Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil.
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
Sports Med. 2022 Aug;52(8):1789-1815. doi: 10.1007/s40279-022-01650-x. Epub 2022 Feb 3.
Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date.
The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III).
A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database.
Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I = 21%), intensity based on treadmill speed (I = 0%), self-perceived exertion rate (I = 33%), and studies composed of individuals with PD and freezing of gait (I = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores.
ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.
有证据表明，耐力训练（ET）可减轻帕金森病（PD）的运动症状。然而，迄今为止，还没有对研究进行全面的荟萃分析。
本研究旨在比较 ET 与非活动和活动对照条件对运动症状的影响，评估指标为统一帕金森病评定量表第 3 部分（UPDRS-III）或运动障碍协会-UPDRS-III（MDS-UPDRS-III）。
使用标准化均数差值（Hedges'g）的随机效应荟萃分析模型确定治疗效果。采用亚分析中的调节因素（例如，耐力和物理治疗联合训练[CEPTT]）和元回归（例如，治疗次数）。使用物理治疗证据数据库评估方法学质量。
符合纳入标准的 27 项随机对照试验（RCT）（共 1152 名参与者）。与非活动和活动对照条件相比，ET 可有效降低 UPDRS-III 评分（g=-0.68 和 g=-0.33）。与 PD 建议的 UPDRS-III 评分（-4.5 至-6.7 点）中度变化范围相比，这种下降幅度更大（平均每组内和组间 UPDRS-III 评分分别降低 8.0 和 6.8 分）。尽管 RCT 之间存在较大的异质性（I²=74%），但一些增加 ET 对运动症状影响的调节因素降低了分析的异质性，例如 CEPTT（I²=21%）、基于跑步机速度的强度（I²=0%）、自我感知用力率（I²=33%）和包含 PD 和冻结步态个体的研究（I²=0%）。元回归未显示 ET 剂量与 UPDRS-III 评分之间存在显著关系。
ET 可有效降低 UPDRS-III 评分。ET 与运动症状减轻之间的剂量反应关系仍存在疑问。
