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


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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    • "For example the Parkinson Society of Canada [9] provides online detailed instructions on how to correctly perform stretching and other physical exercises. Exercise interventions in randomized controlled trials [10] prove that physical exercise such as stretching, aerobics, unweighted or weighed treadmill and strength training improves motor functionality (leg stretching, muscle strength, balance and walking) and quality of life. In addition, the " training BIG " strategy for PD rehabilitation [11] has also shown promising results: exercises that focus on amplitude training lead to faster upper and lower limb movements. "
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    ABSTRACT: Parkinson's Disease (PD) is a progressive neurodegenerative movement disorder that affects more that 6 million people worldwide. Motor dysfunction gradually increases as the disease progress. It is usually mild in the early stages of the disease but it relentlessly progresses to a severe or very severe disability that is characterized by increasing degrees of bradykinesia, hypokinesia, muscle rigidity, loss of postural reflexes and balance control as well as freezing of gait. In addition to a line of treatment based on dopaminergic PD-specific drugs, attending neurologists strongly recommend regular exercise combined with physiotherapy. However, the routine of traditional rehabilitation often create boredom and loss of interest. Opportunities to liven up a daily exercise schedule may well take the form of character-based virtual reality games which engage the player to physically train in a non-linear and looser fashion, providing an experience that varies from one game loop the next. Such "exergames", a word that results from the amalgamation of the words "exercise" and "game" challenge patients into performing movements of varying complexity in a playful and immersive virtual environment. In fact, today's game consoles using controllers like Nintendo's Wii, Sony PlayStation Eye and the Microsoft Kinect sensor present new opportunities to infuse motivation and variety to an otherwise mundane physiotherapy routine. But are these controllers and the games built for them appropriate for PD patients? In this paper we present some of these approaches and discuss their suitability for these patients mainly on the basis of demands made on balance, agility and gesture precision.
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    • "Regular physical exercise is considered to be a potential prophylactic and therapeutic recommendation for various disorders due to its impact on the improvement of cognitive function [6] [7], reduction of anxiety and depression [8] and the ability to protect the brain against neurodegenerative disorders [9] [10]. "
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    ABSTRACT: Epigenetics has recently been linked to molecular adaptive responses evoked by physical exercise and stress. Herein we evaluated the effects of physical exercise on global DNA methylation and expression of the Dnmt1 gene in the rat brain and also verified its potential to modulate responses evoked by repeated restraint stress (RRS). Wistar rats were classified into the following experimental groups: 1) physically active (EX): animals submitted to swimming during postnatal days 53-78 (PND); 2) Stress (ST): animals submitted to RRS during 75-79PND; 3) Exercise-stress (EX-ST): animals submitted to swimming during 53-78PND and to RRS during 75-79PND, and 4) Control (CTL): animals that were not submitted to intervention. Samples from the hippocampus, cortex and hypothalamus were obtained at 79PND. The global DNA methylation profile was assessed using an ELISA-based method and the expression of Dnmt1 was evaluated by real-time PCR. Significantly increased methylation was observed in the hypothalamus of animals from the EX group in comparison to CTL. Comparative analysis involving the EX-ST and ST groups revealed increased global DNA methylation in the hippocampus, cortex, and hypothalamus of EX-ST, indicating the potential of physical exercise in modulating the responses evoked by RRS. Furthermore, decreased expression of the Dnmt1 gene was observed in the hippocampus and hypothalamus of animals from the EX-ST group. In summary, our data indicate that physical exercise affects DNA methylation of the hypothalamus and might modulate epigenetic responses evoked by RRS in the hippocampus, cortex, and hypothalamus. Copyright © 2015. Published by Elsevier B.V.
    Behavioural brain research 09/2015; 296. DOI:10.1016/j.bbr.2015.08.038 · 3.03 Impact Factor
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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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