promote neuroplasticity and enhance cerebellar function, even in the context of ongoing neurodegeneration. The home-based nature of the intervention, coupled with the use of wearable heart rate monitors and strong adherence during the supervised phase, demonstrates its practicality and potential for wide implementation without the need for intensive in-person oversight. Still, the decline in adherence once study support was withdrawn highlights a major challenge in clinical application (i.e., maintaining motivation and engagement over time). Future efforts might address this by incorporating virtual coaching, social incentives, or interactive elements to sustain participation.
Another strength of the study is its inclusion of heterogeneous ataxia subtypes, which broadens the relevance of findings to everyday clinical practice, although this heterogeneity also limits detection of subtype-specific effects. Overall, the results provide compelling evidence that aerobic exercise (often underused in ataxia care) should be part of standard rehabilitation as a safe, accessible, and potentially neuroprotective treatment. The study reinforces the growing recognition that physical activity can play a disease-modifying role, supporting not only motor improvement but also long-term functional maintenance.
Evelyn Ooi, MD, is Assistant Professor of Clinical Neurology and Assistant Attending Neurologist, NewYork-Presbyterian/Weill Cornell Medical Center.
