Kaagman Daan G M, van Wegen Erwin E H, Cignetti Natalie, Rothermel Emily, Vanbellingen Tim, Hirsch Mark A
Faculty of Behavioral and Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
Brain Sci. 2024 Feb 21;14(3):194. doi: 10.3390/brainsci14030194.
Exercise therapy may increase brain-derived neurotrophic factor (BDNF) levels and improve clinical outcomes in people living with Parkinson's disease (PD). This systematic review was performed to investigate the effect of exercise therapy on BDNF levels and clinical outcomes in human PD and to discuss mechanisms proposed by authors.
A search on the literature was performed on PubMed up to December 2023 using the following key words: Parkinson's disease AND exercise, exercise therapy, neurological rehabilitation AND brain-derived neurotrophic factor, brain-derived neurotrophic factor/blood, brain-derived neurotrophic factor/cerebrospinal fluid AND randomized clinical trial, intervention study. Only randomized clinical trials comparing an exercise intervention to treatment as usual, usual care (UC), sham intervention, or no intervention were included.
A meta-analysis of BDNF outcomes with pooled data from five trials (N = 216 participants) resulted in a significant standardized mean difference (SMD) of 1.20 [95% CI 0.53 to 1.87; Z = 3.52, = 0.0004, I = 77%], favoring exercise using motorized treadmill, Speedflex machine, rowing machine, and non-specified exercise. Significant improvements were found in Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS-III, 6 Minute Walk Test (6MWT), and Berg Balance Scale (BBS). Methodological quality of trials was categorized as "good" in three trials, "fair" in one trial, and "poor" in one trial.
Key results of this systematic review are that exercise therapy is effective in raising serum BDNF levels and seems effective in alleviating PD motor symptoms. Exercise therapy confers neuroplastic effects on Parkinson brain, mediated, in part, by BDNF.
运动疗法可能会提高帕金森病（PD）患者的脑源性神经营养因子（BDNF）水平，并改善其临床结局。本系统评价旨在研究运动疗法对人类PD患者BDNF水平和临床结局的影响，并探讨作者提出的作用机制。
截至2023年12月，在PubMed上使用以下关键词进行文献检索：帕金森病与运动、运动疗法、神经康复与脑源性神经营养因子、脑源性神经营养因子/血液、脑源性神经营养因子/脑脊液与随机临床试验、干预研究。仅纳入将运动干预与常规治疗、常规护理（UC）、假干预或无干预进行比较的随机临床试验。
对五项试验（N = 216名参与者）的汇总数据进行BDNF结局的荟萃分析，得出显著的标准化平均差（SMD）为1.20 [95% CI 0.53至1.87；Z = 3.52，P = 0.0004，I² = 77%]，支持使用电动跑步机、Speedflex机器、划船机和未指明的运动进行锻炼。在统一帕金森病评定量表（UPDRS）、UPDRS-III、6分钟步行试验（6MWT）和伯格平衡量表（BBS）方面发现了显著改善。三项试验的方法学质量被归类为“良好”，一项试验为“中等”，一项试验为“差”。
本系统评价的主要结果是，运动疗法在提高血清BDNF水平方面有效，并且似乎在缓解PD运动症状方面有效。运动疗法对帕金森病大脑具有神经可塑性作用，部分由BDNF介导。
