The effects of exercise dose on patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials

Cui, Wenlai; Li, Dong; Yue, Leijiao; Xie, Jun

doi:10.1007/s00415-023-11887-9

Cited by 9 publications

(5 citation statements)

References 77 publications

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“…There is uncertainty not only about the type of exercise that should be recommended to patients with PD, but also regarding its frequency and intensity ( Martignon et al, 2021 ; Cui et al, 2023 ; El Hayek et al, 2023 ). A synthesis of exercise guidelines suggests that patients with mild to moderate PD should engage in three to five sessions of AT at moderate intensity (40%–60% maximum heart rate) per week and two to three sessions of RT, but the evidence base is less consistent compared to other neurological conditions ( Kim et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson’s disease

Paterno,

Polsinelli,

Federico

2024

Front. Physiol.

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Background: Brain-Derived Neurotrophic Factor (BDNF) serum levels are reduced in patients with Parkinson’s Disease (PD).Objectives: This study aimed to assess the effect of exercise intensity, volume and type on BDNF levels in patients with PD.Methods: We searched clinicaltrials.gov, CINAHL, Embase, PubMed, Scopus, Web of Science for both controlled and non-controlled studies in patients with PD, published between 2003 and 2022, which assessed Brain-Derived Neurotrophic Factor before and after different exercise protocols. Exercise intensity was estimated using a time-weighted average of Metabolic Equivalent of Task (MET), while exercise volume was estimated by multiplying MET for the duration of exercise. Exercise types were classified as aerobic, resistance, balance and others. We computed two distinct standardized measures of effects: Hedges’ g to estimate differences between experimental and control group in pre-post intervention BDNF changes, and Cohen’s d to measure pre-post intervention changes in BDNF values for each study arm. Meta-regression and linear regression were used to assess whether these effect measures were associated with intensity, volume and type. PROSPERO registration number: CRD42023418629.Results: Sixteen studies (8 two-arm trials and 8 single-arm trials) including 370 patients with PD were eligible for the systematic review. Selected studies had a large variability in terms of population and intervention characteristics. The meta-analysis showed a significant improvement in BDNF levels in the exercise group compared to the control group, Hedges’ g = 0.70 (95% CI: 0.03, 1.38), with substantial heterogeneity (I2 = 76.0%). Between-group differences in intensity were positively associated with change in BDNF in a subset of 5 controlled studies. In the analysis which included non-controlled studies, intensity and total exercise volume were both positively associated with BDNF change. No difference was found according to exercise type.Conclusion: Exercises of greater intensity may increase BDNF levels in patients with PD, while the role of volume of exercise needs to be further explored.

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Section: Introductionmentioning

confidence: 99%

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson’s disease

Paterno,

Polsinelli,

Federico

2024

Front. Physiol.

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“…In addition, the result of Gallardo et al showed a nonlinear dose–response relationship between exercise and cognitive improvement in old adults, and their studies, it is also the first time determining the exercise dose by task metabolic equivalents ( Gallardo-Gómez et al, 2022 , 2023 ). At the same time, a recent meta-analysis study results found that exercise interventions recommended by the American College of Sports Medicine (ACSM), which include elements of flexibility, cardiovascular endurance, muscle strength, functional training, and motor control, can significantly enhance motor function, activity ability in PD when adhered to with high compliance ( Cui et al, 2023 ). However, the optimal exercise form and exercise dose to improve TUG in PD patients has not been clearly defined in previous studies.…”

Section: Introductionmentioning

confidence: 99%

Optimal dosage ranges of various exercise types for enhancing timed up and go performance in Parkinson’s disease patients: a systematic review and Bayesian network meta-analysis

Yuan,

Wang,

Wang

et al. 2024

Front. Aging Neurosci.

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ObjectiveTo examine the dose–response relationship between specific types of exercise for alleviating Timed up and Go (TUG) in Parkinson’s disease PD.DesignSystematic review and Bayesian network meta-analysis.Data sourcesPubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 5th, 2024.Study analysisData analysis was conducted using R software with the MBNMA package. Effect sizes of outcome indicators were expressed as mean deviation (MD) and 95% confidence intervals (95% CrI). The risk of bias in the network was evaluated independently by two reviewers using ROB2.ResultsA total of 73 studies involving 3,354 PD patients. The text discusses dose–response relationships in improving TUG performance among PD patients across various exercise types. Notably, Aquatic (AQE), Mix Exercise (Mul_C), Sensory Exercise (SE), and Resistance Training (RT) demonstrate effective dose ranges, with AQE optimal at 1500 METs-min/week (MD: −8.359, 95% CI: −1.398 to −2.648), Mul_C at 1000 METs-min/week (MD: −4.551, 95% CI: −8.083 to −0.946), SE at 1200 METs-min/week (MD: −5.145, 95% CI: −9.643 to −0.472), and RT at 610 METs-min/week (MD: −2.187, 95% CI: −3.161 to −1.278), respectively. However, no effective doses are found for Aerobic Exercise (AE), Balance Gait Training (BGT), Dance, and Treadmill Training (TT). Mind–body exercise (MBE) shows promise with an effective range of 130 to 750 METs-min/week and an optimal dose of 750 METs-min/week (MD: −2.822, 95% CI: −4.604 to −0.996). According to the GRADE system, the included studies’ overall quality of the evidence was identified moderate level.ConclusionThis study identifies specific exercise modalities and dosages that significantly enhance TUG performance in PD patients. AQE emerges as the most effective modality, with an optimal dosage of 1,500 METs-min/week. MBE shows significant benefits at lower dosages, catering to patients with varying exercise capacities. RT exhibits a nuanced “U-shaped” dose–response relationship, suggesting an optimal range balancing efficacy and the risk of overtraining. These findings advocate for tailored exercise programs in PD management, emphasizing personalized prescriptions to maximize outcomes.Systematic Review Registration: International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024506968).

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“…We must, however, offer a proactive preventative strategy which places appropriate emphasis on continuous monitoring, which when coupled to available physician and rehabilitation services will lead to care remaining in an outpatient and home setting, and thus improve outcomes and reduce costs. Collective research strongly supports the idea that consistent exercise with appropriate supplementation by physical, occupational and speech/swallow therapy may lead to better outcomes [ 16–19 ]. Providing a tax benefit will incentivize persons with Parkinson’s to integrate an ‘alternating week personal trainer strategy’ into a proactive Parkinson’s disease plan.…”

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confidence: 99%

U.S. Tax Credits to Promote Practical Proactive Preventative Care for Parkinson’s Disease

Okun

2024

JPD

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Persons with Parkinson’s disease (PD) and society at large can profit from a strategic investment into a forward leaning, practical, preventative, and proactive multidisciplinary care policy. The American healthcare system is not easily bent to accommodate this type of care, and thus a tax benefit is an attractive option. An individual federal income tax benefit of $6200 each year for every person residing in the US with a diagnosis of PD, could among other offerings provide monthly access to a licensed clinical social worker and access to mental health services. The implementation of more coordinated care has the potential reduce the burden of depression, anxiety, and demoralization. Personal training would also be covered and directed by physical and occupational therapists. The combination of home-based and telemedicine services would have the added benefit of improving access. The tax benefit would also provide access to a dietician. This type of care strategy could be designed to proactively identify early signs of aspiration and urinary tract infections to ‘head off’ significant morbidity. A $6200/year individual tax benefit for those diagnosed with PD will thus translate into more fall prevention, more care in the home setting, less hospitalizations, less depression, less anxiety, less demoralization, better diets, and less persons placed in nursing facilities. Additionally, this tax benefit will provide the potential for billions of dollars in savings to the healthcare system. A tax benefit for PD is a practical preventative and proactive strategy which can serve to advantage both this generation and the next.

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The effects of exercise dose on patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials

Cited by 9 publications

References 77 publications

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson’s disease

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson’s disease

Optimal dosage ranges of various exercise types for enhancing timed up and go performance in Parkinson’s disease patients: a systematic review and Bayesian network meta-analysis

U.S. Tax Credits to Promote Practical Proactive Preventative Care for Parkinson’s Disease

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