Discipline of Movement Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Concord Repatriation General Hospital, Sydney, NSW, Australia.
Neurorehabil Neural Repair. 2023 May;37(5):328-352. doi: 10.1177/15459683231172752. Epub 2023 May 11.
Exercise has many benefits for people with Parkinson's disease (PD) and has been suggested to modify PD progression, but robust evidence supporting this is lacking.
This systematic review (PROSPERO registration: CRD42020169999) investigated whether exercise may have neuroplastic effects indicative of attenuating PD progression.
Six databases were searched for randomized controlled trials (RCTs) that compared the effect of exercise to control (no or sham exercise) or to another form of exercise, on indicators of PD progression (eg, brain-derived neurotrophic factor [BDNF], brain activation, "off" Unified Parkinson's Disease Rating Scale [UPDRS] scores). Trial quality was assessed using the Physiotherapy Evidence Database Scale. Random-effects meta-analyses were performed where at least 3 comparable trials reported the same outcome; remaining results were synthesized narratively.
Forty-nine exercise trials involving 2104 PD participants were included. Compared to control, exercise improved "off" UPDRS motor scores (Hedge's g -0.39, 95% CI: -0.65 to -0.13, = .003) and BDNF concentration (Hedge's g 0.54, 95% CI: 0.10-0.98, = .02), with low to very low certainty of evidence, respectively. Narrative synthesis for the remaining outcomes suggested that compared to control, exercise may have neuroplastic effects. The exercise versus exercise comparisons were too heterogenous to enable pooling of results.
This review provides limited evidence that exercise may have an attenuating effect on potential markers of PD progression. Further large RCTs are warranted to explore differential effects by exercise type, dose and PD stage, and should report on a core set of outcomes indicative of PD progression.
运动对帕金森病（PD）患者有诸多益处，并被认为可以改变 PD 的进展，但缺乏强有力的证据支持这一点。
本系统评价（PROSPERO 注册：CRD42020169999）旨在研究运动是否具有神经可塑性效应，从而减缓 PD 的进展。
在六个数据库中搜索了比较运动对对照组（无运动或假运动）或另一种运动形式对 PD 进展指标影响的随机对照试验（RCT），例如脑源性神经营养因子（BDNF）、脑激活、“关期”统一帕金森病评定量表（UPDRS）评分。使用物理治疗证据数据库量表评估试验质量。至少有 3 个可比试验报告了相同的结果时，进行了随机效应荟萃分析；其余结果则进行了叙述性综合。
纳入了 49 项涉及 2104 名 PD 患者的运动试验。与对照组相比，运动可改善“关期”UPDRS 运动评分（Hedge's g -0.39，95%CI：-0.65 至 -0.13， = .003）和 BDNF 浓度（Hedge's g 0.54，95%CI：0.10 至 0.98， = .02），证据确定性分别为低至极低。其余结果的叙述性综合表明，与对照组相比，运动可能具有神经可塑性效应。运动与运动的比较结果差异太大，无法进行汇总。
本综述提供的有限证据表明，运动可能对 PD 进展的潜在标志物具有减缓作用。需要进一步进行大型 RCT 以探讨运动类型、剂量和 PD 阶段的差异效应，并应报告一系列具有 PD 进展指示性的核心结果。
