Nonpharmacological interventions for respiratory health in Parkinson’s disease: A systematic review and meta‐analysis

Abstract

Background and purpose Respiratory dysfunction in Parkinson’s disease (PD) is often an underdiagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support nonpharmacological interventions to improve respiratory impairments in individuals with PD. Methods The relevant literature was searched using a customised and systematic strategy. Randomised and nonrandomised control trials of nonpharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow, and perception of dyspnoea. Results Nonpharmacological interventions included: functional training, generalised strength training, respiratory muscle strength training, aerobic exercise, qigong, yoga, breath stacking, incentive spirometry and singing. Methodological quality of included studies varied. Meta‐analyses of nonpharmacological interventions demonstrated significant effects for inspiratory muscle strength (mean difference [MD] 19.68; confidence interval [CI] 8.49, 30.87; z = 3.45; p = 0.0006; I2 = 2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z = 3.33; p = 0.0009; I2 = 23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z = 3.45; p = 0.0006; I2 = 0%). Best‐evidence synthesis identified level 1 evidence supporting nonpharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD. Conclusions Nonpharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.

Respiratory Abnormalities in Parkinson’s Disease: What Do We Know from Studies in Humans and Animal Models?

“…Inspiratory muscles weakness, assessed during spirometry, was afterwards confirmed in early-stage [ 22 , 31 ], mild to moderate [ 23 , 24 , 46 ], and late-stage PD [ 24 , 47 ]. Recent promising reports indicate that respiratory muscle strength in older adults with PD can be improved by regular muscle training, which also confirms that, at least in part, respiratory muscle weakness is responsible for respiratory distress in this disease [ 48 , 49 , 50 , 51 ].…”

“…Although the pathological basis of dyspnea in PD is still unclear, it seems that it may be conditioned by a pathology of both central (brainstem ventilatory centers) and peripheral structures (upper airway, respiratory muscles, chest wall, chemoreceptors) involved in the respiratory process [ 26 ], as well as by emotional problems of PD patients, such as anxiety and depression [ 129 ]. Nonetheless, a nonpharmacological intervention consisting of exercises to strengthen the respiratory muscles has been described to be an effective tool in reducing the sensation of dyspnea [ 50 ]. Psychological interventions that include breathing exercises (e.g., mindfulness-based) are also feasible for people with PD and may help control the feelings of shortness of breath caused by anxiety [ 130 ].…”

Respiratory Dysfunctions in Parkinson’s Disease Patients

“…Nonetheless, an improvement regarding the rigidity of the thoracic wall significantly improved kinesics and coordination at a precise level. A meta-analysis of the literature demonstrated that non-medical treatment methods in Parkinson’s disease provide statistically significant amelioration in respiratory strength measures and peak expiratory flow rates [ 28 ]. In a systematic review, Rodriguez et al concluded that respiratory muscle training might be helpful for enhancing the strength of the respiratory musculature, swallowing, and phonation capacity [ 29 ].…”

Respiratory disorders of Parkinson’s disease

“…These data suggest that UAO may be sensitive to dopaminergic stimulation and may be aggravated in cases without therapeutic intervention related to dopamine. Respiratory physiotherapy and related exercises can also help to reduce symptoms of UAO among patients with PD (60).…”

“…A meta-analysis, after analyzing four studies, suggested statistically significant improvement in FVC and PEF and no change in FEV 1 after levodopa treatment (84). Thus, the most relevant clinical intervention to date is follow-up by respiratory and swallowing therapists (60,69), as further studies are required to safely investigate the effectiveness of treatments for the peripheral respiratory disorders of PD. In the literature, there are still many issues -prevalence rates, pathophysiological mechanisms and treatments -about peripheral respiratory disorders under discussion and with inconsistencies, making necessary further studies to better understanding those symptoms.…”