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Guidelines on exercise testing and prescription for patients at different stages of Parkinson’s disease

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Abstract

Background

Exercise is highly recommended in patients with Parkinson’s disease (PD). Exercise-induced amelioration of motor, non-motor, and drug-induced symptoms are widely known. However, specific guidelines on exercise testing and prescription in PD are lacking.

Objective

This study reviews the literature on exercise-based approaches to the management of symptoms at each stage of the disease and evaluate: (1) the most suitable clinical exercise testing; (2) training programs based on testing outcomes and PD stage; (3) the effects of exercise on antiparkinsonian drugs and to suggest the most effective exercise–medication combination.

Methods

A systematic search was conducted using the databases MEDLINE, Google Scholar and, Cochrane Library using “Parkinson’s Disease AND Physical therapy”, “Training AND Parkinson”, “Exercise”, “Exercise AND Drug” as key words. In addition, references list from the included articles were searched and cross-checked to identify any further potentially eligible studies.

Results

Of a total of 115 records retrieved, 50 (43%) were included. From these, 23 were included under the rubric “exercise testing”; 20 focused on the effectiveness of different types of exercise in PD motor-functional symptoms and neuroprotective effects, throughout disease progression, were included under the rubric “training protocol prescription”; and 7 concern the rubric “interaction between exercise and medication”, although none reported consistent results.

Conclusions

Despite the lack of standardized parameters for exercise testing and prescription, all studies agree that PD patients should be encouraged to regularly train according to their severity-related limitations and their personalized treatment plan. In this manuscript, specific guidelines for tailored clinical testing and prescription are provided for each stage of PD.

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Funding

This work was partially supported by the Italian Ministry of Research and University (MIUR-Rome, Italy) 5-year special funding (https://www.miur.gov.it/dipartimenti-di-eccellenza).

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Authors and Affiliations

  1. Department of Life Sciences, University of Trieste, Trieste, Italy

    Camilla Martignon

  2. Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

    Camilla Martignon, Anna Pedrinolla, Federico Ruzzante, Gaia Giuriato, Fabio Giuseppe Laginestra, Michele Tinazzi, Federico Schena & Massimo Venturelli

  3. Instituto de Medicina Molecular, Lisbon, Portugal

    Raquel Bouça-Machado & Joaquim J. Ferreira

  4. Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Joaquim J. Ferreira

  5. CNS-Campus Neurológico Sénior, Torres Vedras, Portugal

    Raquel Bouça-Machado & Joaquim J. Ferreira

  6. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Massimo Venturelli

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MC reviewed the literature, collected the data and drafted the manuscript; AP, MV, GG, FR and FGL revised and edited it critically; AP, MV, FS, MT, RBM and JJF supervised the manuscript. All authors approved the final version.

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Correspondence to Massimo Venturelli.

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Martignon, C., Pedrinolla, A., Ruzzante, F. et al. Guidelines on exercise testing and prescription for patients at different stages of Parkinson’s disease. Aging Clin Exp Res 33, 221–246 (2021). https://doi.org/10.1007/s40520-020-01612-1

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