Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review

Physical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events. This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g. having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment). The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months. Some minor adverse effects mainly transient musculoskeletal pain) have been reported. For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate. People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naive to those activities. For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk. For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated

Vastly Different Exercise Programs Similarly Improve Parkinsonian Symptoms:A Randomized Clinical Trial

Objectives: To directly compare the effects of agility exergaming (EXE) and stationary cycling (CYC) exercise training on Parkinson’s disease (PD) patients’ mobility and clinical symptoms. Design: Randomized clinical trial. Setting: Outpatient physiotherapy clinic in a hospital. Participants: Seventy-four stage 2–3, nondemented PD patients were included in this study. Intervention: The groups were as follows: EXE (n = 25), CYC (n = 25), and a wait-listed control group (CON; n = 24). The EXE and CYC groups exercised 5×/week for 5 weeks, matched at 80% of the age-predicted maximal heart rate. Main Outcomes: The primary outcome was the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (UPDRS-II) score. Secondary outcomes were Parkinson’s Disease Quastionnaire-39 (PDQ-39), the Beck Depression Inventory (BDI), the Schwab and England Activities of Daily Living (SE-ADL) scale, Euro-Quality of Life-5 Dimensions (EQ-5D) questionnaire, the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Tinetti Assessment Tool (TAT), the Dynamic Gait Index, the 6-min walk test (6MWT), and standing posturography. Results: After treatment, UPDRS-II scores improved (mean change: EXE, –4.5 points; CYC, –3.2 points). The results for the other outcomes (EXE and CYC, respectively) were: PDQ, 13 and 17%; BDI, –2.5 and –2.1 points; 6MWT, 129.6 and 141.6 m; and EQ-5D, 12 and 9% (all p 0.05). Conclusion: Two highly different exercise programs resulted in similar improvement of most motor and clinical symptoms in PD patients

The effects of stretching in Parkinson's disease: A systematic review of randomized controlled trials

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. While incurable, exercise has shown therapeutic benefits. Stretching, an accessible and low-cost modality, may improve mobility, balance, and flexibility, warranting systematic evaluation for managing PD symptoms. This systematic review aimed to examine and critically analyze scientific evidence on the effects of stretching in people with Parkinson's disease. Methods: A search was conducted in four electronic databases (Scopus, Web of Science, PEDro, and MEDLINE/PubMed) from inception to November 2024. The methodological quality of included studies was assessed using the PEDro scale. Results: Twelve randomized controlled trials were analyzed. Stretching programs lasted 4 weeks to 6 months. Positive effects were observed in motor symptoms and functional mobility for people with PD, although these were generally less pronounced compared to interventions like Tai Chi or WuQinXi Qigong. In contrast, mixed results to no significant improvements were observed for balance, gait, strength, cardiorespiratory fitness, mental health, neurocognitive function, sleep quality, physical activity levels, and fatigue. Conclusion: Stretching improves motor symptoms and mobility in people with PD, but its benefits for gait, motor function, and mental health are limited compared to other exercises. Further studies are needed to assess its impact on motor and neurocognitive functions.Universidade de Vigo/CISU

Parkinson’s disease motor intervention patterns: a network meta-analysis based on patient motor function

BackgroundParkinson’s disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients’ independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson’s disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients.MethodsA systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson’s disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool.ResultsThe network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients’ MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = −28.97, −4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients’ completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = −7.88, 95%CI = −9.47, −6.28). Dance and Tai Chi exercises significantly improved patients’ balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = −0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients’ walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84).ConclusionCompared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson’s disease patients

Effects of Exercise on Parkinson\u27s Symptom Relief

In this review of twenty research articles, the effects of moderate exercise therapy on the symptoms of Parkinson’s Disease will be explored. Appropriate literature was located using the research question, “In older adults with a Parkinson’s Disease Diagnosis, how does moderate exercise influence the symptoms of this disease?” Twenty peer-reviewed research articles were examined for the impact of different forms of exercise on various symptoms associated with Parkinson’s. Nineteen of the articles reviewed provide substantial evidence in support of exercise therapy as a treatment option for people with Parkinson’s, and one of the articles found inconclusive evidence neither in support nor against exercise therapy. The purpose of reviewing this research is to explore the options that people with a Parkinson’s diagnosis have to achieve the best quality of life while managing the symptoms of their disease

Identifying the Types of Physical Exercise that Help Individuals with Parkinson’s Disease Manage Their Symptoms: A Modified Delphi Study

It is largely accepted that exercise results in short-term benefits that have a positive effect on activities of daily living and quality of life. Similarly, there is growing evidence that exercise results in long-term benefits36,42-44,48,63,67,69,71. Despite the growing awareness of benefits of incorporating exercise as a part of therapy, there is little consensus on ideal dosages and types of exercise needed to target the wide range of symptoms that occur with Parkinson’s26. The purposes of this study were to identify types of exercise people with Parkinson’s have used for symptom management and to determine which types they have found most beneficial in relieving the symptoms of Parkinson’s. The results will help future researchers use resources efficiently by identifying interventions with high benefit potential that avoid barriers and directing future research away from areas with low benefit potential. The 10 most common types of exercise identified though this modified Delphi study were walking, cycling, yardwork, Static Exercises, resistance training, stretching, Slow Moving Exercises, dancing, Physical Therapy, and Speech Therapy. This list provides some direction for future research by identifying common types of exercise that people with Parkinson’s are willing and physically able to do at some point throughout the course of their disease. Investing future resources to identify better intervention strategies for any of these types of exercise may be warranted since innovations could influence a large percentage of the Parkinson’s community. Once the ten most common types of exercise were identified, subjects determined which types they have found most beneficial in relieving the symptoms of Parkinson’s. Results identified walking, stretching, resistance training, and cycling as relatively high ranked types of exercise. Therefore, all 10 types of exercise warrant future research but walking, stretching, resistance training, and cycling may provide additional benefits from the investment of future resources

The potential of physical exercise: Evidence from two complex systematic reviews in Parkinson's disease and cancer

Background Physical exercise is a promising treatment option for improving health outcomes in people with various health conditions including Parkinson’s disease (PD) and cancer. Evidence of beneficial effects has been identified for several exercise programs for people with PD, but the relative impact of different exercise types on outcomes such as the severity of motor signs and quality of life (QoL) remains uncertain. Positive effects on health outcomes including cancer-related fatigue (CRF) and QoL have been demonstrated also for different types of exercise for people with cancer, but previous evidence syntheses provided promising but inconclusive results about the specific impact of resistance training. Objective The objective of this dissertation was to investigate the potential of physical exercise to improve health outcomes in people with PD and people with cancer by conducting comprehensive systematic reviews that integrate the most recent evidence from randomized controlled trials (RCTs). Methods This cumulative dissertation comprises two systematic reviews: • Systematic review I: A systematic review with network meta-analysis to compare the effects of different types of physical exercise in people with PD on the severity of motor signs, QoL and adverse events, and to generate a clinically relevant treatment ranking. • Systematic review II: A systematic review with pairwise meta-analysis to compare the effects of resistance training with no training on CRF at different periods of treatment in relation to anticancer therapy, and different periods of assessment, and to compare the effects of resistance training with no training on QoL and adverse events. Results Systematic review I identified evidence of beneficial effects for most types of physical exercise for people with PD included in the review compared with a passive control group: Dance and gait/balance/functional training probably have a moderate beneficial effect, and multi-domain training probably has a small beneficial effect, on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. Aqua-based training probably has a large beneficial effect on QoL. Mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL. Across outcomes, there was little evidence of differences between exercise programs. In systematic review II, evidence of beneficial effects for resistance training compared with no training for people with cancer was observed: Resistance training during anticancer therapy probably has a beneficial effect on short term CRF and may have a small beneficial effect on short term QoL. Resistance training after anticancer therapy may have a small beneficial effect or no effect on short term QoL. The evidence was very uncertain about the medium, and long term effects of resistance training. In both systematic reviews, the evidence was very uncertain about the effects of physical exercise on adverse events. Conclusion This dissertation provides evidence of beneficial effects of several types of physical exercise on the severity of motor signs and QoL for people with PD, and evidence of beneficial effects of resistance training during anticancer therapy on CRF and QoL for people with cancer. Therefore, this dissertation highlights the potential of physical exercise to improve health outcomes in people with PD and people with cancer. More consistent and complete reporting of adverse events in RCTs is needed to evaluate the safety of exercise with more certainty