The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: a systematic review and meta-analysis of clinical trials

Salari, Nader; Hayati, Aida; Kazeminia, Mohsen; Rahmani, Adibeh; Mohammadi, Masoud; Fatahian, Reza; Shohaimi, Shamarina

doi:10.1007/s10072-021-05689-y

Cited by 10 publications

(9 citation statements)

References 74 publications

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“…Finally, BWS interventions, dance, and sensorimotor training not including endurance show positive effects on balance, as indicated by the BBS. In line with the current study results, previous reviews have shown that physical exercise interventions are effective in managing PD symptoms such as balance, postural stability, and mobility impairments ( 17 , 18 ).…”

Section: Discussionsupporting

confidence: 92%

“…Recent systematic reviews and meta-analyses have studied the effects of some types of physical exercise on PD and other neurological diseases, but have not reported separate and comparative effects among the different types of physical exercise ( 17 , 18 ). In addition, a recently published Cochrane review compared the effectiveness of the different categories of physical exercise for the severity of motor signs, quality of life, occurrence of adverse events, gait freezing, and functional mobility and balance measured with the Timed Up and Go Test (TUG); however, the review did not evaluate balance and postural stability ( 19 ).…”

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confidence: 99%

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Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson’s disease: a network meta-analysis

Lorenzo-García,

Cavero-Redondo,

Núñez de Arenas-Arroyo

et al. 2024

JRM

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Objective: To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson’s disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG). Design: Network meta-analysis. Methods: The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise. Results: Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (–0.54; 95% CI –0.82, –0.26), balance (–0.42; 95% CI –0.75, –0.08), resistance (–0.60; 95% CI –0.89, –0.31), and sensorimotor training including endurance interventions (–0.61; 95% CI –0.95, –0.27) vs control comparisons. Conclusion: Balance interventions improve balance, postural stability, and general mobility in people with Parkinson’s disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson’s disease: a network meta-analysis

Lorenzo-García,

Cavero-Redondo,

Núñez de Arenas-Arroyo

et al. 2024

JRM

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“…The most effective non-pharmacological approach to manage walking impairment and improve balance is the practice of physical exercise [ 17 , 18 ]. The rehabilitation of balance and gait deficits usually relies on the principles of neuroplasticity and motor learning strategies [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Marotta

Sire

Marinaro

et al. 2022

JCM

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Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing–remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects.

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“…So far, although immunosuppressants can delay the progression and deterioration of the disease, there is no effective drug treatment that can completely block the advance and cure the disease in MS patients ( 9 ). The latest research found that rehabilitation treatment can improve the functional status of patients and reduce their disability level, which is an important treatment method to improve the ability of daily living ( 10 , 11 ). As an essential method of treating MS, rehabilitation therapy has become a hot spot in international medical research in recent years, and has also been paid more and more attention by developing countries.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation treatment of multiple sclerosis

Duan

Jing

et al. 2023

Front. Immunol.

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Multiple sclerosis is a slowly progressive disease, immunosuppressants and other drugs can delay the progression and progression of the disease, but the most patients will be left with varying degrees of neurological deficit symptoms, such as muscle weakness, muscle spasm, ataxia, sensory impairment, dysphagia, cognitive dysfunction, psychological disorders, etc. From the early stage of the disease to the stage of disease progression, professional rehabilitation treatment can reduce the functional dysfunction of multiple sclerosis patients, improve neurological function, and reduce family and social burdens. With the development of various new rehabilitation technologies such as transcranial magnetic stimulation, virtual reality technology, robot-assisted gait, telerehabilitation and transcranial direct current stimulation, the advantages of rehabilitation therapy in multiple sclerosis treatment have been further established, and more treatment means have also been provided for patients.

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The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: a systematic review and meta-analysis of clinical trials

Cited by 10 publications

References 74 publications

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson’s disease: a network meta-analysis

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson’s disease: a network meta-analysis

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Rehabilitation treatment of multiple sclerosis

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