Introduction
Parkinson’s disease (PD) is a progressive neurodegenerative disorder more common with age.
The prevalence of PD is rising worldwide in accordance with age: from 41/100,000 in 40 to 49 years; to 428/100,000 in 60 to 69 years; and 1903/100,000 in older than age 80. Some differences in prevalence occur by geographic location and sex.[1]
Symptoms of PD develop gradually and usually include motor problems such as tremors, slowness of movement, stiffness, and problems with balance and coordination. Other symptoms include emotional and mood disturbances, fatigue, constipation, sleep issues and cognitive issues. While there is no cure for PD, treatments such as exercise, medication, or surgery can help with managing symptoms.[2]
Exercise improves motor symptoms, functional mobility and quality of life scores in PD. The magnitude of effect is similar to that seen with medications.
Intervention
Structured exercise – many types of exercise have proven beneficial including dancing, training to improve gait, balance and movement, multi-exercise training, and mind-body training.
Examples: Dance 2–3 hrs week for 10–52 weeks, or typically exercise programs 30–60 min 3 times per week in a supervised group setting, though there is a wide variety of intensity and duration in the systematic review of 154 studies. [2]
Indication
People with Parkinson’s disease
Precautions / Adverse effects
Data on safety are from 85 of 154 studies in the review. A few studies reported falls or pain in intervention groups, but no data were provided for control groups. 40 studies reported no adverse events. Evidence on the risk of harm is uncertain.[2]
As the disease progresses, safety concerns may increase, and the availability of safe exercise options may decrease.
Availability
Structured and supervised PD specific exercise programs are likely to be more successful for pragmatic reasons, such as experience in working with patients with PD.
Description
Exercise can help improve the severity of movement-related symptoms and quality of life for people with PD compared with no exercise, according to a Cochrane review and network meta-analysis (NMA). The reviewed trials included people with mild to moderate PD with no major cognitive impairment.[2]
Motor signs and quality of life measured using the motor scale of the Unified Parkinson's Disease Rating Scale (UPDRS‐M) and the Parkinson's Disease Questionnaire 39 (PDQ‐39), respectively. Negative estimates reflect improvement. Full details on effect sizes and evidence certainty are available in the Cochrane review. [2]
Severity of motor signs
The following types of exercise likely have an effect on the severity of motor signs:[2]
- Dance and gait/balance/functional training may have a moderate beneficial effect.
- Multi-domain training may have a small beneficial effect.
- Endurance, aqua‐based, strength/resistance, and mind‐body training may have a small beneficial effect.
- The evidence is very uncertain about the effects of the PD-specific physical therapy "Lee Silverman Voice Training BIG" (LSVT BIG) and flexibility training.
Quality of life
For quality of life improvements, aqua‐based training probably has a large beneficial effect. Mind‐body, gait/balance/functional, and multi‐domain training and dance may have a small beneficial effect.[2]
Tips
- Consider the individual’s preferences for type of exercise.
- The review showed specific PD programs are likely effective and are consistent with the evidence but lack strong program-specific evidence or proof of superiority. Note the follow-up was mostly only for 6 weeks.
Grading
MODERATE (We are moderately confident in this research evidence, ie further research could have an important impact, which may change the estimates.)