Effects of Exercise on Depressive Symptoms in Patients With Parkinson Disease: A Meta-analysis

Moderators of aerobic exercise effects on motor symptoms in patients with Parkinson's disease: A systematic review and meta-analysis

INTRODUCTION

Although growing evidence suggests that aerobic exercise has beneficial effects on motor symptoms in patients with Parkinson's disease (PD), it remains unclear which specific aerobic exercise regimen optimizes improvement in these symptoms. This study aimed to investigate the difference in the effects of aerobic exercise on motor function in patients with PD according to exercise intervention protocols.

METHODS

Through 28 qualified studies with randomized controlled trials, we assessed motor function using either the Unified PD Rating Scale (UPDRS) III or Movement Disorder Society-UPDRS III as an outcome measure. We employed random effects meta-analysis models to obtain standardized mean differences and 95 % confidence intervals (CIs). Moderator variable analyses were conducted based on exercise type (aerobic exercise vs. aerobic-based combined exercise), duration (<60 min vs. ≥60 min per session), frequency (

RESULTS

Aerobic exercise interventions demonstrated significant improvements in overall motor function. Although all categories were significantly effective in improving motor function, aerobic-based combined exercise had a greater effect size on motor symptoms compared to aerobic exercise alone. Additionally, ≥60 min per session showed a significantly increased effect size compared to <60 min per session. The impact of aerobic exercise did not differ based on exercise frequency, period, or intensity.

CONCLUSIONS

Our observations suggest that aerobic-based combined exercise and exercise sessions lasting 60 min or longer may be associated with greater improvements in motor symptoms in patients with PD.

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Key Words

• Aerobic
• Exercise
• Meta-analysis
• Motor
• Parkinson's disease

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MESH Headings

• Humans
• Exercise/physiology
• Exercise Therapy/methods
• Outcome Assessment, Health Care
• Parkinson Disease/physiopathology
• Parkinson Disease/therapy
• Parkinson Disease/rehabilitation
• Randomized Controlled Trials as Topic

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Affiliation(s)

Ryul Kim Department of Neurology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
Nyeonju Kang Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
Joon Ho Lee Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
Hanall Lee Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
Tae Lee Lee Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
Do Kyung Ko Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
Hajun Lee Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
Kyeongho Byun Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea
Kiwon Park Department of Mechatronics Engineering, Incheon National University, Incheon, South Korea
Jee-Young Lee Department of Neurology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
Beomseok Jeon Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

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Irisin's emerging role in Parkinson's disease research: A review from molecular mechanisms to therapeutic prospects

Parkinson's disease (PD), a neurodegenerative disorder characterized by impaired motor function, is typically treated with medications and surgery. However, recent studies have validated physical exercise as an effective adjunct therapy, significantly improving both motor and non-motor symptoms in PD patients. Irisin, a myokine, has garnered increasing attention for its beneficial effects on the nervous system. Research has shown that irisin plays a crucial role in regulating metabolic balance, optimizing autophagy, maintaining mitochondrial quality, alleviating oxidative stress and neuroinflammation, and regulating cell death-all processes intricately linked to the pathogenesis of PD. This review examines the mechanisms through which irisin may counteract PD, provides insights into its biological effects, and considers its potential as a target for therapeutic strategies.

Exercise as medicine in Parkinson's disease

Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.

Effectiveness of Balance Exercise and Brisk Walking on Alleviating Nonmotor and Motor Symptoms in People With Mild-to-Moderate Parkinson Disease: A Randomized Clinical Trial With 6-Month Follow-up

OBJECTIVE

To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up.

DESIGN

Two-arm, assessor-blinded randomized controlled trial SETTING: University research laboratory and the community PARTICIPANTS: Ninety-nine eligible individuals with mild-to-moderate PD INTERVENTIONS: Participants were randomized to balance and brisk walking group (B&B, n=49) or active control group (n=50). B&B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1-6: weekly, week 7-26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2-3 times/wk during intervention and continued at follow-up.

MAIN OUTCOME MEASURES

Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score.

RESULTS

Eighty-three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19-2.81) at 6 months and 1.09 (-0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69-6.80) at 6 months and 4.57 (1.05-8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B&B group in mini-BEST score, CGS, 6MWT, and DTUG time.

CONCLUSIONS

This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD.

Effects of physical exercise interventions on cognitive function in Parkinson's disease: An updated systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To determine whether physical exercise interventions can improve cognitive function, including overall performance and specific domains, in patients with Parkinson's disease (PD) and to provide potential evidence on how cognitive benefits can be optimized by exercise prescriptions.

METHODS

Using PubMed, Web of Science, and Cochrane Library (from inception to August 2022), four independent reviewers screened the search results and extracted data from randomized controlled trials of physical exercise interventions in patients with PD with an outcome measure of cognitive function. Random-effects meta-analysis models were used to report standardized mean differences (SMDs) with 95 % confidence intervals (CIs).

RESULTS

Twenty-one randomized controlled trials including 761 patients with PD were eligible for inclusion. Physical exercise interventions led to significant improvements in global cognitive function (SMD = 0.69; 95 % CI = 0.31 to 1.06; P < 0.001). With respect to cognitive domains, the significant effect of exercise was found on executive function (SMD = 0.94; 95 % CI = 0.05 to 1.83; P = 0.039), but not on attention/working memory, language, memory, and visuospatial function. In moderator variable analyses, the effect on global cognition was observed in combined exercise programs (SMD = 0.79; 95 % CI = 0.46 to 1.12; P < 0.001), whereas there were no significant positive effects in aerobic exercise programs, strength exercise programs, and flexibility exercise programs. In addition, exercise interventions of light-to-moderate intensity with at least 60 min in duration, and of any frequency or period, were beneficial to the global cognitive function.

CONCLUSION

This updated systematic review and meta-analysis suggests that physical exercise interventions are effective in improving global cognitive function and, to a lesser extent, executive function in patients with PD. At least 60 min a day of combined exercise programs on as many days of the week as feasible may be recommended as the non-pharmacological therapeutic option to improve cognitive function.

Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.