Mind–Body Exercises for Non-motor Symptoms of Patients With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Functional training and Mat Pilates have a positive effect on non-motor symptoms improving cognition, depressive symptoms, anxiety, and happiness in people with Parkinson's disease: a randomized controlled clinical trial with follow-up

OBJECTIVES

To analyze the short-term (12-wk post-intervention) and long-term (6-month follow-up) effects of two exercise interventions (functional training or Mat Pilates) compared to a control group and a healthy reference group on non-motor symptoms in people with Parkinson's disease.

METHOD

35 individuals with Parkinson's disease were randomized into three groups: functional training, Mat Pilates, and control group, along with 11 age- and sex-matched healthy individuals for the healthy reference group. The exercise groups received twice-weekly 60-min sessions for 12 wk. The control group and healthy reference group maintained routine activities and also received educational lectures during the 12-wk period. Outcome measures included cognition (MoCA), depressive symptoms (BDI), anxiety (BAI), mood (BRUMS), and aging perspective (Sheppard Inventory).

RESULTS

Short-term effects were observed for the functional training group in the short term for depressive symptoms (p = 0.010) and cognition (p = 0.040), and in the short and long term for anxiety (p = 0.007) and happiness (aging perspective) (p = 0.002). For the Mat Pilates group, effects were observed in cognition (p = 0.048) and confusion (p = 0.049) in the short term, and in depressive symptoms (p < 0.001), anxiety (p = 0.033), happiness (p < 0.001), and loneliness (aging perspective) (p = 0.017) in the short and long term. The control group showed worsening in depressive symptoms (p = 0.030) and confusion (p = 0.033).

CONCLUSION

Mat Pilates and functional training classes were effective in improving cognition, depressive symptoms, anxiety, and happiness. The control group and healthy reference group did not show significant effects in most studied variables. Both types of exercise can be recommended by professionals working with people with Parkinson's disease.

REGISTRATION

ReBEC - RBR-6ckggn.

Efficacy of Oriental Exercises for Non-Motor Symptoms and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis

Parkinson's disease (PD) is a progressive neurodegenerative disorder without a definitive cure. Oriental exercises (OEs) have emerged as a complementary and alternative therapy for PD, but their efficacy in ameliorating non-motor symptoms (NMS) and quality of life (QOL) remains uncertain. This systematic review and meta-analysis actively investigated the efficacy of OEs in addressing NMS and enhancing QOL and sought to offer recommendations for optimal OE regimens for PD patients. By analyzing 30 controlled trials involving 2029 participants, we found that OEs significantly improved cognitive function, neuropsychiatric symptoms, and QOL compared to control groups. Specifically, significant improvements were observed in several outcome measures: Parkinson's Disease Questionnaire (PDQ) [MD: [Formula: see text]3.67, 95% CI: [Formula: see text]5.72-[Formula: see text]1.63, [Formula: see text], [Formula: see text]%], Parkinson's Disease Non-Motor Symptom Questionnaire (NMSQ) [MD: [Formula: see text]2.34, 95% CI: [Formula: see text]4.67-[Formula: see text]0.01, [Formula: see text], [Formula: see text]%], Montreal Cognitive Assessment (MoCA) [MD: 1.75, 95% CI: 1.46-2.03, [Formula: see text], [Formula: see text]%], Stroop Color and Word Test (SCWT) [MD: 0.87, 95% CI: 0.49-1.24, [Formula: see text], [Formula: see text]%], Frontal Assessment Battery (FAB) [MD: 1.49, 95% CI: 1.16-1.81, [Formula: see text], [Formula: see text]%], Hamilton Depression Scale (HAMD) [MD: [Formula: see text]4.27, 95% CI: [Formula: see text]6.85-[Formula: see text]1.69, [Formula: see text], [Formula: see text]%], Hamilton Anxiety Scale (HAMA) [MD: [Formula: see text]0.24, 95% CI: [Formula: see text]0.32-[Formula: see text]0.16, [Formula: see text], [Formula: see text]%], and the Symptom Checklist-90 (SCL-90) [MD: [Formula: see text]0.37, 95% CI: [Formula: see text]0.48-[Formula: see text]0.25, [Formula: see text], [Formula: see text]%]. Our findings provide compelling evidence for the potential benefits of OEs in managing NMS and improving QOL in PD patients. To optimize outcomes, we recommend customizing OE regimens based on individual clinical phenotypes, and to validate these results we emphasize the need for rigorous, large-scale studies.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

BACKGROUND AND OBJECTIVE

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.

METHODS

The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.

RESULTS

Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.

CONCLUSIONS

In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

A pilot randomized clinical trial examining the effects of Qigong on inflammatory status and sleep quality in people with Parkinson's disease

BACKGROUND

Neuroinflammation contributes to degeneration of neurons in people with Parkinson's disease (PD). The concentrations of inflammatory cytokines, IL-1β, IL-6, and TNF-α, are often increased in people with PD and are associated with various non-motor symptoms. Qigong exercise is a mind-body practice which has been used as a rehabilitation intervention for people with PD. A previous study showed a strong association between sleep quality and inflammatory status. This study investigated the effect of Qigong on inflammatory status in people with PD and explored potential relationships between inflammatory status and sleep quality in this population.

METHODS

The study was a randomized controlled trial. A total of 17 participants completed the 12-week intervention (Qigong (n = 8), sham Qigong (n = 9)). Questionnaires were utilized to assess non-motor symptoms, including sleep quality. Inflammatory cytokines were measured by a high sensitivity antibody-based multiplex assay.

RESULTS

After the 12-week intervention, a decreasing trend in the concentrations of IL-1β and IL-6 was found in the Qigong group. Moderate to strong correlations were found between changes in IL-1β concentrations and sleep quality.

CONCLUSION

Inflammation is an important aspect of PD. This study explored the inflammatory status after a mind-body exercise. Further studies need to extend our findings to confirm the effect of Qigong in people with PD.

Distinct effects of long-term Tai Chi Chuan and aerobic exercise interventions on motor and neurocognitive performance in early-stage Parkinson's disease: a randomized controlled trial

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative condition characterized by movement disorders and probable cognitive impairment. Exercise plays an important role in PD management, and recent studies have reported improvement in motor symptoms and cognitive function following aerobic and Tai Chi Chuan exercise.

AIM

To explore the different effects of Tai Chi Chuan and aerobic exercise on the clinical motor status and neurocognitive performance of patients with early-stage PD.

DESIGN

A randomized controlled trial.

SETTING

Parkinson's Disease Center at Kaohsiung Chang Gung Memorial Hospital and National Cheng Kung University Hospital.

POPULATION

Patients with idiopathic PD.

METHODS

Fifty-six patients with PD were recruited and divided into three groups: aerobic exercise (AE, N.=14), Tai Chi Chuan exercise (TE, N.=16), and control (CG, N.=13). Before and after a 12-week intervention period, we used unified Parkinson's disease rating scale Part III (UPDRS-III) scores and neuropsychological (e.g., accuracy rates [ARs] and reaction times [RTs]) and neurophysiological (e.g., event-related potential [ERP] N2 and P3 latencies and amplitudes) parameters to respectively assess the patients' clinical motor symptoms and neurocognitive performance when performing a working memory (WM) task.

RESULTS

Compared to baseline, UPDRS-III scores were significantly lower in the AE and TE groups after the intervention period, whereas those for the CG group were higher. In terms of the neurocognitive parameters, when performing the WM task after the intervention period, the AE group exhibited significantly faster RTs and larger ERP P3 amplitudes, the TE group exhibited an improvement only in ERP P3 amplitude, and the CG group exhibited a significantly reduced ERP P3 amplitude. However, neither the TE nor the AE group exhibited improved ARs and ERP N2 performance.

CONCLUSIONS

The present study supported the distinct effectiveness of Tai Chi Chuan and aerobic exercise for improving motor symptoms and providing neurocognitive benefits in PD patients.

CLINICAL REHABILITATION IMPACT

These results have important implications regarding the use of these exercise interventions for managing PD, particularly in the early stages.

[The adapted physical activity teacher, a professional helping people to live better with Parkinson's disease]

Recognized by numerous scientific studies as an effective non-drug therapy for the treatment of most chronic illnesses, physical activity is booming. Many players are currently sharing the market. Among these professionals is the adapted physical activity teacher. They have a university degree in adapted physical activity and health. They propose motorized teaching situations using adapted physical activities, whether sporting or artistic, under technical, material, regulatory and motivational conditions that are appropriate to the situation and to the safety of the participant. The aim is rehabilitation, education, prevention and/or social integration.

Can Physical Exercise Be Considered as a Promising Enhancer of Global Cognition in People with Parkinson's Disease? Results of a Systematic Review and Meta-Analysis

Background

Physical exercise interventions are known to improve quality of life, motor and non-motor symptoms in people with Parkinson's disease (PD). However, systematic reviews and meta-analyses on cognitive outcomes are rare.

Objective

To perform a systematic review and meta-analysis of physical exercise intervention effects compared with passive and active control groups (CGs) on global cognition in people with PD.

Methods

A literature search was performed for randomized controlled trials (RCTs) on physical exercise interventions in PD using nine databases. We included RCTs reporting global cognition outcomes. A meta-analysis was performed using random-effects models and standardized mean differences (SMDs) with 95% confidence intervals (CIs). Bias was assessed with the revised Cochrane Risk of Bias tool and the certainty of evidence was rated using the GRADE approach.

Results

Seventeen studies (ten with passive, seven with active CGs) were included in the systematic review. Exercise interventions varied considerably between studies. The meta-analysis included nine studies with 236 people with PD (seven with passive, two with active CGs). The SMD was 0.33 (95% CI 0.00; 0.65) demonstrating a small effect (p = 0.05) in favor of physical exercise. Compared with passive CGs, physical exercise had a small non-significant effect (SMD = 0.22, 95% CI -0.14;0.58, p = 0.24). Compared with active CGs, physical exercise had a medium significant effect (SMD = 0.72, 95% CI 0.12;1.33, p = 0.02).

Conclusions

Physical exercise may increase global cognition in people with PD, but the evidence is very uncertain. Further large-scale RCTs are needed to confirm this finding and to identify the most effective type of physical exercise for improving cognition.

The Park Sleep subtype in Parkinson's disease: from concept to clinic

INTRODUCTION

The heterogeneity of Parkinson's disease (PD) is evident from descriptions of non-motor (NMS) subtypes and Park Sleep, originally identified by Sauerbier et al. 2016, is one such clinical subtype associated with the predominant clinical presentation of sleep dysfunctions including excessive daytime sleepiness (EDS), along with insomnia.

AREAS COVERED

A literature search was conducted using the PubMed, Medline, Embase, and Web of Science databases, accessed between 1 February 2023 and 28 March 2023. In this review, we describe the clinical subtype of Park Sleep and related 'tests' ranging from polysomnography to investigational neuromelanin MRI brain scans and some tissue-based biological markers.

EXPERT OPINION

Cholinergic, noradrenergic, and serotonergic systems are dominantly affected in PD. Park Sleep subtype is hypothesized to be associated primarily with serotonergic deficit, clinically manifesting as somnolence and narcoleptic events (sleep attacks), with or without rapid eye movement behavior disorder (RBD). In clinic, Park Sleep recognition may drive lifestyle changes (e.g. driving) along with therapy adjustments as Park Sleep patients may be sensitive to dopamine D3 active agonists, such as ropinirole and pramipexole. Specific dashboard scores based personalized management options need to be implemented and include pharmacological, non-pharmacological, and lifestyle linked advice.

Efficacy of rehabilitation robot-assisted gait training on lower extremity dyskinesia in patients with Parkinson's disease: A systematic review and meta-analysis

BACKGROUND

Robot-assisted training is used as a new rehabilitation training method for the treatment of motor dysfunction in neurological diseases. Robot-assisted gait training (RAGT) has been reported to treat motor dysfunction in patients with Parkinson's disease (PD). The purpose of this study was to summarize previous clinical studies comparing the effectiveness of RAGT and conventional training for lower extremity dyskinesia in PD patients.

METHODS

PubMed, Cochrane library, Scopus, Embase, EBSCO, Web of Science, CNKI, and Wanfang databases were searched. This study included all randomized controlled trials (RCTs) compared lower extremity RAGT with conventional training on motor impairment in PD patients. The retrieval time limit is from the establishment of the database to October 2022. Two researchers independently screened the literature, extracted data, assessed the risk of bias of included studies, and then used RevMan 5.3 software for meta-analysis.

RESULTS

A total of 14 RCTs with 572 patients were included. The results showed that compared with the control group, RAGT significantly improved the motor function evaluation-related indicators 10MWT, 6MWT, TUG and UPDRS III, 10MWT [MD= 0.08, 95 % CI (0.01, 0.14), P = 0.03], 6MWT [MD= 42.83, 95 % CI (22.05, 63.62), P < 0.0001], TUG[MD= -1.81, 95 % CI (-2.55, -1.08), P < 0.0001], UPDRS III [MD= - 3.82, 95 % CI (-4.27, -3.37), P < 0.00001]; For the balance function evaluation index BBS [MD= 3.33, 95 % CI (2.76, 3.89), P < 0.00001], the above results were significantly different significance.

CONCLUSION

The currently limited evidence suggests that RAGT provides evidence for the effectiveness of lower extremity motor function and balance dysfunction, and RAGT can significantly improve motor and balance function in PD patients.

Physical Exercise as a Potential Treatment for Fatigue in Parkinson's Disease? A Systematic Review and Meta-Analysis of Pharmacological and Non-Pharmacological Interventions

BACKGROUND

Fatigue is one of the most common and debilitating non-motor symptoms among patients with Parkinson's disease (PD) and significantly impacts quality of life. Therefore, effective treatment options are needed.

OBJECTIVE

To provide an update on randomized controlled trials (RCTs) including pharmacological and non-pharmacological (but non-surgical) treatments that examine the effects of fatigue on PD patients.

METHODS

We searched the MEDLINE, EMBASE, PsycINFO, CENTRAL, and CINAHL databases for (cross-over) RCTs on pharmacological and non-pharmacological interventions for treating fatigue in PD patients until May 2021. Meta-analyses for random-effects models were calculated when two or more studies on the same treatment option were available using standardized mean differences (SMDs) with 95% confidence intervals (CIs).

RESULTS

Fourteen pharmacological and 16 non-pharmacological intervention RCTs were identified. For pharmacological approaches, a meta-analysis could only be performed for modafinil compared to placebo (n = 2) revealing a non-significant effect on fatigue (SMD = - 0.21, 95% CI - 0.74-0.31, p = 0.43). Regarding non-pharmacological approaches, physical exercise (n = 8) following different training approaches versus passive or placebo control groups showed a small significant effect (SMD = - 0.37, 95% CI - 0.69- - 0.05, p = 0.02) which could not be demonstrated for acupuncture vs. sham-acupuncture (SMD = 0.16, 95% CI - 0.19-0.50, p = 0.37).

CONCLUSION

Physical exercise may be a promising strategy to treat fatigue in PD patients. Further research is required to examine the efficacy of this treatment strategy and further interventions. Future studies should differentiate treatment effects on physical and mental fatigue as the different underlying mechanisms of these symptoms may lead to different treatment responses. More effort is required to develop, evaluate, and implement holistic fatigue management strategies for PD patients.