The Effectiveness of Exercise Interventions for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Primary Care Research Group, Peninsula Medical School, Exeter, United Kingdom.
Movement Disorders (Impact Factor: 5.68). 04/2008; 23(5):631-40. DOI: 10.1002/mds.21922
Source: PubMed

ABSTRACT Parkinson's disease (PD) is a neurodegenerative disorder affecting the physical, psychological, social, and functional status of individuals. Exercise programs may be an effective strategy to delay or reverse functional decline for people with PD and a large body of empirical evidence has emerged in recent years. The objective is to systematically review randomized controlled trials (RCTs) reporting on the effectiveness of exercise interventions on outcomes (physical, psychological or social functioning, or quality of life) for people with PD. RCTs meeting the inclusion criteria were identified by systematic searching of electronic databases. Key data were extracted by two independent researchers. A mixed methods approach was undertaken using narrative, vote counting, and random effects meta-analysis methods. Fourteen RCTs were included and the methodological quality of most studies was moderate. Evidence supported exercise as being beneficial with regards to physical functioning, health-related quality of life, strength, balance and gait speed for people with PD. There was insufficient evidence support or refute the value of exercise in reducing falls or depression. This review found evidence of the potential benefits of exercise for people with PD, although further good quality research is needed. Questions remain around the optimal content of exercise interventions (dosing, component exercises) at different stages of the disease.

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Available from: Suzanne H Richards, Sep 26, 2015
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    • "Among many different types of physical exercising (e.g., resistance training, flexibility, coordination etc.), aerobic exercise training (AET) has been the most studied and has shown unequivocal health benefits across the life span (Voss, Nagamatsu, Liu-Ambrose, & Kramer, 2011), as well as in different clinical populations , such as PD. Specifically in PD, AET has been found to improve physical functioning, quality of life, and functional capacities (Ahlskog, 2011; Goodwin, Richards, Taylor, Taylor, & Campbell, 2008; Gracies, 2010; Herman, Giladi, & Hausdorff, 2009; Nadeau, Pourcher, & Corbeil, 2014; Petzinger et al., 2013; Speelman et al., 2011). For instance, progressive treadmill training has revealed mobility gains following 6 weeks of AET, resulting in improvements in both activities of daily living and quality of life in people with PD (Herman, Giladi, Gruendlinger, & Hausdorff, 2007). "
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    ABSTRACT: Aerobic exercise training (AET) has been shown to provide health benefits in individuals with Parkinson's disease (PD). However, it is yet unknown to what extent AET also improves cognitive and procedural learning capacities, which ensure an optimal daily functioning. In the current study, we assessed the effects of a 3-month AET program on executive functions (EF), implicit motor sequence learning (MSL) capacity, as well as on different health-related outcome indicators. Twenty healthy controls (HC) and 19 early PD individuals participated in a supervised, high-intensity, stationary recumbent bike-training program (3 times/week for 12weeks). Exercise prescription started at 20min (+5min/week up to 40min) based on participant's maximal aerobic power. Before and after AET, EF tests assessed participants' inhibition and flexibility functions, whereas implicit MSL capacity was evaluated using a version of the Serial Reaction Time Task. The AET program was effective as indicated by significant improvement in aerobic capacity in all participants. Most importantly, AET improved inhibition but not flexibility, and motor learning skill, in both groups. Our results suggest that AET can be a valuable non-pharmacological intervention to promote physical fitness in early PD, but also better cognitive and procedural functioning. Copyright © 2015 Elsevier Inc. All rights reserved.
    Brain and Cognition 08/2015; 99:68-77. DOI:10.1016/j.bandc.2015.07.005 · 2.48 Impact Factor
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    • "In recent years, the use of exercise to improve motor symptoms in PD has received great interest. Several meta-analyses investigating the effects of aerobic exercise interventions such as treadmill walking reported significant improvements to gait, balance, and cardiovascular fitness in people with moderate-to-severe PD (Goodwin et al., 2008; Shu et al., 2014). In particular, several studies have also reported beneficial effects on motor function, muscle strength, and endurance following progressive resistance training (PRT) (Brienesse and Emerson, 2013; Lima et al., 2013). "
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    ABSTRACT: The use of progressive resistance training (PRT) to improve gait and balance in people with Parkinson’s disease (PD) is an emerging area of interest. However, the main effects of PRT on lower limb function such as gait, balance and leg strength in people with PD remain unclear. Therefore the aim of the meta-analysis is to evaluate the evidence surrounding the use of PRT to improve gait and balance in people with PD. Five electronic databases, from inception to December 2014, were searched to identify the relevant studies. Data extraction was performed by two independent reviewers and methodological quality assessed using the PEDro scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) of fixed and random effects models were used to calculate the effect sizes between experimental and control groups and I2 33 statistics were used to determine levels of heterogeneity. In total, 7 studies were identified consisting of 172 participants (Experimental n=84; Control n=88). The pooled results showed a moderate but significant effect of PRT on leg strength (SMD 1.42, 95% CI 0.464 to 2.376), however no significant effects were observed for gait speed (SMD 0.418, 95% CI -0.219 to 1.055). No significant effects were observed for balance measures included in this review. In conclusion, our results showed no discernable effect of PRT on gait and balance measures, although this is likely due to the lack of studies available. It may be suggested that PRT be performed in conjunction with balance or task-specific functional training to elicit greater lower limb functional benefits in people with PD.
    Frontiers in aging series 03/2015; DOI:10.3389/fnagi.2015.00040
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    • "Particularly , the study of Tomlinson et al. [8] present an extensive review of physiotherapy treatments and their assessment of effectiveness and report that there is significant benefit of physiotherapy for a series of outcomes including functional activities for PD. Along the same lines, the review of Goodwin et al. [9] examined the effects of physiotherapy for PD and found evidence of physiotherapy being very beneficial to aspects of the patient's life like physical functioning and well-being. Moreover, Nimwegen et al. [10] studied levels of physical inactivity associated with PD, by quantifying and comparing levels of everyday activity in individuals with PD and a control group. "
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    ABSTRACT: The research presented in this paper proposes a set of design guidelines in the context of a Parkinson’s Disease (PD) rehabilitation design framework for the development of serious games for the physical therapy of people with PD. The game design guidelines provided in the paper are informed by the study of the literature review and lessons learned from the pilot testing of serious games designed to suit the requirements of rehabilitation of patients with Parkinson’s Disease. The proposed PD rehabilitation design framework employed for the games pilot testing utilises a low-cost, customized and off-the-shelf motion capture system (employing commercial game controllers) developed to cater for the unique requirement of the physical therapy of people with PD. Although design guidelines have been proposed before for the design of serious games in health, this is the first research paper to present guidelines for the design of serious games specifically for PD motor rehabilitation.
    Entertainment Computing 12/2014; 5(4). DOI:10.1016/j.entcom.2014.10.006
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