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Effects of Endurance Training on Motor Signs of Parkinson’s Disease: A Systematic Review and Meta-Analysis

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Abstract

Background

Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson’s disease (PD). However, there has not been a comprehensive meta-analysis of studies to date.

Objective

The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III).

Methods

A random-effect meta-analysis model using standardized mean differences (Hedges’ g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database.

Results

Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g =  − 0.68 and g =  − 0.33, respectively). This decrease was greater (within- and between-groups average of − 8.0 and − 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (− 4.5 to − 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores.

Conclusions

ET is effective in decreasing UPDRS-III scores. Questions remain about the dose–response relationship between ET and reduction in motor signs.

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Author notes

  1. Filipe Oliveira de Almeida and Vagner Santana have contributed equally to this work.

Authors and Affiliations

  1. Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil

    Filipe Oliveira de Almeida, Vagner Santana & Carla Silva-Batista

  2. School of Arts, Sciences and Humanities of University of São Paulo, St. Arlindo Béttio, 1000, 03828-000, Vila Guaraciaba, São Paulo, Brazil

    Carla Silva-Batista

  3. Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA

    Daniel M. Corcos

  4. Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil

    Carlos Ugrinowitsch & Carla Silva-Batista

Authors
  1. Filipe Oliveira de Almeida
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  2. Vagner Santana
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  3. Daniel M. Corcos
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  4. Carlos Ugrinowitsch
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  5. Carla Silva-Batista
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Corresponding author

Correspondence to Carla Silva-Batista.

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Data availability statement

All data supporting the results of this study are available as Electronic Supplementary Material.

Funding

The authors are grateful to Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa (FAPESP) for financial support. FAPESP under award number 2018/16909–1 for Carla Silva-Batista and CNPq under award numbers 406609/2015–2 and 03085/2015–0 for Carlos Ugrinowitsch. Research reported in this publication was also supported by the Neurological Institute of the Neurological Disorders and Stroke of the National Institutes of Health under award number U01NS11385.

Conflict of interest

Filipe Oliveira de Almeida, Vagner Santana, Daniel M. Corcos, Carlos Ugrinowitsch, and Carla Silva-Batista declare that they have no conflicts of interest relevant to the content of this review.

Author Contributors

FOA and VS conceived the idea. FOA, VS, and CSB led the research team in undertaking the systematic review and meta-analysis. FOA, VS, CU, and CSB selected, extracted and analyzed data. FOA, VS, and CSB were involved in quality appraisal. FOA and VS elaborated the first draft. FOA, VS, DMC, CU, and CSB also drafted the paper, discussed results, and made final edits. All authors provided an important intellectual contribution, approved the final version and agreed on all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

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de Almeida, F.O., Santana, V., Corcos, D.M. et al. Effects of Endurance Training on Motor Signs of Parkinson’s Disease: A Systematic Review and Meta-Analysis. Sports Med 52, 1789–1815 (2022). https://doi.org/10.1007/s40279-022-01650-x

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