Effects of Exercise on Depressive Symptoms in Patients With Parkinson Disease

Abstract

Objective:To provide clear evidence in support of the use of exercise to improve depressive symptoms in patients with Parkinson’s disease (PD), and to investigate whether this effect differs by exercise type and intensity.Methods:Three independent reviewers searched for randomized controlled trials that applied exercise interventions with depressive symptoms as an outcome measure for patients with PD on PubMed and Web of Science up to February 28, 2022. Random effects meta-analyses were performed, in which standardized mean differences (SMDs) between the effects of exercise and control interventions on depressive symptoms with 95% confidence intervals (CIs) were calculated.Results:A total of 19 randomized controlled trials including 1,302 PD patients were eligible for meta-analysis, and we obtained 23 comparisons from the included studies for data synthesis. Physical exercise interventions showed significant effects on the reduction in depressive symptoms in PD patients (SMD=0.829; 95% CI=0.516 to 1.142; P<0.001). Moderator analyses on exercise type revealed significant positive effects for combined exercise interventions (SMD=1.111; 95% CI=0.635 to 1.587; P<0.001), whereas aerobic training alone failed to show significant effects (SMD=0.202; 95% CI =-0.045 to 0.449; P=0.108). With respect to exercise intensity, both light-to-moderate intensity exercises (SMD=0.971; 95% CI=0.521 to 1.421; P<0.001) and moderate-to-vigorous intensity exercises (SMD=0.779; 95% CI=0.407 to 1.152; P<0.001) significantly improved depressive symptoms with a small difference between the exercise intensities.Conclusion:Our results suggest that physical exercise has significant antidepressant effects in PD patients. These effects appeared to be more closely associated with exercise type than intensity. Different types of exercise interventions may result in greater benefit and require further investigation.

Effects of high-intensity interval training and moderate-intensity continuous training on non-motor symptoms in patients with Parkinson’s disease: a randomized pilot trial

“…However, in a recent meta-analysis of 19 randomized controlled trials involving 1302 patients with PD, the effect size of light-to-moderate-intensity exercise was slightly higher than that of moderate-to-vigorous-intensity exercise, although both exercise intensities significantly improved depressive symptoms. 6 Similarly, a mindfulness yoga program was found to be more effective compared to stretching and resistance training exercises in reducing depressive and anxiety symptoms in patients with PD, 14 which may emphasize the importance of exercise type over intensity in improving mood symptoms.…”

“…PD was diagnosed based on the UK PD Society Brain Bank Diagnostic Criteria. Patients who met the following criteria were included: (1) aged between 50 and 80 years, (2) had a Hoehn and Yahr stage 1 or 2, (3) had the disease duration of <5 years, (4) performed less than the recommended aerobic exercise proposed by the American College of Sports Medicine (≥20 minutes of vigorous exercise ≥3 days/week or ≥30 minutes of moderate exercise ≥5 days/week), (5) were on stable dopaminergic pharmacotherapy for 3 months, (6) and had a score ≥1 in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 1. We excluded patients who (1) had neurological, orthopedic, or cardiac comorbidities that made them unfit to perform aerobic exercise, (2) had a Montreal Cognitive Assessment (MoCA) score of <18, (3) were on antipsychotics, or (4) were unavailable for >10% of the study period.…”

“…4 With respect to non-motor symptoms, previous studies have demonstrated the efficacy of physical exercises on cognitive function and depressive and sleep-related symptoms. [5][6][7] However, it is largely unknown whether exercise improves other non-motor symptoms and how such effects differ with exercise intensity and mode.…”

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

“…Several meta-analyses have confirmed that compared to control interventions, physical activity and exercise could significantly reduce depressive symptomatology in PD patients [ 85 , 89 , 90 , 91 ]. In particular, general and aerobic exercise, as well as balance training, could ameliorate depressive symptoms of PD patients while stretching exercises did not have significant antidepressant effects [ 85 ].…”

“…In particular, general and aerobic exercise, as well as balance training, could ameliorate depressive symptoms of PD patients while stretching exercises did not have significant antidepressant effects [ 85 ]. Regarding intensity, both light-to-moderate and moderate-to-vigorous exercises provided significant benefits, as shown by a recent meta-analysis [ 91 ]. Combined training interventions displayed significant effects while aerobic exercise alone did not reach a level of statistical significance in the moderator analysis of this study [ 91 ], suggesting that exercise type rather than intensity might substantially affect the antidepressant effects of physical exercise.…”