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HongFei Z, Li Z, Liang L, Ru GW, Yi HL, Zhen W. Current interventional model for movement in Parkinson's disease: network meta-analysis based on the improvement of motor ability. Front Aging Neurosci 2024; 16:1431277. [PMID: 39318860 PMCID: PMC11419980 DOI: 10.3389/fnagi.2024.1431277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024] Open
Abstract
Aim To identify optimally therapeutic exercise interventions for improving motor ability among patients with Parkinson's disease (PD), we conducted a network meta-analysis (NMA) of randomized controlled trials comparing different exercise regimens. Methods Relevant RCTs were retrieved by searching PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, and other databases from inception to July 9, 2023 is available in English as the primary language. Exercise outcomes as measured by Movement Disorder Society- Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) score change were evaluated and ranked using STATA software version 18.0. All included studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Results The final NMA included 71 studies involving 3,732 participants, 87 intervention experiments, and 27distinct interventions. Although most exercise interventions showed some efficacy (reducing MDS-UPDRS-III score), cumulative ranking probability surface (SUCRA) values indicated that the best exercise interventions for motor function improvement were archery (95.6%), riding a bicycle (80.9%), and binary rhythm dance (80.8%). Conclusion An exercise intervention comprising archery, cycling, and(or) binary rhythm dance may yield superior improvements in motor function among patients with Parkinson's disease.
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Affiliation(s)
- Zhao HongFei
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Zhang Li
- Xiamen Medical College, Xiamen, China
| | - Li Liang
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Guo Wan Ru
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Huang Lan Yi
- School of Psychology, Shanghai Sport University, Shanghai, China
| | - Wang Zhen
- Wushu College, Shanghai Sport University, Shanghai, China
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Zhao H, Zhang L, Yang J, Guo W, Sun C, Shi R, Wang Z. Parkinson's disease motor intervention patterns: a network meta-analysis based on patient motor function. Front Neurol 2024; 15:1432256. [PMID: 39314864 PMCID: PMC11418397 DOI: 10.3389/fneur.2024.1432256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Background Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients. Methods A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool. Results The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84). Conclusion Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.
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Affiliation(s)
- Hongfei Zhao
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Li Zhang
- Xiamen Medical College, Xiamen, Fujian, China
| | - Jingling Yang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanru Guo
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Chunyang Sun
- School of Exercise and Health, Shanghai Sport University, Shanghai, China
| | - Runbo Shi
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Zhen Wang
- Wushu College, Shanghai Sport University, Shanghai, China
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Albrecht F, Johansson H, Poulakis K, Westman E, Hagströmer M, Franzén E. Exploring Responsiveness to Highly Challenging Balance and Gait Training in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 39166410 DOI: 10.1002/mdc3.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Exercise potentially improves gait, balance, and habitual physical activity in Parkinson's disease (PD). However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. Factors determining responsiveness to exercise interventions remain unclear. OBJECTIVES To address this uncertainty, we explored the responsiveness to our highly challenging balance and gait intervention (HiBalance) in people with PD. METHODS Thirty-nine participants with mild-moderate PD who underwent the HiBalance intervention from our randomized controlled trial were included. We defined response in three domains: (1) balance based on Mini-BESTest, (2) gait based on gait velocity, and (3) physical activity based on accelerometry-derived steps per day. In each domain, we explored three responsiveness levels: high, low, or non-responders according to the change from pre- to post-intervention. Separate Random Forests for each responder domain classified these responsiveness levels and identified variable importance. RESULTS Only the Random Forest for the balance domain classified all responsiveness levels above the chance level indicated by a Cohen's kappa of "slight" agreement. Variable importance differed among the responsiveness levels. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important. CONCLUSIONS Among three responder domains and responsiveness levels, we could moderately classify responders in the balance domain, but not for the gait or physical activity domain. This can guide inclusion criteria for balance-targeted, personalized intervention studies in people with PD.
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Affiliation(s)
- Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
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4
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Rotondo R, Padua E, Annino G, Guescini M, Donati-Zeppa S, Goffredo M, Stocchi V, Stocchi F, De Pandis MF. Dose-response effects of physical exercise standardized volume on peripheral biomarkers, clinical response, and brain connectivity in Parkinson's disease: a prospective, observational, cohort study. Front Neurol 2024; 15:1412311. [PMID: 39022736 PMCID: PMC11251892 DOI: 10.3389/fneur.2024.1412311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024] Open
Abstract
Background Exercise has been proposed as the "Universal Prescription for Parkinson's Disease"; however, the specificity of exercise dose in terms of frequency, intensity, duration, and type to be prescribed remains to be elucidated. The 2018 US updated guidelines and WHO Guidelines on Physical Activity and Sedentary Behavior recommend older adults (> 65+ years) to achieve weekly minimal activity levels, indicating the intensity of aerobic exercise as the metabolic equivalent of task and duration as minutes/week (150-300 min/week at a moderate intensity of 3-5.9 MET- or 75-150 min/week of a vigorous intensity of ≥6 MET). Translating these recommendations to PD patients, the study aimed to assess the dose-response effects of standardized volume of structured exercise, measured as METs-minutes/week (weekly energy expenditure) of two different rehabilitation settings to quantify the change in neurotrophic factors. The exercise-induced benefits between the two rehabilitation settings will be evaluated based on motor and non-motor symptoms, kinematic parameters of gait, cognitive function, quality of life, and cortical activity and brain connectivity. Methods METEX-PD is a pilot, prospective, observational, cohort study. The study will enroll consecutively thirty (N = 30) participants with mild-to-moderate Parkinson's disease diagnosis to be assigned to a non-intensive or intensive rehabilitation group. The non-intensive rehabilitation group will achieve a range of 180-270 METs-min/week (90 min/week of low-intensity aerobic exercise, 2-3 METs), while the intensive rehabilitation group will exercise at 1350-1980 METs-min/week (225 min/week of high-intensity aerobic exercise, 6-8.8 METs). The METEX-PD trial will last 12 weeks, including 4 weeks of aerobic training program and two follow-ups. Assessments will be performed at baseline (T0), at the end of the exercise program (T1-end of the program), and 4- and 8 weeks after the end of the training program (FU-1 and FU-2). The primary outcome is the change from baseline in peripheral blood BDNF levels. Secondary outcomes are differences in peripheral biomarkers, functional-motor assessments, clinical-functional evaluations, and brain imaging. Conclusion METEX-PD trial will enable us to estimate the change in BDNF levels and other peripheral biomarkers under precise exercise-induced energy expenditure. The primary results of the METEX-PD study will allow the development of a larger multicenter randomized controlled trial to investigate the molecular pathways inducing the change in selected neurotrophic factors, such as BDNF, IGF-1, or irisin, and the downstream mechanisms of neuroplasticity in PD patients.
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Affiliation(s)
| | - Elvira Padua
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
| | - Giuseppe Annino
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
- Center of Space Bio-Medicine, Department of Medicine Systems, Tor Vergata University, Rome, Italy
| | - Michele Guescini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Sabrina Donati-Zeppa
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Michela Goffredo
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Vilberto Stocchi
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
| | - Fabrizio Stocchi
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Maria Francesca De Pandis
- San Raffaele Cassino, Cassino, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy
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5
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Langeskov-Christensen M, Franzén E, Grøndahl Hvid L, Dalgas U. Exercise as medicine in Parkinson's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332974. [PMID: 38418216 DOI: 10.1136/jnnp-2023-332974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.
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Affiliation(s)
- Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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6
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Liu M, He J, Liu D, Hou M, Ma Y. Bibliometric and visualized analysis of dynamic balance and brain function using web of science and CiteSpace from 1995 to 2022. Heliyon 2024; 10:e24300. [PMID: 38293478 PMCID: PMC10824782 DOI: 10.1016/j.heliyon.2024.e24300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose This study aims to explore the dynamic balance of human beings and investigate the relationship between functional structure as well as functional connectivity. Through a comprehensive bibliometric and visual analysis of the research literature from 1995 to 2022, we quantitatively display the development of the dynamic balance and brain structure as well as functional connection. Our objective is to present new trends and frontiers in the study of dynamic balance and brain function through bibliometrics software, providing valuable insights for future research in this domain. Methods The literature on dynamic balance, brain structure and functional connectivity between 1995 and 2022 was retrieved from the Web of Science database. We employed CiteSpace software to analyze various aspects, including the year of publication, journal, authors, keywords, institutions, countries, and references. Based on the analysis results, a co-reference map was generated to visually observe research hotspots and knowledge structures. Results A total of 1533 records were retrieved during the survey period (1995-2022), with a gradually increase in the number of annual publications. Notably, the data suggests a notable increase in publications between 2020 and 2021. The number of publications increased by 20 % from 2020 to 2021. The journal "Proceedings of the National Academy of Sciences (PNAS)" emerged as the most prolific journal. Among the cited authors, Deco and Gustavo ranked at the top. Key research terms in this field include "neural network", "functional connectivity", "dynamic", "model" and "brain". Particularly, the keyword "neural network" exhibited the strongest growth. The analysis of keywords cluster revealed the top 10 clusters of research themes. Oxford University stood out as the most productive institution, while the United States held the greatest influence with the highest number of publications and centrality. The reference cluster analysis further demonstrated the top 10 clusters in the literature. Conclusion Through the use of CiteSpace software, this study performed a comprehensive bibliometric and visual analysis of the Web of Science research literature on human dynamic balance and brain structural as well as functional connectivity over the past few decades. This may help researchers identify new perspectives on potential collaborators as well as collaborating institutions, hot topics, and research frontiers in the research field. The results provided an intuitive displayed overview of research trends, hotspots and frontiers in this field, facilitating a general understanding of its progression. Through unremitting efforts, it provides valuable guidance and reference for future research work.
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Affiliation(s)
- Mengjiao Liu
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo 315211, China
| | - Jian He
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo 315211, China
| | - Dongwei Liu
- School of Information Management and Artificial Intelligence, Zhejiang University of Finance and Economics, Hangzhou 310018, China
| | - Meijin Hou
- National Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350108, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Ye Ma
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo 315211, China
- National Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350108, China
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7
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Folkerts AK, Ernst M, Gollan R, Cryns N, Monsef I, Skoetz N, Kalbe E. Can Physical Exercise Be Considered as a Promising Enhancer of Global Cognition in People with Parkinson's Disease? Results of a Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S115-S133. [PMID: 38457150 PMCID: PMC11380223 DOI: 10.3233/jpd-230343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Physical exercise interventions are known to improve quality of life, motor and non-motor symptoms in people with Parkinson's disease (PD). However, systematic reviews and meta-analyses on cognitive outcomes are rare. Objective To perform a systematic review and meta-analysis of physical exercise intervention effects compared with passive and active control groups (CGs) on global cognition in people with PD. Methods A literature search was performed for randomized controlled trials (RCTs) on physical exercise interventions in PD using nine databases. We included RCTs reporting global cognition outcomes. A meta-analysis was performed using random-effects models and standardized mean differences (SMDs) with 95% confidence intervals (CIs). Bias was assessed with the revised Cochrane Risk of Bias tool and the certainty of evidence was rated using the GRADE approach. Results Seventeen studies (ten with passive, seven with active CGs) were included in the systematic review. Exercise interventions varied considerably between studies. The meta-analysis included nine studies with 236 people with PD (seven with passive, two with active CGs). The SMD was 0.33 (95% CI 0.00; 0.65) demonstrating a small effect (p = 0.05) in favor of physical exercise. Compared with passive CGs, physical exercise had a small non-significant effect (SMD = 0.22, 95% CI -0.14;0.58, p = 0.24). Compared with active CGs, physical exercise had a medium significant effect (SMD = 0.72, 95% CI 0.12;1.33, p = 0.02). Conclusions Physical exercise may increase global cognition in people with PD, but the evidence is very uncertain. Further large-scale RCTs are needed to confirm this finding and to identify the most effective type of physical exercise for improving cognition.
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Affiliation(s)
- Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Ernst
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Nora Cryns
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Malmir K, Ashrafganjooie M. Effects of HiBalance training program on physical function of individuals with idiopathic Parkinson disease: a systematic review and meta-analysis. Eur Geriatr Med 2023; 14:1273-1288. [PMID: 37698784 DOI: 10.1007/s41999-023-00860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The effectiveness of the HiBalance training program for individuals with Parkinson disease (PD) remains debated, prompting a systematic investigation. This study aims to assess whether the HiBalance training program yields favorable outcomes on physical function and self-reported function measures in PD individuals. METHODS A systematic search across PubMed, Cochrane Library, Ovid, Scopus, and PEDro databases identified studies exploring HiBalance training's impact on physical function in idiopathic PD. Publication date restrictions were not applied. Two independent reviewers evaluated bias risk using the Cochrane Risk of Bias tool and study quality using the PEDro scale. Effect size (standardized mean difference, SMD) and heterogeneity (Higgins I2) were determined. RESULTS Six studies underwent qualitative analysis, with two randomized-controlled trials and one multi-center clinical trial being included in the meta-analysis. HiBalance training exhibited a significant impact on physical function (SMD = 0.49; P = 0.0003). The Mini-BESTest score and gait velocity displayed improvements with moderate-effect sizes. However, solely gait velocity showed clinical enhancement. Yet, these benefits did not remain at the 6- and 12-month follow-ups post-intervention. Self-reported function measures showed no alteration post-HiBalance training. Publication bias was absent. CONCLUSION HiBalance training led to clinically significant improvements solely in gait velocity, though these gains waned over time. The findings suggest the necessity of refining the HiBalance program to sustain positive outcomes and ensure lasting enhancements. This underscores the importance of post-HiBalance training exercise programs to maintain benefits in the long term. PROSPERO REGISTRATION NUMBER The protocol of this review and meta-analysis was registered at PROSPERO (CRD42022325649). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022325649 .
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Affiliation(s)
- Kazem Malmir
- School of Rehabilitation, Physical Therapy Department, Tehran University of Medical Sciences, P. O. Box: 113635-1683, Tehran, Iran.
| | - Majid Ashrafganjooie
- School of Paramedical Sciences, Physical Therapy Department, Kerman University of Medical Sciences, Kerman, Iran
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9
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Tonkin PG, Miller TD, Hartmann TE, Skein M. The effects of exercise on non-motor experiences of daily living experienced in Parkinson's Disease: A systematic review and network meta-analysis. Clin Park Relat Disord 2023; 9:100203. [PMID: 37293547 PMCID: PMC10245098 DOI: 10.1016/j.prdoa.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Whilst non-motor experiences of daily living (NMeDL) reduce quality of life (QoL) in people with Parkinson's Disease (PD), research dedicated to NMeDL is lacking compared to motor symptoms. The aim of this Network Meta-Analysis (NMA) was to compare and determine the effects of exercise and dual-task training interventions on NMeDL for people with early-to-mid stage PD. Methods Eight electronic databases were systematically searched, identifying randomised control trials (RCTs) that assessed the effect of interventions on the Movement Disease Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS); Part I scores. A fixed-effect pairwise and NMA were completed and confidence in estimates were assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. Results Five RCTs involving exercise were identified, involving 218 participants. No dual-tasking studies were suitable. Pairwise comparisons favoured tango and mixed-treadmill training (TT) when compared to control, however 95% Confidence Intervals (CI) crossed the line of no effect (MD = 0). Indirect comparisons revealed tango had clinically meaningful reductions in Part I scores compared to speed-TT and body-weight resistance training, (MD -4.47; 95% CI -8.50 to -0.44 and MD -4.38; 95% CI -7.86 to -0.90), indicating improved NMeDL. Compared to control, low confidence evidence suggests tango and mixed-TT improves NMeDL. Conclusions Tango and mixed-TT are the most effective exercise interventions for improving NMeDL. Adoption of an exercise program in the early stages of PD, irrespective of modality, may be effective and holds potential clinical importance immediately following a diagnosis of PD.Other: Prospero Registration Number; CRD42022322470.
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Wang D, Zhou J, Huang Y, Yu H. Identifying the changes in the cortical activity of various brain regions for different balance tasks: A review. NeuroRehabilitation 2023:NRE220285. [PMID: 37125575 DOI: 10.3233/nre-220285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Balance support is critical to a person's overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control. OBJECTIVE This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements. METHODS Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies. RESULTS In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types. CONCLUSION Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks.
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Affiliation(s)
- Duojin Wang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Jiankang Zhou
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Yanping Huang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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11
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Freidle M, Thompson WH, Albrecht F, Franzén E. Implicit Motor Sequence Learning in People with Mild to Moderate Parkinson's Disease: Behavior and Related Brain Function. JOURNAL OF PARKINSON'S DISEASE 2023; 13:367-378. [PMID: 36938739 DOI: 10.3233/jpd-223480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Deficits in motor learning could be an important explanation for the balance and gait impairments characteristic of people with Parkinson's disease (PD). Empirical studies often report that so-called implicit motor sequence learning is impaired in people with PD, but the results are inconclusive. Altered brain activity during implicit motor sequence learning has also been reported for people with PD in comparison to healthy individuals. OBJECTIVE To investigate implicit motor sequence learning and associated neural correlates in individuals with mild to moderate PD. METHODS Fifty-seven participants with PD and 34 healthy participants, all ≥60 years of age, performed the serial reaction time task (SRTT) during the acquisition of functional magnetic resonance imaging (fMRI) data. We analyzed the SRTT as a measure of implicit motor sequence learning in two complementary ways. We analyzed the task-induced fMRI data within regions of interest (ROIs) as well as functional connectivity between ROIs. RESULTS We found a significant group difference in SRTT performance indicating that the participants with PD had a somewhat lower level of implicit motor sequence learning than the healthy participants. Exploratory analyses suggested that impairments in implicit motor sequence learning for people with PD might be due to a lower learning rate. We did not find any significant group differences in the fMRI data. CONCLUSION Our exploratory finding of a lower implicit motor learning rate in PD could have important implications for how people with PD should practice new motor tasks and physical exercise. Future studies need to confirm this finding with hypothesis-driven analyses.
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Affiliation(s)
- Malin Freidle
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - William H Thompson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Applied Information Technology, Gothenburg, University of Gothenburg, Gothenburg, Sweden
| | - Franziska Albrecht
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,R&D unit, Stockholms Sjukhem, Stockholm, Sweden
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