Year: 2012
Type: editorial
Abstract: Parkinson disease (PD) is a disabling neurodegenerative disease for which current treatments are suboptimal.As exercise is generally safe, inexpensive, and associated with secondary benefits, interest in exercise as a treatment for the motorsymptomsof thedisease is increasing.In this issue of the journal, Shulman and colleagues 1 offer compelling evidence that exercise can improve gait and fitnessamongindividuals with PD.This research adds to the evidence regarding the value of interventions for PD beyond medications and surgery and offers an opportunity for patients to be active participants in their care.Shulman et al performed a comparative, prospective, randomized, single-blinded clinical trial of 3 types of exercise among patients with PD and gait impairment.Sixtyseven patients were randomized to either lower-intensity treadmill exercise, higher-intensity treadmill exercise, or a combination of stretching and resistance training.For their primary outcome of gait speed, all training types increased distance walked in 6 minutes at 4 months, but lower-intensity treadmill exercise led to the greatest increases.For their secondary outcome of cardiovascular fitness, both treadmill groups demonstrated improvement.In contrast, the stretching-resistance group improved muscle strength and motor scores on the Unified Parkinson Disease Rating Scale.The authors conclude that all 3 types of exercise have benefits, and patients may benefit most from a combination of lower-intensity training and stretching and resistance.The investigation by Shulman et al adds to the growing body of literature demonstrating the value of exercise in PD (Figure ). 2 In 2001, the Cochrane Collaboration examined randomized controlled trials that compared physiotherapy to placebo, and only 11 trials were eligible for their systematic review.At that time, authors concluded that there was "insufficient evidence to support or refute the efficacy of physiotherapy in Parkinson's disease." 3 By 2012, the evidence had increased, and Cochrane's updated review included 33 trials and discussed 6 additional ongoing studies.4 Using these new data, the authors concluded that while differences between physiotherapy and placebo groups in motor performance and other measures were small, they would be clinically meaningful to patients.The Table highlights the results of select randomized controlled trials from recent reviews [4][5][6][7][8][9][10][11][12] or that were conducted.While the investigation by Shulman et al certainly ©2013
Source: JAMA Neurology
Authors: Liana S. Rosenthal, E. Ray Dorsey
Institutions: Johns Hopkins University, Johns Hopkins Medicine
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2083830848