Resistance training linked to improvements in Parkinson’s symptoms

Resistance training (RT) may help improve several symptoms of Parkinson’s disease (PD) – but is not superior to other physical activities, new research suggests.

A meta-analysis that included 18 randomized controlled trials and more than 1000 patients with PD showed that those who underwent RT had significantly greater improvements in motor impairment, muscle strength, and mobility/balance than their peers who underwent passive or had undergone placebo intervention.

However, there was no significant difference between patients participating in RT and patients participating in other active physical interventions, including yoga.

Overall, the results underscore the importance of these patients participating in some form of physical activity, said study lead author Romina Gollan, MSc, Research Associate, Department of Medical Psychology, University of Cologne, Germany Medscape Medical News. “Patients should definitely do exercise, including resistance training, if they choose. But the nature of the exercise is of secondary interest,” she said.

The findings were presented at the 2022 International Congress of Parkinson’s Disease and Movement Disorders (MDS).

Positive but contradictory

Previous reviews suggested that RT has beneficial effects on motor function in Parkinson’s disease. However, the results of the included studies were contradictory; and few reviews have examined the non-motor outcomes of RT in this population, the researchers note.

After reviewing the literature of studies examining the effects of RT in Parkinson’s disease, the researchers included 18 randomized controlled trials in their current review. Among the 1134 participants, the mean age was 66 years, the mean Hoehn & Yahr stage was 2.3 (range 0-4), and the mean duration of Parkinson’s disease was 7.5 years.

The research was divided into two meta-analysis groups: one studied RT versus a passive or placebo intervention, and the other evaluated RT versus active physical interventions such as yoga.

During RT, participants use their full strength to do one repetition and train the muscles to overcome a certain threshold, Gollan said. In contrast, a placebo intervention is “very low-intensity” and has a much lower threshold, she added.

Passive interventions include things like stretches where the stimulus “isn’t high enough for the muscles to adjust” and building strength, Gollan noted.

Passive intervention may also include “treat as usual” or normal daily routines.

Patient preference important

The meta-analysis comparing RT groups to passive control groups showed significant large effects on muscle strength (standard mean difference [SMD], -0.84; 95% CI, -1.29 to -0.39; P = 0.0003), motor impairment (SMD, -0.81; 95% CI, -1.34 to -0.27; P = 0.003) and mobility and balance (SMD, -1.80; 95% CI, -3.13 to -0.49; P = 0.007).

The review also showed significant but small effects on quality of life.

However, the meta-analysis evaluating RT in comparison to other physical interventions showed no significant differences between the groups.

Gollan noted that while the data included some assessments of cognition and depression, the data were too limited to determine the impact of RT on these outcomes.

“We need more studies, especially randomized controlled trials, to examine the effects of RT on non-motor outcomes such as depression and cognition,” she said.

dr Ann Kristin Folkerts

Co-researcher Ann-Kristin Folkerts, PhD, who heads the Medical Psychology group at the University of Cologne, found that while exercise is generally beneficial for patients with Parkinson’s, the choice of activity should take patient preferences into account.

It’s important that patients choose an exercise they enjoy, “because otherwise they probably wouldn’t stick to the treatment,” Folkerts said Medscape Medical News. “It’s important to have fun.”

Specific goals or goals, such as improving quality of life or balance, should also be considered, she added.

Simplification?

Comment for Medscape Medical NewsAlice Nieuwboer, PhD, professor in the Department of Rehabilitation Sciences and head of the Neurorehabilitation research group at the University of Leuven, Belgium, disagreed that the type of physical activity is of secondary importance in Parkinson’s disease.

“In my view, it’s of primary interest, especially in the mid to late phase,” said Nieuwboer, who was not involved in the research.

She noted that doing meta-analysis of RT versus other interventions is difficult because studies comparing different exercise types are “rather scarce.”

“Another problem is that the dose can be different, so you’re comparing apples to oranges,” Nieuwboer said.

She agreed that all patients should exercise because it is “better than no exercise” and they should be “free to choose a mode that interests them.”

However, she emphasized that exercise by patients with Parkinson’s requires significant effort, requires “persistent motivation” and must become a habit. This makes “exercise targeting” very important, with the target changing as the disease progresses, Nieuwboer said.

For example, in a patient early in the disease who is still able to move reasonably well, both RT and endurance training can improve fitness and health; But at an intermediate stage, it may be better for patients to work on balance and walking quality “to reduce the risk of falls and frostbite,” she noted.

Later, when the movement becomes very difficult, “the exercise menu is even more limited,” Nieuwboer said.

The bottom line is that a message that says “every move counts” is an oversimplification, she added.

The study was funded by a grant from the Federal Ministry of Education and Research. Investigators and Nieuwboer have not reported any relevant financial ties.

International Congress of Parkinson’s Disease and Movement Disorders (MDS) 2022: Abstract 237. Presented September 15, 2022.

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