Efficacy and evaluation of therapeutic exercises on adults with Parkinson's disease: a systematic review and network meta-analysis

Yong Yang; Guotuan Wang; Shikun Zhang; Huan Wang; Wensheng Zhou; Feifei Ren; Huimin Liang; Dongdong Wu; Xinying Ji; Makoto Hashimoto; Jianshe Wei

doi:10.1186/s12877-022-03510-9

Efficacy and evaluation of therapeutic exercises on adults with Parkinson's disease: a systematic review and network meta-analysis

BMC Geriatr. 2022 Oct 21;22(1):813. doi: 10.1186/s12877-022-03510-9.

Authors

Yong Yang^{1

2}, Guotuan Wang², Shikun Zhang³, Huan Wang⁴, Wensheng Zhou⁵, Feifei Ren⁶, Huimin Liang^{1

7}, Dongdong Wu^{1

8}, Xinying Ji^{1

8}, Makoto Hashimoto⁹, Jianshe Wei^{10

11

12

13}

Affiliations

¹ Institute for Brain Sciences Research, School of Life Sciences, Shunhe District, Henan University, 85 Minglun Rd, Kaifeng City, 475001, China.
² Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, Kaifeng, 475001, China.
³ Department of Police Physical Education, Jiangsu Police Institute, Nanjing, China.
⁴ Department of Orthopedics, the Second Affiliated Hospital of Air Force Medical University, Xi 'an, China.
⁵ College of Physical Education, Nanjing Xiao-Zhuang University, Nanjing, China.
⁶ Department of Physical Education, Beijing Language and Culture University, Beijing, China.
⁷ Henan Medical School, Parkinson's Disease Research Center, Henan University, Kaifeng, China.
⁸ Henan International Joint Laboratory for Nuclear Protein Regulation, Henan Medical School, Henan University, Kaifeng, China.
⁹ Tokyo Metropolitan Institute of Medical Science, Setagaya Ku, 2-1-6 Kamikitazawa, Tokyo, 1560057, Japan.
¹⁰ Institute for Brain Sciences Research, School of Life Sciences, Shunhe District, Henan University, 85 Minglun Rd, Kaifeng City, 475001, China. jswei@henu.edu.cn.
¹¹ Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, Kaifeng, 475001, China. jswei@henu.edu.cn.
¹² Henan Medical School, Parkinson's Disease Research Center, Henan University, Kaifeng, China. jswei@henu.edu.cn.
¹³ Henan International Joint Laboratory for Nuclear Protein Regulation, Henan Medical School, Henan University, Kaifeng, China. jswei@henu.edu.cn.

Abstract

Background: Exercises are an effective treatment in Parkinson's disease (PD), but there is still controversy over which types should be used. We aimed to compare and rank the types of exercise that improve PD symptoms by quantifying information from randomised controlled trials.

Methods: We performed a systematic review and network meta-analysis and searched PubMed, MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and China National Knowledge Infrastructure (CNKI) from their inception date to June 30, 2022. We included randomized controlled trials of 24 types of exercise for the interventional treatment of adults (≥ 50 years old) with PD. Effect size measures were standardized mean differences (SMDs) with 95% credible intervals (CrIs). The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA).

Results: We identified 10 474 citations and included 250 studies involving 13 011 participants. Results of NMA showed that power training (PT) had the best benefits for motor symptoms compared with the control group (CON), with SMDs (95% CrI) (-1.46, [-2.18 to -0.74]). Body weight support treadmill training (BWS_TT) showed the best improvement in balance (1.55, [0.72 to 2.37]), gait velocity (1.15 [0.57 to 1.31]) and walking distance (1.96, [1.18 to 2.73]), and robotic assisted gait training (RA_GT) had the most benefits for freezing of gait (-1.09, [-1.80 to -0.38]). For non-motor symptoms, Dance showed the best benefits for depression (-1.71, [-2.79 to -0.73]). Only Yoga significantly reduced anxiety symptom compared with CON (-0.53, [0.96 to -0.11]). Only resistance training (RT) significantly enhanced sleep quality and cognition (-1.42, [-2.60 to -0.23]; 0.51, [0.09 to 0.94]). For muscle strength, PT showed the best advance (1.04, [0.64 to 1.44]). For concern of falling, five types of exercise were more effective than CON.

Conclusions: There is low quality evidence that PT, Yoga, BWS_TT, Dance, and RT are the most effective treatments, pending outcome of interest, for adults with PD.

Trial registration: PROSPERO (CRD42021220052).

Keywords: Evidence-based medicine; Exercise; Parkinson' s disease; Physical activity; Quality of life.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Exercise Therapy / methods
Gait / physiology
Gait Disorders, Neurologic*
Humans
Network Meta-Analysis
Parkinson Disease* / therapy