The Impact of Physical Activity on Non-Motor Symptoms in Parkinson's Disease: A Systematic Review.

Melanie E Cusso,Kenneth J Donald,Tien K Khoo

doi:10.3389/fmed.2016.00035

Abstract

Parkinson’s disease (PD) is a neurological disorder that is associated with both motor and non-motor symptoms (NMS). The management of PD is primarily via pharmaceutical treatment; however, non-pharmaceutical interventions have become increasingly recognized in the management of motor and NMS. In this review, the efficacy of physical activity, including physiotherapy and occupational therapy, as an intervention in NMS will be assessed. The papers were extracted between the 20th and 22nd of June 2016 from PubMed, Web of Science, Medline, Ovid, SportsDiscuss, and Scopus using the MeSH search terms “Parkinson’s,” “Parkinson,” and “Parkinsonism” in conjunction with “exercise,” “physical activity,” “physiotherapy,” “occupational therapy,” “physical therapy,” “rehabilitation,” “dance,” and “martial arts.” Twenty studies matched inclusion criteria of having 10 or more participants with diagnosed idiopathic PD participating in the intervention as well as having to evaluate the effects of physical activity on NMS in PD as controlled, randomized intervention studies. The outcomes of interest were NMS, including depression, cognition, fatigue, apathy, anxiety, and sleep. Risk of bias in the studies was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias. Comparability of the various intervention methods, however, was challenging due to demographic variability and methodological differences. Nevertheless, physical activity can positively impact the global NMS burden including depression, apathy, fatigue, day time sleepiness, sleep, and cognition, thus supporting its therapeutic potential in neurodegenerative conditions such as PD. It is recommended that further adequately powered studies are conducted to assess the therapeutic role of physical activity on both motor and non-motor aspects of PD. These studies should be optimally designed to assess non-motor elements of disease using instruments validated in PD.

Highlights

Parkinson’s disease (PD) is a progressive bradykinetic disorder commonly presenting unilaterally, affecting over 1% of people over 55 years of age and marked by the degeneration of dopaminergic neurons in the substantia nigra (1, 2)
This review included articles which met all of the following criteria: 10 or more participants diagnosed with idiopathic PD completing the intervention, participants needed to be randomized, and studies must evaluate the effect of physical activity on nonmotor symptoms (NMS) in PD
Titles and abstracts were read with papers not meeting selection criteria being discarded, and those remaining were read in full to check for suitability, in accordance with the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) (16)

Summary

Introduction

Parkinson’s disease (PD) is a progressive bradykinetic disorder commonly presenting unilaterally, affecting over 1% of people over 55 years of age and marked by the degeneration of dopaminergic neurons in the substantia nigra (1, 2). Exercise and Nonmotor Symptoms in Parkinson’s with PD can be challenging and non-pharmacological options such as education, support services, and exercise are likely to be underutilized due to various reasons that include limited knowledge on its therapeutic potential. There is a growing body of evidence which supports the beneficial effects of non-pharmacological therapy, in particular, the effect of exercise on both motor and NMS (4). Physical activity has been found to influence the brain’s neurochemistry and plasticity, through the upregulation of neurotrophins such as brain-derived nerve factor (BDRF) and nerve growth factor (NGF) in rat models (5, 6). BDRF has been suggested to increase turnover rate of dopamine in vitro and provide a neuroprotective role in nigral dopamine neurons (7). The increased presence of such chemicals in the brain could help impede the progression of PD and potentially provide a neuroprotective effect

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