Effect of Resistance Exercise on Body Structure and Function, Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review

Published:February 12, 2021DOI:



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

      Data Sources

      Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms “Parkinson Disease,” “Exercise,” “Resistance Training,” “Muscle Strength,” “Cardiorespiratory Fitness,” “Postural Balance,” “Gait,” and “Quality of Life.”

      Study Selection

      We included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies.

      Data extraction

      Two reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach.

      Data Synthesis

      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; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, 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). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.


      List of abbreviations:

      GRADE (Grading of Recommendations Assessment, Development, and Evaluation), Embase (Embase Biomedical Answers), ICF (International Classification of Functioning, Disability, and Health), Lilacs (Latin American and Caribbean Health Sciences Literature), Medline (Medical Literature Analysis and Retrieval System Online), PD (Parkinson Disease), PEDro (Physiotherapy Evidence Database), RCT (randomized controlled trial), RE (resistance exercise), TUG (Timed Up and Go)
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        • Schapira A.H.V.
        • Olanow C.W.
        Neuroprotection in Parkinson disease: mysteries, myths, and misconceptions.
        JAMA. 2004; 291: 358-364
        • Pringsheim T.
        • Jette N.
        • Frolkis A.
        • Steeves T.D.L.
        The prevalence of Parkinson's disease: a systematic review and meta-analysis.
        Mov Disord. 2014; 29: 1583-1590
        • Hirsch L.
        • Jette N.
        • Frolkis A.
        • Steeves T.
        • Pringsheim T.
        The incidence of Parkinson's disease: a systematic review and meta-analysis.
        Neuroepidemiology. 2016; 46: 292-300
        • World Health Organization
        International classification of functioning, disabilities, and health: ICF.
        World Health Organization, Geneva2001
        • World Health Organization
        How to use the ICF: a practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment.
        World Health Organization, Geneva2013
        • Barbieri F.A.
        • Rinaldi N.M.
        • Santos P.C.R.
        • et al.
        Functional capacity of Brazilian patients with Parkinson's disease (PD): relationship between clinical characteristics and disease severity.
        Arch Gerontol Geriatr. 2012; 54: e83-e88
        • Parashos S.A.
        • Luo S.
        • Biglan K.M.
        • et al.
        Measuring disease progression in early Parkinson disease: the National Institutes of Health Exploratory Trials in Parkinson Disease (NET-PD) experience.
        JAMA Neurol. 2014; 71: 710-716
        • van Nimwegen M.
        • Speelman A.D.
        • Hofman-van Rossum E.J.M.
        • et al.
        Physical inactivity in Parkinson's disease.
        J Neurol. 2011; 258: 2214-2221
        • Morris M.E.
        • Watts J.J.
        • Iansek R.
        • et al.
        Quantifying the profile and progression of impairments, activity, participation, and quality of life in people with Parkinson disease: protocol for a prospective cohort study.
        BMC Geriatr. 2009; 9: 2
        • Opara J.A.
        • Brola W.
        • Leonardi M.
        • Błaszczyk B.
        Quality of life in Parkinson`s Disease.
        J Med Life. 2012; 5: 375-381
        • Fox S.H.
        • Katzenschlager R.
        • Lim S.-Y.
        • et al.
        The Movement Disorder Society evidence-based medicine review update: treatments for the motor symptoms of Parkinson's disease.
        Mov Disord. 2011; 26: S2-S41
        • Hirsch M.A.
        • Farley B.G.
        Exercise and neuroplasticity in persons living with Parkinson's disease.
        Eur J Phys Rehabil Med. 2009; 45: 215-229
        • David F.J.
        • Rafferty M.R.
        • Robichaud J.A.
        • et al.
        Progressive resistance exercise and Parkinson's disease: a review of potential mechanisms.
        Parkinsons Dis. 2012; 2012: 124527
        • Corcos D.M.
        • Robichaud J.A.
        • David F.J.
        • et al.
        A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease.
        Mov Disord. 2013; 28: 1230-1240
        • Scandalis T.A.
        • Bosak A.
        • Berliner J.C.
        • Helman L.L.
        • Wells M.R.
        Resistance training and gait function in patients with Parkinson's disease.
        Am J Phys Med Rehabil. 2001; 80: 38-43
        • Goodwin V.A.
        • Richards S.H.
        • Taylor R.S.
        • Taylor A.H.
        • Campbell J.L.
        The effectiveness of exercise interventions for people with Parkinson's disease: a systematic review and meta-analysis.
        Mov Disord. 2008; 23: 631-640
        • Dibble L.E.
        • Hale T.F.
        • Marcus R.L.
        • Gerber J.P.
        • LaStayo P.C.
        High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson's disease: a preliminary study.
        Parkinsonism Relat Disord. 2009; 15: 752-757
        • Hoehn M.M.
        • Yahr M.D.
        Parkinsonism: onset, progression and mortality.
        Neurology. 1967; 17: 427-442
        • Lima L.O.
        • Scianni A.
        • Rodrigues-de-Paula F.
        Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease: a systematic review.
        J Physiother. 2013; 59: 7-13
        • Brienesse L.A.
        • Emerson M.N.
        Effects of resistance training for people with Parkinson's disease: a systematic review.
        J Am Med Dir Assoc. 2013; 14: 236-241
        • Roeder L.
        • Costello J.T.
        • Smith S.S.
        • Stewart I.B.
        • Kerr G.K.
        Effects of resistance training on measures of muscular strength in people with Parkinson's disease: a systematic review and meta-analysis.
        PLoS One. 2015; 10e0132135
        • Chung C.L.H.
        • Thilarajah S.
        • Tan D.
        Effectiveness of resistance training on muscle strength and physical function in people with Parkinson's disease: a systematic review and meta-analysis.
        Clin Rehabil. 2016; 30: 11-23
        • Kulisevsky J.
        • Luquin M.R.
        • Arbelo J.M.
        • et al.
        [Advanced Parkinson's disease: clinical characteristics and treatment (part 1)] [Spanish].
        Neurologia. 2013; 28: 503-521
        • Kulisevsky J.
        • Luquin M.R.
        • Arbelo J.M.
        • et al.
        [Advanced Parkinson's disease: clinical characteristics and treatment. Part II.] [Spanish].
        Neurologia. 2013; 28: 558-583
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        PLoS Med. 2009; 6e1000097
      1. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Available at: Accessed November 30, 2020.

        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
      2. Riebe D. Ehrman J.K. Liguori G. Magal M. ACSM's guidelines for exercise testing and prescription. 10th ed. Wolters Kluwer, Philadelphia2016
        • Fabbri S.
        • Silva C.
        • Hernandes E.
        • Octaviano S.
        • Di Thommazo A.
        • Belgamo A.
        Improvements in the StArt tool to better support the systematic review process. Proceedings of the 20th International Conference on Evaluation and Assessment in Software Engineering.
        2016 (doi: 10.1145/2915970.2916013)
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Hedges L.
        • Olkin I.
        Statistical methods for meta-analysis, 1st ed.
        Academic Press, Orlando1985
        • Cohen J.
        The concepts of power analysis.
        in: Cohen J. Statistical power analysis for the behavioral sciences. L. Erlbaum Associates, Hillsdale, NJ1988: 1-17
        • Schilling B.K.
        • Pfeiffer R.F.
        • Ledoux M.S.
        • Karlage R.E.
        • Bloomer R.J.
        • Falvo M.J.
        Effects of moderate-volume, high-load lower-body resistance training on strength and function in persons with Parkinson's disease: a pilot study.
        Parkinson’s Dis. 2010; : 824734
        • Hass C.J.
        • Buckley T.A.
        • Pitsikoulis C.
        • Barthelemy E.J.
        Progressive resistance training improves gait initiation in individuals with Parkinson's disease.
        Gait Posture. 2012; 35: 669-673
        • Carvalho A.
        • Barbirato D.
        • Araujo N.
        • et al.
        Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson's disease: pilot study.
        Clin Interv Aging. 2015; 10: 183-191
        • Silva-Batista C.
        • Corcos D.M.
        • Roschel H.
        • et al.
        Resistance training with instability for patients with Parkinson's disease.
        Med Sci Sports Exerc. 2016; 48: 1678-1687
        • Kanegusuku H.
        • Silva-Batista C.
        • Peçanha T.
        • Nieuwboer A.
        • Silva Jr., N.D.
        • Costa L.A.
        Effects of progressive resistance training on cardiovascular autonomic regulation in patients with Parkinson disease: a randomized controlled trial.
        Arch Phys Med Rehabil. 2017; 98: 2134-2141
        • Ni M.
        • Signorile J.F.
        High-speed resistance training modifies load-velocity and load-power relationships in Parkinson's disease.
        J Strength Cond Res. 2017; 31: 2866-2875
        • Santos L.
        • Fernandez-Rio J.
        • Winge K.
        • et al.
        Effects of progressive resistance exercise in akinetic-rigid Parkinson's disease patients: a randomized controlled trial.
        Eu J Phys Rehab Med. 2017; 53: 651-663
        • Alves W.M.
        • Alves T.G.
        • Ferreira R.M.
        • et al.
        Strength training improves the respiratory muscle strength and quality of life of elderly with Parkinson disease.
        J Sports Med Phys Fitness. 2019; 59: 1756-1762
        • Leal L.C.
        • Abrahin O.
        • Rodrigues R.P.
        • et al.
        Low-volume resistance training improves the functional capacity of older individuals with Parkinson's disease.
        Geriatr Gerontol Int. 2019; 19: 635-640
        • de Lima T.A.
        • Ferreira-Moraes R.
        • Alves W.M.G.D.C.
        • et al.
        Resistance training reduces depressive symptoms in elderly people with Parkinson disease: a controlled randomized study.
        Scand J Med Sci Sports. 2019; 29: 1957-1967
        • Gelb D.J.
        • Oliver E.
        • Gilman S.
        Diagnostic criteria for Parkinson disease.
        Arch Neurol. 1999; 56: 33-39
        • Hughes A.J.
        • Daniel S.E.
        • Kilford L.
        • Lees A.J.
        Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.
        J Neurol Neurosurg Psychiatry. 1992; 55: 181-184
        • World Health Organization
        Definition of an older or elderly person.
        World Health Organization, Geneva2010
        • Lindquist R.
        • Wyman J.F.
        • Talley K.M.
        • Findorff M.J.
        • Gross C.R.
        Design of control-group conditions in clinical trials of behavioral interventions.
        J Nurs Scholarsh. 2007; 39: 214-221
        • Bown M.J.
        • Sutton A.J.
        Quality control in systematic reviews and meta-analyses.
        Eur J Vasc Endovasc Surg. 2010; 40: 669-677
        • Mustafa R.A.
        • Santesso N.
        • Brozek J.
        • et al.
        The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses.
        J Clin Epidemiol. 2013; 66: 736-742.e7425
        • Hass C.J.
        • Collins M.A.
        • Juncos J.L.
        Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial.
        Neurorehabil Neural Repair. 2007; 21: 107-115
        • Gray W.K.
        • Hildreth A.
        • Bilclough J.A.
        • Wood B.H.
        • Baker K.
        • Walker R.W.
        Physical 5 assessment as a predictor of mortality in people with Parkinson's disease: a study 6 over 7 years.
        Mov Disord. 2009; 24: 1934-1940
        • Allen N.E.
        • Canning C.G.
        • Sherrington C.
        • Fung V.S.C.
        Bradykinesia, muscle weakness and reduced muscle power in Parkinson's disease.
        Mov Disord. 2009; 24: 1344-1351
        • Clael S.
        • Brandão E.
        • Caland L.
        • et al.
        Association of strength and physical functions in people with Parkinson's disease.
        Neurosci J. 2018; 2018: 8507018
        • Schlenstedt C.
        • Paschen S.
        • Kruse A.
        • Raethjen J.
        • Weisser B.
        • Deuschl G.
        Resistance versus balance training to improve postural control in Parkinson’s disease: a randomized rater blinded controlled study.
        PLoS One. 2015; 10e0140584
        • Dibble L.E.
        • Hale T.F.
        • Marcus R.L.
        • Droge J.
        • Gerber J.P.
        • LaStayo P.C.
        High intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease.
        Mov Disord. 2006; 21 (1444-52)
        • Petzinger G.M.
        • Fisher B.E.
        • McEwen S.
        • Beeler J.A.
        • Walsh J.P.
        • Jakowec M.W.
        Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease.
        Lancet Neurol. 2013; 12: 716-726
        • Mak M.K.Y.
        • Pang M.Y.C.
        Balance confidence and functional mobility are independently associated with falls in people with Parkinson's disease.
        J Neurol. 2009; 256: 742-749
        • Kunz R.
        • Vist G.
        • Oxman A.D.
        Randomisation to protect against selection bias in healthcare trials.
        Cochrane Database Syst Rev. 2007; MR000012
        • Capurro D.
        • Gabrielli D.
        • Letelier L.M.
        [Intention to treat and follow up are important in assessing validity of a randomized clinical trial] [Spanish].
        Rev Med Chil. 2004; 132: 1557-1560
        • Herman A.
        • Botser I.B.
        • Tenenbaum S.
        • Chechick A.
        Intention-to-treat analysis and accounting for missing data in orthopaedic randomized clinical trials.
        J Bone Joint Surg Am. 2009; 91: 2137-2143