Effects of physical activity in Parkinson's disease: A new tool for rehabilitation

Table 1 Essential points in Parkinson’s disease exercise therapy

	Effects
Cueing strategies	Improve motor performance (especially gait)
Cognitive movement strategies	Improve everyday motor tasks (walking, standing up, sitting down, dressing, etc.), and quality of life
Balance training	Prevent risk of falls, improve postural stability
Aerobic training	Improve physical capacity
Strength and flexibility	Improve general well-being and quality of life

Table 2 Results of treadmill training

Pohl et al[32]	Single session 10 s at maximum safe speed	After 30 min training	Improvement in gait speed and stride length
Bello et al[40]	Single 20 min session		Improvement in gait speed and stride length
Miyai et al[41]	Body weight supported treadmill training	45-min session, 3 times/wk, for 4 wk	Decrease of symptoms (UPDRS scale) and improvements in gait speed
Miyai et al[37]	Body weight supported treadmill training	45-min session, 3 times/wk, for 4 wk with progressive increasing of belt speed	Improvement in gait speed, decreasing of steps number over a 10 m distance. The effects lasted over 1 and 4 mo of follow up
Herman et al[36]	Intensive treadmill protocol	30 min session, 4 times/wk, for 6 wk with progressive increasing of belt speed	Improvement in gait parameters (speed, swing time variability), balance, motor symptoms (UPDRS scale) and in quality of life
Cakit et al[21]	Speed dependent treadmill training	30 ± 5 min session, 8 wk	Improvement in tolerated speed and distance walked, in balance and reduction in fear of falls
Fisher et al[29]	Body weight supported treadmill training	3.0 metabolic equivalents session, 3 times/wk for 8 wk	Improvement in gait speed, step and stride length, hip and ankle joint excursion, and decrease cortico-motor excitability
Protas et al[39]	Walking in all 4 directions and step training	1 h session, 3 times/wk for 8 wk	Reduction of falls, improvement in gait speed and stride length, improvement in dynamic balance
Rose et al[42]	Skipping, sprinting, walking, running and jumping on a lower body positive-pressure antigravity treadmill + spatial cues	1 h session, 3 times/wk for 8 wk	Improvement in gait and functional capacity, better quality of life, improvement in motor symptoms (UPDRS scale)

UPDRS: Unified Parkinson’s Disease Rating Scale.

Table 3 Results of cueing training

Thaut et al[49]	Rhythmic auditory cues	Walking, stop-and-go, stair stepping listening to music	30 min/d for 3 wk	Improvement in gait speed, stride length and cadence
McIntosh et al[50]	Rhythmic auditory cues	Walking and stop-and-go listening to music	Single session	Improvement in gait speed, stride length and cadence
del Olmo et al[34]	Rhythmic auditory cues	Walking in different condition (with or without metronome cadence)	1 h/d, for 5 times/wk for 4 wk	Improvement in gait temporal stability
Azulay et al[48]	Dynamic and static visual cues	Walking on a 12-m walkway with parallel transversal white stripes with normal/stroboscopic lights	Single session	Increased velocity and stride length in the normal lights condition, suggesting the role of a specific visuo-motor pathway elicited by the moving cues
Rochester et al[35]	Auditory + visual cues	Little itinerary performed at home	Single session	Auditory cues improved performance (stride length) in the functional task, and a tendency for increased walking speed was noticed with both types of cue
Nieuwboer et al[23]	Visual, auditory or somato- sensory cues	Home-based cueing training program	30 mine session, 3 d/wk for 3 wk	Improvement in posture, gait speed, step length, reduction of FoG episodes and increased confidence in gait tasks
Frazzitta et al[9]	Treadmill + external cues	Progressive treadmill training with auditory (musical beats) and visual cues	20 min every day for 4 wk	Improvement in UPDRSIII, 6MWT, gait speed, stride cycle, FoG questionnaire

FoG: Freezing of Gait; 6MWT: 6-Minute walk test; UPDRS: Unified Parkinson’s Disease Rating Scale.

Table 4 Effects of resistance training

Scandalis et al[55]	Exercises for quadriceps, hamstring, calves and also abdominal muscles	2 times/wk for 8 wk	Improved strength, gait speed and stride length
Schilling et al[56]	PRE for lower limbs muscles	2 times/wk for 8 wk	Improved leg strength
Hirsch et al[57]	Balance exercise plus high-intensity PRE for knee and ankle muscles	3 times/wk for 10 wk	Improved balance, strength and reduced falls
Hass et al[53]	PRE program, focused mainly on lower limbs muscles	2 times/wk for 10 wk	Improvement in both postural adjustment and spatiotemporal parameters during gait initiation (protective effect on falls), and improved muscle strength
O'Brien et al[58]	PRE	2 times/wk for 10 wk	Physical and psychological benefits
Dibble et al[59,60]	High Intensity eccentric training exercise program for lower muscles which included calisthenics, treadmill, balance training and conditioning	3 times/wk for 12 wk	Improvement in muscle hypertrophy, strength, mobility, bradykinesia, Quality of life and UPDRS score

PRE: Progressive resistance exercise; UPDRS: Unified Parkinson’s Disease Rating Scale.

Table 5 Effects of balance training

Li et al[62]	Tai Chi vs resistance training and stretching	60 min sessions 2 times/wk for 24 wk	Tai Chi group improved their postural stability significantly more than both the other groups; stride length and velocity, strength, timed up-and-go test, functional reaching and UPDRS-III score were significantly higher in the Tai Chi group when compared with stretching; Tai Chi improved stride length, reduced rate of falls at follow up and, as shown by the posturography, there was a reduction of deviations of movement, which the authors suggest to be a reduction of dyskinesia
Hackney et al[63]	Tai Chi program	60 min session for 10-13 wk (total 20 session)	Improved global and motor symptoms (UPDRS and UPDRS-III), balance, tandem stance, one leg stance, backward walking, and gait endurance (6MWT)
Schmitz-Hubsch et al[24]	Qi Gong program	90 min weekly training for 2 mo	Intervention showed a “stabilizing effect on PD symptoms”: specifically, postural instability improved, as well as UPDRS-III score. Also, autonomic dysfunction (constipation and pain) decreased, and during physiotherapy sleep disturbances and daytime sleepiness diminished

6MWT: 6-Minute Walk Test; UPDRS: Unified Parkinson’s Disease Rating Scale.

Table 6 Results of dance training

Hackney et al[66,69]	Tango	60 min session, 2 d/wk for 10 wk (total 20 sessions)	Decreased UPDRS score, improved balance, reduced fear of falling. Trends of improvement for FoG and at Timed Up and Go test
Hackney et al[67]	Tango vs Foxtrot	60 min session, 2 d/wk for 13 wk (total 20 session)	Both types of dance improved gait speed, balance, backward stride length, cardiovascular function and symptoms (UPDRS); only Tango generated improvements for FoG
Duncan et al[70]	Tango in patients “off medication”	60 min session, 2 d/wk for 12 mo	Bradykinesia and motor symptoms severity (assessed with MDS-UPDRS-III) were reduced; gait speed, balance, dual task walking speed and upper extremity function all improved; rigidity, FoG and gait endurance remained stable, but in the control group they progressively worsened, (“braking” effect on PD progression)

PD: Parkinson’s disease; UPDRS: Unified Parkinson’s Disease Rating Scale.