- Researchers looked at 156 randomized controlled trials which compared the benefits of engaging in one type of physical exercise for adults with Parkinson’s disease to another type of exercise, a control group, or both.
- They observed that many types of exercise proved beneficial for people with Parkinson’s compared to no exercise.
- Researchers found little evidence that certain types of exercises work better than others.
- Specific motor symptoms may be most effectively treated with programs designed specifically for Parkinson’s patients.
Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s disease, according to the Parkinson’s Foundation, a nonprofit organization that funds research and provides educational resources about the condition.
Experts are not sure what causes Parkinson’s. However, many believe a combination of genetic and environmental factors may be to blame.
The brains of people with Parkinson’s often exhibit a loss of
In a recent
Common symptoms of Parkinson’s include:
- slow movement
- limb stiffness
- gait and balance problems.
While there is currently no cure for Parkinson’s, there are medications and surgeries to treat the disease. Experts also believe lifestyle modifications can help.
A systemic review and network meta-analysis about the benefits of Parkinson’s patients undertaking regimens of physical exercise to manage the disease was recently published in the Cochrane Database of Systematic Reviews.
For more than
The Parkinson’s Outcomes Project, a clinical study of more than 13,000 individuals with Parkinson’s disease from five countries, which was launched in 2009, found that doing at least 2.5 hours of exercise per week can slow an individual’s decline in quality of life from the disease.
Scientists are learning more about the mechanics of how exercise helps individuals with Parkinson’s.
A 2022 study, for instance, found that a hormone produced during exercise reduces the levels of a protein responsible for Parkinson’s symptoms.
For this systematic review and network meta-analysis, researchers set out to compare the impacts of different types of physical exercise on adults with Parkinson’s disease.
The studies examined as part of the analysis looked at the benefits of exercise programs that the researchers divided into 10, broader, categories, namely:
- aqua‐based exercise
- gait/ balance/ functional exercise
- multi‐domain training
- mind‐body training
- endurance training
- flexibility training
- strength/ resistance training
- LSVT BIG — a physical therapy programmme that trains people with Parkinson’s disease to use their bodies with more ease.
“They really did try to cover, I think, really the range of the different types of exercises,” Dr. Giselle Petzinger, a neurologist and associate professor of neurology at the Keck School of Medicine at the University of Southern California, told Medical News Today. She was not involved in this research.
“The scope, I think, is pretty broad,” she added.
The researchers looked at the impact of these different types of exercise on both motor signs and quality of life. They also studied the adverse effects reported by different study investigators.
To begin, the researchers performed a systematic search for articles in eight databases, including Embase, as well as trial registries, conference proceedings, and reference lists of identified studies dated through May 2021.
The researchers included
Ultimately, the researchers included 156 RCTs with a total of 7,939 participants who, for the most part, had mild to moderate Parkinson’s with no major cognitive impairment.
The mean number of participants in the trials was 51. The included studies were conducted in several countries around the world, and the country with the most number of included cases was the United States.
The selected studies looked at the impacts of exercise up to 6 weeks following the intervention. The mean age of participants was between 60 years and 74 years. Three studies included only men, and the rest included both men and women.
Of the remaining studies, the proportion of men ranged from between 31% and 90%. In their paper, the researchers speculate that many of the studies had more male participants possibly because the risk of developing Parkinson’s is
Researchers analyzed the effects of the exercises using network meta‐analysis, which is
Specifically, the analysis examined the effects of the different forms of exercise on the severity of motor signs and quality of life. They also looked at the adverse effects of exercise.
Network meta-analyses were conducted on 71 trials involving 3,196 participants on the severity of motor signs and on 55 trials and 3,283 participants on the quality of life. Eighty-five studies and 5,192 participants provided safety data.
In their paper, the researchers express the effects of the different types of exercise on the severity of motor signs in individuals with Parkinson’s using scores from the Unified Parkinson Disease Rating Scale (UPDRS‐M).
Evidence from the network meta‐analyses on the impact of different types of exercise on the severity of motor signs was as follows:
- dance — evidence suggests a moderate beneficial effect
- aqua-based exercise — evidence suggests it “might have a moderate beneficial effect”
- gait/balance/functional exercise — evidence suggests it “might have a moderate beneficial effect”
- multi-domain training — evidence suggests it “might have a moderate beneficial effect”
- mind-body training — evidence suggests it “might have a small beneficial effect”
- endurance training — evidence suggests it “might have a small beneficial effect”
- flexibility training — evidence suggests it “might have a trivial or no effect”
- strength/resistance training — evidence very uncertain
- LSVT BIG — evidence very uncertain.
The researchers qualified the effects of the different types of exercise on the quality of life of individuals with Parkinson’s using scores from the Parkinson’s Disease Questionnaire 39. This is what they found:
- aqua-based training — evidence suggests “probably has a large beneficial effect”
- endurance training — evidence suggests “might have a moderate beneficial effect”
- gait/balance/functional exercise — evidence suggests “might have [a] small beneficial effect”
- multi‐domain training — evidence suggests “might have a small beneficial effect”
- mind-body training — evidence very uncertain
- gaming — evidence very uncertain
- strength-resistance training — evidence very uncertain
- dance — evidence very uncertain
- LSVT BIG — evidence very uncertain
- flexibility training — evidence very uncertain.
Only 85 of the selected studies provided any kind of safety data. No adverse events occurred in 40 of the RCTs studied. Adverse events did occur in 28 studies.
Eighteen studies reported that participants experienced falls, and 10 studies reported that they experienced pain. The analyses reported that the compiled evidence “is very uncertain about the effect of physical exercise on the risk of adverse events.”
The researchers did note that they observed little evidence of differences in adverse effects among the different types of exercises.
Dr. Petzinger appreciated that the study showed how the different types of exercise impacted the scores on the UPDRS‐M.
“It’s sort of the more traditional scale,” she told MNT. “So for those skeptics in the [Parkinson’s disease] field the idea is […] ‘What does this scale show you?’ It’s talking about a scale that most people in the [Parkinson’s disease] field would say ‘Yeah, that’s the most important scale to look at to convince me’.”
In conclusion, the researchers stress that many types of exercise are beneficial for improving the ability to move and the quality of life of individuals with Parkinson’s disease.
In their paper, the researchers note they found little evidence supporting the idea that one type of exercise may be better than another for individuals with Parkinson’s disease.
Nevertheless, “I think there [were] some subtle things with aqua therapy,” Dr. Petzinger noted.
The fact that, for the most part, the researchers did not find that one type of exercise really rises above the rest in delivering benefits for people with Parkinson’s disease means health practitioners have some flexibility when talking with their patients, according to Dr. Petzinger.
“Physicians are able to tell patients that their preferences [are] important,” she said.
In their paper, the researchers take time to note that specific motor symptoms might be relieved best with an exercise program designed especially for individuals with Parkinson’s disease.
Although the researchers describe the evidence about adverse effects in individuals with Parkinson’s disease who undertake exercise programs as uncertain, they note that the exercises detailed in the review “were described as relatively safe.”
In their paper, the researchers stress they would like to see larger, well-designed studies on the impact of different types of exercise on individuals with Parkinson’s disease, as well as research looking at the impact of exercise on individuals with advanced Parkinson’s disease and those with cognitive impairment.
Dr. Michael Okun, national medical advisor for the Parkinson’s Foundation and director at the Norman Fixel Institute for Neurological Diseases at the University of Florida Health, who was not involved in this review and analysis, appreciated having the data about the impact of different types of exercise for individuals with Parkinson’s disease.
“This Cochrane review puts an exclamation mark on what we already know: Exercise is beneficial for Parkinson’s disease,” he told MNT.
However, he agreed with the researchers that more research on exercise and Parkinson’s is needed.
“Where we fall short as a field is in providing more precision in the prescribing process,” Dr. Okun said.
“We need to inform clinicians recommending exercise with the data necessary to guide ‘how’ it should be conducted: The timing and frequency of exercise in Parkinson’s disease are critical yet largely unexplored areas. Finally, we need to understand more about the durability of a beneficial Parkinson’s disease ‘exercise effect’.”
– Dr. Michael Okun