#382 Exercise for Parkinson’s Disease: More movement = Better movement?
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- Results statistically significant unless stated.
- 11 systematic reviews [7-78 Randomized Controlled Trials (RCTs), 174-4859 patients]1-11 over the last 5 years evaluated exercise (includes group, individual, home-based such as dance, strength/resistance, balance/functional training, endurance, yoga) versus control (usual care or self-directed activity) in predominantly mild-to-moderate Parkinson’s Disease. At ~1-6 months:
- Motor symptoms:
- Unified Parkinson’s Disease Rating Scale (UPDRS III) [0-108 points (lower=better); baseline ~20-30; clinically meaningful change: 3 points]:12,13
- 3.6 to 9.3-point improvement versus control3-5 [Example:~2 to 11 point improvement from baseline versus 0-2 point improvement (control)]
- No clear differences between exercise types.1,3-5
- Unified Parkinson’s Disease Rating Scale (UPDRS III) [0-108 points (lower=better); baseline ~20-30; clinically meaningful change: 3 points]:12,13
- Depressive symptoms:
- Symptom scores (various scales) improved versus non-active comparators:7-10
- Clinically meaningful change (>20% improvement on Beck Depression Inventory) seen in 8/9 RCTs.8,14,16
- Symptom scores (various scales) improved versus non-active comparators:7-10
- Quality of life:
- Parkinson’s Disease Questionnaire-39 [0 to 100-points (lower=better); baseline ~25-35; clinically meaningful change 4.5 points]:15
- 0.5 to 3.1-point improvement.2,4,6 Not clinically meaningful.
- Parkinson’s Disease Questionnaire-39 [0 to 100-points (lower=better); baseline ~25-35; clinically meaningful change 4.5 points]:15
- Proportion of people who fell (at least once). At 6-12 months:6,11
- 57% versus 63% (non-active comparators).
- Injurious falls or fractures: no difference.
- Motor symptoms:
- Limitations: Non-blinded intervention (assessors unblinded in ~1/3 of RCTs), different exercise types and intensities, often short durations (4-6 weeks) and small sample sizes (10-20 patients); baseline depression scores commonly suggest no to mild depression; inconsistent reporting of medication status and few severe patients complicates generalizability.
- Levodopa-carbidopa improves motor score (UPDRS III) by 2-4 points over baseline (3.5-11.5 points over placebo).17
- Adding a second medication improves motor scores by only 2-3 points more versus levodopa alone.18,19
- Guidelines recommend early exercise initiation.20,21
- Compliance dependent on ability to integrate physical activity into daily life.22 Patients should choose activities that they can easily access and enjoy.23
Good information. Exercise is always good.
Very informative
good reminder to recommend early exercise initiation when diagnosing and treating Parkinson’s