Efficacy of Traditional Chinese Exercise in Improving Gait and Balance in Cases of Parkinson's Disease: A Systematic Review and Meta-analysis

Abstract

BackgroundThe efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of motor function in patients with Parkinson's disease (PD) is controversial. The present study aimed to assess the effects of TCE on balance and gait outcomes, as well as motor symptoms in individuals with PD, and evaluate potential discrete moderators such as TCE dosage-related variables.MethodPubMed, Embase, Cochrane's Library, Web of Science, Medline, and Scopus were systematically searched from their dates of inception to February 2022. All studies were randomized controlled trials (RCTs) of TCE-based interventions for PD. The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges' g). The Physiotherapy Evidence Database was used to evaluate the methodological quality of the study.ResultFifteen studies involving a total of 873 participants were included in the final analysis. The meta-analytic findings revealed significant improvements in balance outcomes [Berg Balance Scales (BBS) (g = 0.83, 95% CI = 0.37–1.29, p = 0.000, I2 = 84%), time up and go (TUG) (g = −0.80, 95% CI = −1.13– −0.47, p = 0.000, I2 = 81%), and the one legged blind balance test (g = 0.49, 95% CI = 0.13–0.86, p = 0.01, I2 = 10%)], as well as gait outcomes [gait velocity (g = 0.28, 95% CI = 0.02–0.54, p = 0.04, I2 = 64%), 6-min walking test (6MWT) (g = 0.32, 95% CI 0.01–0.62, p = 0.04, I2= 15%), stride length (g = 0.25, 95% CI = 0.08–0.41, p = 0.003, I2 = 42%)], and motor symptoms [Unified Parkinson's Disease Rating Scale part III (UPDRS-III) (g = −0.77, 95% CI = −1.06– −0.48, p = 0.000, I2 = 76%)]. However, cadence (g = −0.03) and step length (g = 0.02) did not differ significantly. The moderator shows that the effects of TCE on BBS and gait velocity were moderated by Pedro score, exercise type, control group type, and number of sessions. Meta-regression found that TCE (exercise duration, number of sessions, and session duration) was significantly associated with improved UPDRS-III and BBS scores.ConclusionThese findings provide evidence for the therapeutic benefits of TCE as an adjunct therapy for patients with PD. TEC dosage (high-intensity long sessions) may moderate some favorable effects.Systematic Review RegistrationPROSPERO, identifier CRD42022314686.

Effect of Physiotherapy Interventions on Motor Symptoms in People With Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…Previous studies have also reported on the limited effectiveness of strength training, dance, and aerobic exercise in improving walking speed (Karpodini et al, 2022; Radder et al, 2020). However, some reviews have found that Tai Chi and BGT can significantly improve walking speed (Radder et al, 2020; Wu et al, 2022). This difference may be due to the limited number of studies included in this study, in which only studies with sham-treated controls were included and studies with controls receiving other active physiotherapy were excluded.…”

“…This difference may be due to the limited number of studies included in this study, in which only studies with sham-treated controls were included and studies with controls receiving other active physiotherapy were excluded. Walking endurance, as measured by the 6-MWT, is a more commonly used indicator than walking speed (Karpodini et al, 2022; Radder et al, 2020; Wu et al, 2022). Both mind-body exercise and aerobic exercise have been found to improve aerobic endurance (Winser et al, 2018; Zhen et al, 2022), so it is no surprise that both were found to significantly improve walking endurance in people with PD.…”

“…We found that strength training, BGT and mind-body exercise significantly improved functional mobility, while aerobic exercise and NiBS had no significant effect. Strength training, BGT and mind-body exercises can increase muscle strength in the lower limbs (Karpodini et al, 2022; Wu et al, 2022), and mind-body exercises such as Tai Chi and yoga can also improve flexibility (Wu et al, 2022), all of those can help people with PD perform better on TUG tests. Possibly limited by the number of studies included, aerobic exercise and NiBS did not show effectiveness on functional mobility.…”

Comparing the effectiveness of type of the traditional Chinese exercises, frequency, intensity, time in osteoporosis: a protocol for systematic evaluation and network meta-analysis of randomised controlled trials

“…As light to moderate exercises, TCEs are safe, effective and economical. They combine balance and coordination capacity on the basis of aerobic exercise and emphasise the physical–psychological connection 38. Because of this, these traditional sports are very popular among people of all ages in China and have become quite popular around the world in recent years 39.…”

“…They combine balance and coordination capacity on the basis of aerobic exercise and emphasise the physical-psychological connection. 38 Because of this, these traditional sports are very popular among people of all ages in China and have become quite popular around the world in recent years. 39 Evidence has demonstrated the effectiveness of TCEs in improving cardiopulmonary and musculoskeletal system function and quality of life in older adults.…”