Fatigue Limits Motor and Cognitive Improvements after High-intensity Exercise Prior to Balance Training over Telehealth in People with Spinocerebellar Ataxia.

Objective: This pilot randomized controlled trial explored feasibility, and preliminary effects from remotely delivered high- versus low-intensity exercise prior to balance training for people with Spinocerebellar Ataxia (SCA). Methods: Twenty participants with SCA (types 1, 2, 3, or 6) were randomized to high- or low-intensity exercise (30 min), followed by balance training (30 min), delivered via telehealth twice-weekly for 8-weeks. Exercises were progressive and individualized based on ataxia severity, mobility, and home equipment. Outcomes included disease-specific measures (Scale for Assessment and Rating of Ataxia at home, Cerebellar Cognitive Affective Syndrome Scale), and fatigue (Fatigue Severity Scale) assessed at baseline, mid- and post-intervention. Results: Eighteen participants completed the intervention with high adherence. Both groups improved on disease-specific measures, with greater gains in cognition and reduced fatigue in the low-intensity group. Conclusions: Remote delivery of exercise and balance training is feasible in SCA. Fatigue may limit tolerability of higher exercise intensities.