What type of physical exercise works best to improve movement and quality of life for people with Parkinson's disease? - A Cochrane Review summary with commentary.

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural instability. Many studies document the effects of exercise-based interventions, but the benefit of different exercise types remains unclear.

Objective: To provide a commentary on the Cochrane Review by Ernst et al. on the effectiveness of different types of physical exercise regarding motor signs, Quality of Life (QoL), and the occurrence of adverse events.

Methods: A systematic search was performed in CENTRAL, MEDLINE, Embase, and other databases. The search was performed also in trial registries, conference proceedings, and reference list of identified studies.

Results: The review included 154 RCTs (with 7837 participants). The network meta-analyses (NMAs) on the severity of motor signs and QoL included data from 60 (2721 participants) and 48 (3029 participants) trials, respectively. The evidence from the NMA suggests that dance, gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs, and multi-domain training probably has a small beneficial effect on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. In addition, aqua-based training probably has a large beneficial effect on QoL, and mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL.

Conclusions: Current evidence supports the promotion of physical exercise among people with PD, identifying only small differences between exercises in influencing the severity of motor signs and QoL.