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Exercise for Depressive Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Published:August 28, 2022DOI:https://doi.org/10.1016/j.apmr.2022.07.021

      Abstract

      Objective

      To evaluate the efficacy of physical exercise in improving depressive symptoms in Parkinson disease (PD).

      Data Source and Study Selection

      We conducted a systematic review of randomized controlled trials (RCTs) following a prespecified protocol guidance (PROSPERO CRD42021243142). Two independent authors searched for studies in MEDLINE, Cochrane Register of Controlled Trials, Physiotherapy Evidence Database, Embase, PsycINFO, and Sports Discus from database inception to June 2022.

      Data Extraction

      Two independent authors extracted the data and evaluated the risk of bias using the revised Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

      Data Synthesis

      A total of 36 RCTs met the inclusion criteria, 14 of which were pooled in the quantitative synthesis. Depression symptomatology significantly decreased in the exercise group compared with usual care (standardized mean difference [SMD], −0.49; 95% confidence interval [CI], −0.74 to −0.24; very low quality of evidence; 14 RCTs; 961 participants). Physical exercise also improved patients’ quality of life (SMD, −0.51; 95% CI, −0.81 to −0.21; 7 RCTs; 485 participants). As for acceptability, we did not find any difference between exercise and usual care (relative risk, 1.01; 95% CI, 0.97 to 1.05; 12 RCTs; 1048 participants). We judged all the studies except 2 to be at high risk of bias.

      Conclusions

      Results from our systematic review identify physical activity as a viable option to reduce depressive symptoms in PD. Future clinical practice guidelines should consider physical exercise in their recommendations for depression symptomatology reduction in people with PD.

      Keywords

      List of abbreviations:

      BDI (Beck Depression Inventory), GRADE (Grading of Recommendations Assessment, Development, and Evaluation), H&Y (Hoehn and Yahr), PD (Parkinson disease), PDQ-39 (Parkinson's Disease Questionnaire–39), RCT (randomized controlled trial), RoB 2.0 (revised Cochrane risk of bias tool), SMD (standardized mean difference)
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      References

        • Postuma RB
        • Berg D
        • Stern M
        • et al.
        MDS clinical diagnostic criteria for Parkinson's disease.
        Mov Disord. 2015; 30: 1591-1601
        • Sauerbier A
        • Jenner P
        • Todorova A
        • Chaudhuri KR.
        Non motor subtypes and Parkinson's disease.
        Parkinsonism Relat Disord. 2016; 22: S41-S46
        • Titova N
        • Padmakumar C
        • Lewis SJG
        • Chaudhuri KR.
        Parkinson's: a syndrome rather than a disease?.
        J Neural Transm (Vienna). 2017; 124: 907-914
        • Marsh L.
        Depression and Parkinson's disease: current knowledge.
        Curr Neurol Neurosci Rep. 2013; 13: 409
        • Weintraub D
        • Moberg PJ
        • Duda JE
        • Katz IR
        • Stern MB.
        Recognition and treatment of depression in Parkinson's disease.
        J Geriatr Psychiatry Neurol. 2003; 16: 178-183
        • Ishihara L
        • Brayne C.
        A systematic review of depression and mental illness preceding Parkinson's disease.
        Acta Neurol Scand. 2006; 113: 211-220
        • Kostić VS
        • Agosta F
        • Petrović I
        • et al.
        Regional patterns of brain tissue loss associated with depression in Parkinson disease.
        Neurology. 2010; 75: 857-863
        • Assogna F
        • Pellicano C
        • Savini C
        • et al.
        Drug choices and advancements for managing depression in Parkinson's disease.
        Curr Neuropharmacol. 2020; 18: 277-287
        • American Psychological Association
        APA clinical practice guideline for the treatment of depression across three age cohorts.
        American Psychological Association, Washington2019
        • Schuch FB
        • Vancampfort D
        • Richards J
        • Rosenbaum S
        • Ward PB
        • Stubbs B.
        Exercise as a treatment for depression: a meta-analysis adjusting for publication bias.
        J Psychiatr Res. 2016; 77: 42-51
        • Gujral S
        • Aizenstein H
        • Reynolds CF
        • Butters MA
        • Erickson KI.
        Exercise effects on depression: possible neural mechanisms.
        Gen Hosp Psychiatry. 2017; 49: 2-10
        • Wegner M
        • Helmich I
        • Machado S
        • Nardi AE
        • Arias-Carrion O
        • Budde H.
        Effects of exercise on anxiety and depression disorders: review of meta- analyses and neurobiological mechanisms.
        CNS Neurol Disord Drug Targets. 2014; 13: 1002-1014
        • Kandola A
        • Ashdown-Franks G
        • Hendrikse J
        • Sabiston CM
        • Stubbs B.
        Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity.
        Neurosci Biobehav Rev. 2019; 107: 525-539
        • Wu PL
        • Lee M
        • Huang TT.
        Effectiveness of physical activity on patients with depression and Parkinson's disease: a systematic review.
        PLoS One. 2017; 12e0181515
        • Adamson BC
        • Ensari I
        • Motl RW.
        Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2015; 96: 1329-1338
        • Dalgas U
        • Stenager E
        • Sloth M
        • Stenager E.
        The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature.
        Eur J Neurol. 2015; 22 (-e34): 443
        • Eng JJ
        • Reime B.
        Exercise for depressive symptoms in stroke patients: a systematic review and meta-analysis.
        Clin Rehabil. 2014; 28: 731-739
        • Higgins JPT
        • Thomas J
        • Chandler J
        • et al.
        Cochrane handbook for systematic reviews of interventions.
        Wiley-Blackwell, Hoboken, NJ2019
        • Page MJ
        • Moher D
        • Bossuyt PM
        • et al.
        PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews.
        BMJ. 2021; 372: n160
        • Caspersen CJ
        • Powell KE
        • Christenson GM.
        Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
        Public Health Rep. 1985; 100: 126-131
        • Hagell P
        • Nygren C.
        The 39 item Parkinson's disease questionnaire (PDQ-39) revisited: implications for evidence based medicine.
        J Neurol Neurosurg Psychiatry. 2007; 78: 1191-1198
        • Ouzzani M
        • Hammady H
        • Fedorowicz Z
        • Elmagarmid A.
        Rayyan—a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Sterne JAC
        • Savović J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
      1. Schünemann H, Brożek J, Guyatt GH, Oxman AD. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group 2013. Available at: http:\\www.guidelinedevelopment.org/handbook. Accessed September 19, 2022.

        • Guyatt GH
        • Oxman AD
        • Vist GE
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Veroniki AA
        • Jackson D
        • Viechtbauer W
        • et al.
        Methods to estimate the between-study variance and its uncertainty in meta-analysis.
        Res Synth Methods. 2016; 7: 55-79
        • IntHout J
        • Ioannidis JPA
        • Rovers MM
        • Goeman JJ.
        Plea for routinely presenting prediction intervals in meta-analysis.
        BMJ Open. 2016; 6e010247
        • Viechtbauer W
        • Cheung MWL.
        Outlier and influence diagnostics for meta-analysis.
        Res Synth Methods. 2010; 1: 112-125
        • Sterne JAC
        • Sutton AJ
        • Ioannidis JPA
        • et al.
        Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.
        BMJ. 2011; 343: d4002
        • Rothestein H.
        Publication bias in meta-analysis: prevention, assessment and adjustments.
        Wiley, Chichester, England2005
        • Viechtbauer W.
        Conducting meta-analyses in R with the metafor package.
        J Stat Softw. 2010; 36: 1-48
        • Chivers Seymour K
        • Pickering R
        • Rochester L
        • et al.
        Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson's.
        J Neurol Neurosurg Psychiatry. 2019; 90: 774-782
        • Cohen J
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • van der Kolk NM
        • de Vries NM
        • Kessels RPC
        • et al.
        Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial.
        Lancet Neurol. 2019; 18: 998-1008
        • Freidle M
        • Johansson H
        • Ekman U
        • et al.
        Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson's disease.
        NPJ Parkinsons Dis. 2022; 8: 1-10
        • Schmitz-Hübsch T
        • Pyfer D
        • Kielwein K
        • Fimmers R
        • Klockgether T
        • Wüllner U.
        Qigong exercise for the symptoms of Parkinson's disease: a randomized, controlled pilot study.
        Mov Disord. 2006; 21: 543-548
        • Dipasquale S
        • Meroni R
        • Sasanelli F
        • et al.
        Physical therapy versus a general exercise programme in patients with Hoehn Yahr stage II Parkinson's disease: a randomized controlled trial.
        J Parkinsons Dis. 2017; 7: 203-210
        • Dashtipour K
        • Johnson E
        • Kani C
        • et al.
        Effect of exercise on motor and nonmotor symptoms of Parkinson's disease.
        Parkinsons Dis. 2015; 2015586378
        • Schmidt N
        • Tödt I
        • Berg D
        • et al.
        Memory enhancement by multidomain group cognitive training in patients with Parkinson's disease and mild cognitive impairment: long-term effects of a multicenter randomized controlled trial.
        J Neurol. 2021; 268: 4655-4666
        • Passos-Monteiro EB
        • Schuch FT
        • Franzoni L
        • et al.
        Nordic walking and free walking improve the quality of life, cognitive function, and depressive symptoms in individuals with Parkinson's disease: a randomized clinical trial.
        J Funct Morphol Kinesiol. 2020; 5: 82
        • Keus S
        • Munneke M
        • Graziano M
        • et al.
        European physiotherapy guideline for Parkinson’s disease.
        KNGF/ParkinsonNet, The Netherlands2014: 191
        • Kvam S
        • Kleppe CL
        • Nordhus IH
        • Hovland A.
        Exercise as a treatment for depression: a meta-analysis.
        J Affect Disord. 2016; 202: 67-86
        • Greenhalgh T.
        Assessing the methodological quality of published papers.
        BMJ. 1997; 315: 305-308
        • Innocenti T
        • Salvioli S
        • Giagio S
        • Feller D
        • Cartabellotta N
        • Chiarotto A.
        Declaration of use and appropriate use of reporting guidelines in high-impact rehabilitation journals is limited: a meta-research study.
        J Clin Epidemiol. 2021; 131: 43-50
        • Hoffmann TC
        • Glasziou PP
        • Boutron I
        • et al.
        Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.
        BMJ. 2014; 348: g1687
        • Schulz KF
        • Altman DG
        • Moher D
        • Group CONSORT
        CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; 340: c332
        • Welton NJ
        • Caldwell DM
        • Adamopoulos E
        • Vedhara K.
        Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease.
        Am J Epidemiol. 2009; 169: 1158-1165
        • Goetz CG
        • Poewe W
        • Rascol O
        • et al.
        Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations.
        Mov Disord. 2004; 19: 1020-1028
        • Grimes D
        • Fitzpatrick M
        • Gordon J
        • et al.
        Canadian guideline for Parkinson disease.
        CMAJ. 2019; 191: E989-1004
        • NICE guideline
        Parkinson’s disease in adults.
        National Institute for Health and Care Excellence, England2017