Effects of aquatic exercise on the improvement of lower-extremity motor function and quality of life in patients with Parkinson's disease: A meta-analysis

Optimal dose and type of exercise to improve motor symptoms in adults with Parkinson's disease: A network meta-analysis

OBJECTIVES

This study aimed to evaluate the dose-response relationship between different exercise types and the alleviation of motor symptoms in Parkinson's Disease patients.

DESIGN

A systematic review and network meta-analysis were conducted to compare the effects of 12 exercise types on motor symptoms in Parkinson's Disease patients using randomized controlled trials.

METHODS

A systematic search was conducted across PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science until September 10, 2024. A total of 81 trials involving 4596 patients were included. Mean differences with 95 % credible intervals were calculated, and evidence quality was assessed using Confidence in Network Meta-Analysis. The Minimum Clinically Important Difference was used to assess clinical efficacy.

RESULTS

The optimal exercise dose for overall motor symptom improvement was 1300 MET-min/week (mean difference: -6.07, 95 % credible intervals: -8.10 to -4.01). Dance at 850 MET-min/week provided the greatest improvement (mean difference: -11.18, 95 % credible intervals: -16.01 to -6.22). Significant improvements were seen with doses as low as 60-100 MET-min/week for body weight support training, dance, resistance training, and sensory exercise. The Minimum Clinically Important Difference was achieved with doses exceeding 670 MET-min/week for overall exercise, and at lower doses for specific types: aerobic exercise (1100 MET-min/week), body weight support (420 MET-min/week), and dance (230 MET-min/week).

CONCLUSIONS

The optimal exercise dose for alleviating motor symptoms in Parkinson's Disease patients is 1300 MET-min/week, with dance being most effective at 850 MET-min/week. These findings provide evidence-based recommendations for Parkinson's Disease management.

Exercise as medicine in Parkinson's disease

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

Advice to People with Parkinson's in My Clinic: Exercise

There is compelling evidence that exercise must be part of main line therapy for people with Parkinson's disease. In this viewpoint, we outline the four key components of exercise: aerobic exercise, resistance exercise, flexibility exercise, and neuromotor exercises (posture, gait, balance, and agility) that can improve both motor and non-motor symptoms of the disease and, in the case of aerobic exercise, may delay the disease. We outline guidelines on how to change and optimize the exercise prescription at different stages of the disease.