This Cochrane systematic review aimed to estimate the effects of different types of physical exercise compared to another type of exercise, control group or both on the severity of motor signs, quality of life and occurrence of adverse events in people with Parkinson’s Disease (PD).
This Cochrane systematic review included randomised controlled trials that assessed physical exercise interventions for people with PD. Eligible trials were identified from eight electronic databases. Trials were included if they compared one type of physical exercise to another type of exercise, a control, or both. Critical outcomes were; severity of motor signs, reported using the motor scale from the Unified Parkinson Disease Rating Scale (UPDRS-M); quality of life, reported using the Parkinson’s Disease Questionnaire 39 (PDQ-39); and occurrence of adverse events, which was measured by the number of participants with any adverse advent. Two reviewers independently identified and selected studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Confidence in the evidence was evaluated using the CINeMA approach.
The review included 156 randomised controlled trials (7,939 participants) from over 20 countries. Participants had mostly mild to moderate disease, no major cognitive impairment and a mean/median age range between 60 to 74 years. For the outcome severity of motor signs (71 studies; 3196 participants), there is high confidence that dance has a moderate beneficial effect (mean difference (MD) -10.32, 95% confidence interval (CI) -15.54 to -4.96) and low confidence that aqua-based, gait/balance/functional, and multi-domain training might have a moderate beneficial effect (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). There is low confidence that flexibility training might have a trivial or no effect (MD: 2.01, 95% CI -4.82 to 8.98), and very low confidence and high uncertainty about the effects of strength/resistance training (MD: -6.97, 95% CI -11.93 to -2.01).
For the outcome quality of life (55 studies; 3283 participants), there is moderate confidence that aqua-based training probably has a large beneficial effect (MD -14.98, 95% CI -23.26 to -6.52), low confidence that endurance training might have a moderate beneficial effect (MD -9.16, 95% CI -15.68 to -2.82), and that gait/balance/functional and multi-domain training might have a small beneficial effect (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). There is very low confidence and high uncertainty about the effects of strength/resistance training and flexibility training (strength/resistance MD: -6.34; 95% CI -12.33 to -0.35; flexibility MD: 1.23, 95% CI -11.45 to 13.92).
There is very uncertain evidence about the effect of physical exercise on increasing the occurrence of adverse events.
Most physical exercise interventions provide beneficial effects on the severity of motor signs and quality of life for people with PD managing mild to moderate disease, with little evidence of differences between interventions. Although evidence for the effect of exercise on the occurrence of adverse events is very uncertain, the interventions included in the review were considered to be relatively safe.
Ernst M, Folkerts A-K, 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 of Systematic Reviews 2023, Issue 1. Art. No.: CD013856. DOI: 10.1002/14651858.CD013856.pub2.