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Palmieri JL, Jones L, Schenkman M, Deutsch JE. Bicycling for Rehabilitation of Persons With Parkinson Disease: A Scoping Review. J Neurol Phys Ther 2024; 48:125-139. [PMID: 38693613 PMCID: PMC11196205 DOI: 10.1097/npt.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND PURPOSE Exercise is beneficial for persons with Parkinson disease (PwPD). The overarching purpose of this scoping review was to provide guidance to clinicians and scientists regarding current evidence for bicycling exercise for PwPD. A scoping review was conducted to examine the heterogeneous literature on stationary bicycling for PwPD to reduce motor symptoms and body function structure impairments, improve activities and motor performance, and reduce disease severity. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. PubMed, CINAHL, and PEDro were searched from inception to January 23, 2023. Articles reporting original data on relevant outcome measures were included. Search results were screened and articles were extracted. Data were analyzed quantitatively with percentages of significant and clinically meaningful findings and qualitatively to extract themes. RESULTS Bicycling was categorized using bicycle types (assisted, nonassisted) and training modes (speed, aerobic, force). A high percentage of the 34 studies showed statistical significance for reducing motor symptoms (83%), body function structure impairments (78%), disease severity (82%), and improving activities (gait 72%, balance 60%). Clinically meaningful findings were achieved in 71% of the studies for reduction in disease severity and in 50% for improving gait. DISCUSSION AND CONCLUSIONS The literature on bicycling for PwPD has evolved from speed to aerobic studies. The terminology describing types of bicycling was simplified. Of all the outcomes reported, reduction of disease severity achieved the highest frequency of clinical meaningful improvements. Bicycling was comparable with other forms of aerobic training for walking speed and endurance. Opportunities for translation to practice and research are presented.
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Affiliation(s)
- John L Palmieri
- Rivers Lab, Department of Rehabilitation & Movement Sciences (J.L.P., L.J., J.E.D.), Rutgers School of Health Professions, Newark, New Jersey; Rutgers School of Graduate Studies (J.L.P., J.E.D.), New Brunswick, New Jersey; Rutgers New Jersey Medical School (J.L.P.), Newark; and University of Colorado Anschutz Medical Campus (M.S.), Aurora
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Yuan Y, Wang J, Wang G, Wang T, Zhang H, Fu X, Wu L, Chen X, Xia R, Zhang L, Lin SC, Yang Y. 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. Front Aging Neurosci 2024; 16:1399175. [PMID: 38988329 PMCID: PMC11234838 DOI: 10.3389/fnagi.2024.1399175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Objective To examine the dose-response relationship between specific types of exercise for alleviating Timed up and Go (TUG) in Parkinson's disease PD. Design Systematic review and Bayesian network meta-analysis. Data sources PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 5th, 2024. Study analysis Data 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. Results A 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. Conclusion This 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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Affiliation(s)
- Yuan Yuan
- Department of Physical Education, Kunsan National University, Gunsan-si, Jeollabuk-do, Republic of Korea
| | - JunYu Wang
- The School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - GuoTuan Wang
- Institute of Physical Education, Henan University, Kaifeng, China
- School of Physical Education and Health, Krasnoyarsk State Pedagogical University named after V.P., Krasnoyarsk City, Russia
| | - Tao Wang
- College of Physical Education and Health, Southwest University of Science and Technology, Mianyang, China
| | - HaoYang Zhang
- Institute of Physical Education, Henan University, Kaifeng, China
| | - XueYing Fu
- Institute of Physical Education, Henan University, Kaifeng, China
| | - LiHua Wu
- The Seventh Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - XiaoTian Chen
- Second Clinical Medical College, Wenzhou Medical University, Zhejiang, China
| | - Rui Xia
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, China
| | - Lin Zhang
- Department of Rehabilitation, West China Hospital Sichuan University Jintang Hospital, Chengdu, China
| | - Shu-Cheng Lin
- Department of Sport, Leisure and Health Management, Tainan University of Technology, Tainan City, Taiwan
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, China
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Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2024; 4:CD013856. [PMID: 38588457 PMCID: PMC11001292 DOI: 10.1002/14651858.cd013856.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear. OBJECTIVES To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs). SEARCH METHODS An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach. MAIN RESULTS We included 154 RCTs with a total of 7837 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 60 (2721 participants), and 48 (3029 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson's Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (60 studies; 2721 participants) suggests that dance and gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs (dance: mean difference (MD) -10.18, 95% confidence interval (CI) -14.87 to -5.36; gait/balance/functional training: MD -7.50, 95% CI -11.39 to -3.48; moderate confidence), and multi-domain training probably has a small beneficial effect on the severity of motor signs (MD -5.90, 95% CI -9.11 to -2.68; moderate confidence). The evidence also suggests that endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs (endurance training: MD -5.76, 95% CI -9.78 to -1.74; aqua-based training: MD -5.09, 95% CI -10.45 to 0.40; strength/resistance training: MD -4.96, 95% CI -9.51 to -0.40; mind-body training: MD -3.62, 95% CI -7.24 to 0.00; low confidence). The evidence is very uncertain about the effects of "Lee Silverman Voice training BIG" (LSVT BIG) and flexibility training on the severity of motor signs (LSVT BIG: MD -6.70, 95% CI -16.48 to 3.08; flexibility training: MD 4.20, 95% CI -1.61 to 9.92; very low confidence). Quality of life The evidence from the NMA (48 studies; 3029 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -15.15, 95% CI -23.43 to -6.87; moderate confidence). The evidence also suggests that mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL (mind-body training: MD -7.22, 95% CI -13.57 to -0.70; gait/balance/functional training: MD -6.17, 95% CI -10.75 to -1.59; multi-domain training: MD -5.29, 95% CI -9.51 to -1.06; dance: MD -3.88, 95% CI -10.92 to 3.00; low confidence). The evidence is very uncertain about the effects of gaming, strength/resistance, endurance, and flexibility training on QoL (gaming: MD -8.99, 95% CI -23.43 to 5.46; strength/resistance training: MD -6.70, 95% CI -12.86 to -0.35; endurance training: MD -6.52, 95% CI -13.74 to 0.88; flexibility training: MD 1.94, 95% CI -10.40 to 14.27; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types. AUTHORS' CONCLUSIONS We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.
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Affiliation(s)
- Moritz Ernst
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Caro-Valenzuela
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Cryns
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Resarch, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Ambulatory Assessment in Psychology, Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Oberholster CK, Taylor CJ, Huynh M, Gordon BA. The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study. PLoS One 2024; 19:e0299146. [PMID: 38483927 PMCID: PMC10939286 DOI: 10.1371/journal.pone.0299146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE Exercise-based falls-prevention programs are cost-effective population-based approaches to reduce the risk of falling for older adults. The aim was to evaluate the short-term and long-term efficacy of three existing falls-prevention programs. METHODS A non-randomized study design was used to compare the immediate-post and long-term physical outcome measures for three falls prevention programs; one high-level land-based program, one low-level land-based program and a water-based Ai Chi program. Timed-up-and-go (TUG), five-times sit-to-stand (5xSTS), six-minute walk test (6MWT) and six-meter walk test were assessed at baseline, post-program, and at six-months follow-up. Linear mixed models were used to analyze between- and within- group differences, with the high-level land-based program used as the comparator. RESULTS Thirty-two participants completed post-program assessment and 26 returned for follow-up. There was a difference in the age (years) of participants between programs (p = 0.049). The intercept for TUG and six-meter walk test time was 47.70% (23.37, 76.83) and 32.31s (10.52, 58.41), slower for the low-level group and 40.49% (17.35, 69.89) and 36.34s (12.75, 64.87), slower for the Ai Chi group (p < 0.01), compared with the high-level group. Mean time taken to complete the TUG was less both immediately post-program and at 6-month follow-up (p = 0.05). Walking speed for the six-meter walk test was only faster at six-months (p < 0.05). The 5xSTS duration was significantly reduced only at post-intervention (p < 0.05). CONCLUSION These results indicate land-based and water-based falls-prevention programs improve physical outcome measures associated with falls-risk and many improvements are maintained for six months after the completion of the program. (Retrospective trial registration: ACTRN1262300119069).
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Affiliation(s)
- Candice K. Oberholster
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- The Royal Melbourne Hospital, Allied Health (Physiotherapy and Exercise Physiology), Melbourne, Victoria, Australia
| | - Carolyn J. Taylor
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Minh Huynh
- La Trobe School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Brett A. Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Braz de Oliveira MP, Rigo Lima C, da Silva SLA, Firmino Vaz Figueira EC, David Truax B, Smaili SM. Effect of aquatic exercise programs according to the International Classification of Functionality, Disability and Health domains in individuals with Parkinson's disease: a systematic review and meta-analysis with GRADE quality assessment. Disabil Rehabil 2024; 46:429-442. [PMID: 36644928 DOI: 10.1080/09638288.2022.2164800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the effects of aquatic exercise programs (AEP) in body structure and function, activity, and participation outcomes in individuals with Parkinson's disease (PD) with mild to moderate disability levels. METHODS Six databases were searched from inception until November 2022. Randomized clinical trials that used AEP alone, AEP combined and/or compared two types of AEP were included. The quality of evidence was assessed by the GRADE approach and the standardized mean differences (SMD) were calculated the meta-analysis. RESULTS Twelve studies (n = 380) were included. AEP alone was superior to active control in improving body structure and function outcome: postural balance (low evidence, SMD = 0.47, p = 0.02). No statistically significant differences were found for the other body structure and function outcomes: lower limb muscle strength (p = 0.14) and depressive symptoms (p = 0.79), activity outcomes: mobility (p = 0.32) and participation outcomes: quality of life (p = 0.05). AEP combined showed no statistically significant difference for the outcomes of body structure and function: postural balance (p = 0.11) and activity: mobility (p = 0.21) when compared to active control. CONCLUSION AEP showed positive effects on body structure and function outcome (postural balance) in individuals with PD with mild to moderate disability levels while, no significant improvements were noticed for activity and participation outcomes.IMPLICATIONS FOR REHABILITATIONOur findings indicate that aquatic exercise programs (AEP) lead to significant improvements on body structure and function (i.e., postural balance) in individuals with Parkinson's disease (PD).The AEP evaluated in this study implemented postural balance, gait, single and double training, as well as aerobic exercises, trunk mobility exercises, and Ai Chi.The average duration, frequency, and total time implemented were 50 minutes, three times a week, for seven weeks, respectively.Considering the potential benefits identified in this study, AEP can be recommended as an adjunct treatment strategy for individuals with PD.Additionally, the use of the International Classification of Functionality, Disability and Health on the development of rehabilitation treatment plans is advised.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Healthy Aging Research Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Carla Rigo Lima
- Department of Physical Therapy, Mechanisms of Spinal Manual Therapy Laboratory, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Brendon David Truax
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suhaila Mahmoud Smaili
- Department of Physical Therapy, Neurofunctional Physical Therapy Research Group, State University of Londrina, Londrina, Brazil
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Padilha C, Souza R, Grossl FS, Gauer APM, de Sá CA, Rodrigues-Junior SA. Physical exercise and its effects on people with Parkinson's disease: Umbrella review. PLoS One 2023; 18:e0293826. [PMID: 37917715 PMCID: PMC10621990 DOI: 10.1371/journal.pone.0293826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease. OBJECTIVE To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews. METHODS Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2. RESULTS From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes. CONCLUSION Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.
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Affiliation(s)
- Cristiano Padilha
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Renan Souza
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Fernando Schorr Grossl
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Ana Paula Maihack Gauer
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Clodoaldo Antônio de Sá
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
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Qian Y, Fu X, Zhang H, Yang Y, Wang G. Comparative efficacy of 24 exercise types on postural instability in adults with Parkinson's disease: a systematic review and network meta-analysis. BMC Geriatr 2023; 23:522. [PMID: 37641007 PMCID: PMC10463698 DOI: 10.1186/s12877-023-04239-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To compare, rank and evaluate the 24 exercise types that improve postural instability in patients with Parkinson's disease (PD). METHODS We searched the data in PubMed, MEDLINE, Embase, PsycINFO, Cochrane library, and Web of Science from their inception date to January 23, 2023. Randomized controlled trials (RCTs) that aimed at determining the effectiveness of physical activity interventions on postural instability in adults with PD. This review focused on different balance outcome categories: (a) balance test batteries (BBS); (b) static steady-state balance (sSSB); (c) dynamic steady-state balance (dSSB); (d) proactive balance (PB); (e) reactive balance (RB). RESULTS Among 10,474 records, 199 studies (patients = 9523) were eligible for qualitative synthesis. The random-effects NMA model revealed that the following exercise training modalities had the highest p score of being best when compared with control group: body-weight support treadmill training (BWS_TT) for BBS (p score = 0.97; pooled standardised mean difference (95% CI): 1.56 (0.72 to 2.39)) and dSSB (1.00; 1.53 (1.07 to 2.00)), aquatic exercise (AQE) for sSSB (0.85; 0.94 (0.33 to 1.54)), Pilates for PB (0.95; 1.42 (0.59 to 2.26)). Balance and gait training with the external cue or attention (BGT_ECA) and robotic assisted gait balance (RA_GT) had similar superior effects in improving RB. The confidence in evidence was often low according to Confidence in Network Meta-Analysis. CONCLUSIONS There is low quality evidence that BWS_TT, AQE, Pilates, BGT_ECA and RA_GT are possibly the most effective treatments, pending outcome of interest, for adults with PD.
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Affiliation(s)
- Yujia Qian
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Xueying Fu
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China
| | - Haoyang Zhang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, No. 1 Xuefu Road, Chaohu Economic Development Zone, Hefei, Anhui Province, 238000, China.
| | - Guotuan Wang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China.
- School of Physical Education and Health, Krasnoyarsk State Pedagogical University named after V.P. Astafyev Street. Ada Lebedeva, House 89, Krasnoyarsk City, 660049, Russia.
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Wang D, Cui WJ, Hou ZH, Gao Y. Effectiveness of different exercises in improving postural balance among Parkinson's disease patients: a systematic review and network meta-analysis. Front Aging Neurosci 2023; 15:1215495. [PMID: 37529009 PMCID: PMC10388555 DOI: 10.3389/fnagi.2023.1215495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Exercise has been reported as an effective intervention for Parkinson's disease. However, there is still debate on the what kinds of exercises prior to choosing. This study aimed to compare and rank the different exercises that effectively enhance postural balance in Parkinson's disease patients by quantifying the information gleaned from randomized controlled trials (RCTs). Methods We conducted a comprehensive database search, including PubMed, Cochrane Library, Embase, Web of Science, and PsycINFO. The included studies were evaluated for methodological quality by the Cochrane Risk of Bias tool. Results The RCTs were collected between the earliest available date and March 2023. Sixty RCTs were included and the total sample size used in the study was 3,537. Thirty-five studies were defined as low risk of bias, twenty-one studies as medium risk of bias, and four studies as high risk of bias. The network meta-analysis results showed that exergaming exercise can significantly improve patients' Timed-Up-and-Go time (SUCRA = 91.5%). Dance can significantly enhance patients' Berg Balance Scale (surface under the cumulative ranking curve, SUCRA = 81.3%), and rhythmical auditory exercise can significantly improve patients' Mini-Balance Evaluation Systems Test score (SUCRA = 95.6%). Conclusion Compared with other exercises, exergaming exercise, Dance, and rhythmical auditory exercise showed superior efficacy in improving postural balance among Parkinson's disease patients. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023411918.
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Affiliation(s)
- Di Wang
- Department of Sports Science, Zhejiang University, Hangzhou, China
| | - Wen J. Cui
- Department of Physical Education, Zhejiang International Studies University, Hangzhou, China
| | - Zhen H. Hou
- Department of Orthopaedics, No. 903 Hospital of PLA Joint Logistic Support Force, Hangzhou, China
| | - Ying Gao
- Department of Sports Science, Zhejiang University, Hangzhou, China
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Zhang M, Li F, Wang D, Ba X, Liu Z. Exercise sustains motor function in Parkinson's disease: Evidence from 109 randomized controlled trials on over 4,600 patients. Front Aging Neurosci 2023; 15:1071803. [PMID: 36865410 PMCID: PMC9971593 DOI: 10.3389/fnagi.2023.1071803] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Physical exercise has been widely identified as a supplementary therapy for Parkinson's disease (PD). Evaluating changes in motor function over long-term periods of exercise and comparing efficacy of various exercise types will enable a better understanding of the effects of exercise on PD. In the current study, a total of 109 studies that covered 14 types of exercise were included in the analyses, enrolling 4,631 PD patients. The results of meta-regression revealed that chronic exercise delays the progression of PD motor symptoms, mobility, and balance decline deterioration, whereas for the non-exercise PD groups, motor function progressively decline. Results from network meta-analyses suggest that dancing is the optimal exercise for general motor symptoms of PD. Furthermore, Nordic walking is the most efficient exercise to mobility and balance performance. The results from network meta-analyses also suggest that Qigong may have specific benefit in improving hand function. The findings of the current study provide further evidence that chronic exercise preserves the progression of motor function decline in PD and suggest that dancing, yoga, multimodal training, Nordic walking, aquatic training, exercise gaming, and Qigong are effective PD exercises. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276264, identifier: CRD42021276264.
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Affiliation(s)
- Meiqi Zhang
- Department of Physical Education and Health Education, Springfield College, Springfield, MA, United States,Yale/VA Learning-Based Recovery Center, Yale University, New Haven, CT, United States,*Correspondence: Meiqi Zhang ✉
| | - Fang Li
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Dongyu Wang
- Department of Neurology, The Center Hospital of Jinzhou, Jinzhou, Liaoning, China
| | - Xiaohong Ba
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Zhan Liu
- Department of Physical Education and Health Education, Springfield College, Springfield, MA, United States
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Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 1:CD013856. [PMID: 36602886 PMCID: PMC9815433 DOI: 10.1002/14651858.cd013856.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear. OBJECTIVES To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs). SEARCH METHODS An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach. MAIN RESULTS We included 156 RCTs with a total of 7939 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 71 (3196 participants), and 55 (3283 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (71 studies; 3196 participants) suggests that dance has a moderate beneficial effect on the severity of motor signs (mean difference (MD) -10.32, 95% confidence interval (CI) -15.54 to -4.96; high confidence), and aqua-based, gait/balance/functional, and multi-domain training might have a moderate beneficial effect on the severity of motor signs (aqua-based: MD -7.77, 95% CI -13.27 to -2.28; gait/balance/functional: MD -7.37, 95% CI -11.39 to -3.35; multi-domain: MD -6.97, 95% CI -10.32 to -3.62; low confidence). The evidence also suggests that mind-body training and endurance training might have a small beneficial effect on the severity of motor signs (mind-body: MD -6.57, 95% CI -10.18 to -2.81; endurance: MD -6.43, 95% CI -10.72 to -2.28; low confidence). Flexibility training might have a trivial or no effect on the severity of motor signs (MD 2.01, 95% CI -4.82 to 8.98; low confidence). The evidence is very uncertain about the effects of strength/resistance training and "Lee Silverman Voice training BIG" (LSVT BIG) on the severity of motor signs (strength/resistance: MD -6.97, 95% CI -11.93 to -2.01; LSVT BIG: MD -5.49, 95% CI -14.74 to 3.62; very low confidence). Quality of life The evidence from the NMA (55 studies; 3283 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -14.98, 95% CI -23.26 to -6.52; moderate confidence). The evidence also suggests that endurance training might have a moderate beneficial effect, and that gait/balance/functional and multi-domain training might have a small beneficial effect on QoL (endurance: MD -9.16, 95% CI -15.68 to -2.82; gait/balance/functional: MD -5.64, 95% CI -10.04 to -1.23; multi-domain: MD -5.29, 95% CI -9.34 to -1.06; low confidence). The evidence is very uncertain about the effects of mind-body training, gaming, strength/resistance training, dance, LSVT BIG, and flexibility training on QoL (mind-body: MD -8.81, 95% CI -14.62 to -3.00; gaming: MD -7.05, 95% CI -18.50 to 4.41; strength/resistance: MD -6.34, 95% CI -12.33 to -0.35; dance: MD -4.05, 95% CI -11.28 to 3.00; LSVT BIG: MD 2.29, 95% CI -16.03 to 20.44; flexibility: MD 1.23, 95% CI -11.45 to 13.92; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types. AUTHORS' CONCLUSIONS We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.
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Affiliation(s)
- Moritz Ernst
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Caro-Valenzuela
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Cryns
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Resarch, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Ambulatory Assessment in Psychology, Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Shariat A, Ghayour Najafabadi M, Soroush Fard Z, Nakhostin-Ansari A, Shaw BS. A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104107. [PMID: 35988329 DOI: 10.1016/j.msard.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis, we aimed to evaluate the impact of long-term aquatic exercise training on balance, fatigue, and motor function. METHODS Scopus, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing, and Allied Health Literature were searched on April 19, 2021. The search included randomized and non-randomized controlled trials, case-control studies, case series, and case reports. Two independent reviewers reviewed titles and abstracts to determine which studies satisfied the eligibility criteria. Two reviewers independently surveyed the full texts and conducted the study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from included studies. Meta-analysis was performed using RevMan 5. RESULTS From 170 studies that were identified in the initial search, 16 trials (794 participants) satisfied the eligibility criteria. Aquatic therapy had a positive effect on fatigue compared to control group based on Modified Fatigue Impact Scale (MFIS) in physical (SMD, -1.29; 95% CI, [(-1.65) - (-0.93)]; I2=88%) cognitive (SMD, -0.75; 95% CI, [(-1.08)-(- 0.43)]; I2=78%), and psychological (SMD, -1.25; 95% CI, [(-1.59) - (-0.90)]; I2=79%) domains, and Fatigue Severity Scale (FSS) (SMD, -0.53; 95% CI, [(-0.86) - (-0.20)]; I2=57%). In addition, aquatic therapy improved balance based on the Berg Balance Scale (BBS) compared to the control group (SMD, 1.19; 95% CI, [(0.62)-(1.76)]; I2=11%) CONCLUSIONS: Aquatic therapy has positive effects on fatigue and balance. Further research is needed to confirm the clinical utility of aquatic therapy for multiple sclerosis patients in the long term.
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Affiliation(s)
- Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ghayour Najafabadi
- Department of motor behavior, Faculty of physical education and sport science, University of Tehran, Tehran, Iran.
| | - Zahra Soroush Fard
- Department of Sports Injury, Faculty of physical education and sport science, University of Tehran, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brandon S Shaw
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
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12
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Monoli C, Tuhtan JA, Piccinini L, Galli M. Wearable technologies for monitoring aquatic exercises: A systematic review. Clin Rehabil 2022; 37:791-807. [PMID: 36437591 PMCID: PMC10126456 DOI: 10.1177/02692155221141039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To review methods for aquatic exercise monitoring using wearables. Data sources Database search of PubMed, IEEEXplore, Scopus and Web of Science based on keywords, considering articles from the year 2000. The last search was performed on 26 October 2022. Review methods Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol, eligible articles on water exercises were selected and summarized. Further screening process concentrated on studies exploiting wearable devices, organized according to demographics, purpose, protocols, outcomes and methods. A custom critical appraisal questionnaire was applied. Results Out of the 1062 articles identified, 572 were considered eligible and subjected to preliminary synthesis. The final review focused on 27 articles featuring wearable devices applied to aquatic exercises. Four studies were disregarded as they applied wearable devices to determine daily physical activity or for sleep monitoring after training. Summary tables of 23 studies exploiting wearable devices for underwater motion analysis are provided, specifying the investigated parameters, major outcomes and study quality. This review identified four research gaps: (a) the absence of clinical protocols for underwater motion studies, (b) a deficit of whole-body studies, (c) the lack of longitudinal studies monitored via wearable devices and (d) the reliance of underwater studies on measurement and assessment methods developed for land-based investigations. Conclusions This review emphasizes the need for both technological and methodological improvements for underwater motion analysis studies using wearables. We advocate for longitudinal clinical investigations with wearables to substantiate water exercise as an addition or replacement for land-based physical activity.
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Affiliation(s)
- Cecilia Monoli
- Department of Computer System, Tallinn University of Technology, Tallinn, Estonia
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jeffrey A Tuhtan
- Department of Computer System, Tallinn University of Technology, Tallinn, Estonia
| | - Luigi Piccinini
- Scientific Institute “E. Medea” Ass. La Nostra Famiglia, Bosisio Parini, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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13
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Terrens AF, Soh SE, Morgan P. What web-based information is available for people with Parkinson's disease interested in aquatic physiotherapy? A social listening study. BMC Neurol 2022; 22:170. [PMID: 35513789 PMCID: PMC9069763 DOI: 10.1186/s12883-022-02669-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Aquatic physiotherapy is becoming a more frequently utilised treatment for people with Parkinson’s Disease (PD). Consumers are increasingly accessing information regarding health choices online, and it is not known what type or quality of information regarding aquatic physiotherapy is available. Methods Web-based platforms (Facebook™, Twitter™, YouTube™, Instagram™, blogs and the web) were searched using the Awario© social listening software. Webpages had to be in English, mention PD, aquatic physiotherapy and its effects. Quality of webpages was assessed using a modified DISCERN tool and content analysis summarised reported effects. Results Awario© identified 2992 entries, with 133 assessed using the modified DISCERN tool. A small number (n = 31, 24%) described the effects of aquatic physiotherapy for people with PD. Quality of webpages was low, with many lacking information regarding clear sources of information, contraindications to aquatic physiotherapy and descriptions of the therapeutic environment. Content analysis showed several themes; general physical, PD-specific and psychosocial effects. More than a third of webpages indicated that aquatic physiotherapy would improve strength, balance, pain and aid relaxation. A large number (n = 96, 72%) described at least one hydrodynamic or hydrostatic property of water, most commonly buoyancy (n-83, 62%). Conclusions Overall quality of information was poor, and it is recommended that webpages list all potential contraindications to aquatic physiotherapy and direct consumers to discuss potential participation with their healthcare professionals. Webpages also should include information regarding the therapeutic environment, disclose sources of information and focus on enablers to exercise to improve engagement of people with PD in aquatic physiotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02669-3.
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Affiliation(s)
- Aan Fleur Terrens
- Movement Disorder Program, Peninsula Health, VIC, Australia. .,Department of Physiotherapy, Monash University, VIC, Australia.
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, VIC, Australia
| | - Prue Morgan
- Department of Physiotherapy, Monash University, VIC, Australia
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Multicomponent Aquatic Training (MAT) Program for People with Parkinson's Disease: A Protocol for a Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031727. [PMID: 35162750 PMCID: PMC8835400 DOI: 10.3390/ijerph19031727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/04/2022]
Abstract
Introduction: The complications from Parkinson’s disease (PD) are directly related to decreased muscle function, balance deficits, and independence loss. Practicing aquatic exercises can minimize these symptoms and slow disease progress. Objective: To develop a Multicomponent Aquatic Training (MAT) protocol for people with PD between stages 1 and 4 of the Hoehn and Yahr scale. Methods: The protocol is for a single blind controlled clinical trial. The sample will comprise of people with PD between stages 1 and 4 in Hoehn and Yahr scale, divided into a control group and MAT group (who will participate in the MAT). Musculoskeletal function, functional mobility, and balance will be the primary outcomes of interest, assessed with an isokinetic dynamometer, the Five-Times-Sit-to-Stand test (FTSST), the Timed “Up and Go” test (TUG), the 6-m gait speed test, the Berg Balance Scale (BBS), and a force platform. Quality of life (QOL), activities of daily living (ADL), and motor aspects will be the secondary outcome measures, assessed with the Parkinson’s Disease Questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS), sections II and III. The MAT will be 12 weeks long, with two 50-min sessions per week. The outcome measures will be assessed before and after the interventions. Discussion: This study is expected to establish parameters to prescribe and monitor a MAT program for people with PD in stages 1 to 4 in the Hoehn and Yahr scale, respecting individual progress and assisting the professionals in their procedure with these people.
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Carroll LM, Morris ME, O'Connor WT, Volpe D, Salsberg J, Clifford AM. Evidence-Based Aquatic Therapy Guidelines for Parkinson's Disease: An International Consensus Study. JOURNAL OF PARKINSON'S DISEASE 2022; 12:621-637. [PMID: 34842200 DOI: 10.3233/jpd-212881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Aquatic therapy is one therapy option for people living with Parkinson's disease (PD). However, the optimal prescription, dosage, and delivery remain unclear. OBJECTIVE i) To generate consensus statements, ii) to establish evidence-based clinical practice aquatic therapy guidelines for PD. METHODS Seventy-three international experts were invited to participate in a 3-step modified Delphi study. Gaps in the aquatic therapy evidence, patient preferences, and stakeholder engagement were considered when developing the initial list of 43-statements identified by the research development group. Practice experts rated each statement on an 11-point Likert scale. Consensus for inclusion was set at a priori of ≥70% of respondents scoring an item ≥7. Two rounds of Delphi questionnaires were completed online, and the expert comments were analyzed using content analysis. An online consensus meeting with an expert subgroup (n = 10) then advised on the guideline's acceptability and debated items until consensus for inclusion was reached. RESULTS Fifty experts participated in the Delphi round one (83% response rate) and 45 in round two (90% response rate), representing 15 countries. In round one, 35 statements met the criteria for consensus. Content analysis informed the revised statements in round two, where 12 of the remaining 16 statements met consensus. The final agreed aquatic therapy guidelines include key information about dosage, content, safety, contraindications, and the optimal aquatic therapy delivery throughout the disease course. CONCLUSION Stakeholders, including international practice experts, informed a rigorous evidence-based approach to integrate the best available evidence, patient preferences, and practice expertise to inform these guidelines.
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Affiliation(s)
- Louise M Carroll
- School of Allied Health, Faculty of Education and Health Sciences, Aging Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Meg E Morris
- Victorian Rehabilitation Centre, Healthscope; ARCH, College Science, Health and Engineering, La Trobe University, Bundoora, Australia
- College of Healthcare Sciences, James Cook University, Queensland, Australia
| | - William T O'Connor
- University of Limerick School of Medicine, Faculty of Education and Health Sciences, Limerick, Ireland
| | - Daniele Volpe
- Fresco Parkinson Institute Centre of Excellence, "Villa Margherita", Vicenza, Italy
| | - Jon Salsberg
- University of Limerick School of Medicine, Faculty of Education and Health Sciences, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, Aging Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Terrens AF, Soh SE, Morgan P. Perceptions of aquatic physiotherapy and health-related quality of life among people with Parkinson's disease. Health Expect 2021; 24:566-577. [PMID: 33591629 PMCID: PMC8077086 DOI: 10.1111/hex.13202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 01/19/2023] Open
Abstract
Background Enablers for people with Parkinson's disease (PD) participating in aquatic physiotherapy have been identified, and exercise improves health‐related quality of life (HRQoL) but it is unclear whether all enablers and barriers for aquatic physiotherapy specific to the PD population have been explored. Objective To describe HRQoL in people with PD who have undertaken aquatic physiotherapy, and explore their perceptions and attitudes regarding the programme. Methods Twenty‐one participants who participated in a pilot trial on aquatic physiotherapy were included. Participants completed a survey regarding their experiences. The Parkinson's Disease Questionnaire‐39 (PDQ‐39) and Personal Well‐being Index‐Adult (PWI) were used to quantify HRQoL, whilst focus groups were conducted to explore their perceptions and attitudes. Descriptive statistics were used to summarize HRQoL scores. Focus group data were analysed using the deductive coding method. Results Most participants felt that the aquatic programme was worthwhile (n = 20/21, 95%). However, they had poor overall well‐being (mean 41.6, SD 13.5) and HRQoL (mean 31.0, SD 13.2) as measured by the PWI and PDQ‐39. Several barriers to aquatic therapy including safety when getting dressed, fatigue and transport were identified although many enablers were also identified, including an improvement in function, less falls and group socialization. Conclusions Aquatic physiotherapy was well‐accepted. Participants felt their function improved and felt safe in the water. HRQoL is lower in individuals with PD when compared to Australian norms; thus, interventions to optimize HRQoL need to be explored further. Patient or Public Contribution Patients participated in the aquatic intervention, survey and focus groups.
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Affiliation(s)
- Aan Fleur Terrens
- Movement Disorder Program, Peninsula Health, Frankston, VIC, Australia.,Department of Physiotherapy, Monash University, Frankston, VIC, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Frankston, VIC, Australia
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
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