Parkinson's disease and intensive exercise therapy – a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE To evaluate and compare the effect of 3 intensive exercise therapy modalities - Resistance Training (RT), Endurance Training (ET) and Other Intensive Training Modalities (OITM) - in Parkinson's Disease (PD). Design A systematic review and meta-analysis of randomized controlled trials. METHODS A systematic literature search was conducted (Embase, Pubmed, Cinahl, SPORTDiscus, Cochrane, PEDro), which identified 15 studies that were categorized as RT, ET or OITM. The different exercise modalities were reviewed and a meta-analysis evaluating the effect of RT on muscle strength was made. RESULTS In PD intensive exercise therapy (RT, ET and OITM) is feasible and safe. There is strong evidence that RT can improve muscle strength in PD, which is underlined by the meta-analysis (g'=0.54 [95%CI 0.22;0.86]). There is moderate evidence that ET can improve cardio-respiratory fitness in PD. RT, ET and OITM may have beneficial effects on balance, walking performance, Unified Parkinson's Disease Rating Scale-III (UPDRS-III) score and quality of life in PD, but findings are inconsistent. No studies find deterioration in any outcomes following exercise therapy. CONCLUSION RT, ET and OITM all represent feasible, safe and beneficial adjunct rehabilitation therapies in PD.