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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. National Institutes of Health Clinical Trials Registration Number: NCT05826171<\/jats:p>","DOI":"10.63144\/ijt.2025.6713","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T22:46:54Z","timestamp":1766011614000},"source":"Crossref","is-referenced-by-count":0,"title":["Fatigue Limits Motor and Cognitive Improvements after High-intensity Exercise Prior to Balance Training over Telehealth in People with Spinocerebellar Ataxia"],"prefix":"10.63144","volume":"17","author":[{"given":"Chelsea E.","family":"Macpherson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatima","family":"Awad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vruta","family":"Rana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9412-931X","authenticated-orcid":false,"given":"Sheng-Han","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2982-923X","authenticated-orcid":false,"given":"Lori","family":"Quinn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"13351","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"14766","doi-asserted-by":"crossref","unstructured":"Ahlskog, J. 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