#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