The Effects of Exercise on Balance in Persons with Parkinson's Disease: A Systematic Review Across the Disability Spectrum

Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA.
Journal of neurologic physical therapy: JNPT (Impact Factor: 2.89). 04/2009; 33(1):14-26. DOI: 10.1097/NPT.0b013e3181990fcc
Source: PubMed

ABSTRACT Parkinson's disease is a progressive neurodegenerative disorder that affects neurophysiologic function, movement abilities, and quality of life (QOL). Research examining the effects of exercise has suggested benefits related to a variety of outcomes; however, no reviews have synthesized research findings across the spectrum of disability. This project sought to systematically review studies that examined the impact of exercise interventions on balance outcomes for people with Parkinson's disease, within the categories defined by the World Health Organization in the International Classification of Functioning, Disability, and Health (ICF) model.
A systematic review of medical literature databases was performed using keywords Parkinson's disease and exercise. Studies were eligible if the intervention included exercise and examined variables within one of the three ICF categories. Following the ICF model, outcomes regarding Body Structure and Function, Activity, and Participation were measured, respectively, in terms of postural instability, balance task performance, and QOL and fall events.
Within the Body Structure and Function category, there was moderate evidence that exercise resulted in improvements in postural instability. Within the Activity category, there was moderate evidence that exercise was effective for improving balance task performance. In contrast, within the Participation category, there was limited evidence that exercise resulted in improvements in QOL measures or fall events.
Regardless of the strength of the evidence, the studies reviewed all report that exercise resulted in improvements in postural stability and balance task performance. Despite these improvements, the number and quality of the studies and the outcomes used were limited. There is a need for longer term follow-up to establish trajectory of change and to determine if any gains are retained long term. The optimal delivery and content of exercise interventions (dosing, component exercises) at different stages of the disease are not clear.

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    • "Recent studies have provided evidence that exercise modalities can improve motor and nonmotor features of PD [24] [25] [26]. However, the effects of LSVT BIG therapy on nonmotor symptoms of PD have not yet been extensively studied. "
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    ABSTRACT: Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and non-motor symptoms of Parkinson’s disease (PD). Objective. To compare the effects of Lee Silverman Voice Therapy BIG (LSVT BIG therapy) versus a general exercise program (combined treadmill plus seated trunk and limb exercises) on motor and non-motor symptoms of PD. Methods. Eleven patients with early-mid stage PD participated in the prospective, double-blinded, randomized clinical trial. Both groups received 16 one-hour supervised training sessions over 4 weeks. Outcome measures included the Unified Parkinson’s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Modified Fatigue Impact Scale (MFIS). Five patients performed general exercise and six patients performed LSVT BIG therapy. Post-intervention evaluations were conducted at weeks 4, 12 and 24. Results. The combined cohort made improvements at all follow-up evaluations with statistical significance for UPDRS total and motor, BDI, and MFIS (p<0.05). Conclusion. This study demonstrated positive effects of general exercise and LSVT BIG therapy on motor and non-motor symptoms of patients with PD. Our results suggest that general exercise may be as effective as LSVT BIG therapy on symptoms of PD for patients not able to readily access outpatient LSVT BIG therapy.
    Parkinson's Disease 02/2015; 2015. DOI:10.1155/2015/586378 · 2.10 Impact Factor
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    • " al . ( 2011 ) evaluated aerobic exercise in an animal model of HPA and found that regular exercise prevents the decreased antioxi - dant enzyme activities and lipid peroxidation caused by HPA . Regular exercise has been proven to act as a neuroprotective factor in neurodegenerative diseases that involve oxidative stress in their physiopathology ( Dibble et al . 2009 ; Um et al . 2008 ) . Each exercise session normally increases reactive species due to increased metabolic de - mand which emphasizes the prospect of exercising with antioxidant supplementation , since the stress caused by each exercise session can effectively increase the antioxidant de - fenses ( Halliwell 2011 ) . Furthermore , alpha"
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    ABSTRACT: Hyperphenylalaninemia (HPA) leads to increased oxidative stress in patients with phenylketonuria (PKU) and in animal models of PKU. Early diagnosis and immediate adherence to a phenylalanine-restricted diet prevents HPA and, consequently, severe brain damage. However, treated adolescent and adult PKU patients have difficulties complying with the diet, leading to an oscillation of phenylalanine levels and associated oxidative stress. The brain is especially susceptible to reactive species, and oxidative stress might add to the impaired cognitive function found in these patients. The restricted PKU diet has a very limited nutrient content from natural foods and almost no animal protein, which reduces the intake of important compounds. These specific compounds can act as scavengers of reactive species and can be co-factors of antioxidant enzymes. Supplementation with nutrients, vitamins, and tetrahydropterin has given quite promising results in patients and animal models. Antioxidant supplementation has been studied in HPA, however there is no consensus about its always beneficial effects. In this way, regular exercise could be a beneficial addition on antioxidant status in PKU patients. A deeper understanding of PKU molecular biochemistry, and genetics, as well as the need for improved targeted treatment options, could lead to the development of new therapeutic strategies.
    Metabolic Brain Disease 05/2013; 28(4). DOI:10.1007/s11011-013-9414-2 · 2.40 Impact Factor
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    • "Therefore, exercise-specific differences in efficacy may have been overlooked. A recent review paper synthesized the effects of balance rehabilitation across the spectrum of PD disability [5]. This review systematically examined the impact of exercise interventions on balance outcomes on categories of disability defined by the World Health Organization in the International Classification of Functioning, Disability, and Health (ICF) model [20]. "
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    ABSTRACT: Background. It is widely believed that exercise improves mobility in people with Parkinson's disease (PD). However, it is difficult to determine whether a specific type of exercise is the most effective. The purpose of this study was to determine which outcome measures were sensitive to exercise intervention and to explore the effects of two different exercise programs for improving mobility in patients with PD. Methods. Participants were randomized into either the Agility Boot Camp (ABC) or treadmill training; 4x/week for 4 weeks. Outcome measures were grouped by the International Classification of Function/Disability (ICF). To determine the responsiveness to exercise, we calculated the standardized response means. t-tests were used to compare the relative benefits of each exercise program. Results. Four of five variables at the structure/function level changed after exercise: turn duration (P = 0.03), stride velocity (P = 0.001), peak arm speed (P = 0.001), and horizontal trunk ROM during gait (P = 0.02). Most measures improved similarly for both interventions. The only variable that detected a difference between groups was postural sway in ABC group (F = 4.95; P = 0.03). Conclusion. Outcome measures at ICF body structure/function level were most effective at detecting change after exercise and revealing differences in improvement between interventions.
    Parkinson's Disease 04/2013; 2013:572134. DOI:10.1155/2013/572134 · 2.10 Impact Factor
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