report number 43

#043 – 5 Articles on The Effect of Physiotherapy on Parkinson’s Disease in 2021

1 – Effect of Resistance Exercise on Body Structure and Function, Activity, and Participation in Individuals With Parkinson Disease

A Systematic Review (Restricted Access)


  • Investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson’s Disease (PD) in the mild to moderate stages.


10 studies including 270 participants.

  • The level of evidence for body structure and function was low, and without effect for lower limb muscle strength.
  • Very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance.
  • Very low and without effect for flexibility after RE training.
  • Evidence was very low and with effect for gait.
  • Very low and without effect for mobility.
  • For participation (quality of life), the evidence was very low and without effect.


  • Although the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait).
  • In contrast, RE did not significantly improve participation (quality of life).
  • Based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.

2 – The efficacy and safety of moderate aerobic exercise for patients with Parkinson’s disease

A systematic review and meta-analysis of randomized controlled trials. (Open Access)

🚴‍♂️Aerobic exercise in the included studies

  • Frequency: 2 to 7 sessions per week for 8 to 16 weeks.
  • Time: 20 to 90 minutes per session
  • Intensity: moderate, and the HRR ranged from 50% to 80%
  • Type: treadmill training, bike training, walking, and jogging


9 RCTs with 444 patients.

  • Effect on Timed Up and Go Test (TUG):
    • Compared with the placebo, moderate-intensity aerobic exercise showed a significant difference in improving balance in patients with PD. (4 studies)
  • Effect on 6-Minute Walking Test (6MWT):
    • Moderate aerobic exercise showed superior effects in improving gait in both groups (experimental and control). (6 studies)
  • Effect on Unified Parkinson’s Disease Rating Scale Part III (UPDRS III):
    • Moderate aerobic exercise was not associated with an improvement in UPDRS III. (7 studies)
  • Effect on 39-item Parkinson’s Disease Questionnaire (PDQ-39):
    • Compared with the placebo, the experimental group’s quality of life was not significantly improved.
    • In subgroup analysis comparing treadmill, bicycle, or jogging, the score of PDQ-39 in the treadmill subgroup was better than that in the control group (P<0.00001), while there was no significant difference in the other subgroups.


  • Moderate aerobic exercise effectively improves balance and gait in patients with PD, but the effect on motor symptoms is not obvious.
  • Different exercise types may differentially affect the improvement of PD patients’ quality of life with moderate-intensity aerobic exercise.

3 – The effects of exercise on sleep quality in persons with Parkinson’s disease

A systematic review with meta-analysis (Restricted Access)


  • Determine the evidence in support of exercise to improve sleep quality assessed subjectively and objectively in Parkinson’s Disease (PD).


10 randomized and 2 non-randomized controlled trials, including a total of 690 participant.


Duration: 20 to 60 minutes for 4 to 6 weeks

Intensity: mild to moderate in 4 studies, and moderate to maximal in 8 studies.

  • 3 studies used multimodal training combining different types of exercise
  • 3 studies implemented cardiovascular training
  • 1 study strength training
  • 1 study a combination of strength and muscle endurance training.
  • Yoga, Qigong, samba and Tai-chi used by 1 study.

Effect of exercise on sleep

  • 12 studies in the meta-analysis showed a moderate but significant effect of exercise on subjectively measured sleep quality.
  • 1 study that used objective measurement (polysomnography) found a significant improvement in sleep efficiency, reduction in wake time after sleep onset, and an increased total sleep time.
    • But no significant difference in sleep latency (time to fall asleep).

Effect of exercise intensity

  • Studies that used mild to moderate exercise intensities showed non-significant effects.
  • Studies using exercise performed at moderate to maximal intensities showed significant effects.

Effect of exercise type

  • Multimodal interventions combining different types of exercise and, to a lesser extent, interventions using exclusively cardiovascular exercise, showed the largest effects on subjective sleep quality.
  • Studies using exclusively resistance training or meditative movement exercise interventions (Yoga, Qigong, Tai-chi) showed non-significant effects on sleep quality assessed subjectively.
  • High-intensity resistance training demonstrated to have large effects on different measures of objective sleep quality in the only study that implemented these measures.


  • Physical exercise has a positive impact on subjective sleep quality in persons with PD.
  • Multimodal training programs performed at vigorous intensities appear to be the most effective exercise intervention to improve subjective sleep quality.

4 – Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson’s disease

A randomized controlled study comparing three exercise models (Open Access)


  • Investigate the effect of Lee Silverman Voice Treatment (LSVT) BIG, an intensified and personalized physiotherapy (INTENSIVE), and a conventional physiotherapy (NORMAL) on NMSs in PD.


Lee Silverman Voice Treatment (LSVT) BIG:

14 participants at 8 weeks follow-up

  • 16 individual 1-hour-sessions, four times a week for 4 weeks
  • Half of the treatment sessions consist of standardized multidirectional whole-body movements performed with maximal amplitude of reaching and stepping.
  • The second half is designed to address individual deficits in movement that occur in activities of daily living.


13 participants at 8 weeks follow-up

16 individual 1-hour-sessions, four times a week for 4 weeks

  • The training was conducted according to the European Guideline for Parkinson’s Physiotherapy with a special focus on assessment of individual deficits, gait, falls, freezing of gait and dexterity, and the according to practice considerations.
    • Examples: complex motor sequences, stretching items to increase mobility, dual tasks, core stability, or mental imagery.

Normal Physiotherapy

12 participants at 8 weeks follow-up

  • Patients assigned to normal physiotherapy received 16 1-hour-sessions (two times a week for 8 weeks). Patients were allowed to undergo training in an office-based physiotherapy practice of their choice outside of the premises of the University Hospital of Cologne (UHoC).
  • No special exercises were prescribed nor the number of repetitions or resistance levels observed. This group was aimed to reflect the current standard physiotherapeutic treatment of PD in office-based practice.

📏Outcome measures

Primary: non-motor symptom assessment scale for Parkinson’s disease (NMSS)

Secondary: UPDRS part III motor score, 6-meter Leonardo Mechanograph Gangway system, chair rising test was performed on a Leonardo Mechanograph GRFP system, revised final version of the PD NMS questionnaire, PDQ-39, Beck Depression Inventory (BDI-2), Apathy Evaluation Scale (AES), Parkinson Neuropsychometric Dementia Assessment (PANDA), Mini Mental Status Test (MMST).


  • There was no significant effect on the mean change of the NMSS total score between baseline and 8 weeks of LSVT BIG in comparison to normal or intensive physiotherapy.
  • INTENSIVE training was superior to NORMAL based on UPDRS part III motor score.
  • Assessment of gait parameters and chair rising test performance observed superior results for both LSVT BIG and INTENSIVE in comparison to NORMAL.


  • reduced NMSS scores for all groups, with INTENSIVE being superior to NORMAL.
  • For secondary outcome measures (stride length, gait velocity and chair rising test) LSVT BIG and INTENSIVE were both superior to NORMAL.
  • The study provides evidence that all three exercise programs are effective techniques to improve NMSs as well as motor function in PD.

5 – Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson’s Disease

A Retrospective and Observational Study (Open Access)


  • Explore the short-term changes in functional, cognitive, and geriatric domains of an intensive, inpatient, multidisciplinary, and person-tailored rehabilitative program in persons with Parkinson’s disease PwPD (as primary condition) in mild-moderate (M-Ms) to severe (Ss) stages.
  • Compare the effects of multidimensional rehabilitation in mild-moderate stage vs. severe stage of PD.


  • 24 PwPD accessed the NeuroRehabilitation Unit.


  • Barthel Index (BI), Mini-Mental State Examination (MMSE), Token test, Phonemic and Semantic Fluency, Copy and Recall Rey’s Figure, Raven’s Colored Progressive Matrices, Numeric Rating Scale (NRS), Norton Scale, Conley Scale, (MDS-UPDRS) Part III.


  • Intensive rehabilitation program consisting of daily sessions from Monday to Sunday for a total of at least 500 min a week.
  • Physiotherapy (stretching, postural changes, gait exercises, balance, and postural control), occupational therapy (functional and goal-based exercises in order to readapting the use of daily tools and performing everyday tasks to recover personal autonomy and to improve targeted domains of QoL), cognitive rehabilitation (paper-and-pencil and computerized activities), and speech and swallowing rehabilitation (exercises to improve speech prosody and articulation, meal monitoring, and learning strategies for proper ingestion of liquids and foods).


  • 87.50% of patients reported higher scores vs. 12.50% of patients who remained stable in terms of the BI total score
    • MMSE at baseline had a significant impact on changes after treatment in BI total score.
  • A significant improvement was observed in language (Token test), in visuoconstructional abilities Copy Rey’s Figure, in abstract reasoning Raven’s Colored Progressive Matrices.
    • MMSE at baseline had a significant impact on changes after treatment.
  • Significant differences were also reported for the NRS, and for the Norton Scale
    • There was no statistically significant association between change scores in geriatric aspects and the number of rehabilitative sessions.
    • MMSE at baseline had a significant impact on changes after treatment in the Norton Scale.
  • Results suggest a potential role of inpatient multidisciplinary rehabilitation in driving activity-dependent functional improvement in mild-moderate PwPD’s motor skills.
  • Data showed that treatment intensity is not a mediating factor in determining posttreatment changes, and that only PwPD with mild-moderate motor impairment can improve after a multidimensional treatment.


  • Findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in PwPD with mild–moderate motor impairment.

Thank you for reading.

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