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Effect of Exercise on Motor Symptoms in Patients With Parkinson's Disease: A Network Meta-analysis.

BACKGROUND
Although the pharmacological approach may help with motor symptoms in Parkinson's disease (PD), they are clearly not the complete solution. Thus, for the treatment of PD motor symptoms, physical activity has been proposed as an effective intervention.


METHODS
A systematic search in MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized controlled trials testing the effectiveness of exercise interventions on motor symptoms of PD. Physical exercise interventions were divided into 9 categories: endurance, resistance, combined, balance, dance, alternative exercises, body weight supported, sensorimotor interventions including endurance exercise, and sensorimotor interventions not including endurance exercise. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out.


RESULTS
Fifty-six studies met the inclusion criteria, including 2740 participants, aged between 57.6 and 77.7 years. Results of our analyses showed that sensorimotor training including endurance (effect size [ES]-1.09; 95% confidence interval [CI], -1.68 to -0.50), resistance (ES-0.82; 95% CI, -1.23 to -0.41), and dance (ES-0.64; 95% CI, -1.24 to -0.05) were the most effective physical activity interventions for mitigating PD motor symptoms.


CONCLUSION
Physical activity interventions are an effective strategy for the management of motor symptoms in patients with PD. Among the different exercise intervention programs, those including more complex and demanding activities (sensorimotor training including endurance, resistance, and dance) seem to be the most effective physical activity interventions.