Impacts of dance on cognition, psychological symptoms and quality of life in Parkinson's disease

If Art Were a Drug: Implications for Parkinson's Disease

Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder. Conventional pharmacological or surgical therapies alone are often insufficient at adequately alleviating disability. Moreover, there is an increasing shift toward person-centered care, emphasizing the concept of "living well". In this context, arts-based interventions offer great promise, functioning as platforms for creative expression that could provide novel mechanisms to promote quality of life. Here we present a qualitative review of arts-based interventions for PD, including music, dance, drama, visual arts, and creative writing. For each, we discuss their applications to PD, proposed mechanisms, evidence from prior studies, and upcoming research. We also provide examples of community-based projects. Studies to date have had relatively small sample sizes, but their findings suggest that arts-based interventions have the potential to reduce motor and non-motor symptoms. They may also empower people with PD and thereby address issues of self-esteem, foster personal problem-solving, and augment holistic well-being. However, there is a paucity of research determining optimal dosage and symptom-specific benefits of these therapies. If art were a drug, we would have to perform appropriately powered studies to provide these data before incorporating it into routine patient care. We therefore call for further research with properly designed studies to offer more rigorous and evidence-based support for what we intuitively think is a highly promising approach to support individuals living with PD. Given the possible positive impact on people's lives, arts-based approaches merit further development and, if proven to be effective, systematic inclusion within integrated management plans.

The effect of dance on mental health and quality of life of people with Parkinson's disease: A systematic review and three-level meta-analysis

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disease that affects millions of individuals worldwide. Dance has emerged as a comprehensive intervention for enhancing well-being in this population. This meta-analysis aimed to assess the effectiveness of dance on mental health and quality of life among individuals with PD.

METHODS

Three databases were searched in December 2022. Research papers comparing the effects of dance with a non-dance control on the quality of life or mental health of individuals with PD were included. Two authors independently screened the studies, extracted data, and assessed methodological quality of eligible studies. To address the interdependence of effect sizes within studies, the three-level meta-analysis approach was employed to analyze the data.

RESULTS

Thirteen trials involving a total of 496 participants were included, with 11 being subjected to statistical analysis. The results indicated that dance had a positive impact on mental health (g = 0.43, 95 % CI = [0.11, 0.75]) and quality of life (g = 0.46, 95 % CI = [-0.04, 0.95]) when compared to passive control groups. Moderator analyses revealed that non-partnered dance and dance interventions with lower total dosages were particularly beneficial for mental health.

CONCLUSION

Dance interventions are an effective lifestyle activity for enhancing mental health and quality of life in individuals with PD. A theoretical framework is proposed to explain the impact of dance on well-being from neurological, social, physical, and psychological perspectives.

The Effectiveness of Dance Interventions on Psychological and Cognitive Health Outcomes Compared with Other Forms of Physical Activity: A Systematic Review with Meta-analysis

BACKGROUND

Physical activity is known to improve psychological and cognitive outcomes. Learning dance sequences may challenge cognition, partnered or group dance may benefit social interactions, and the artistic aspect may improve psychological wellbeing. Dance is an equally effective form of physical activity compared with other structured physical activities to improve physical health, but it is unclear how effective dance could be for psychological and cognitive outcome measures.

OBJECTIVE

To systematically review the literature on the effectiveness of structured dance interventions, compared with structured exercise programmes, on psychological and cognitive outcomes across the lifespan.

METHODS

Eight databases were searched from earliest records to July 2022. Studies investigating a dance intervention lasting ≥ 4 weeks, including psychological and/or cognitive health outcomes, and having a structured exercise comparison group were included. Screening and data extraction were performed by two independent reviewers at all stages. All reviewer disagreements were resolved by the primary author. Where appropriate, meta-analysis was performed, or an effect size estimate generated.

RESULTS

Of 21,737 records identified, 27 studies met the inclusion criteria. Total sample size of included studies was 1392 (944 females, 418 males, 30 unreported). Dance was equally as effective as other physical activity interventions in improving quality of life for people with Parkinson's disease [mean difference 3.09; 95% confidence interval (CI) - 2.13 to 8.30; p = 0.25], reducing anxiety (standardised mean difference 2.26; 95% CI - 2.37 to 6.90; p = 0.34), and improving depressive symptoms (standardised mean difference 0.78; 95% CI - 0.92 to 2.48; p = 0.37). Preliminary evidence found dance to be superior to other physical activity interventions to improve motivation, aspects of memory, and social cognition and to reduce distress. Preliminary evidence found dance to be inferior to other physical activity interventions to improve stress, self-efficacy and language fluency.

CONCLUSION

Undertaking structured dance of any genre is generally equally and occasionally more effective than other types of structured exercise for improving a range of psychological and cognitive outcomes.

TRIAL REGISTRATION

PROSPERO: CRD42018099637.

Non-pharmacological therapies for treating non-motor symptoms in patients with Parkinson's disease: a systematic review and meta-analysis

Objective

The non-motor symptoms of Parkinson's disease (PD) are an important part of PD. In recent years, more and more non-drug interventions have been applied to alleviate the non-motor symptoms of PD, but the relevant evidence is limited. This systematic review and meta-analysis was designed to evaluate the efficacy of non-drug interventions in patients with non-motor symptoms in patients with PD.

Methods

Seven databases, including Pubmed, Embease, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database (WANFANG), VIP database (VIP), and China Biomedical Literature Service System (CBM) were searched from the establishment of the database to December 2023. Non-drug interventions such as acupuncture, cognitive behavioral therapy (CBT), exercise, repetitive transcranial magnetic stimulation (rTMS), and non-motor symptoms of Parkinson's disease were selected as search words, and two independent evaluators evaluated the included literature's bias risk and data extraction. The therapeutic efficacy was evaluated by the Parkinson's Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MoCA), Minimum Mental State Examination (MMSE), and Parkinson's Disease Questionnaire-39 (PDQ-39). RevMan 5.4.1 (Reviewer Manager Software 5.4.1). Cochrane Collaboration, Oxford, United Kingdom analyzed the data and estimated the average effect and the 95% confidence interval (CI). A heterogeneity test is used to assess differences in the efficacy of different non-drug treatments.

Results

We selected 36 from 4,027 articles to participate in this meta-analysis, involving 2,158 participants. Our combined results show that: PDSS: [mean difference (MD) = -19.35, 95% CI (-30.4 to -8.28), p < 0.0006]; HAMD: [MD = -2.98, 95% CI (-4.29 to -1.67), p < 0.00001]; BDI: [MD = -2.69, 95% CI (-4.24 to 4.80), p = 0.006]; HAMA: [MD = -2.00, 95% CI (-2.83 to -1.17), p < 0.00001]; MMSE: [MD = 1.20, 95% CI (0.71 to 1.68), p < 0.00001]; CoMA: [MD = 2.10, 95% CI (-0.97 to 3.23), p = 0.0003]; PDQ-39: [MD = -4.03, 95% CI (-5.96 to -1.57), p < 0.00001].

Conclusion

The four non-drug measures used in our review showed significant improvements in sleep, depression, anxiety, cognition, constipation, and quality of life compared with the control group, and no serious adverse events were reported in the included research evidence, and we found that there were some differences among the subgroups of different intervention methods, but due to the less literature included in the subgroup, and the comparison was more indirect. So, we should interpret these results carefully.

Systematic review registration

www.crd.york.ac.uk/PROSPERO, identifier CRD42023486897.

Adherence to Non-Pharmacological Interventions in Parkinson's Disease: A Rapid Evidence Assessment of the Literature

Background

Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson's disease (PD).

Objective

1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions.

Methods

A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of 'adherence' OR 'compliance', published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative thematic analysis was conducted to identify determinants of adherence.

Results

The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental.

Conclusions

There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis

BACKGROUND

Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear.

OBJECTIVES

To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs).

SEARCH METHODS

An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach.

MAIN RESULTS

We included 154 RCTs with a total of 7837 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 60 (2721 participants), and 48 (3029 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson's Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (60 studies; 2721 participants) suggests that dance and gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs (dance: mean difference (MD) -10.18, 95% confidence interval (CI) -14.87 to -5.36; gait/balance/functional training: MD -7.50, 95% CI -11.39 to -3.48; moderate confidence), and multi-domain training probably has a small beneficial effect on the severity of motor signs (MD -5.90, 95% CI -9.11 to -2.68; moderate confidence). The evidence also suggests that endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs (endurance training: MD -5.76, 95% CI -9.78 to -1.74; aqua-based training: MD -5.09, 95% CI -10.45 to 0.40; strength/resistance training: MD -4.96, 95% CI -9.51 to -0.40; mind-body training: MD -3.62, 95% CI -7.24 to 0.00; low confidence). The evidence is very uncertain about the effects of "Lee Silverman Voice training BIG" (LSVT BIG) and flexibility training on the severity of motor signs (LSVT BIG: MD -6.70, 95% CI -16.48 to 3.08; flexibility training: MD 4.20, 95% CI -1.61 to 9.92; very low confidence). Quality of life The evidence from the NMA (48 studies; 3029 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -15.15, 95% CI -23.43 to -6.87; moderate confidence). The evidence also suggests that mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL (mind-body training: MD -7.22, 95% CI -13.57 to -0.70; gait/balance/functional training: MD -6.17, 95% CI -10.75 to -1.59; multi-domain training: MD -5.29, 95% CI -9.51 to -1.06; dance: MD -3.88, 95% CI -10.92 to 3.00; low confidence). The evidence is very uncertain about the effects of gaming, strength/resistance, endurance, and flexibility training on QoL (gaming: MD -8.99, 95% CI -23.43 to 5.46; strength/resistance training: MD -6.70, 95% CI -12.86 to -0.35; endurance training: MD -6.52, 95% CI -13.74 to 0.88; flexibility training: MD 1.94, 95% CI -10.40 to 14.27; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types.

AUTHORS' CONCLUSIONS

We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.

Effect of Rhythmically Cued Exercise Interventions on Functions in Patients With Parkinson Disease: A Meta-Analysis

OBJECTIVE

The purpose of this review was to investigate the efficacy of rhythmically cued exercise interventions on motor function, cognition, and mental state in patients with Parkinson disease.

METHODS

PubMed, Cochrane Database, Web of Science, Embase, and CINAHL were searched June 15, 2023. Original studies investigating the efficacy of rhythmically cued exercise interventions on the functions of patients with Parkinson disease were included. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. The protocol was registered in PROSPERO (CRD42022371203).

RESULTS

A total of 38 original studies involving 1486 participants were included. Rhythmically cued exercise interventions demonstrated superior effects on motor function compared to exercise therapy without rhythm (standardized mean difference [SMD] = -0.31). However, no significant improvements were observed in cognition and mental state. Overall, significant improvements were observed in motor examination (SMD = -0.61), Timed "Up & Go" Test (mean difference [MD] = -0.91), activities of daily living (SMD = -0.49), balance (SMD = 0.59), walking velocity (MD = 0.06), step length (MD = 2.65), and stride length (MD = 0.04) following rhythmically cued exercise interventions. No significant improvements were observed in freezing of gait and cadence. Assessment of publication bias showed no significant evidence of publication bias. Meta-regression analyses revealed a significant association between treatment duration and improvement in motor function. Furthermore, adverse events and dropout rates did not significantly differ between the 2 groups.

CONCLUSION

Rhythmically cued exercise interventions are effective in improving motor function in the early to middle stages of Parkinson disease. More than 10 weeks of intervention yielded better results. However, these interventions do not have a significant impact on cognition and mental states. Importantly, rhythmically cued exercise interventions are safe and well tolerated. Large-scale trials are needed for further confirmation.

IMPACT

This study contributes to the development of safe and reliable home rehabilitation programs, aiming to enhance the quality of life for patients with Parkinson disease.

Brazilian dance self-perceived impacts on quality of life of people with Parkinson's

Background

Parkinson's disease (PD) causes several motor and non-motor symptoms, resulting in negative impacts on physical, mental, emotional, and social aspects of people with PD quality of life. Dance has been considered as a potential non-pharmacological intervention to improve people with PD motor and non-motor symptoms, thereby enhancing quality of life.

Purpose

To analyze the self-perceive impacts of Brazilian Dance on the quality of life (physical, mental, emotional, and social) of PwPD, both before and during the COVID-19 pandemic.

Methods

Fourteen participants from the "Dança & Parkinson" project were included in this qualitative study. Data collection instruments consisted of a profile and personal data sheet; assessment of accessibility to the online dance classes; Telephone Montreal Cognitive Assessment by phone call; and semi-structured interview conducted through ZOOM video call. The participants characterization data were calculated using mean, standard deviation, and percentages with the Excel Program version 2013. Qualitative data was analyzed using the Thematic Analysis technique in the Nvivo, version 8.0, qualitative analysis of text, sound, and video program.

Results

The participants reported facing various challenges in dealing with PD, which negatively impact their quality of life. However, their resilience, acceptance, and dedication to treatment play an important role in coping with the issues related to the disease. Brazilian dance, both in-person before the COVID-19 pandemic and online during the pandemic, led the participants to perceive improvements in physical, mental, emotional, and social aspects of quality of life.

Conclusion

The Brazilian dance appears to have a positive impact on the physical, mental, emotional, and social aspects of the participants' quality of life, both before and during the COVID-19 pandemic.

Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?

Psychological stress, a state of mental strain caused by mentally or physically threatening situations, plays a significant role in Parkinson's disease (PD). Motor symptoms worsen during acute stress and common non-motor symptoms in PD, such as anxiety and depression, are linked to chronic stress. Although evidence in humans is lacking, animal models of PD suggest that chronic stress can accelerate dopaminergic cell death. This suggests that stress-reducing interventions have not only symptomatic, but perhaps also disease-modifying effects. Our objective was to identify the most promising strategies for stress-reduction in PD and to analyze their potential value for disease-modification. An unstructured literature search was performed, primarily focusing on papers published between 2020-2023. Several large clinical trials have tested the efficacy of aerobic exercise and mindfulness-based interventions on PD symptoms. The evidence is promising, but not definitive yet: some exercise trials found a reduction in stress-related symptoms, whereas others did not or did not report it. In the majority of trials, biological measures of stress and of disease progression are missing. Furthermore, follow-up periods were generally too short to measure disease-modifying effects. Hence, mechanisms underlying the intervention effects remain largely unclear. These effects may consist of attenuating progressive neurodegeneration (measured with MRI-markers of substantia nigra integrity or cortical thickness), or a strengthening of compensatory cerebral mechanisms (measured with functional neuroimaging), or both. Lifestyle interventions are effective for alleviating stress-related symptoms in PD. They hold potential for exerting disease-modifying effects, but new evidence in humans is necessary to fulfill that promise.

A general clinical overview of the non-motor symptoms in Parkinson's disease: Neuropsychiatric symptoms

The heterogeneity of non-motor features observed in people with Parkinson's disease (PD) is often dominated by one or more symptoms belonging to the neuropsychiatric spectrum, such as cognitive impairment, psychosis, depression, anxiety, and apathy. Due to their high prevalence in people with PD (PwP) and their occurrence in every stage of the disease, from the prodromal to the advanced stage, it is not surprising that PD can be conceptualised as a complex neuropsychiatric disorder. Despite progress in understanding the pathophysiological mechanisms underlying the neuropsychiatric signs and symptoms in PD, and better identification and diagnosis of these symptoms, effective treatments are still a major unmet need. The impact of these symptoms on the quality of life of PwP and caregivers, as well as their contribution to the overall non-motor symptom burden can be greater than that of motor symptoms and require a personalised, holistic approach. In this chapter, we provide a general clinical overview of the major neuropsychiatric symptoms of PD.

Virtual Group Music Therapy for Apathy in Parkinson's Disease: A Pilot Study

OBJECTIVE

To evaluate the effect of virtual group music therapy on apathy in people with Parkinson's disease (PD).

INTRODUCTION

Apathy affects 40% of people with PD, lacks effective therapies, and independently predicts poorer quality of life and greater caregiver burden. Music therapy is the clinical application of music to address a person's physical or emotional needs and is effective in treating apathy in dementia.

METHODS

People with idiopathic PD and apathy (Movement Disorders Society-Unified Parkinson's Disease Rating Scale, apathy item ≥ 2) and their caregivers participated in twelve, weekly virtual group music therapy sessions, with session attendance signifying adherence. Participants completed pre- and post-intervention assessments of apathy (Apathy Scale (AS)), quality of life (Parkinson's Disease Questionnaire-short form), functional ability (Schwab & England Activities of Daily Living Scale), depression (Beck Depression Inventory (BDI-II)), and cognition (Montreal Cognitive Assessment-Blind). Among secondary outcomes, we assessed caregiver burden (Zarit Burden Interview-short form) and strain (Multidimensional Caregiver Strain Index).

RESULTS

Sixteen PD participants (93.8% men, mean age 68.3 ± 8.4 years, median 6 years PD duration) and their caregivers (93.8% women, mean age 62.6 ± 11 years) completed the study. All PD participants and 88% of caregivers were >70% adherent to the intervention. Apathy (AS, effect size = 0.767, P = 0.002) and depression (BDI-II, effect size = 0.542, P = 0.03) improved, with no change in caregiver measures.

CONCLUSION

Group music therapy is an effective treatment for apathy in PD and may improve mood. The virtual format is a feasible alternative to in-person sessions with high adherence and satisfaction.

A Safe and Feasible Online Dance Intervention for Older Adults With and Without Parkinson's Disease

Introduction: Dancing is one way of maintaining an active lifestyle, and online dance interventions in group settings can be a solution when in-person classes are impossible. This study investigated the feasibility and potential clinical effects of an online dance program for older adults with and without Parkinson disease (PD). Methods: Participants attended 2 weekly dance classes in the same videoconference room for 2 months. The dance activities were mainly performed while seated (around 75%). Researchers monitored feasibility (ie, adherence, attendance, and technological barriers) and safety. Pre- and post-intervention assessments investigated self-perceptions, effects on emotional domains, quality of life, activity-specific balance confidence, lower-limb functional mobility, and PD non-motor symptoms. Individuals also reported their self-perceptions regarding technology usability, enjoyment, and social interaction. Results: Most of the participants with PD (n = 12) had moderate PD (Hoehn & Yahr score) and presented a greater risk of falls when compared to participants without PD (n = 14). Overall, we found a high rate of adherence (100%), attendance (87.5%-91.7%), and safety (100%) for both groups. No falls or near-falls occurred during the sessions. Only the PD group ameliorated emotional domains (anxiety and depression) and improved lower-limb functional mobility. All participants reported feeling safe and perceived benefits, although over a third of older adults with PD reported moderate difficulties in using technology and in socializing with the group. Conclusion: This online dance protocol is feasible, safe, and a potential strategy to improve clinical parameters in older adults and people with moderate PD.

Exercise Made Accessible: the Merits of Community-Based Programs for Persons with Parkinson's Disease

PURPOSE OF REVIEW

Many studies have identified positive effects of physiotherapy and exercise for persons with Parkinson's disease (PD). Most work has thus far focused on the therapeutic modality of exercise as used within physiotherapy programs. Stimulated by these positive findings, there is now a strong move to take exercise out of the clinical setting and to deliver the interventions in the community. Although the goals and effects of many such community-based exercise programs overlap with those of physiotherapy, it has also become more clear that both exercise modalities also differ in various ways. Here, we aim to comprehensively review the evidence for community-based exercise in PD.

RECENT FINDINGS

Many different types of community-based exercise for people with PD are emerging and they are increasingly being studied. There is a great heterogeneity considering the types of exercise, study designs, and outcome measures used in research on this subject. While this review is positive regarding the feasibility and potential effects of community-based exercise, it is also evident that the general quality of these studies needs improvement. By focusing on community-based exercise, we hope to generate more knowledge on the effects of a wide range of different exercise modalities that can be beneficial for people with PD. This knowledge may help people with PD to select the type and setting of exercise activity that matches best with their personal abilities and preferences. As such, these insights will contribute to an improved self-management of PD.

Whether mindfulness-guided therapy can be a new direction for the rehabilitation of patients with Parkinson's disease: a network meta-analysis of non-pharmacological alternative motor-/sensory-based interventions

Background

The treatment for Parkinson's disease (PD) consumes a lot of manpower and financial resources. Non-pharmacological alternative motor-/sensory-based interventions are optimized for the rehabilitation of PD patients. Mindfulness-based therapy shows ideal efficacy, but the diversity of the therapy brings difficulties to the selection of clinicians and patients.

Methods

Network meta-analysis in the Bayesian framework was used to evaluate the efficacy of non-pharmacological alternative motor-/sensory-based interventions in improving motor and non-motor symptoms in PD patients.

Results

A total of 58 studies (2,227 patients) were included. Compared with the non-intervention group, qigong was associated with improved outcomes in the Timed Up and Go (TUG) test (mean difference (MD) -5.54, 95% confidence interval (CI) -8.28 to -2.77), and UPDRS-I (MD -15.50, 95% CI -19.93 to -7.63). Differences between non-pharmacological alternative motor-/sensory-based interventions were not significant for PDQ-39, UPDRS-I, or UPDRS-II; however, qigong was superior to dance (MD -3.91, 95% CI -6.90 to -0.95), Tai Chi (MD -3.54, 95% CI -6.53 to -0.69), acupuncture (MD -6.75, 95% CI -10.86 to -2.70), music (MD -3.91, 95% CI -7.49 to -0.48), and exercise (MD -3.91, 95% CI -6.49 to -1.33) in the TUG test.

Conclusion

This network meta-analysis supports mindfulness-based therapy (e.g., qigong, yoga, and Tai Chi) as a preferred non-pharmacological alternative motor-/sensory-based intervention for PD rehabilitation.

Systematic review registration

https://inplasy.com/inplasy-2022-10-0109/, INPLASY2022100109.

The Effects of Dance Interventions on Depression in Older Adults: A Meta-Analysis

Meta-analyses of the effects of dance on depressive symptoms in older adults have shown contradictory results, but few primary studies were included (5 and 8 studies). We aimed to examine the effects of dance on depressive symptoms in older adults aged 60 years and older and to examine the moderator effects of the source, participants, methods, and intervention characteristics. We included 23 primary studies that compared depressive symptoms across dance and comparison/control groups of older adults (72 ± 6.7 years old) and were written in English (N = 1,398) participants. Dance groups showed significantly less depressive symptoms post-intervention than comparison groups (ES = 0.66, 95% CI [0.42, 0.91], p < .001, I2 = 76.80%). South America and Australia showed the greatest effects. Using quasi-experimental designs showed significant effect sizes compared to using randomized designs. Only one quality indicator, intention-to-treat, influenced effect size. Dance might be used as an alternative treatment to improve depression.

Adapted Portuguese folk dance intervention for subacute rehabilitation post-stroke: study protocol

Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.

Benefits of Cultural Activities on People with Cognitive Impairment: A Meta-Analysis

BACKGROUND

Museums and cultural institutions are increasingly aware of both the interests and needs of society. Accordingly, these institutions are becoming allies in terms of health and well-being due to the importance of their social functions. Presently, many institutions create cultural activities aimed at cognitively impaired people, a group on the rise owing to the prevalence of dementia and the aging of society. Nevertheless, scientific evidence in this field remains scarce. As a result, the main objective of this research was to empirically evaluate and identify the benefits that cultural interventions can bring to cognitively impaired participants.

METHOD

A meta-analysis (MA) was performed following PRISMA guidelines. When inclusion and eligibility criteria had been established, articles were subsequently selected through a strategic search of Web of Science, SCOPUS, PubMed, and Medline.

RESULTS

Twenty-six studies met the eligibility criteria, involving a total of 1201 participants with cognitive impairment. The results showed a statistically non-significant effect size when analyzing these cultural interventions for cognitively impaired people overall. However, when conducting partial meta-analyses (MA'), focusing on studies related to a specific disease, a particular type of treatment, or a specific type of evaluation, the results concurred with the conclusion of the previous systematic review (SR).

CONCLUSION

Despite the high heterogeneity of the studies, benefits were identified in emotional well-being and social aspects but not in clinical ones such as the deterioration of cognitive or motor function, among others.

Unleashing the potential of dance: a neuroplasticity-based approach bridging from older adults to Parkinson's disease patients

Parkinson's disease (PD) is a neurodegenerative disorder that affects >1% of individuals worldwide and is manifested by motor symptoms such as tremor, rigidity, and bradykinesia, as well as non-motor symptoms such as cognitive impairment and depression. Non-pharmacological interventions such as dance therapy are becoming increasingly popular as complementary therapies for PD, in addition to pharmacological treatments that are currently widely available. Dance as a sensorimotor activity stimulates multiple layers of the neural system, including those involved in motor planning and execution, sensory integration, and cognitive processing. Dance interventions in healthy older people have been associated with increased activation of the prefrontal cortex, as well as enhanced functional connectivity between the basal ganglia, cerebellum, and prefrontal cortex. Overall, the evidence suggests that dance interventions can induce neuroplastic changes in healthy older participants, leading to improvements in both motor and cognitive functions. Dance interventions involving patients with PD show better quality of life and improved mobility, whereas the literature on dance-induced neuroplasticity in PD is sparse. Nevertheless, this review argues that similar neuroplastic mechanisms may be at work in patients with PD, provides insight into the potential mechanisms underlying dance efficacy, and highlights the potential of dance therapy as a non-pharmacological intervention in PD. Further research is warranted to determine the optimal dance style, intensity, and duration for maximum therapeutic benefit and to determine the long-term effects of dance intervention on PD progression.

Interaction and psychological characteristics of art teaching based on Openpose and Long Short-Term Memory network

As living standards improve, people's demand for appreciation and learning of art is growing gradually. Unlike the traditional learning model, art teaching requires a specific understanding of learners' psychology and controlling what they have learned so that they can create new ideas. This article combines the current deep learning technology with heart rate to complete the action recognition of art dance teaching. The video data processing and recognition are conducted through the Openpose network and graph convolution network. The heart rate data recognition is completed through the Long Short-Term Memory (LSTM) network. The optimal recognition model is established through the data fusion of the two decision levels through the adaptive weight analysis method. The experimental results show that the accuracy of the classification fusion model is better than that of the single-mode recognition method, which is improved from 85.0% to 97.5%. The proposed method can evaluate the heart rate while ensuring high accuracy recognition. The proposed research can help analyze dance teaching and provide a new idea for future combined research on teaching interaction.

A machine learning approach to predict quality of life changes in patients with Parkinson's Disease

OBJECTIVE

Parkinson disease (PD) is a progressive neurodegenerative disorder with an annual incidence of approximately 0.1%. While primarily considered a motor disorder, increasing emphasis is being placed on its non-motor features. Both manifestations of the disease affect quality of life (QoL), which is captured in part II of the Unified Parkinson's Disease Rating Scale (UPDRS-II). While useful in the management of patients, it remains challenging to predict how QoL will change over time in PD. The goal of this work is to explore the feasibility of a machine learning algorithm to predict QoL changes in PD patients.

METHODS

In this retrospective cohort study, patients with at least 12 months of follow-up were identified from the Parkinson's Progression Markers Initiative database (N = 630) and divided into two groups: those with and without clinically significant worsening in UPDRS-II (n = 404 and n = 226, respectively). We developed an artificial neural network using only UPDRS-II scores, to predict whether a patient would clinically worsen or not at 12 months from follow-up.

RESULTS

Using UPDRS-II at baseline, at 2 months, and at 4 months, the algorithm achieved 90% specificity and 56% sensitivity.

INTERPRETATION

A learning model has the potential to rule in patients who may exhibit clinically significant worsening in QoL at 12 months. These patients may require further testing and increased focus.

Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis

BACKGROUND

Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear.

OBJECTIVES

To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs).

SEARCH METHODS

An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data. A third author was involved in case of disagreements.  We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach.

MAIN RESULTS

We included 156 RCTs with a total of 7939 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 71 (3196 participants), and 55 (3283 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (71 studies; 3196 participants) suggests that dance has a moderate beneficial effect on the severity of motor signs (mean difference (MD) -10.32, 95% confidence interval (CI) -15.54 to -4.96; high confidence), and aqua-based, gait/balance/functional, and multi-domain training might have a moderate beneficial effect on the severity of motor signs (aqua-based: MD -7.77, 95% CI -13.27 to -2.28; gait/balance/functional: MD -7.37, 95% CI -11.39 to -3.35; multi-domain: MD -6.97, 95% CI -10.32 to -3.62; low confidence). The evidence also suggests that mind-body training and endurance training might have a small beneficial effect on the severity of motor signs (mind-body: MD -6.57, 95% CI -10.18 to -2.81; endurance: MD -6.43, 95% CI -10.72 to -2.28; low confidence). Flexibility training might have a trivial or no effect on the severity of motor signs (MD 2.01, 95% CI -4.82 to 8.98; low confidence). The evidence is very uncertain about the effects of strength/resistance training and "Lee Silverman Voice training BIG" (LSVT BIG) on the severity of motor signs (strength/resistance: MD -6.97, 95% CI -11.93 to -2.01; LSVT BIG: MD -5.49, 95% CI -14.74 to 3.62; very low confidence). Quality of life The evidence from the NMA (55 studies; 3283 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -14.98, 95% CI -23.26 to -6.52; moderate confidence). The evidence also suggests that endurance training might have a moderate beneficial effect, and that gait/balance/functional and multi-domain training might have a small beneficial effect on QoL (endurance: MD -9.16, 95% CI -15.68 to -2.82; gait/balance/functional: MD -5.64, 95% CI -10.04 to -1.23; multi-domain: MD -5.29, 95% CI -9.34 to -1.06; low confidence). The evidence is very uncertain about the effects of mind-body training, gaming, strength/resistance training, dance, LSVT BIG, and flexibility training on QoL (mind-body: MD -8.81, 95% CI -14.62 to -3.00; gaming: MD -7.05, 95% CI -18.50 to 4.41; strength/resistance: MD -6.34, 95% CI -12.33 to -0.35; dance: MD -4.05, 95% CI -11.28 to 3.00; LSVT BIG: MD 2.29, 95% CI -16.03 to 20.44; flexibility: MD 1.23, 95% CI -11.45 to 13.92; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types.

AUTHORS' CONCLUSIONS

We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.

Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017

BACKGROUND

Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need.

OBJECTIVE

This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations.

METHODS

We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials.

RESULTS

We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness.

CONCLUSION

Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.

Effects of dance on gait and dual-task gait in Parkinson's disease

BACKGROUND

Gait impairments in Parkinson's disease (PD) limit independence and quality of life. While dance-based interventions could improve gait, further studies are needed to determine if the benefits generalise to different terrains and when dual-tasking. The aim was to assess the effects of a dance intervention, based on the Dance for PD® (DfPD®) program, on gait under different dual-tasks (verbal fluency, serial subtraction) and surfaces (even, uneven), and to determine if a larger scale follow-up RCT is warranted.

METHODS

A dance group (DG; n = 17; age = 65.8 ± 11.7 years) and a control group (CG: n = 16; age = 67.0 ± 7.7 years) comprised of non-cognitively impaired (Addenbrooke's score: DG = 93.2 ± 3.6, CG = 92.6 ± 4.3) independently locomoting people with PD (Hoehn & Yahr I-III). The DG undertook a one-hour DfPD®-based class, twice weekly for 12 weeks. The CG had treatment as usual. The spatiotemporal variables of gait were assessed at baseline and post-intervention while walking on two surfaces (even, uneven) under three conditions: regular walking; dual-task: verbal-fluency (DTVERB), and serial-subtraction (DTSUBT). The data were analysed by means of a linear mixed model.

RESULTS

At baseline, there was no significant group difference for any spatiotemporal gait variable. The DG improved significantly compared to the CG with and without a dual task when walking on even surface. During regular walking, DG improved in gait velocity (p = 0.017), cadence (p = 0.039), step length (p = 0.040) and stride length (p = 0.041). During DTVERB significant improvements were noted in gait velocity (p = 0.035), cadence (p = 0.034) and step length (p = 0.039). The DG also exhibited significant improvement compared to the CG during DTSUBT in the measures of gait velocity (p = 0.012), cadence (p = 0.021), step length (p = 0.018), and stride length (p = 0.151). On the uneven surface, improvements were noted when walking while performing serial subtractions only. During regular walking, improvements were noted for the CG but not for the DG. CG has spent less time in double support following the intervention than DG. While DTVERB condition had no significant group differences for any gait parameter (p's >0.05), in the DTSUBT condition, the DG improved significantly compared to the controls on gait velocity (p = 0.048), cadence (p = 0.026), and step length (p = 0.051).

CONCLUSIONS

DfPD®-based classes produced clinically significant improvement in spatiotemporal gait parameters under dual-task conditions and on uneven surfaces. This could arise from improved movement confidence and coordination; emotional expression; cognitive skills (planning, multitasking), and; utilisation of external movement cues. A large-scale RCT of this program is warranted.

TRIAL REGISTRATION

A protocol for this study has been registered retrospectively at the Australian New Zealand Clinical Trials Registry. Identifier: ACTRN12618001834246.

Benefits of dance for Parkinson's: The music, the moves, and the company

Dance classes designed for people with Parkinson's are very popular and associated not only with increasing individuals' motor control abilities but also their mood; not least by providing a social network and the enjoyment of the music. However, quantitative evidence of the benefits is inconsistent and often lacks in power. For a better understanding of the contradictory findings between participants' felt experiences and existing quantitative findings in response to dance classes, we employed a mixed method approach that focussed on the effects of music. Participant experience of the dance class was explored by means of semi-structured interviews and gait changes were measured in a within-subjects design through the Timed Up and Go (TUG) test before and after class, with and without music. We chose the TUG test for its ecological validity, as it is a simple test that resembles movements done in class. We hypothesised that the music and the dance class would have a facilitating effect on the TUG performance. In line with existing research, we found that before class, the gait of 26 participants was significantly improved when accompanied by a soundtrack. However, after class, music did not have a significantly facilitating effect, yet gait without music significantly improved after class compared to before. We suggest that whilst the music acts as an external stimulator for movement before the dance class, after the dance class, participants have an internalised music or rhythm that supports their motor control. Thus, externally played music is of less relevance. The importance of music was further emphasised in the qualitative data alongside social themes. A better understanding of how music and dance affects Parkinson's symptoms and what aspects make individuals 'feel better' will help in the design of future interventions.

The Effect of a Combined Exercise Program on Postural Control and Fine Motor Skills in Parkinson's Disease: Study Design

Parkinson's disease (PD) is a progressive and neurodegenerative disorder defined by physical symptoms such as hand disability and postural instability. To counteract the detrimental effects of PD, physical activity programs showed improvements in overall aspects of physical functioning. Therefore, this protocol will aim to evaluate the effect a of postural and fine motor skills training program in older adults with PD. PD individuals, with mild to moderate stage PD, aged between 65 to 80 years, will be voluntary selected from the Nursing Home Residences and Rehabilitation Centers. Subsequently, they will be randomly assigned to intervention group (PD) to receive a combined training program (postural control and fine motor skills exercises) or to the Control group (CON) to receive a stretching program. Before (PRE) and after (POST) a 12-week program both groups will perform wobble board (WB) and grooved pegboard (GPT) tests. Different performances between groups will be expected: (1) no significant differences between PD and CON group for WB and GPT test values before the beginning of the training intervention (PRE); (2) significantly better WB and GPT test values in PD subjects after the training intervention (POST) when compared to the base values (PRE); and (3) no significant differences in WB and GPT test values in CON subjects after the training intervention (POST) when compared to the base values (PRE). The findings of the present study protocol could be used for future studies investigating clinical populations, such as PD, and the effects of different rehabilitative interventions aiming to improve postural control and fine motor skills performances assessed by WB and GPT tests.

Effects of mind-body exercises on cognitive impairment in people with Parkinson's disease: A mini-review

Parkinson's disease (PD) is an important health problem caused by the degeneration of brain neurons. Bradykinesia and lower balance ability seriously affect the quality of life of people with PD. Non-motor symptoms, such as cognitive impairment, accompany the course of the disease but still lack sufficient attention. In general, drugs combined with cognitive training are the most common ways to improve cognitive impairment in people with PD. However, long-term use of psychiatric drugs may lead to side effects such as brain death and movement disorders. Recently, mindfulness has been used by researchers in the treatment of cognitive impairment, because healthy older adults who engage in mind-body exercises for a long time have higher cognitive levels than normal aging populations. Mind-body exercise, as a therapy that combines concentration, breath control, and physical activity, is beneficial for improving practitioners' brain and mental health. Mind-body exercises such as Tai Chi, yoga, dance, and Pilates can improve cognitive performance in older adults with or without cognitive impairment. Therefore, mind-body exercise may be a feasible strategy for the treatment of cognitive impairment in people with PD. This study summarizes the latest evidence that mind-body exercises including Tai Chi, Qigong, yoga, and dance improve cognitive impairment associated with PD. We also explored the limitations of current mind-body exercise research, aiming to provide new ideas for improving mind-body exercise as a strategy to alleviate cognitive impairment in people with PD.

Community Exercise: A New Tool for Personalized Parkinson’s Care or Just an Addition to Formal Care?

Physiotherapy and exercise are associated with motor and non-motor benefits in Parkinson’s disease (PD). Community exercise programs may increase ongoing exercise participation and help people with Parkinson’s disease actively participate in their health management. But there is still limited knowledge about these programs regarding their benefits, safety, implications over the long-term, and effective implementation. These questions could hold relevant clinical implications. In this perspective article, we identify the current challenges and reflect upon potential solutions to help community exercise to be implemented as an additional anchor to personalize management models for Parkinson’s disease.

The Effects of a Dance and Music-Based Intervention on Parkinson's Patients' Well-Being: An Interview Study

Previous research has shown the positive effects of music and dance-based interventions on the physical and psychosocial symptoms of Parkinson’s disease (PD). The aims of this study were: (1) to investigate how PD patients subjectively perceive the emotional, cognitive, and social benefits of a music- and dance-based intervention; (2) to apply an innovative methodology for an interview analysis combining findings from a linguistic text with an analytic approach and conducted with the software LIWC and from the content analysis performed by human coders. Extensive, open-ended interviews were conducted with 13 patients with PD who had participated in a dance and music program. The interviews were analyzed using both human coders and the computer-based approach. The results show that emotional and social aspects are considered the most frequent perceived benefits of the dance program. The data confirm the positive impact of dance- and music-based programs on promoting participants’ emotional and social well-being. A combined approach to text analysis appears to be a promising way to achieve more in-depth insights into patients’ subjective perceptions.

Effects of physical exercise on cognitive function of breast cancer survivors receiving chemotherapy: A systematic review of randomized controlled trials

Background

Cognitive impairment has a great negative impact on quality of life for breast cancer survivors. Emerging evidence suggested that physical exercise can improve cognitive function in order adults with Alzheimer's disease. However, less is known about the effects of physical exercise on cognitive function for breast cancer survivors. The purpose of this meta-analysis was to evaluate the effect of physical exercise on cognitive function in breast cancer survivors.

Methods

EMBASE, the Cochrane Library, Web of Science and PubMed were searched from the establishment of the databases to June 2021. Randomized controlled trials were included. All analysis were conducted using the Revman 5.3.

Results

12 studies (936 participants) indicated that exercise improved self-reported cognitive function (MD 10.12, 95% CI [5.49,14.76], p < 0.0001), cognitive fatigue (MD -5.41, 95% CI [-10.31,-0.51], p = 0.03) and executive function (MD -13.63, 95% CI [-21.86,-5.39], p = 0.0001).

Conclusion

Physical exercise can improve cognitive function for breast cancer survivors, particularly in self-reported cognitive function, and executive function. Future studies need to explore the effect of exercise on cognitive function from the frequency and duration of exercise.

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Physical exercise can improve cognitive function among breast cancer survivors.

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Aerobic exercise and combined exercise intervention were more effective than other exercise.

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Physical exercise can improve self-reported cognitive function, cognitive fatigue and executive function in breast cancer patients.

Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson's: a feasibility study

Background

Community-based dance programs for people living with Parkinson’s have grown in popularity over the past two decades. Studies investigating these programs have demonstrated multidimensional benefits in motor, non-motor, and quality of life related outcomes, yet there is a need to focus on the feasibility of larger trials. The primary objective of this study was to assess the feasibility and acceptability of conducting a trial investigating dance and Parkinson’s in Northern Ireland. The secondary objectives were to conduct preliminary analyses of the classes’ effects and to assess the appropriateness of outcome measures for a randomized controlled trial.

Methods

Participants were recruited through the community, Parkinson’s UK, and university contacts to participate in a 12-week dance intervention inspired by the Dance for PD® model. Pre- and post-intervention, participants completed the following outcomes: MDS-UPDRS III, TUG, DT-TUG, Sensory Organization Test, MoCA, Trail Making Tests A&B, Digit Symbol Substitution Test, Digit Span, PDQ-39, FOG-Q, PHQ-9, FES-I, and an exit questionnaire (post-test only). Data were analyzed using paired samples t tests or Wilcoxon signed ranked test.

Results

Ten people living with Parkinson’s participated. Running a larger trial was deemed infeasible in this setting due to recruitment issues; conversely, the dance intervention was accepted by participants with all but one completing the study. Functional mobility (TUG), symptoms of depression (PHQ-9), and bodily discomfort showed improvement. All other outcomes did not. The exit questionnaire revealed that the social aspect of classes was important, and improvements in mood or mental state were cited most frequently as perceived benefits. Outcome measures were feasible, with some changes suggested for future trials.

Conclusions

This study highlighted the infeasibility of running a larger trial using this design in this setting despite demonstrating the acceptability of implementing a dance program in Northern Ireland for people living with Parkinson’s. The results support existing evidence demonstrating that dance may improve functional mobility and symptoms of depression in people living with Parkinson’s, though the study design and small sample size prevent the generalizability of results. The findings also support the idea that dancing has the potential to support several aspects of physical, emotional, mental, and social health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00982-9.

Digital Dance for People With Parkinson's Disease During the COVID-19 Pandemic: A Feasibility Study

Background

Dance as a treatment to support physical, cognitive and emotional functioning, has gained increased acceptance as a healthcare intervention for people with Parkinson's Disease (PD). The impact of the COVID-19 pandemic has been far reaching with devastating effects for at-risk populations. To find alternative and safe treatment delivery options during the pandemic has been of utmost importance. The purpose of this mixed-methods study was to evaluate the feasibility and the experience of digital dance for people with PD (Dance for PD©) and to examine change in self-reported quality of life, psychological health, subjective cognitive complaints and mental fatigue.

Methods

23 participants with PD (mean age 70) partook in 10-h weekly digital Dance for PD sessions. Feasibility outcome measures were assessed at post-test. Web-based questionnaires examining quality of life, subjective memory complaints, depression, anxiety and mental fatigue were administered at pre- and post-test. Moreover, nine participants partook in focus group discussions at post-test.

Results

The results showed an acceptable feasibility to home-based digital Dance for PD, where 86% of the dance classes were completed, only minor negative side effects were reported (i.e., sore joints), and all experienced the dance classes as motivating and safe to do at home. The majority also reported positive effects on mood and physical functioning. The results from the questionnaires showed significant improvements in depressive symptoms (p = 0.006) and quality of life (p < 0.001) at post-test. In the focus groups, participants indicated that digital dance was a beneficial and enjoyable activity with a strong added value during the COVID-19 pandemic. Nevertheless, they experienced that digital dance missed some important elements of live dance.

Conclusions

This study showed that digital Dance for PD is feasible and holds promise as a viable and safe method to keep people with PD dancing even when physical meetings are not possible. Beyond the pandemic, digital dance could be applied to a wide variety of patient groups including rural populations and patients for whom transportation may not be feasible for practical or financial reasons.

Trial Registration

Retrospectively registered at ClinicalTrials.gov on 25/06/2021 with the following registration number: NCT04942392.

Effects of a structured dance program in Parkinson's disease. A Greek pilot study

INTRODUCTION

Dance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients.

MATERIAL AND METHODS

A total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed.

RESULTS

Statistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported.

CONCLUSION

A twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Dance Is an Accessible Physical Activity for People with Parkinson's Disease

OBJECTIVE

To evaluate the outcomes of face-to-face, digital, and virtual modes of dancing for people living with Parkinson's disease (PD).

DESIGN

Systematic review informed by Cochrane and PRIMSA guidelines. Data Sources. Seven electronic databases were searched: AMED, Cochrane, PEDro, CINHAL, PsycINFO, EMBASE, and MEDLINE.

METHODS

Eligible studies were randomised controlled trials (RCT) and other trials with quantitative data. The PEDro scale evaluated risk of bias for RCTs. Joanna Briggs Institute instruments were used to critically appraise non-RCTs. The primary outcome was the feasibility of dance interventions, and the secondary outcomes included gait, balance, quality of life, and disability.

RESULTS

The search yielded 8,327 articles after duplicates were removed and 38 met the inclusion criteria. Seven were at high risk of bias, 20 had moderate risk of bias, and 11 had low risk of bias. There was moderately strong evidence that dance therapy was beneficial for balance, gait, quality of life, and disability. There was good adherence to digital delivery of dance interventions and, for people with PD, online dance was easy to access.

CONCLUSION

Dancing is an accessible form of exercise that can benefit mobility and quality of life in people with PD. The COVID-19 pandemic and this review have drawn attention to the benefits of access to digital modes of physical activity for people living with chronic neurological conditions.

The Proper Diet and Regular Physical Activity Slow Down the Development of Parkinson Disease

From year to year, we know more about neurodegeneration and Parkinson’s disease (PD). A positive influence of various types of physical activity is more often described in the context of neuroprotection and prevention as well as the form of rehabilitation in Parkinson’s patients. Moreover, when we look at supplementation, clinical nutrition and dietetics, we will see that balancing consumed products and supplementing the vitamins or minerals is necessary. Considering the biochemical pathways in skeletal muscle, we may see that many researchers desire to identify molecular mediators that have an impact through exercise and balanced diet on human health or development of the neurodegenerative disease. Therefore, it is mandatory to study the potential mechanism(s) related to diet and factors resulted from physical activity as molecular mediators, which play a therapeutic role in PD. This review summarizes the available literature on mechanisms and specific pathways involved in diet-exercise relationship and discusses how therapy, including appropriate exercises and diet that influence molecular mediators, may significantly slow down the progress of neurodegenerative processes. We suggest that a proper diet combined with physical activity will be a good solution for psycho-muscle BALANCE not only in PD but also in other neurodegenerative diseases.

A Novel Boot Camp Program to Help Guide Personalized Exercise in People with Parkinson Disease

Given the variety of exercise programs available for people with Parkinson's disease (PD), such individuals may struggle to make decisions about what exercise to perform. The objective of this study was to assess the usefulness, satisfaction, and preferences regarding participation in a PD-personalized educational and exercise boot camp program. Attendees participated in a four-day program consisting of exercise sessions, workshops, and social activities. We collected demographic and clinical information. We assessed satisfaction and preferences immediately after. At one-month follow-up, participants assessed usefulness and changes in exercise habits. Eight individuals diagnosed with PD, with a mean age of 59.5 ± 6.8 years, participated. All participants felt "very satisfied" and likely to attend future events. The two favorite sessions were: cognitive stepping and dance-based movements. At one-month follow-up, participants considered the program "very useful" and reported changes in their exercise routine. Our results suggest that the boot camp program was considered useful and capable of influencing participants' exercise habits.

Development of an Exercise-Specific Parkinson's Disease Questionnaire: The PDQ-Exercise

BACKGROUND

Exercise is now a significant and key component in the management of Parkinson's disease. However, no self-report, Parkinson's-specific measure of exercise currently exists.

OBJECTIVE

To develop a patient-reported outcome measure (PROM) for use in studies and clinical trials that aim to assess the efficacy of exercise therapy for people with Parkinson's (PwP).

METHODS

Participants were recruited via Parkinson's UK. To generate meaningful items, PwP participated in exploratory cognitive interviews. To pretest the items generated, PwP took part in two rounds of cognitive debrief interviews. Items were subsequently tested through an online survey that also included the eight-item Parkinson's Disease Questionnaire (PDQ-8) and Oxford Participation and Activities Questionnaire (Ox-PAQ).

RESULTS

Twenty PwP were interviewed for item generation. Analyses identified issues related to adopting and maintaining exercise, resulting in the generation of 10 items. Fourteen PwP took part in subsequent cognitive debrief interviews. Following the first 10 interviews, one item was removed, and minor adjustments were made to the wording of two items. Four final interviews verified that no further adjustments were required. Consequently, nine items were included in the validation survey, which was fully completed by 398 PwP. Inspection of floor and ceiling effects resulted in the removal of two further items. A principal component analysis identified a single seven-item factor explaining 61.6% of variance. Further analyses indicated that the measure demonstrates sound reliability and validity.

CONCLUSIONS

Results indicate that the PDQ-Exercise is an acceptable, reliable, and valid PROM. Further assessment of its psychometric properties is in progress. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Efficacy of dance for Parkinson's disease: a pooled analysis of 372 patients

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative disorder that presents with motor and nonmotor symptoms such as bradykinesia, resting tremor, postural instability, and cognitive and neuropsychiatric manifestations. Dance therapy or complex motor activity, besides pharmacological treatment, may have benefits in PD patients.

OBJECTIVE

To assess the effect of dance in patients with PD.

METHODS

We searched for clinical trials in PubMed, Scopus, and Web of Science, and Cochrane till April 2020 using relevant keywords. Data were extracted and pooled as mean difference (MD) with 95% confidence interval (CI) by Review Manager 5.3.

RESULTS

Fourteen randomized controlled trials with 372 patients were included. Dance showed a significant improvement over the control group in term of the Unified Parkinson's Disease Rating Scale III (UPDRS III) after three (MD = - 4.49, 95% CI [- 6.78, - 2.21], p = 0.00001), six, (MD = - 5.96, 95% CI [- 8.89, - 3.02], p < 0.0001), and 12 months (MD = - 14.58, 95% CI [- 24.76, - 4.4], p = 0.005), and Mini-BES test after 12 months. Compared to exercise, dance showed a significant improvement in Timed Up and Go (TUG) test, Berg Balance Scale (BBS), and Mini-BES test.

CONCLUSION

In comparison to other types of exercise or no activity, dance improves the symptoms and outcomes in patients with PD, especially motor symptoms. Dance also has positive effects on balance, functional mobility, and cognition.

The Relationship Between Anxiety Disorders and Parkinson's Disease: Clinical and Therapeutic Issues

PURPOSE OF REVIEW

This paper seeks to describe anxiety's different symptomatologic presentations in Parkinson's disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities.

RECENT FINDINGS

In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.

Perceptions of aquatic physiotherapy and health-related quality of life among people with Parkinson's disease

Background

Enablers for people with Parkinson's disease (PD) participating in aquatic physiotherapy have been identified, and exercise improves health‐related quality of life (HRQoL) but it is unclear whether all enablers and barriers for aquatic physiotherapy specific to the PD population have been explored.

Objective

To describe HRQoL in people with PD who have undertaken aquatic physiotherapy, and explore their perceptions and attitudes regarding the programme.

Methods

Twenty‐one participants who participated in a pilot trial on aquatic physiotherapy were included. Participants completed a survey regarding their experiences. The Parkinson's Disease Questionnaire‐39 (PDQ‐39) and Personal Well‐being Index‐Adult (PWI) were used to quantify HRQoL, whilst focus groups were conducted to explore their perceptions and attitudes. Descriptive statistics were used to summarize HRQoL scores. Focus group data were analysed using the deductive coding method.

Results

Most participants felt that the aquatic programme was worthwhile (n = 20/21, 95%). However, they had poor overall well‐being (mean 41.6, SD 13.5) and HRQoL (mean 31.0, SD 13.2) as measured by the PWI and PDQ‐39. Several barriers to aquatic therapy including safety when getting dressed, fatigue and transport were identified although many enablers were also identified, including an improvement in function, less falls and group socialization.

Conclusions

Aquatic physiotherapy was well‐accepted. Participants felt their function improved and felt safe in the water. HRQoL is lower in individuals with PD when compared to Australian norms; thus, interventions to optimize HRQoL need to be explored further.

Patient or Public Contribution

Patients participated in the aquatic intervention, survey and focus groups.

DARE to move: feasibility study of a novel dance-based rehabilitation method in severe traumatic brain injury

Objective: Dance is a versatile and multimodal rehabilitation method, which may be useful also in traumatic brain injury (TBI) rehabilitation. Here, we assessed the feasibility and preliminary effects of a novel dance-based intervention called Dual-Assisted Dance Rehabilitation (DARE).Method: This is a feasibility study with a cross-over design where 11 persons with severe/extremely severe TBI received a 12-week (2 times/week) DARE program. Motor and neuropsychological tests and questionnaires measuring mood, executive functions, and quality of life were performed at baseline, 3-month, and 6-month stage. Self-perceived benefits were assessed with a post-intervention questionnaire.Results: Acceptability of and adherence to DARE were encouraging: 91% were fully consistent with protocol, and adherence to DARE sessions was 83-100%. Pre-post treatment effects sizes were medium-large for self-reported depression (BDI-II: d = 1.19-1.74) and executive deficits (BRIEF-A: d = 0.43-1.09) and for test-assessed trunk movement control (TIS: d = 0.47-0.76) and cognitive functioning (WAIS-IV subtests: d = 0.34-0.89). Other outcome measures did not show similar positive effect sizes. Self-perceived benefits were largest for mobility and cognition.Conclusion: Dance-based rehabilitation is a feasible and promising method in severe TBI and its efficacy should be assessed with a larger clinical trial.

A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status.

METHODS

Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists.

RESULTS

Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains.

CONCLUSIONS

This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.

Staying Physically Active During the Quarantine and Self-Isolation Period for Controlling and Mitigating the COVID-19 Pandemic: A Systematic Overview of the Literature

The COVID-19 pandemic has created an unprecedented worldwide public health concern. Characterized by rapid and high frequency human-to-human transmission, the World Health Organization has recommended implementation of public health measures, including isolation of all suspected infectious individuals for a 14-day quarantine period, while governments have introduced "social distancing" and "lock-downs" of varying severity to curtail COVID-19 spread. Recent COVID-19 research further suggests there are major sleep problems and psychological disorders (e.g., stress, anxiety, depression) associated with the reduction of movement and activities, as well as the reduced social interaction. There have been no studies examining the effect of physical activity at home during such periods of isolation. However, based on previous research, potential tactics to overcome these negative effects include home-based exercise, exergaming, dancing to music, and participation in yoga. Adults should accumulate at least 150 min of moderate-intensity and at least 75 min of vigorous-intensity of activity divided in to 5-7 sessions per week. This training volume could be reduced by 30% for children and adolescents if replaced by recess or active play in and around the home. Additionally, exercises should be adapted to the fitness level of the participant and a progressive model of intensity and training volume should be utilized, preferably monitored by telephone applications and wearable sensors.

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson's disease: A systematic review and meta-analysis

Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.

Dance improves symptoms, functional mobility and fine manual dexterity in people with Parkinson disease: a quasi-experimental controlled efficacy study

BACKGROUND

Clinically, individuals diagnosed with Parkinson disease (PD) present several symptoms that impact on their functional independence and quality of life. While there is accumulating evidence supporting dance as an effective symptom management option, few studies have objectively assessed these benefits, particularly related to the Dance for Parkinson's Disease^® (DfPD^®) program.

AIM

The aim of this study was to explore the effects of DfPD^®-based dance classes on disease-related symptoms, fine-manual dexterity and functional mobility in people with PD.

DESIGN

A quasi-experimental controlled efficacy study, with pre and post testing of two parallel groups (dance versus control).

SETTING

Community.

POPULATION

Thirty-three participants with PD allocated to one of two groups: dance group (DG; N.=17; age=65.8±11.7 years) or control group (CG: N.=16; age=67.0±7.7 years). They were cognitively intact (Addenbrooke's Score: DG=93.2±3.6, CG=92.6±4.3) and in early-stage of disease (Hoehn & Yahr: DG=1.6±0.7, CG=1.5±0.8).

METHODS

The DG undertook a one-hour DfPD^®-based class, twice weekly for 12 weeks. The CG had treatment as usual. Both groups were assessed at baseline and after 12 weeks on disease-related symptom severity (MDS-Unified Parkinson Disease Rating Scale: MDS-UPDRS), fine-manual dexterity (Perdue Peg Board), measures of functional mobility (Timed Up & Go: single & dual task, Tinetti, Berg, Mini-BESTest) and self-rated balance and gait questionnaires (Activities Balance Confidence Scale: ABC-S; Gait and Falls: G&F-Q; Freezing of Gait: FOG).

RESULTS

Compared to the CG, there was significantly greater improvement in the DG pre-post change scores on measures of symptom severity MDS-UPDRS, dexterity, six measures of functional mobility, and the ABC-S, G&F-Q, FOG questionnaires.

CONCLUSIONS

DfPD^®-based dance classes improved disease-related symptom severity, fine-manual dexterity, and functional mobility. Feasibility of the approach for a large scale RCT was also confirmed.

CLINICAL REHABILITATION IMPACT

DfPD^® could be an effective supportive therapy for the management of symptoms and functional abilities in PD.

Effects of a community-based exercise program on mobility, balance, cognition, sleep, activities of daily living, and quality of life in PD: a pilot study

Aim: The primary objective of the study was to evaluate the effects of a community-based exercise program for adults with Parkinson's disease (PD). Patients & methods: This one-group pretest and post-test design involved 22 participants with PD who participated in two to three exercise sessions per week for 8 weeks. Outcomes assessed for statistical significance included balance, mobility, cognition, activities of daily living, sleep and quality of life. Results: Although exercise is positively correlated with improvements in function, this short-duration study did not demonstrate this. Qualitative themes revealed an increase in self-perceived socialization, coordination and motivation to continue exercise. Conclusion: This community-based exercise study showed improvements in socialization, self-reported coordination and motivation to exercise. Further research is needed to assess community exercise interventions for PD.