Exercise Therapies for Parkinson's Disease: A Systematic Review and Meta-Analysis (original) (raw)
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Effects of Exercise-based Management on Motor Symptoms in Parkinsonamp Disease - A Meta-analysis
Journal of the College of Physicians and Surgeons Pakistan
Parkinson's disease (PD) is the second most common neurological illness after Alzheimer's disease. According to research, medication alone can give palliative alleviation; however, freezing of gait (FOG) and balance can be treated with physical therapy. This meta-analysis aims to bridge gaps about exercise-based therapy's impact on balance and FOG in patients with PD. Google Scholar, CINHAL, Medline, PubMed, and PEDro were searched for 2016-2021 citations using the PIOD paradigm. Pooled effect size mean and SD were analysed using a fixed and random effects model. A total of 21 trials were included in this review, with SMD=0.60 and p=0.0007 utilising BBS. The pooled analysis revealed statistically significant impacts on exercise-based management in the experimental group. With SMD=0.87 and p<0.00001 using Mini-BESTest, the pooled analysis revealed that exercise-based management was also effective on balance in the experimental group. The fixed effect model of FOG in terms of SMD was used to draw the pooled effects of FOG in terms of SMD and FOG in terms of SMD (0.21; 95 percent CI-0.01 to 0.44; p=0.06). According to this research, several physiotherapy approaches such as exergaming, gamepad systems, virtual reality, gait exercises, and core training, help Parkinson's patients regain balance and FOG.
The Universal Prescription for Parkinson’s Disease: Exercise
Journal of Parkinson's Disease, 2020
Over the past two decades, aerobic exercise has emerged as a mainstream recommendation to aid in treating Parkinson’s disease (PD). Despite the acknowledgement of the benefits of exercise for people with PD (PwPD), frequently, exercise recommendations lack specificity in terms of frequency, intensity and duration. Additionally, conflating physical activity with exercise has contributed to providing vague exercise recommendations to PwPD. Therefore, the beneficial effects of exercise may not be fully realized in PwPD. Data provided by animal studies and select human trials indicate aerobic exercise may facilitate structural and functional changes in the brain. Recently, several large human clinical trials have been completed and collectively support the use of aerobic exercise, specifically high-intensity aerobic exercise, in improving PD motor symptoms. Data from these and other studies provide the basis to include aerobic exercise as an integral component in treating PD. Based on p...
Trials
Background To date, no medication has slowed the progression of Parkinson’s disease (PD). Preclinical, epidemiological, and experimental data on humans all support many benefits of endurance exercise among persons with PD. The key question is whether there is a definitive additional benefit of exercising at high intensity, in terms of slowing disease progression, beyond the well-documented benefit of endurance training on a treadmill for fitness, gait, and functional mobility. This study will determine the efficacy of high-intensity endurance exercise as first-line therapy for persons diagnosed with PD within 3 years, and untreated with symptomatic therapy at baseline. Methods This is a multicenter, randomized, evaluator-blinded study of endurance exercise training. The exercise intervention will be delivered by treadmill at 2 doses over 18 months: moderate intensity (4 days/week for 30 min per session at 60–65% maximum heart rate) and high intensity (4 days/week for 30 min per sess...
Parkinson's disease, 2012
There is research evidence that exercise and motor training are beneficial for people with Parkinson's disease (PD), and clinicians seek to implement optimal programs. This paper summarizes important factors about the nature and reporting of randomized controlled trials of exercise and/or motor training for people with PD which are likely to influence the translation of research into clinical practice. Searches identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 (SD 4.2) weeks. Most interventions were fully supervised (74%) and conducted at a facility (79%). Retention rates were high with 69% of interventions retaining ≥85% of their participants; however adherence was infrequently reported, and 72% of trials did not report adverse events. Overall, the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to bala...
2020
Objective: The aim of the study was to conduct a systematic review evaluating the effects of physical exercise on balance and motor symptoms of Parkinson’s Disease. Method: The search was carried out on the PubMed, Scielo and PEDro databases. The articles were evaluated by two independent researchers, following the criteria: presenting a control group, having more than eight weeks of intervention, assessing motor symptoms (Unified Parkinson’s Disease Rating Scale and Parkinson’s Disease Questionnaire -39) and balance (Timed Up and Go and Berg Scale). Results: The search resulted in 1377 articles, of which 11 were included in the study. The total number of participants was 925, in which 545 were allocated in the intervention groups and 380 in the control groups. The strength training and balance, performed alone or in combination, are highlighted in improvements related to balance. Exercise, regardless of type, improves motor symptoms. Conclusions: Thus, physical exercise has a posit...
Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease
JAMA Neurology, 2013
To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease. Design: A comparative, prospective, randomized, singleblinded clinical trial of 3 types of physical exercise. Setting: The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center. Patients: A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. Interventions: (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lowerintensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months. Main Outcome Measures: The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [V O 2 ], and muscle strength (1-repetition maximum strength). Results: All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P = .001), stretching and resistance exercises (9% increase; P Ͻ .02), and higherintensity treadmill exercise (6% increase; P=.07), with no between-group differences. Both treadmill exercises improved peak V O 2 (7%-8% increase; PϽ.05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; PϽ .001). Conclusions: The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher-and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.
Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts
Movement Disorders Clinical Practice, 2019
Background Background: Exercise is gaining extreme relevancy as a new therapeutic intervention for Parkinson's disease (PD). However, the frequent misuse of the concepts exercise, physiotherapy, and physical activity limits the possibility of summarizing research findings. This review aims to clarify these concepts and summarize the evidence on exercise in PD. Methods Methods: We critically appraised physical activity-related concepts and conducted a systematic review of clinical trials evaluating exercise interventions in PD. Additionally, we discussed the implications for PD clinical practice and research. Results Results: Exercise is a subset of physical activity, and a major component of physiotherapy for PD management, having as the main goal to improve physical fitness. The appraisal of the 83 identified clinical trials found high variability in exercise interventions. Multimodal exercise was the most studied, and 60 minutes, two times/week for 12 weeks, the most reported prescription parameters. Conclusion Conclusion: The best available evidence recommends increasing physical activity levels in PD. Exercise and physiotherapy programs seem the most efficacious strategies to achieve this goal. As a result of the heterogeneity in the type and manner exercise is prescribed, it is not possible to propose strong recommendations for exercise in PD. We believe that, in addition to the clarification of concepts here presented, a collaborative and rigorous work of different areas of knowledge is needed.