The efficacy and safety of moderate aerobic exercise for patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Exercise therapy is an important component of non-drug treatment for Parkinson's disease (PD). However, the impact of moderate aerobic exercise on PD remains unclear. The purpose of this systematic review was to evaluate the efficacy and safety of moderate aerobic exercise for patients with PD. Methods: Databases including the Cochrane Library, PubMed, Web of Science, EMBASE, Chinese Biomedical Literature (CBM) Database, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Weipu Database for Chinese Technical Periodicals (VIP) were searched electronically from the date of inception of the database to June 2020 to recruit relevant randomized controlled trials (RCTs) investigating the efficacy and safety of moderate aerobic exercise on balance and other symptoms in patients with PD. Literature screening, data extraction, and quality evaluation were carried out. Revman5.1 (http:// ims.cochrane.org/revman) was used for data analysis. Results: In total, nine RCTs with 444 patients were included in this study. Most of the included trials had a low risk of bias and high methodological quality. The meta-analysis suggested that moderate aerobic exercise is effective in improving balance [weighted mean difference (WMD) =−0.42, 95% confidence interval (CI): −0.59 to −0.25, P<0.001] and gait (WMD =49.97, 95% CI: 17.84-82.10, P<0.001) in patients with PD, but not in motor symptoms (WMD =−2.14, 95% CI: −4.86-0.58, P=0.12). Subgroup analysis showed that the improvement in the quality of life of PD patients was affected by different types of exercise, and the treadmill subgroup improved significantly (WMD =−3.90, 95% CI: −5.02 to −2.78), P<0.001).Conclusions: On the whole, moderate aerobic exercise effectively improves balance and gait in patients with PD, but the effect on motor symptoms is not obvious. Different exercise styles have varying effects on the quality of life of PD patients. It is necessary to standardize the exercise program further and carry out indepth research in the future.

Parkinson’s disease and intensive exercise therapy — An updated systematic review and meta‐analysis

“…Since the original literature search, a number of systematic reviews have been published 86–89 . However, these studies only included ET 89 or RT 86,87 exercise studies alone, only used the PEDro scale for quality assessment of individual studies, 86 reported no clear requirements of exercise intensity, 87,88 and reported minimal information (i.e., no clear definition) of ET or RT 88 …”

“…Since the original literature search, a number of systematic reviews have been published. [86][87][88][89] However, these studies only included ET 89 or RT 86,87 exercise studies alone, only used the PEDro scale for quality assessment of individual studies, 86 reported no clear requirements of exercise intensity, 87,88 and reported minimal information (i.e., no clear definition) of ET or RT. 88 Thus, the present review covers both ET, RT, and OITM, extends quality assessment of individual studies (i.e., TESTEX assessment), and applies strict definitions of included exercise modalities.…”

Biomechanical responses of Nordic walking in people with Parkinson's disease

“…13 Aerobic exercise appears to improve gait, cardiovascular capacity, and drug effect. 14 Nordic walking (NW) is a type of exercise intervention that uses a specifically designed pole, with the contribution of the upper body limbs to aid in the displacement of the body moving forward, which generates two propulsive actions in addition to the gait cycle. 15 The NW technique is characterized by a longer stride and a higher range of upper and lower limbs motion, 16 due to the contralateral coordination between the arms and legs.…”

“…Aside from its benefits to neuropathological aspects, physical exercise is a strategy to aid drug treatment and reduce the harmful effects of Parkinson's disease because it increases the receptors of dopaminergic neurons 13 . Aerobic exercise appears to improve gait, cardiovascular capacity, and drug effect 14 . Nordic walking (NW) is a type of exercise intervention that uses a specifically designed pole, with the contribution of the upper body limbs to aid in the displacement of the body moving forward, which generates two propulsive actions in addition to the gait cycle 15 .…”

Synchronous and asynchronous remote exercise may improve motor and non-motor symptoms in people with Parkinson’s disease during the COVID-19 pandemic

“…5 It is well-established that higher levels of physical activity improve PD-related symptoms. 6 On the other hand, lower level of physical activity increases motor (e.g., rigidity, tremor, akinesia, bradykinesia, unbalance, freezing of gait) and non-motor (e.g., depression, anxiety, sleep disturbance, fatigue) symptoms. 7 Thus, keeping physically active can be a good strategy to avoid the negative effects of routine changes due to the COVID-19 pandemic in people with PD.…”