Abstract
ObjectiveThe aim of this systematic review and meta-analysis was to determine the overall effect of resistance training (RT) on measures of muscular strength in people with Parkinson’s disease (PD).MethodsControlled trials with parallel-group-design were identified from computerized literature searching and citation tracking performed until August 2014. Two reviewers independently screened for eligibility and assessed the quality of the studies using the Cochrane risk-of-bias-tool. For each study, mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous outcomes based on between-group comparisons using post-intervention data. Subgroup analysis was conducted based on differences in study design.ResultsNine studies met the inclusion criteria; all had a moderate to high risk of bias. Pooled data showed that knee extension, knee flexion and leg press strength were significantly greater in PD patients who undertook RT compared to control groups with or without interventions. Subgroups were: RT vs. control-without-intervention, RT vs. control-with-intervention, RT-with-other-form-of-exercise vs. control-without-intervention, RT-with-other-form-of-exercise vs. control-with-intervention. Pooled subgroup analysis showed that RT combined with aerobic/balance/stretching exercise resulted in significantly greater knee extension, knee flexion and leg press strength compared with no-intervention. Compared to treadmill or balance exercise it resulted in greater knee flexion, but not knee extension or leg press strength. RT alone resulted in greater knee extension and flexion strength compared to stretching, but not in greater leg press strength compared to no-intervention.DiscussionOverall, the current evidence suggests that exercise interventions that contain RT may be effective in improving muscular strength in people with PD compared with no exercise. However, depending on muscle group and/or training dose, RT may not be superior to other exercise types. Interventions which combine RT with other exercise may be most effective. Findings should be interpreted with caution due to the relatively high risk of bias of most studies.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease [1] and affects approximately six million people worldwide [2]
Pooled data showed that knee extension, knee flexion and leg press strength were significantly greater in PD patients who undertook resistance training (RT) compared to control groups with or without interventions
Resistance Training for People with Parkinson's Disease aerobic/balance/stretching exercise resulted in significantly greater knee extension, knee flexion and leg press strength compared with no-intervention
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease [1] and affects approximately six million people worldwide [2]. Non-motor symptoms include a decline in cognitive function, psychiatric problems such as depression and anxiety, and autonomic, sleep, and sensory disturbances [10]. Common motor symptoms are tremor, bradykinesia (slowness of movement), rigidity, postural instability and a stooped posture, gait difficulties including freezing of gait (inability to initiate movement), and muscle weakness [1,2,11]. These movement difficulties lead to decreased activity levels in people with PD which, in turn, further impairs strength and physical functioning. Muscle weakness may contribute to postural instability and gait difficulties [16,17] and has been identified as a secondary cause for bradykinesia in PD [18]
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