Remote Dynamic Cycling for the Customized Off-site Rehab in Parkinson's Disease

This research will develop novel and accessible way to deliver effective and customized rehab to those suffering from common and devastating neurodegenerative condition called Parkinson's disease. The investigators will examine the efficacy of novel rehab technique that can be monitored and modified in real-time but over virtual interface using a remotely located device in a paradigm called dynamic cycling. This technology will benefit thousands of Veterans who need customized and cost-effective rehab but cannot travel to specialized facilities due to inevitable limitations such as pandemics or because of lack of resources, social support, frailty, or home-bound status.

Inclusion Criteria: Diagnosis of PD using the UK Brain Bank criteria * Ability to perform informed consent. * Hoehn and Yahr (H\&Y) stages I-III when off medication, * Stable medical regimen of antiparkinsonian medication for at least six months Exclusion Criteria: * Montreal Cognitive Assessment Scoreless than 18 * Hamilton depression score of 20 or higher * Hamilton anxiety rating score greater than 24 * Clinical diagnosis including perinatal brain injury, stroke, and atypical parkinsonism * One or more signs or symptoms of untreated cardiovascular disease including Pain, discomfort in the chest, neck, jaw, arms or other areas that may result from ischemia - Shortness of breath at rest or with mild exertion - Dizziness or syncope - Orthopnea or paroxysmal nocturnal dyspnea - Ankle edema - Palpitations or tachycardia - Intermittent claudication - heart murmur - Unusual fatigue or shortness of breath with usual activity (ACSM Cardiovascular Risk Assessment)