Effects of Ten Different Exercise Interventions on Motor Function in Parkinson’s Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials

Quality assessment and umbrella review of systematic reviews about dance for people with Parkinson's disease

OBJECTIVE(S)

To determine (1) the quality of systematic reviews about dance-based intervention in individuals with Parkinson's disease (PD) and (2) standard evidence for dance-based intervention efficacy based on the categories of The International Classification of Functioning, Disability, and Health (ICF) from the World Health Organization's (WHO).

METHODS

The data source included MEDLINE, PUBMED, Embase, Scopus, CENTRAL (Cochrane Library), CINAHL, PEDro, SPORTDiscus, APA PsycNet (APA PsycINFO), LILACS, SciELO, and AMED. Pairs of independent reviewers screened titles, abstracts, and full texts of eligible studies by using the software Covidence. Criteria included: systematic review designs; individuals with PD; dance-based interventions aimed to change critical PD symptoms matched to IFC domains (body functions, activities, and participation). Independent reviewers extracted information regarding the characteristics of all systematic reviews included and appraised quality using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Randomized controlled trials and their risk of bias were identified within each review and were used to perform an updated pairwise meta-analysis.

RESULTS

Of the 571 manuscripts screened, 55 reviews met the inclusion criteria. The overall confidence in the results of 38 reviews (69%) was rated as 'critically low,' nine (9%) as 'low,' one (2%) as 'moderate,' while seven of 55 reviews (13%) were rated as 'high'. Dance associated with pharmacological usual care is better than pharmacological usual care alone for essential components of ICF, such as motor symptoms severity (body function), depressive symptoms (body function), balance (body function and activity), and functional mobility (activity), but not for gait distance (activity) and quality of life (participation). Dance is also superior to multimodal exercise to improve balance.

CONCLUSIONS

Clinicians and people with PD can refer to this paper for a summary of high-quality reviews and the overall evidence supporting dance as an adjunct rehabilitation. This umbrella review not only underscores the therapeutic potential of dance but also reinforces the use of arts-based approaches into healthcare practices for people with neurological conditions.

Exercise as medicine in Parkinson's disease

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.

Exercise, Neuroprotective Exerkines, and Parkinson's Disease: A Narrative Review

Parkinson's disease (PD) is a prevalent neurodegenerative disease in which treatment often includes an exercise regimen. Exercise is neuroprotective in animal models of PD, and, more recently, human clinical studies have verified exercise's disease-modifying effect. Aerobic exercise and resistance training improve many of PD's motor and non-motor symptoms, while neuromotor therapy and stretching/flexibility exercises positively contribute to the quality of life in people with PD. Therefore, understanding the role of exercise in managing this complex disorder is crucial. Exerkines are bioactive substances that are synthesized and released during exercise and have been implicated in several positive health outcomes, including neuroprotection. Exerkines protect neuronal cells in vitro and rodent PD models in vivo. Aerobic exercise and resistance training both increase exerkine levels in the blood, suggesting a role for exerkines in the neuroprotective theory. Many exerkines demonstrate the potential for protecting the brain against pathological missteps caused by PD. Every person (people) with Parkinson's (PwP) needs a comprehensive exercise plan tailored to their unique needs and abilities. Here, we provide an exercise template to help PwP understand the importance of exercise for treating PD, describe barriers confronting many PwP in their attempt to exercise, provide suggestions for overcoming these barriers, and explore the role of exerkines in managing PD. In conclusion, exercise and exerkines together create a powerful neuroprotective system that should contribute to slowing the chronic progression of PD.

The effects of hydrotherapy and cryotherapy on recovery from acute post-exercise induced muscle damage-a network meta-analysis

BACKGROUND

This systematic review and network meta-analysis assessed via direct and indirect comparisons the recovery effects of hydrotherapy and cold therapy at different temperatures on exercise induced muscle damage.

METHODS

Five databases were searched in English and Chinese. The included studies included exercise interventions such as resistance training, high-intensity interval training, and ball games, which the authors were able to define as activities that induce the appearance of EIMD. The included RCTs were analyzed using the Cochrane Risk of Bias tool. Eligible studies were included and and two independent review authors extracted data. Frequentist network meta-analytical approaches were calculated based on standardized mean difference (SMD) using random effects models. The effectiveness of each intervention was ranked and the optimal intervention was determined using the surface under the cumulative ranking curve (SUCRA) indicator.

RESULTS

57 studies with 1220 healthy participants were included, and four interventions were examined: Cold Water Immersion (CWI), Contrast Water Therapy (CWT), Thermoneutral or Hot Water Immersion (TWI/HWI), and Cryotherapy(CRYO). According to network meta-analysis, Contrast Water Immersion (SUCRA: 79.9% )is most effective in recovering the biochemical marker Creatine Kinase. Cryotherapy (SUCRA: 88.3%) works best to relieve Delayed Onset Muscle Soreness. In the recovery of Jump Ability, cryotherapy (SUCRA: 83.7%) still ranks the highest.

CONCLUSION

We found that CWT was the best for recovering biochemical markers CK, and CRYO was best for muscle soreness and neuromuscular recovery. In clinical practice, we recommend the use of CWI and CRYO for reducing EIMD.

SYSTEMATIC REVIEW REGISTRATION

[PROSPERO], identifier [CRD42023396067].

Enhanced Parkinson's gait, reduced fall risk, and improved cognitive function through multimodal rehabilitation combined with rivastigmine treatment

OBJECTIVE

This study aimed to examine the effects of combined rehabilitation and rivastigmine treatment on patients with Parkinson's disease (PD).

METHODS

Gait parameters were assessed using the Gibbon Gait Analyzer in fifteen patients. Baseline gait data and cognitive assessments were collected. Each patient underwent external counterpulsation therapy, transcranial magnetic stimulation therapy, and exercise therapy for one hour per day, five days a week for three weeks. Post-intervention, gait and cognitive data were re-evaluated. Alongside their standard PD medications, all participants were administered rivastigmine throughout the study period.

RESULTS

The intervention significantly enhanced motor function in the single-task test, evidenced by marked improvements in gait metrics such as stride width and walking speed, and a substantial reduction in fall risk. Cognitive function, assessed by mini-mental state examination and Montreal cognitive assessment, showed an improvement trend after the three-week intervention. Improvements in dual-task walking function were observed, although these changes did not reach statistical significance.

CONCLUSION

Multimodal exercise training combined with rivastigmine treatment significantly improves certain gait parameters in the single-task test, enhances balance, and reduces the risk of falling in patients with PD. Cognitive function also demonstrated improvement.

A recent update on drugs and alternative approaches for parkinsonism

Parkinson's disease, often known as PD, is a more common age-related neurological disorder that affects a huge number of older adults worldwide. Parkinson's disease is predominantly a movement-related pathosis and is distinguished by the deposition of intra-neuronal aggregates, as the alpha-synuclein gene is expressed as Lewy bodies (LB) causing dopaminergic neurons to die. Stress in early life may contribute to the development of depression, and depression in patients may result in the development of Parkinson's disease as they mature. Depression is a non-motor condition that leads to motor symptoms, such as Parkinson's disease. PD Patients are currently utilizing a variety of other therapies like utilizing nutritional supplements, herbal remedies, vitamins, and massage. When a patient's functional ability is impaired, drug treatment is usually initiated according to the individual's condition and the severity of signs and symptoms. The current marketed anti-Parkinson drugs, has low brain distribution and failing to repair dopaminergic neurons or delaying the progression of the disease these negative effects were unavoidable. To overcome these disadvantages, this review considers the inclusion of drugs used in Parkinson's disease, focusing on strategies to reuse existing compounds to speed up drug development, their capacity to traverse the BBB, and drug dispersion in the brain. We look at cellular therapies and repurposed drugs. We also investigate the mechanisms, effectiveness, as well as safety of several new medications that are being repositioned for Parkinson's disease pharmacotherapy. In this study, we focus on global trends in Parkinson's disease research. We hope to raise awareness about the present state of major factors for disability worldwide, including yearly prevalence's from international and national statistics. The pathophysiology of Parkinsonism and also analyze existing therapies for Parkinson's disease, moreover new and innovative drug therapies, and to assess the prospects for disease modification.

Bone mineral density in haemophilia patients: A systematic review and meta-analysis

INTRODUCTION

With the increase in life expectancy of haemophilia patients (PWH), the risk of osteoporosis increases, but there is little research on whether haemophilia is the cause of osteoporosis.

AIM

To conduct systematically review whether bone mineral density (BMD) in PWH decreased and the factors affecting BMD.

METHODS

Two authors independently searched databases and reviewed citations from relevant articles, selecting studies published in any language and performed in humans before March 2023. Eligibility criteria were observational studies in PWH, with BMD as at least one outcome other than osteoporosis or bone loss, and analyses in a group of PWH and healthy controls.

RESULTS

Twelve studies were ultimately identified, consisting of 1210 individuals (534 PWH and 676 healthy controls), compared with the control group, BMD in PWH decreased by 0.13 g/cm2 [95% confidence interval (CI) -0.18 to -0.08, I2  = 89%]. No evidence of publication bias was detected. There was no evidence that age, BMI, level of physical activity, the types of haemophilia, haemophilia severity, a blood-borne virus (HCV) and treatment modality predicted the BMD in PWH.

CONCLUSION

The results indicate that BMD in PWH is lower than in healthy controls. Therefore, we strongly recommend PWH early measurement of BMD to prevent osteoporosis.

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

OBJECTIVE

The effects of different exercise doses on motor function, balance, mobility, and quality of life (QOL) in patients with Parkinson's disease (PD) were evaluated.

METHOD

The exercise intervention dose was evaluated based on the recommendations of the American College of Sports Medicine (ACSM) for developing and maintaining cardiorespiratory health, muscle strength, and physical function for PD patients and classified into high ACSM compliance and low or uncertain ACSM compliance. The impact of ACSM compliance on Unified Parkinson's Disease Rating Scale, Part III (UPDRS-III), Berg Balance Scale (BBS), Timed Up and Go (TUG), and 39-item Parkinson's Disease Questionnaire (PDQ-39) in patients with PD was compared using the standardized mean difference (SMD) along with the corresponding 95% confidence interval (95% CI).

RESULTS

A total of 26 articles were included, comprising 32 studies. Twenty-one studies were classified as high ACSM compliance, and 11 studies were classified as low or uncertain ACSM compliance. For the four outcome measures, the SMD ratio of exercise interventions with high ACSM compliance to those with low or uncertain ACSM compliance was as follows: UPDRS-III (- 0.74: - 0.17), TUG (- 0.62: - 0.17), PDQ-39 (- 0.58: - 0.31), and BBS (0.51: 0.52).

CONCLUSION

The results suggest that compared with exercise interventions with low or uncertain ACSM compliance, exercise interventions with high ACSM compliance had a more significant improvement effect on motor function, mobility, and QOL in PD patients. However, the effect on balance was not as pronounced, and further research is needed to validate these findings.

The impact of Pilates exercise for depression symptoms in female patients: A systematic review and meta-analysis

BACKGROUND

The Pilates exercise has recently become an increasingly popular way of exercise in female patients since it is an attractive and low-cost physical exercise modality. Pilates may be a beneficial method of exercise for female patients with depression and anxiety symptoms. However, to date, there has been no attempt to collate this literature. This review aims to systematically assess and meta-analyze the efficacy of Pilates exercise for female patients with depression and anxiety symptoms and inform evidence-based guidelines for exercise prescription.

METHODS

Five electronic databases (Scopus, MEDLINE/PubMed, Embase, Web of Science, and the Cochrane Library) were systematically searched up to January 2023 to examine randomized controlled trials (RCTs) focused on the effects of Pilates exercise for female patients with depressive disorders and individuals with elevated levels of depression were included. The primary outcomes were the severity of depression, and the secondary outcomes were anxiety. Statistical analyses were performed using Stata version 15.1 software with a 95% confidence interval (Registration number: CRD42023426522), and the PEDRO Scale was used to evaluate the risk of bias for RCT.

RESULTS

18 RCTs with 827 female patients were included. The methodological quality of the RCTs was considered an A level in 4 studies, B level in 13, studies, and C level in 1 study investigation. The meta-analysis showed that there was moderate evidence for the Pilates exercise significantly improved the severity of depression symptoms (SMD = -0.73; 95% CI -0.86 to -0.59; P < .01) and anxiety symptoms (SMD = -0.62; 95% CI -0.79 to -0.46; P < .01).

CONCLUSIONS

Pilates exercise could reduce levels of depression and anxiety in female patients with depression and anxiety symptoms. Pilates exercise can be used as a potential ancillary program to improve depression and anxiety symptoms for female patients.

Whether mindfulness-guided therapy can be a new direction for the rehabilitation of patients with Parkinson's disease: a network meta-analysis of non-pharmacological alternative motor-/sensory-based interventions

Background

The treatment for Parkinson's disease (PD) consumes a lot of manpower and financial resources. Non-pharmacological alternative motor-/sensory-based interventions are optimized for the rehabilitation of PD patients. Mindfulness-based therapy shows ideal efficacy, but the diversity of the therapy brings difficulties to the selection of clinicians and patients.

Methods

Network meta-analysis in the Bayesian framework was used to evaluate the efficacy of non-pharmacological alternative motor-/sensory-based interventions in improving motor and non-motor symptoms in PD patients.

Results

A total of 58 studies (2,227 patients) were included. Compared with the non-intervention group, qigong was associated with improved outcomes in the Timed Up and Go (TUG) test (mean difference (MD) -5.54, 95% confidence interval (CI) -8.28 to -2.77), and UPDRS-I (MD -15.50, 95% CI -19.93 to -7.63). Differences between non-pharmacological alternative motor-/sensory-based interventions were not significant for PDQ-39, UPDRS-I, or UPDRS-II; however, qigong was superior to dance (MD -3.91, 95% CI -6.90 to -0.95), Tai Chi (MD -3.54, 95% CI -6.53 to -0.69), acupuncture (MD -6.75, 95% CI -10.86 to -2.70), music (MD -3.91, 95% CI -7.49 to -0.48), and exercise (MD -3.91, 95% CI -6.49 to -1.33) in the TUG test.

Conclusion

This network meta-analysis supports mindfulness-based therapy (e.g., qigong, yoga, and Tai Chi) as a preferred non-pharmacological alternative motor-/sensory-based intervention for PD rehabilitation.

Systematic review registration

https://inplasy.com/inplasy-2022-10-0109/, INPLASY2022100109.

Effects of Baduanjin exercise on motor function, balance and gait in Parkinson's disease: a systematic review and meta-analysis

OBJECTIVE

This study aims to systematically evaluate the effects of Baduanjin on motor function, balance and gait in patients with Parkinson's disease (PD).

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

All eligible randomised controlled trials (RCTs) published in the English and Chinese language were included.

DATA SOURCES

Ten electronic databases were systematically searched, from inception to 17 March 2022: PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, OVID, SinoMed, China National Knowledge Infrastructure, Wanfang Data and China Science Journal Database (VIP).

REVIEW METHODS

Methodological quality assessment and meta-analysis were performed for the included studies using the Cochrane Review Manager V.5.4 software.

RESULTS

Ten RCTs with 804 participants were included. The results revealed the following: (1) Baduanjin significantly improved the motor function of patients with PD, based on the Unified Parkinson's Disease Rating Scale Part III (mean difference, MD -5.37, 95% CI -8.96 to -1.78, p=0.003) and Fugl-Meyer Assessment of Lower Extremity (MD 5.39, 95% CI 2.71 to 8.07, p<0.0001); (2) Baduanjin significantly improved the ability of balance of patients with PD, based on the Berg Balance Scale (MD 4.40, 95% CI 3.08 to 5.73, p<0.00001); (3) Baduanjin significantly improved the gait of patients with PD, based on the 6 min walk distance (MD 21.62, 95% CI 11.14 to 32.10, p<0.0001). After the further subgroup and sensitivity analyses, the heterogeneity was identified to be potentially due to the different degrees of disease severity in patients with PD and the difference in Baduanjin intervention durations.

CONCLUSIONS

The analysis of this systematic evaluation indicates that Baduanjin might have a positive effect in improving the motor function, balance and gait of patients with PD. However, due to the quantity and clinical heterogeneity limitations of the included studies, this conclusion still warrants more high-quality and multicentre RCTs for further verification.

Accuracy of novel urinary biomarker tests in the diagnosis of prostate cancer: A systematic review and network meta-analysis

Objective

The purpose of this study was to conduct a network meta-analysis comparing the diagnostic value of different urinary markers for prostate cancer.

Methods

As of June 2022, the literature was retrieved by searching Pubmed, EMBASE, Web of Science databases and other databases. The methodological quality of included studies was assessed using the Cochrane Collaboration’s risk of bias tool, and publication bias was assessed using funnel plots. The surface under the cumulative ranking curve (SUCRA) values ​​was used to determine the most effective diagnostic method and the data were analyzed accordingly using data analysis software.

Results

A total of 16 articles was included including 9952 patients. The ranking results of network meta-analysis showed that the diagnostic performance of the four urine markers Selectmdx, MIPS, PCA3 and EPI was better than that of PSA. Among them, the specificity, positive predictive value and diagnostic accuracy of Selectmdx ranked first in the SUCRA ranking (SUCRA values: 85.2%, 88.3%, 97.1%), and the sensitivity ranked second in the SUCRA ranking (SUCRA value: 54.4%), and the negative predictive value ranked fourth in SUCRA (SUCRA value: 51.6%). The most sensitive screening tool was MIPS (SUCRA value: 67.1%), and it was also the second screening tool ranked higher in specificity, positive predictive value, negative predictive value and diagnostic accuracy (SUCRA value: 56.5%, respectively)., 57.1%, 67.9%, 74.3%). The high negative predictive value SUCRA ranking is EPI (SUCRA value: 68.0%), its sensitivity ranks third (SUCRA value: 45.6%), and its specificity, positive predictive value and diagnostic accuracy are ranked fourth (SUCRA values are: 45%, 38.2%, 35.8%).

Conclusion

According to the network ranking diagram, we finally concluded that Selectmdx and MIPS can be used as the most suitable urine markers for prostate cancer screening and diagnosis. To further explore the diagnostic value of different urinary markers in the screening of PCa patients.

Systematic Review Registration

https://inplasy.com/, identifier INPLASY202290094.

NADPH and Mitochondrial Quality Control as Targets for a Circadian-Based Fasting and Exercise Therapy for the Treatment of Parkinson's Disease

Dysfunctional mitochondrial quality control (MQC) is implicated in the pathogenesis of Parkinson's disease (PD). The improper selection of mitochondria for mitophagy increases reactive oxygen species (ROS) levels and lowers ATP levels. The downstream effects include oxidative damage, failure to maintain proteostasis and ion gradients, and decreased NAD⁺ and NADPH levels, resulting in insufficient energy metabolism and neurotransmitter synthesis. A ketosis-based metabolic therapy that increases the levels of (R)-3-hydroxybutyrate (BHB) may reverse the dysfunctional MQC by partially replacing glucose as an energy source, by stimulating mitophagy, and by decreasing inflammation. Fasting can potentially raise cytoplasmic NADPH levels by increasing the mitochondrial export and cytoplasmic metabolism of ketone body-derived citrate that increases flux through isocitrate dehydrogenase 1 (IDH1). NADPH is an essential cofactor for nitric oxide synthase, and the nitric oxide synthesized can diffuse into the mitochondrial matrix and react with electron transport chain-synthesized superoxide to form peroxynitrite. Excessive superoxide and peroxynitrite production can cause the opening of the mitochondrial permeability transition pore (mPTP) to depolarize the mitochondria and activate PINK1-dependent mitophagy. Both fasting and exercise increase ketogenesis and increase the cellular NAD⁺/NADH ratio, both of which are beneficial for neuronal metabolism. In addition, both fasting and exercise engage the adaptive cellular stress response signaling pathways that protect neurons against the oxidative and proteotoxic stress implicated in PD. Here, we discuss how intermittent fasting from the evening meal through to the next-day lunch together with morning exercise, when circadian NAD⁺/NADH is most oxidized, circadian NADP⁺/NADPH is most reduced, and circadian mitophagy gene expression is high, may slow the progression of PD.