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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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Unal N, Bektaş Akpinar N, Bek D, Yurtsever S. The Effect of Reiki on Pain, Functional Status, and Holistic Well-Being in Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Orthop Nurs 2024; 43:109-118. [PMID: 38546686 DOI: 10.1097/nor.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
Knee osteoarthritis (OA) is a chronic degenerative joint disease that causes pain and adversely affects functional status and holistic well-being. This randomized controlled trial investigated the effect of Reiki on pain, functional status, and holistic well-being in patients with knee OA. The sample consisted of 42 patients. The control group received standardized treatment only, whereas the intervention group received face-to-face Reiki (nine positions; 39 minutes) and distance Reiki on two consecutive days in addition to standardized treatment. The Reiki group had lower pain scores than the control group as measured by the Visual Analog Scale (p < .001) and the Western Ontario and McMaster Universities Arthritis Index pain score (p < .001). Those participating in the Reiki group had improved holistic well-being scores specifically for the subscales of Sadness, Perception of Sadness, Spiritual Disruption, Cognitive Awareness, and General mood. Reiki is a safe, noninvasive, and cost-effective alternative treatment technique that has the potential to reduce symptoms of pain and improve holistic well-being in patients with knee OA.
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Affiliation(s)
- Nursemin Unal
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Nilay Bektaş Akpinar
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Doğan Bek
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
| | - Sabire Yurtsever
- Nursemin Unal, PhD, RN, Assistant Professor, Faculty of Nursing, Midwifery Department, Ankara University, Ankara, Turkey
- Nilay Bektaş Akpinar, PhD, RN, Assistant Professor, School of Nursing, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
- Doğan Bek, MD, Professor, Orthopaedic and Traumatology Department, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
- Sabire Yurtsever, PhD, RN, Professor, Faculty of Health Sciences, Girne University
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Kwok JYY, Cheung DSK, Zarit S, Cheung KSL, Lau BHP, Lou VW, Cheng ST, Gallagher-Thompson D, Chou KL. Multiphase optimization of a multicomponent intervention for informal dementia caregivers: a study protocol. Trials 2023; 24:791. [PMID: 38053147 DOI: 10.1186/s13063-023-07801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Family caregiver interventions are essential to support dementia caregiving. However, such interventions are typically complex and consist of multiple components. Existing evidence rarely delineates the effectiveness and interactions between individual components. To optimise intervention, we adopt the multiphase optimisation strategy (MOST) to test the implementation fidelity and determine the effect of each component and the interactions between each component and the corresponding outcome. METHODS A prospective, assessor-blinded, randomised clinical trial with fractional factorial design using the MOST principle. Two hundred fifty family dementia caregivers will be randomised to one of 16 experimental conditions in a fractional factorial design involving six intervention components: (1) dementia and caregiving education; (2) self-care skills; (3) behavioural symptom management; (4) behavioural activation; (5) modified mindfulness-based cognitive therapy; and (6) support group. The first one is the core component, and the five remaining will be examined. Physical health, caregiver burden, stress, psychological well-being, anxiety and depressive symptoms, and social support will be assessed over the 12-month study period. Following the intention-to-treat principle, linear mixed models and regression analyses will be used to examine the specific effect of the five components and their two-way interactions to propose the most effective combination. DISCUSSION This is the first study adopting the multiphase optimisation strategy to identify the most active and engaging components of a psychological intervention for caregivers of patients with dementia. In view that dementia caregiver interventions are increasingly diversified and complex, such knowledge is important to maximise the intervention efficacy and allow the intervention to be implemented within an efficient timeframe and dosage. The optimisation of caregiver support interventions is critical to enhance the health outcomes of caregivers and care recipients, thereby, delaying possible institutionalisation and reducing the costs of long-term dementia care. TRIAL REGISTRATION This study was retrospectively registered in the WHO Primary Registry - Chinese Clinical Trials Registry (ChiCTR2300071235). (Protocol date 30/10/2020; version identifier 2020-2021-0045). Registered on 9 May, 2023. REPORTING METHOD SPIRIT guideline was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR.
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Steven Zarit
- Human Development & Family Studies, Penn State University, University Park, USA
| | - Karen Siu-Lan Cheung
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
- WHO Collaborating Centre (WHO CC), School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- Asia-Pacific Institute of Ageing Studies (APIAS), Lingnan University, Tuen Mun, Hong Kong SAR
| | - Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR
| | - Vivian Weiqun Lou
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong SAR
| | | | - Kee-Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Tai Po, Hong Kong SAR
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Kwok JYY, Auyeung M, Pang SYY, Ho PWL, Yu DSF, Fong DYT, Lin CC, Walker R, Wong SYS, Ho RTH. A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol. BMC Complement Med Ther 2023; 23:241. [PMID: 37461018 PMCID: PMC10351114 DOI: 10.1186/s12906-023-04049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Between 40 and 50% of patients with Parkinson's disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants' experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management. METHODS We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews. DISCUSSION The study would also generate important insights to enhance the patients' adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services. TRIAL REGISTRATION WHO Primary Registry - Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 ( https://www.chictr.org.cn/showproj.html?proj=125878 ).
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | | | - Philip Wing Lok Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- The State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon Tong, Hong Kong SAR
| | - Doris Sau Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Chia-chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Samuel Yeung-shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- CUHK Thomas Jing Centre for Mindfulness Research and Training, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
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Borotikar S, Tillu G, Lavalekar A, Nagarkar A. Effect of Yoga on Psychological Well-Being in Men. GEROPSYCH 2023. [DOI: 10.1024/1662-9647/a000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Abstract: Retirement brings a major transition in life. This transition may affect a retired person’s physical, mental, and social health and lead to psychological problems. This study investigated the effects of Yoga on the well-being of retired men. It was a nonrandomized study involving 90 retired men aged 60–75 years following purposive sampling. The 14-week intervention included a daily session of 90 minutes at a yoga training center in Pune, India. Each session comprised light exercises, loosening, breathing exercises, relaxation, and meditation. Ryff’s validated scale was used to measure psychological well-being in six domains. The data were analyzed using a t-test. Integrated yoga practice showed a significant improvement in well-being ( p < .05), proving Yoga can be useful for improving the psychological well-being of retired people. The findings of this study should be implemented in a larger group of people for assessing and improving psychological well-being.
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Affiliation(s)
- Sonyabapu Borotikar
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind, Pune, India
| | - Girish Tillu
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind, Pune, India
| | | | - Aarti Nagarkar
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind, Pune, India
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A randomized clinical trial of mindfulness meditation versus exercise in Parkinson's disease during social unrest. NPJ Parkinsons Dis 2023; 9:7. [PMID: 36681670 PMCID: PMC9862216 DOI: 10.1038/s41531-023-00452-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
Clinical practice guidelines support resilience training and exercise for patients with Parkinson's disease (PD). This assessor-blinded, randomized clinical trial aimed to compare the effects of a modified mindfulness meditation program versus stretching and resistance training exercise (SRTE) in patients with mild-to-moderate PD. A total of 126 potential participants were enrolled via convenience sampling, of which 68 eligible participants were randomized 1:1 to receive eight weekly 90-min sessions of mindfulness meditation or SRTE. Compared to the SRTE group, generalized estimating equation analyses revealed that the mindfulness group had significantly better improvement in outcomes, particularly for improving depressive symptoms (d, -1.66; 95% CI, -3.31 to -0.02) at week 8 and maintaining emotional non-reactivity at week 20 (d, 2.08; 95% CI, 0.59 to 3.56). Both groups demonstrated significant immediate, small-moderate effects on cognition (effect size [d] = 0.36-0.37, p = 0.006-0.011). Compared with the SRTE, mindfulness meditation appeared to be a feasible and promising strategy for managing depressive symptoms and maintaining emotional stability, with comparable benefits on cognitive performance. To combat the psychospiritual and cognitive sequelae of social unrest and COVID-19 pandemic, the integration of mindfulness training into motor-oriented PD rehabilitation protocols is recommended to strengthen the resilience and minimize the psycho-cognitive comorbidities among patients with mild-to-moderate PD.Trial Registration: HKU Clinical Trials Registry identifier: HKUCTR-2681.
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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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Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson's disease? A systematic review with network meta-analysis. Acta Neurol Belg 2022; 122:1433-1446. [PMID: 36056269 DOI: 10.1007/s13760-022-02070-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Several studies have investigated the effect of mind-body exercise (MBE) on functional performance and health-related quality of life (HRQoL) in Parkinson's disease (PD), but it is still very difficult for clinicians to make informed decision on the best mind-body exercise for PD. PURPOSE We analyzed the relative efficacy of MBE (yoga, Tai-Chi, Pilates, Qigong, and dance) in improving functional performance and HRQoL in patients with PD. METHODS A systematic review of randomized controlled trials (RCTs) was performed using network meta-analysis (NMA), searching the following databases: Cochrane, Web of Science, and PubMed using specific keywords until December 28, 2021, assessing the effects of MBE on functional performance and HRQoL in patients with PD. RESULTS This review included 60 RCTs with 2037 participants. A ranking of MBE for modifying various aspects of functional performance and HRQoL was achieved. Pairwise NMA showed Pilates to be the most effective in improving functional mobility (MD: - 3.81; 95% CI (- 1.55, - 6.07) and balance performance (SMD: 2.83; 95% CI (1.87, 3.78). Yoga (MD: - 5.95; 95% CI (- 8.73, - 3.16) and dance (MD: - 5.87; 95% CI (- 8.73, - 3.01) to be the most effective in improving motor function, whereas Qigong (MD: 0.32; 95% CI (0.00, 0.64) was most effective in improving gait speed. Considering HRQoL, dance was found to be the most effective (SMD: - 0.36; 95% CI (- 0.70, -0.01). CONCLUSION MBE should be considered an effective strategy for improving functional performance and HRQoL in patients with PD. The most effective MBE intervention varied with the functional performance domain. Dance was an effective exercise for improving HRQoL among people with PD. PROSPERO REGISTRATION ID CRD42022301030.
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9
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Kwok JYY, Choi EPH, Lee JJ, Lok KYW, Kwan JCY, Mok VCT, Auyeung M. Effects of Mindfulness Yoga Versus Conventional Physical Exercises on Symptom Experiences and Health-related Quality of Life in People with Parkinson's Disease: The Potential Mediating Roles of Anxiety and Depression. Ann Behav Med 2022; 56:1068-1081. [PMID: 35460239 DOI: 10.1093/abm/kaac005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several studies have reported positive effects of mind-body exercises on symptom management and health-related quality of life (HRQOL) of people living with Parkinson's disease (PD), it is not known whether these effects are attributable to a change in anxiety and depression. PURPOSE To compare the effects of mindfulness yoga to conventional stretching exercises in a randomized controlled trial while examining potentially mediating effects of anxiety and depression. METHODS 138 adults with PD were randomized to eight weekly yoga (n = 71) or stretching (n = 67) sessions. Symptom experiences, anxiety and depression, and HRQOL outcomes were assessed at baseline, immediate post-intervention, and 3-month post-intervention. RESULTS Generalized estimating equation analyses revealed that, compared to stretching, yoga significantly improved patients' nonmotor (time-by-group interaction, T1:β = -1.99, p = .008; T2:β = -2.86, p < .001) and motor (time-by-group interaction, T1:β = -1.77, p = .03) symptom experiences. The mediation analysis found that the changes in anxiety and depression were the mediators in the associations between non-motor experience and HRQOL; while only the changes in depression were found to be the mediator in the relationship between motor experience and HRQOL. CONCLUSIONS Yoga is superior to conventional stretching exercises in improving nonmotor and motor symptoms in daily living. Reduced anxiety and depression play a role in mediating the positive effects of the mindfulness yoga intervention. To optimize HRQOL, rehabilitation should reinforce psychological care in addition to pharmacological treatments and physical relief of PD symptoms. Future studies are needed to identify strategies for facilitating the implementation and sustainability of mind-body rehabilitation to enhance the quality of care for PD.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pukfulam, Hong Kong SAR
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pukfulam, Hong Kong SAR
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pukfulam, Hong Kong SAR
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pukfulam, Hong Kong SAR
| | | | - Vincent Chung Tong Mok
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | - Man Auyeung
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Center for Prevention of Dementia, Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
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10
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Cognitive and Physical Intervention in Metals’ Dysfunction and Neurodegeneration. Brain Sci 2022; 12:brainsci12030345. [PMID: 35326301 PMCID: PMC8946530 DOI: 10.3390/brainsci12030345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023] Open
Abstract
Metals—especially iron, copper and manganese—are important elements of brain functions and development. Metal-dysregulation homeostasis is associated with brain-structure damage to the motor, cognitive and emotional systems, and leads to neurodegenerative processes. There is more and more evidence that specialized cognitive and motor exercises can enhance brain function and attenuate neurodegeneration in mechanisms, such as improving neuroplasticity by altering the synaptic structure and function in many brain regions. Psychological and physical methods of rehabilitation are now becoming increasingly important, as pharmacological treatments for movement, cognitive and emotional symptoms are limited. The present study describes physical and cognitive rehabilitation methods of patients associated with metal-induced neurotoxicity such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease and Wilson’s disease. In our review, we describe physical (e.g., virtual-reality environments, robotic-assists training) and psychological (cognitive training, cognitive stimulation, neuropsychological rehabilitation and cognitive-behavioral and mindfulness-based therapies) methods, significantly improving the quality of life and independence of patients associated with storage diseases. Storage diseases are a diverse group of hereditary metabolic defects characterized by the abnormal cumulation of storage material in cells. This topic is being addressed due to the fact that rehabilitation plays a vital role in the treatment of neurodegenerative diseases. Unfortunately so far there are no specific guidelines concerning physiotherapy in neurodegenerative disorders, especially in regards to duration of exercise, type of exercise and intensity, as well as frequency of exercise. This is in part due to the variety of symptoms of these diseases and the various levels of disease progression. This further proves the need for more research to be carried out on the role of exercise in neurodegenerative disorder treatment.
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11
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Kwok JYY, Lee JJ, Choi EPH, Chau PH, Auyeung M. Stay mindfully active during the coronavirus pandemic: a feasibility study of mHealth-delivered mindfulness yoga program for people with Parkinson's disease. BMC Complement Med Ther 2022; 22:37. [PMID: 35130894 PMCID: PMC8818838 DOI: 10.1186/s12906-022-03519-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Importance Patients with long-term neurological conditions, such as Parkinson’s disease (PD), are particularly vulnerable to the public health measures taken to combat the COVID-19 pandemic. The inaccessibility of center-based rehabilitation further aggravated their motor dysfunctions as well as mental distress, leading to exacerbation of motor and non-motor symptoms, high healthcare utilization and worsened health-related quality of life (HRQOL). Objective This study aimed to evaluate the feasibility, safety, and preliminary effects of the mHealth-delivered home-based mindfulness yoga program on functional balance, motor symptoms, mental health and HRQOL in patients with PD. Design, setting and participants This prospective, single-arm, non-randomized feasibility study adopted a sequential explanatory mixed-method design. Adults (aged ≥ 18) with a clinical diagnosis of idiopathic Parkinson’s disease (Hoehn and Yahr stage I to III) who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Intervention Home-based mindfulness yoga training were delivered via video-conferencing software (Zoom) in eight bi-weekly 90-min sessions. Main outcomes and measures This current study measured functional balance, motor symptoms, perceived balance confidence, perceived freezing of gait symptoms, anxiety and depression, mindfulness and HRQOL using a tele-assessment approach at baseline and 1-week post-intervention. All participants were invited to attend qualitative individual interviews to explore their experience of using online mindfulness yoga program as a lifestyle intervention for PD rehabilitation. Results Among the ten patients, 80% completed the program with an adherence rate of 98.4%. All participants were able to learn and practice mindfulness yoga following the eight bi-weekly online mindfulness yoga training sessions, without any significant adverse events. Tele-assessment of outcomes were feasible and uneventful. Qualitative feedback revealed participants had a high preference of using the tele-rehabilitation approach to stay mindful and being active, both physically and socially, while confronting the changes brought by COVID-19 pandemic. Conclusions and relevance The mHealth-delivered home-based mindfulness yoga intervention was feasible, safe, and well-accepted among people with PD to relieve the burden brought by COVID-19 pandemic. Future studies should adopt a design with enhanced rigor, a comparison group, and enlarged sample size to evaluate the efficacy of the program in patients with long-term neurological conditions and/or physical impairments. We recommend a longer intervention duration of at least 8 weeks to enhance the psychophysiological effects.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
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12
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The Effect of Physical Exercise on Cognitive Impairment in Neurodegenerative Disease: From Pathophysiology to Clinical and Rehabilitative Aspects. Int J Mol Sci 2021; 22:ijms222111632. [PMID: 34769062 PMCID: PMC8583932 DOI: 10.3390/ijms222111632] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022] Open
Abstract
Neurodegenerative diseases are a group of pathologies that cause severe disability due to motor and cognitive limitations. In particular, cognitive impairment is a growing health and socioeconomic problem which is still difficult to deal with today. As there are no pharmacologically effective treatments for cognitive deficits, scientific interest is growing regarding the possible impacts of healthy lifestyles on them. In this context, physical activity is gaining more and more evidence as a primary prevention intervention, a nonpharmacological therapy and a rehabilitation tool for improving cognitive functions in neurodegenerative diseases. In this descriptive overview we highlight the neurobiological effects of physical exercise, which is able to promote neuroplasticity and neuroprotection by acting at the cytokine and hormonal level, and the consequent positive clinical effects on patients suffering from cognitive impairment.
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13
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Nourollahimoghadam E, Gorji S, Gorji A, Khaleghi Ghadiri M. Therapeutic role of yoga in neuropsychological disorders. World J Psychiatry 2021; 11:754-773. [PMID: 34733640 PMCID: PMC8546763 DOI: 10.5498/wjp.v11.i10.754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
Yoga is considered a widely-used approach for health conservation and can be adopted as a treatment modality for a plethora of medical conditions, including neurological and psychological disorders. Hence, we reviewed relevant articles entailing various neurological and psychological disorders and gathered data on how yoga exerts positive impacts on patients with a diverse range of disorders, including its modulatory effects on brain bioelectrical activities, neurotransmitters, and synaptic plasticity. The role of yoga practice as an element of the treatment of several neuropsychological diseases was evaluated based on these findings.
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Affiliation(s)
| | - Shaghayegh Gorji
- Epilepsy Research Center, Münster University, Münster 48149, Germany
| | - Ali Gorji
- Epilepsy Research Center, Münster University, Münster 48149, Germany
- Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
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14
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The Effects of Yoga on Patients with Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials. Behav Neurol 2021; 2021:5582488. [PMID: 34285724 PMCID: PMC8275425 DOI: 10.1155/2021/5582488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 12/27/2022] Open
Abstract
Methods A meta-analysis was conducted by systematically searching PubMed, Embase, and Cochrane Library databases till August 2020 for studies published in English. The reference lists of eligible studies were also searched. The motor symptoms (UPDRS-Part III), balance function (BBS and BESTest), functional mobility (TUG), anxiety (HADS and BAI), depression (HADS and BDI), and the quality of life (PDQ-39 and PDQ-8) were the primary evaluation indexes. Results Ten studies including 359 participants were included in this meta-analysis. The pooled results showed significant difference between the yoga training group and the control group. Patients in the yoga training group had better functional outcomes in terms of motor status (MD = −5.64; 95% CI, -8.57 to -2.7), balance function (SMD = 0.42; 95% CI, 0.08 to 0.77), functional mobility (MD = −1.71; 95% CI, -2.58 to -0.84), anxiety scale scores (SMD = −0.72; 95% CI, -1.01 to -0.43), depression scale scores (SMD = −0.92; 95% CI, -1.22 to -0.62), and QoL (SMD = −0.54; 95% CI, -0.97 to -0.11). Conclusion Our pooled results showed the benefits of yoga in improving motor function, balance, functional mobility, reducing anxiety and depression, and increasing QoL in PD patients.
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15
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Luo A, Zhong S, Lai S, Jia Y. The influences of behavioral and psychological interventions on the neurological function and MMSE scores in Parkinson's disease patients. Am J Transl Res 2021; 13:4915-4921. [PMID: 34150075 PMCID: PMC8205817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze the effects of behavioral and psychological interventions on the neurological function in Parkinson's disease (PD) patients. METHODS A total of 103 patients with PD admitted to our hospital were randomly divided into the observation group (OG, n=52) or the control group (CNG, n=51). The CNG was treated with routine nursing, while the OG was treated with behavioral and psychological interventions. RESULTS At 1, 2, and 3 months after the nursing, the National Institutes of Health Stroke Scale (NIHSS) scores, the unified PD disease rating scale III (UPDRS-III) scores, and the Pittsburgh Sleep Quality Index (PSQI) scores in both groups were lower than they were before the nursing, the NIHSS, UPDRS-III, and PSQI scores in the OG were lower than they were in the CNG, the General Self-efficacy Scale (GSES) and Mini-Mental State Examination (MMSE) scores and the Barthel scores in both groups were higher than they were before the nursing, and the GSES, MMSE, and Barthel scores in the OG were higher than they were in the CNG (P < 0.05). CONCLUSION Behavioral and psychological interventions can improve PD patients' impaired neurological function, self-efficacy, cognitive function, motor dysfunction, sleep quality, and quality of life.
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Affiliation(s)
- Aimin Luo
- Department of Psychiatry, The First Affiliated Hospital of Jinan University Guangzhou 510630, Guangdong Province, PR China
| | - Shuming Zhong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University Guangzhou 510630, Guangdong Province, PR China
| | - Shunkai Lai
- Department of Psychiatry, The First Affiliated Hospital of Jinan University Guangzhou 510630, Guangdong Province, PR China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University Guangzhou 510630, Guangdong Province, PR China
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16
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Wan Z, Liu X, Yang H, Li F, Yu L, Li L, Wang Y, Jiang H, Zou J, Du J. Effects of Health Qigong Exercises on Physical Function on Patients with Parkinson's Disease. J Multidiscip Healthc 2021; 14:941-950. [PMID: 33953563 PMCID: PMC8091455 DOI: 10.2147/jmdh.s303945] [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: 01/28/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To measure motor function improvements in patients with Parkinson's disease (PD) using Health Qigong exercises. Patients and Methods Fifty-two PD patients (Hoehn and Yahr stages I to IV) were randomly divided into experimental and control groups. Twenty-six PD patients in the experimental group were intervened with routine medicine and fitness Qigong exercise. The other 26 PD patients as the control group were treated only with regular medication. Twelve-week intervention had been conducted for the study, and participants completed the scheduled exercises 4 times per week for 60 minutes each time. Data which included the one-legged blind balance, physical coordination, and gait was collected before, during, and after the intervention. Comparisons were made between the experimental and control groups through the repeated measures analysis of variance. Results A total of 40 participants (77% response rate) completed the study. There was no significant difference in baseline data. After 12 weeks of Health Qigong therapy, the length of time the one-legged blind balance test had increased (P < 0.01), and the time it took to TUG test was reduced (P < 0.01). Joint range of motion and gait significantly improved. The control group's there were no significant differences in the above variables, except for joint range of motion, which decreased. Conclusion Health Qigong exercises can significantly improve physical functions in patients with PD, especially for the balance ability, gait, joint range of motion in patients with PD. It can reduce their activity risk factor and improve their quality of life.
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Affiliation(s)
- Zhirong Wan
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
| | - Xiaolei Liu
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing, 100084, People's Republic of China
| | - Hui Yang
- China Wushu Academy, Beijing Sport University, Beijing, 100084, People's Republic of China
| | - Fang Li
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing, 100084, People's Republic of China
| | - Lingling Yu
- Physical Education School of Inner Mongolia Normal University, Hohhot, Inner Mongolia, People's Republic of China
| | - Lei Li
- School of Physical Education, Lu Dong University, Shandong, 264011, People's Republic of China
| | - Yulin Wang
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Hao Jiang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, 518172, People's Republic of China
| | - Junjie Zou
- Neurology Department, Yantai Penglai People's Hospital, Yantai, 265600, People's Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
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Scott R, Nahin RL, Weber W. Longitudinal Analysis of Complementary Health Approaches in Adults Aged 25-74 Years from the Midlife in the U.S. Survey Sample. J Altern Complement Med 2021; 27:550-568. [PMID: 33877882 DOI: 10.1089/acm.2020.0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Complementary health approaches include herbal products and mind-body practices. Several studies have identified predictors for complementary health approach use, yet there are two gaps: (1) How does use change? (2) Do factors associated with use influence this change over time? Using the Midlife in the United States (MIDUS), we examined how sociodemographic factors affected use longitudinally, and whether these associations differed between new and continued/discontinued use of herbal products, meditation, chiropractic, and massage therapy. Design: MIDUS is a national probability sample of adults aged 25 or older that has collected more than 20 years of longitudinal data, including the use of complementary health approaches. We employed the Andersen Model as a framework to identify predisposing, enabling, and health need factors associated with complementary health approach use based on previously identified and hypothesized factors. We ran Chi-square analyses to first test bivariate associations between our independent variables and four modalities to further guide logistic regression models. Results: Each of the four approaches examined saw substantial increases in prevalent use. However, only about 25% to 38% of individuals continued use from one wave to the next, whereas only 2%-9% of individuals who did not use a given approach in a wave reported use in the subsequent wave. Age, spiritual importance, and previous wave one use were all significantly associated with new use across all four modalities. Previous wave one use was associated with continued/discontinued use for all modalities. Age and education were significantly associated with discontinued use of chiropractic. Conclusion: We present the first longitudinal analysis of complementary health approaches in a nationally representative sample. These data distinguish between new and continued/discontinued use of complementary health approaches over time and provide insights into the interpretation of complementary health approach prevalence data, as well as important predictors of use.
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Affiliation(s)
- Remle Scott
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Richard L Nahin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Wendy Weber
- Clinical Research in Complementary and Integrative Health Branch, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
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Hill HM, Swink LA, Atler KE, Anderson AK, Fling BW, Schmid AA. Merging Yoga and Occupational Therapy for Parkinson’s Disease improves fatigue management and activity and participation measures. Br J Occup Ther 2021. [DOI: 10.1177/0308022620909086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The purpose of this study was to explore the influence of a falls-risk management intervention, Merging Yoga and Occupational Therapy for Parkinson’s Disease, on fatigue and activity and participation measures, as well as examine the relationship between these constructs. Methods This mixed methods study included 17 participants with Parkinson’s disease. Participants took the Modified Fatigue Impact Scale and the International Classification of Functioning, Disability, and Health Measure of Participation and Activities Screener at three 8-week intervals: baseline (followed by an 8-week control period), pre-intervention, and post-intervention. Focus groups were completed at the conclusion of the study to explore participants’ perception of Merging Yoga and Occupational Therapy for Parkinson’s Disease related to their fatigue and activity and participation. Results Fatigue and activity and participation measures were significantly correlated ( r = 0.76). Activity and participation measures (Measure of Participation and Activities Screener) significantly improved after the intervention ( p = 0.012). Four themes related to fatigue and/or activity and participation emerged following qualitative analysis, including: managing fatigue: paying attention and acting accordingly; creating mindfulness in daily activities; giving and receiving within a community; and strengthening relationship to self and others. Conclusion Participants experienced improvement in activity and participation measures and perceived fatigue management after engagement in the community-based Merging Yoga and Occupational Therapy for Parkinson’s Disease program.
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Affiliation(s)
| | - Laura A Swink
- Eastern Colorado Veterans Administration Geriatric Research, Education and Clinical Center, CO, USA
| | - Karen E Atler
- Department of Occupational Therapy, Colorado State University, CO, USA
| | | | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, CO, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, CO, USA
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Binary dance rhythm or Quaternary dance rhythm which has the greatest effect on non-motor symptoms of individuals with Parkinson's disease? Complement Ther Clin Pract 2021; 43:101348. [PMID: 33743390 DOI: 10.1016/j.ctcp.2021.101348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/12/2021] [Accepted: 02/27/2021] [Indexed: 12/15/2022]
Abstract
This study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson's Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.
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20
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Li X, He J, Yun J, Qin H. Lower Limb Resistance Training in Individuals With Parkinson's Disease: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol 2020; 11:591605. [PMID: 33281732 PMCID: PMC7691593 DOI: 10.3389/fneur.2020.591605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/07/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Initial randomized controlled trials (RCTs) and recently released systematic reviews have identified resistance training (RT) as a modality to manage motor symptoms and improve physical functioning in individuals with Parkinson's disease (PD), although the effects are inconsistent. Therefore, we conducted an updated meta-analysis to reassess the evidence of the relationship. Methods: We performed a systematic search of studies reporting the effects of RT in PD available through major electronic databases (PubMed, Medline, Embase, Ovid, Cochrane Library, CNKI, Wanfang) through 20 July 2020. Eligible RCTs were screened based on established inclusion criteria. We extracted data on the indicators of leg strength, balance, gait capacity, and quality of life (QoL) of lower limbs. Random and fixed effects models were used for the analysis of standard mean differences (SMD) or mean differences (MD) with their 95% confidence intervals (CI). Results: Thirty-one papers from 25 independent trials compromising 1,239 subjects were selected for eligibility in this systematic review and meta-analysis. Summarized data indicated that the leg strength increased statistically significant in PD patients (SMD = 0.79, 95% CI 0.3, 1.27, P = 0.001), the balance capability was improved statistically significant in PD patients (SMD = 0.34, 95% CI 0.01, 0.66, P = 0.04), and QoL statistically significantly improved (MD = −7.22, 95% CI −12.05, −2.39, P = 0.003). For gait performance, four indicators were measured, the results as follows: fast gait velocity (MD = 0.14, 95% CI 0.06, 0.23, P = 0.001), Timed-up-and-go-test (TUG, MD = −1.17, 95% CI −2.27, −0.08, P = 0.04) and Freezing of Gait Questionnaire (FOG-Q, MD = −1.74, 95% CI −3.18, −0.3, P = 0.02) were improved statistically significant across trials, while there were no statistically significant improvement in stride length (MD = −0.05, 95% CI −0.12, 0.02, P = 0.15) in PD patients. Conclusions: Lower limb RT has positive effects during rehabilitation in individuals with PD in leg strength, QoL, and improve gait performance to a certain extent. RT also could improve balance capacity of patients, although a wide variety of tools were used, and further study is needed to confirm these findings.
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Affiliation(s)
- Xiaoyan Li
- Department of Endocrinology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie He
- Department of Respiratory and Critical Care Medicine, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie Yun
- Nursing Department of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Qin
- Department of Endocrinology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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21
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Li C, An H, Wang J, Jiang Z, Zhang T, Huo Q. Comparison of efficacy and safety of complementary and alternative therapies for Parkinson's disease: A Bayesian network meta-analysis protocol. Medicine (Baltimore) 2020; 99:e22265. [PMID: 32957377 PMCID: PMC7505290 DOI: 10.1097/md.0000000000022265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, the incidence of Parkinson's disease (PD) has been on the rise. However, the existing therapy of PD cannot fundamentally treat the disease. Meanwhile, the complementary and alternative therapies of PD have played a positive role in the treatment of PD. Traditional meta-analysis was only able to compare 2 interventions, while the efficacy and safety of many complementary and alternative therapies were not comparable. Therefore, this study compared the efficacy and safety of different complementary and alternative therapies through network meta-analysis (NMA). METHODS A comprehensive search of randomized controlled trials of complementary and alternative therapies for PD, as well as trials currently in progress, will be conducted until August 2020. Literature and data extraction were independently completed by two researchers. Through the meta-analysis of pairwise comparison and Bayesian NMA, all evidences are comprehensively evaluated. Use STATA15.0 and WinBUGS1.4.3 software for data processing and analysis, and use grading of recommendations assessment development and evaluation to classify the quality of evidence in the NMA. RESULTS The aim of this study is to obtain a ranking of efficacy and safety of different complementary and alternative therapies for PD. CONCLUSION Complementary and alternative therapies for PD have positive significance in improving the symptoms of PD, and can provide evidence support for clinicians and patients. INPLASY REGISTRATION NUMBER INPLASY202080079.
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Affiliation(s)
- Chuancheng Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan
| | - Hongqiang An
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Jiahao Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan
| | - Zhenyuan Jiang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan
| | - Tianqi Zhang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan
| | - Qing Huo
- Xintai People's Hospital, Xintai
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22
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Effects of spiritual resilience on psychological distress and health-related quality of life in Chinese people with Parkinson's disease. Qual Life Res 2020; 29:3065-3073. [PMID: 32572757 DOI: 10.1007/s11136-020-02562-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is an increasingly critical outcome of chronic illness care. However, its disease-independent attributes, particularly its spiritual resilient indicators, for people with Parkinson's disease (PD) have not been explicitly examined. This study aimed to (i) assess the associations between psychological distress, spiritual resilience and HRQOL, and (ii) examine the mediating effects of spiritual resilience on psychological distress and HRQOL amongst individuals with PD. METHODS This is a secondary data analysis of the baseline data of a clinical trial that involved 138 individuals with PD. The subjects completed a structured questionnaire assessing psychological distress in terms of anxiety and depression, spiritual resilience in terms of perceived affliction and perceived equanimity, severity of motor symptoms and disease-specific HRQOL. RESULTS Analysis by independent t test suggested that distressed individuals with PD demonstrated less spiritual resilience and presented poorer HRQOL than non-distressed individuals with PD. Multiple linear regression models revealed that high emotional distress was associated with low spiritual resilience and poor HRQOL. The mediation analysis found that after simultaneously controlling for the degree of perceived affliction and perceived equanimity, a significant reduction was observed in the direct effect between psychological distress and HRQOL. This result indicated the partially mediating roles of perceived affliction and equanimity in the pathways between psychological distress and HRQOL. CONCLUSION In order to enhance HRQOL, PD interventions should address the spiritual resilience of patients in addition to providing psychological care and physical relief of symptoms.
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Kwok JYY, Kwan JCY, Auyeung M, Mok VCT, Lau CKY, Choi KC, Chan HYL. Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2020; 76:755-763. [PMID: 30958514 DOI: 10.1001/jamaneurol.2019.0534] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Clinical practice guidelines support exercise for patients with Parkinson disease (PD), but to our knowledge, no randomized clinical trials have tested whether yoga is superior to conventional physical exercises for stress and symptom management. Objective To compare the effects of a mindfulness yoga program vs stretching and resistance training exercise (SRTE) on psychological distress, physical health, spiritual well-being, and health-related quality of life (HRQOL) in patients with mild-to-moderate PD. Design, Setting, and Participants An assessor-masked, randomized clinical trial using the intention-to-treat principle was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. A total of 187 adults (aged ≥18 years) with a clinical diagnosis of idiopathic PD who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Eligible participants were randomized 1:1 to mindfulness yoga or SRTE. Interventions Mindfulness yoga was delivered in 90-minute groups and SRTE were delivered in 60-minute groups for 8 weeks. Main Outcomes and Measures Primary outcomes included anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included severity of motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Part III motor score), mobility, spiritual well-being in terms of perceived hardship and equanimity, and HRQOL. Assessments were done at baseline, 8 weeks (T1), and 20 weeks (T2). Results The 138 participants included 65 men (47.1%) with a mean (SD) age of 63.7 (8.7) years and a mean (SD) MDS-UPDRS score of 33.3 (15.3). Generalized estimating equation analyses revealed that the yoga group had significantly better improvement in outcomes than the SRTE group, particularly for anxiety (time-by-group interaction, T1: β, -1.79 [95% CI, -2.85 to -0.69; P = .001]; T2: β, -2.05 [95% CI, -3.02 to -1.08; P < .001]), depression (T1: β, -2.75 [95% CI, -3.17 to -1.35; P < .001]); T2: β, -2.75 [95% CI, -3.71 to -1.79; P < .001]), perceived hardship (T1: β, -0.92 [95% CI, -1.25 to -0.61; P < .001]; T2: β, -0.76 [95% CI, -1.12 to -0.40; P < .001]), perceived equanimity (T1: β, 1.11 [95% CI, 0.79-1.42; P < .001]; T2: β, 1.19 [95% CI, 0.82-1.56; P < .001]), and disease-specific HRQOL (T1: β, -7.77 [95% CI, -11.61 to -4.38; P < .001]; T2: β, -7.99 [95% CI, -11.61 to -4.38; P < .001]). Conclusions and Relevance Among patients with mild-to-moderate PD, the mindfulness yoga program was found to be as effective as SRTE in improving motor dysfunction and mobility, with the additional benefits of a reduction in anxiety and depressive symptoms and an increase in spiritual well-being and HRQOL. Trial Registration Centre for Clinical Research and Biostatistics identifier: CUHK_CCRB00522.
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Affiliation(s)
- Jojo Y Y Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Jackie C Y Kwan
- The Hong Kong Society for Rehabilitation, Hong Kong Special Administrative Region
| | - M Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Center for Prevention of Dementia, Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Claire K Y Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administration Region
| | - K C Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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Lister T. Nutrition and Lifestyle Interventions for Managing Parkinson's Disease: A Narrative Review. J Mov Disord 2020; 13:97-104. [PMID: 32498495 PMCID: PMC7280935 DOI: 10.14802/jmd.20006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 01/20/2023] Open
Abstract
The etiology of Parkinson's disease (PD) is not fully understood, but environmental toxin overexposure, increased intestinal permeability, and dysbiosis related to nutrition and lifestyle habits are thought to be contributors. Considering these nutrition and lifestyle implications, there is a lack of practice-based programs utilizing interventions for managing symptoms or slowing the progression of the disease. The purpose of this narrative review was to identify relevant research related to nutrition and lifestyle interventions for PD, evaluate the research utilizing the evidence analysis process of the Academy of Nutrition and Dietetics to assess the quality of each research article, and group the research into categories. A grading of recommendations assessment, development and evaluation (GRADE) of either good, fair, limited, or not assignable was allocated to each category of research, including diet patterns, vitamin D, B-complex, omega-3 fatty acids, coenzyme Q10, probiotics, physical activity, stress, and sleep. An intervention based on the research presented in the review may be utilized for coaching people with PD on symptom management.
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Affiliation(s)
- Tracy Lister
- Maryland University of Integrative Health, Laurel, MD, USA
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25
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Peña-Bautista C, Casas-Fernández E, Vento M, Baquero M, Cháfer-Pericás C. Stress and neurodegeneration. Clin Chim Acta 2020; 503:163-168. [PMID: 31987795 DOI: 10.1016/j.cca.2020.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
Neurodegenerative diseases are a great concern because of aging worldwide population. Despite substantial effort to advance our understanding of the etiology and potential treatment of neurodegeneration, there remains a paucity of information with respect to this complex disease process. Interestingly, stress has been implicated among the potential mechanisms implicated in neurodegenerative pathology. Given the increase in chronic stress in modern society, this premise warrants further investigation. The aim of this review is to evaluate the influence of stress on neurodegeneration, the effect of neurodegenerative diseases diagnosis on stress, and therapeutic strategies for neurodegenerative diseases with a special focus on stress reduction. Neurodegenerative disorders such as Alzheimer's, Parkinson's and Huntington's Disease showed an acceleration in disease progression and a worsening of symptoms under stress. Some therapies (e.g., yoga, meditation) focused on reducing stress showed beneficial effects against neurodegeneration. Nevertheless, more studies are necessary in order to completely understand the implications of stress in neurodegeneration and the usefulness of stress reduction in the treatment thereof.
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Affiliation(s)
| | | | - Máximo Vento
- Health Research Institute La Fe, Valencia, Spain
| | - Miguel Baquero
- Division of Neurology, University and Polytechnic Hospital La Fe, Valencia, Spain
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26
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Feng YS, Yang SD, Tan ZX, Wang MM, Xing Y, Dong F, Zhang F. The benefits and mechanisms of exercise training for Parkinson's disease. Life Sci 2020; 245:117345. [PMID: 31981631 DOI: 10.1016/j.lfs.2020.117345] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is a significantly progressive neurodegenerative disease characterised by both motor and nonmotor disorders. The main pathological characteristics of PD consist of the loss of dopaminergic neurons and the formation of alpha-synuclein-containing Lewy bodies in the substantia nigra. Currently, the main therapeutic method for PD is anti-Parkinson medications, including levodopa, madopar, sirelin, and so on. However, the effect of pharmacological treatment has its own limitations, the most significant of which is that the therapeutic effect of dopaminergic treatments gradually diminishes with time. Exercise training, as an adjunctive treatment and complementary therapy, can improve the plasticity of cortical striatum and increase the release of dopamine. Exercise training has been proven to effectively improve motor disorders (including balance, gait, risk of falls and physical function) and nonmotor disorders (such as sleep impairments, cognitive function and quality of life) in PD patients. In recent years, various types of exercise training have been used to treat PD. In this review, we summarise the exercise therapy mechanisms and the protective effects of different types of exercise training on PD patients.
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Affiliation(s)
- Ya-Shuo Feng
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Si-Dong Yang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane 4072, Australia; Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Zi-Xuan Tan
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Man-Man Wang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Ying Xing
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China; Hebei Provincial Orthopedic Biomechanics Key Laboratory, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China.
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Jin X, Wang L, Liu S, Zhu L, Loprinzi PD, Fan X. The Impact of Mind-body Exercises on Motor Function, Depressive Symptoms, and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E31. [PMID: 31861456 PMCID: PMC6981975 DOI: 10.3390/ijerph17010031] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022]
Abstract
Purpose: To systematically evaluate the effects of mind-body exercises (Tai Chi, Yoga, and Health Qigong) on motor function (UPDRS, Timed-Up-and-Go, Balance), depressive symptoms, and quality of life (QoL) of Parkinson's patients (PD). Methods: Through computer system search and manual retrieval, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang Database, and CQVIP were used. Articles were retrieved up to the published date of June 30, 2019. Following the Cochrane Collaboration System Evaluation Manual (version 5.1.0), two researchers independently evaluated the quality and bias risk of each article, including 22 evaluated articles. The Pedro quality score of 6 points or more was found for 86% (19/22) of these studies, of which 21 were randomized controlled trials with a total of 1199 subjects; and the trial intervention time ranged from 4 to 24 weeks. Interventions in the control group included no-intervention controls, placebo, waiting-lists, routine care, and non-sports controls. Meta-analysis was performed on the literature using RevMan 5.3 statistical software, and heterogeneity analysis was performed using Stata 14.0 software. Results: (1) Mind-body exercises significantly improved motor function in PD patients, including UPDRS (SMD = -0.61, p < 0.001), TUG (SMD = -1.47, p < 0.001) and balance function (SMD = 0.79, p < 0.001). (2) Mind-body exercises also had significant effects on depression (SMD = -1.61, p = 0.002) and QoL (SMD = 0.66, p < 0.001). (3) Among the indicators, UPDRS (I2 = 81%) and depression (I2 = 91%) had higher heterogeneity; according to the results of the separate combined effect sizes of TUG(I2 = 29%), Balance(I2 = 16%) and QoL(I2 = 35%), it shows that the heterogeneity is small; (4) After meta-regression analysis of the age limit and other possible confounding factors, further subgroup analysis showed that the reason for the heterogeneity of UPDRS motor function may be related to the sex of PD patients and severity of the disease; the outcome of depression was heterogeneous. The reason for this may be the use of specific drugs in the experiment and the duration of intervention in the trial. Conclusion: (1) Mind-body exercises were found to have significant improvements in motor function, depressive symptoms, and quality of life in patients with Parkinson's disease, and can be used as an effective method for clinical exercise intervention in PD patients. (2) Future clinical intervention programs for PD patients need to fully consider specific factors such as gender, severity of disease, specific drug use, and intervention cycle to effectively control heterogeneity factors, so that the clinical exercise intervention program for PD patients is objective, scientific, and effective.
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Affiliation(s)
- Xiaohu Jin
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China;
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China;
| | - Shijie Liu
- School of Physical Education & Training, Shanghai University of Sport, Shanghai 200438, China;
| | - Lin Zhu
- School of Physical Education, Soochow University, Suzhou, Jiangsu 205301, China;
| | - Paul Dinneen Loprinzi
- Exercise & Memory Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS 38677, USA;
| | - Xin Fan
- College of Physical Education, Hubei Normal University, Huangshi 435002, China;
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Abdollahi A, Panahipour H, Allen KA, Hosseinian S. Effects of Death Anxiety on Perceived Stress in Individuals With Multiple Sclerosis and the Role of Self-Transcendence. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:91-102. [PMID: 31584337 DOI: 10.1177/0030222819880714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stress is a commonly reported concern of individuals with chronical diseases, including multiple sclerosis (MS). This study sought to investigate the relationships between self-transcendence, death anxiety, and perceived stress among individuals with MS from Iran. A second aim of the study was to assess the buffering effect of self-transcendence in the relationship between death anxiety and perceived stress. Two hundred and fifteen participants with MS from four hospitals completed measures assessing self-transcendence, death anxiety, and perceived stress. Using structural equation modeling, death anxiety was found to be positively related to perceived stress. In addition, there was a negative relationship between self-transcendence and perceived stress. Results of the study suggest that self-transcendence is a buffer in the link between death anxiety and perceived stress for individuals with MS. The findings demonstrate the importance of self-transcendence in decreasing the effects of death anxiety on perceived stress and have clinical implications for health professionals.
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Affiliation(s)
- Abbas Abdollahi
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Hannaneh Panahipour
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Kelly A Allen
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Simin Hosseinian
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
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Tang MF, Chiu HY, Xu X, Kwok JY, Cheung DST, Chen CY, Lin CC. Walking is more effective than yoga at reducing sleep disturbance in cancer patients: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2019; 47:1-8. [DOI: 10.1016/j.smrv.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022]
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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Tamtaji OR, Naderi Taheri M, Notghi F, Alipoor R, Bouzari R, Asemi Z. The effects of acupuncture and electroacupuncture on Parkinson's disease: Current status and future perspectives for molecular mechanisms. J Cell Biochem 2019; 120:12156-12166. [PMID: 30938859 DOI: 10.1002/jcb.28654] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/18/2018] [Accepted: 02/07/2019] [Indexed: 12/11/2022]
Abstract
Among the progressive neurodegenerative disorders, Parkinson's disease (PD) is the second most common. Different factors have critical role in pathophysiology of PD such as apoptosis pathways, inflammatory cytokines, oxidative stress, and neurotransmitters and its receptors abnormalities. Acupuncture and electroacupuncture were considered as nondrug therapies for PD. Although numerous studies has been conducted for assessing the mechanism underlying electroacupuncture and acupuncture, various principal aspects of these treatment procedures remain not well-known. There have also been few investigations on the molecular mechanism of acupuncture and electroacupuncture therapy effects in PD. This review evaluates the effects of electroacupuncture and acupuncture on the molecular mechanism in PD.
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Affiliation(s)
- Omid Reza Tamtaji
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Mojtaba Naderi Taheri
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.,Deptartment of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fahimeh Notghi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Reza Alipoor
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Reihanesadat Bouzari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
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Rebamipide Mitigates Impairments in Mitochondrial Function and Bioenergetics with α-Synuclein Pathology in 6-OHDA-Induced Hemiparkinson’s Model in Rats. Neurotox Res 2019; 35:542-562. [DOI: 10.1007/s12640-018-9983-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/16/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022]
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Ponte SB, Lino C, Tavares B, Amaral B, Bettencourt AL, Nunes T, Silva C, Mota-Vieira L. Yoga in primary health care: A quasi-experimental study to access the effects on quality of life and psychological distress. Complement Ther Clin Pract 2018; 34:1-7. [PMID: 30712710 DOI: 10.1016/j.ctcp.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/13/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND and purpose: Yoga is growing in popularity, but its benefits and integration into primary care remain uncertain. Here, we determine yoga effects on quality of life and psychological distress, and evaluate the feasibility of introducing yoga at primary care level. MATERIALS AND METHODS This is a prospective, longitudinal, quasi-experimental study, with an intervention (n = 49) and a control group (n = 37). Yoga group underwent 24-weeks program of one-hour sessions. Our primary endpoint was quality of life and psychological distress, as well as satisfaction level and adherence rate. RESULTS Participants reported a significant improvement in all domains of quality of life and a reduction of psychological distress. Linear regression analysis showed that yoga significantly improves psychological quality of life (p = 0.046). CONCLUSION Yoga in primary care is feasible, safe and has a satisfactory adherence, as well as a positive effect on psychological quality of life of participants.
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Affiliation(s)
- Sara B Ponte
- Unidade de Saúde da Ilha de São Miguel, Azores, Portugal.
| | | | - Bruno Tavares
- Unidade de Saúde da Ilha de São Miguel, Azores, Portugal
| | - Beatriz Amaral
- Unidade de Saúde da Ilha de São Miguel, Azores, Portugal
| | | | - Tatiana Nunes
- Unidade de Saúde da Ilha de São Miguel, Azores, Portugal
| | - Catarina Silva
- Eurotrials - Scientific Consultants and CISP, Escola Nacional de Saúde Pública, Portugal
| | - Luisa Mota-Vieira
- Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel Island, Azores, Portugal; BioISI - Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Portugal; Instituto Gulbenkian de Ciência, Oeiras, Portugal
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Examining Factors Related to Health-Related Quality of Life in People With Parkinson’s Disease. Rehabil Nurs 2018; 45:122-130. [DOI: 10.1097/rnj.0000000000000179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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The Associations among Psychological Distress, Coping Style, and Health Habits in Japanese Nursing Students: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111434. [PMID: 29165395 PMCID: PMC5708073 DOI: 10.3390/ijerph14111434] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
Background: Nursing students in many countries have been reported to experience high levels of stress and psychological distress. Health habits could potentially mediate the association between coping styles and psychological status. The purpose of this study was to evaluate the mediation effect of health habits in the relationship between stress coping styles and psychological distress in Japanese nursing students. Methods: A total of 181 nursing students completed anonymous self-reported questionnaires comprised of the General Health Questionnaire-12 (GHQ-12), the Brief Coping Orientation questionnaire, and an additional questionnaire on health behavior. A mediation analysis using path analysis with bootstrapping was used for data analysis. Results: Multivariate linear regression analysis showed that psychological distress was significantly and positively associated with “Avoidance coping” (β = 0.39, p < 0.001), and was negatively associated with “Active coping” (β = −0.30, p < 0.001), “exercise habit” (β = −0.25, p = 0.001), and “sleeping” (β = −0.24, p = 0.002). In the path model, “Active coping” and “Avoidance coping” had significant or marginally significant associations with “exercise habits” (active: β = 0.19, p = 0.008, avoidance: β = −0.12, p = 0.088), and psychological distress (active: β = −0.25, p < 0.001, avoidance: β = 0.363, p < 0.001). However, these coping style variables did not have a significant association with “sleep”. In general, the size of the correlations was below 0.4. Conclusions: Exercise habits mediated the relationship between coping styles and psychological distress to a greater extent than sleep. The present study suggests the possibility that complex interactions between health habits and coping styles may influence the psychological status of nursing students.
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