Parkinson’s disease is one of the leading neurodegenerative disorders in the elderly and the second most common neurodegenerative disease. This chronic progressive disease usually develops around the age of 55 and affects about 2 to 3 in 100 people over the age of 65 . It is the fastest growing neurological disorder in the world. The number of people with Parkinson’s disease is expected to double from 6 million in 2015 to 12 million in 2040 (1,2).

Physiotherapy interventions, such as balance exercises, treadmill training and strength training exercises are now an integral part of the management of Parkinson’s disease. Quality systematic reviews and randomised, controlled trials have shown that exercise improves mobility, balance and quality of life, and can reduce the risk of falling(1).

BUT WHAT TYPES OF EXERCISE CAN BE BENEFICIAL IN IMPROVING PATIENTS WITH PARKINSON’S DISEASE?
Between 2019 and 2020, teams of researchers analysed several studies on a given method.

AN AUSTRALIAN TEAM analysed 17 studies on PRESCRIBED HOME-BASED EXERCISE and found that it improves activities related to balance and walking speed in people with Parkinson’s disease. These improvements are similar to improvements observed with exercises carried out in rehabilitation centres. Exercises were prescribed by a physiotherapist or health professional with a degree in exercise prescription. In 76% of the studies, the exercise program included multiple elements, including balance, range of motion, strength, walking and dayto-day activities (e.g., sitting down, turning around and climbing stairs). The duration of the programme ranged from 3 to 26 weeks, the total number of sessions ranged from 9 to 182 (30 on average) and the duration of sessions ranged from 15 to 60 minutes. For the majority of the studies (93%), participants had at least one supervised in-home or centre-based session before starting home exercises(1).

A SPANISH TEAM focused on physical interventions in combination with conventional physiotherapy in Parkinson’s disease. The authors analysed 11 randomised, controlled trials, demonstrated the potential benefit of DANCE THERAPY in functional balance, and recommended its integration into clinical practice. Dance therapy can be an enjoyable social activity that produces physical, emotional and social benefits because it simultaneously affects motor and cognitive function, factors strongly related to the quality of life of patients with Parkinson’s disease. Future studies on dance therapy should include specific and rhythmic activities, as well as auditory and visual feedback. It would be interesting to analyse the most effective types of dance to improve the motor function, balance and quality of life of these patients.

A BRAZILIAN TEAM analysed 15 randomised, controlled trials on the effects of WATER FITNESS in people with Parkinson’s disease. Compared to conventional exercise, water fitness resulted in improved balance, mobility and quality of life, but no significant difference in functional performance. An improvement in the fear of falling has been shown in relation to traditional fitness.

AN ITALIAN TEAM selected seven studies with 236 participants on the value of EXERGAMING training for people with Parkinson’s disease. The results show that Nintendo Wii and Xbox Kinect have immediate positive effects on the locomotion of these patients. Compared to Kinect, Wii can be considered the best therapy to provide functional recovery.

A SPANISH TEAM critically sought scientific evidence on PILATES as a rehabilitation strategy for patients with Parkinson’s disease. The research identified eight studies demonstrating that the Pilates method has beneficial effects on their physical fitness, balance and functional autonomy.
The duration of the programs ranged from 6 to 12 weeks and included 60-minute sessions conducted 2-3 times weekly. All studies used well-known Pilates exercises which, in some cases, were tailored to the characteristics of the participants.
Pilates exercises, focused on maintaining optimal posture, contraction of the trunk muscles and good breathing during exercises, must be conducted under the supervision of a certified instructor or physiotherapist. Pilates can be safely prescribed to people with mild to moderate Parkinson’s disease. Future randomised studies with larger samples are required to confirm these observations.

A CHINESE TEAM analysed 16 studies with 555 participants on the effects of VIRTUAL REALITY REHABILITATION in people with Parkinson’s disease.
Their results show that virtual reality rehabilitation has been more effective than traditional rehabilitation in three ways: step and stride length, balance function and mobility. There was no effect on the dynamic walking index and walking speed. In addition, virtual reality rehabilitation has demonstrated significant effects on improving quality of life, confidence and neuropsychiatric symptoms. Both types of rehabilitation have similar effects on overall motor function, daily life activities and cognitive function. Mild dizziness and/or severe vomiting were observed in FIVE patients. The authors believe that virtual reality rehabilitation can at least be used as an alternative therapy when traditional walking and balance rehabilitation does not yield sufficiently satisfactory results. Further larger-scale studies are required to verify its potential benefits.

IN CONCLUSION, A PATIENT WITH PARKINSON’S DISEASE CAN TEST THESE DIFFERENT METHODS, BUT ONLY UNDER MEDICAL SUPERVISION AND UNDER THE SUPERVISION OF A PHYSIOTHERAPIST OR HEALTH PROFESSIONAL.

SOURCES:

1. Flynn A, Allen NE, Dennis S, Canning CG, Preston E. Home-based prescribed exercise improves balance-related activities in people with Parkinson’s disease and has benefits similar to centre-based exercise: a systematic review. J Physiother. 2019; 65(4): 189-199. https://pubmed.ncbi.nlm.nih.gov/31521554/
2. Hidalgo-Agudo RD, Lucena-Anton D, Luque-Moreno C, Heredia-Rizo AM, Moral-Munoz JA. Additional Physical Interventions to Conventional Physical Therapy in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Randomised Clinical Trials. J Clin Med. 2020; 9(4): 1038. Published 2020 Apr 7. https://pubmed.ncbi.nlm.nih.gov/32272665/
3. Gomes Neto M, Pontes SS, Almeida LO, da Silva CM, da Conceição Sena C, Saquetto MB. Effects of water-based exercise on functioning and quality of life in people with Parkinson’s disease: a systematic review and metaanalysis [published online ahead of print, 2020 Jul 27]. Clin Rehabil. 2020;269215520943660. https://pubmed.ncbi.nlm.nih.gov/32715810/
4. Suárez-Iglesias D, Miller KJ, Seijo-Martínez M, Ayán C. Benefits of Pilates in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019; 55(8): 476. Published 2019 Aug 13. https://pubmed.ncbi.nlm.nih.gov/32478581/5. Marotta N, Demeco A, Indino A, de Scorpio G, Moggio
5. L, Ammendolia A. Nintendo WiiTMversus Xbox KinectTM for functional locomotion in people with Parkinson’s disease: a systematic review and network meta-analysis [published online ahead of print, 2020 Jun 1]. Disabil Rehabil. 2020; 1-6. https://pubmed.ncbi.nlm.nih.gov/32478581/
6. Lei C, Sunzi K, Dai F, et al. Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson’s disease: A systematic review. PLoS One. 2019; 14(11): e0224819. Published 2019 Nov 7. https://pubmed.ncbi.nlm.nih.gov/31697777/

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