Exercise Eases Motor Symptoms in Parkinson’s Early-to-mid Stages

Meta-analysis highlights importance of 'long-term physical therapy'

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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At least six months of physical therapy helps to ease motor symptoms, possibly allowing for lower medication doses among people with mild-to-moderate Parkinson’s disease, according to findings from a recent meta-analysis of published clinical trial data.

Beneficial changes in Parkinson’s motor symptoms were observed regardless of whether patients were using anti-parkinsonian medications.

“The results of this study emphasized the importance of persisting in long-term physical therapy regardless of whether it is in the state of drug treatment,” the researchers wrote, adding their findings highlight the “necessity of continuous physical therapy from the early and middle stages of the disease.”

The study, “Physical Therapy for at Least 6 Months Improves Motor Symptoms in Parkinson’s Patients: A Meta-Analysis,” was published in Computational and Mathematical Methods in Medicine

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Despite disease-relevant treatments, Parkinson’s patients experience declines in physical functioning and their capacity to participate in daily activities as their disease progresses.

Adding physical therapy to medication regimens is a common approach to help slow these declines. Physical therapy can encompass a range of activities, with most programs involving Parkinson’s-relevant exercises to build muscle strength, improve balance, and restore or retain a more normal posture and gait, all with the goal of improving or maintaining functional abilities.

Study focuses on exercise programs lasting 6 months to 2 years

Repeat studies have shown that such interventions help with motor symptoms and daily living in the short-term, the researchers noted, but fewer studies have evaluated the benefits of a long-term physical therapy program

Long-term programs, those running for six months or more, might further delay symptom progression and improve daily functioning, the team suggested. If so, it could be possible for patients to rely less on their medications, lowering the likelihood of side effects and other associated costs.

A research team in China did a meta-analysis of published data from randomized and controlled trials investigating the effects of long-term rehabilitation in order to better establish its potential benefits. The final analysis included 10 studies involving 523 people with mild-to-moderate Parkinson’s disease, as determined by a Hoehn and Yahr staging of 1 to 3. Stage one on this five-stage scale designates mild and unilateral disease, that affecting one side of the body; stage three is bilateral disease with mild-to-moderate symptoms and some postural instability.

Across the studies, physical therapy was given to a randomized patient group at least once weekly for a minimum of six months and up to two years, with results compared with a control group given no exercise, a short-term exercise program, or another intervention. Exercise types included aerobic exercise (e.g., walking, cycling), resistance training (strengthening exercises), or a multidisciplinary rehabilitation approach.

Motor symptoms were assessed with the Movement Disorder Society–Revised Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor score, a standard measure of motor abilities and complications, and daily activities determined with the MDS-UPDRS Activities of Daily Living scale.

Long-term physical therapy lessened motor symptoms overall when used either in combination with anti-parkinsonian medications or alone, the meta-analysis found, but it had no significant impact on daily activities.

Since patients were taking a range of medicines across the studies — not detailed in this analysis — levodopa equivalent doses (LED) were determined. LED accounts for the effects of all medications a person is using, and equates it to the dose of levodopa — a gold-standard Parkinson’s treatment — that would have the same effect. Essentially, it’s a way of standardizing a total medication dose.

Among benefits, lesser reliance on pharmaceutical treatments

Results showed that LEDs significantly decreased with a long-term rehabilitation or exercise program, indicating patients were generally able to lower their medication doses.

A subgroup analysis of each exercise type found that no individual exercise led to significant motor gains when anti-parkinsonian medications were not being used. Only resistance training was associated with motor improvements in the absence of medications, and it was the finding of a single study.

Multidisciplinary rehabilitation, which “mainly consisted of physical therapy” with “some visual and auditory guidance training to improve gait and posture,” was linked to improvements in daily life activities and a reduction in LED.

The researchers suggested that a multidisciplinary approach “has more treatment modes and improves the functional impairment of the patients more widely,” which could account for daily life gains not seen with other approaches. But they noted that a small number of studies for each intervention type limits their analyses.

Still, overall findings support that at least six months of physical therapy for people with mild-to-moderate Parkinson’s “could effectively improve the motor symptoms of patients … whether combined with antiparkinson drug therapy or not,” the researchers wrote.

Such gains “boost the confidence of Parkinson’s patients and make them pay more attention to and adhere to long-term physical therapy,” they added.

A need for lesser medication, the team also noted, could lower the risk of complications with exercise that can accompany higher doses, further encouraging exercise while easing Parkinson’s economic burden.

 

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