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Article
The Effectiveness of Exercise Interventions for People With Parkinson's Disease

Parkinson's Disease
Parkinson’s Disease (PD) is a progressive neurological disorder which impacts an individuals physical, psychological and functional abilities. Parkinson’s is known to effect the older population with the average age of diagnosis being 65 years.

What causes Parkinson's Disease?
The disease is caused due to a neural degeneration in a specific section of the midbrain known as the Substantia Nigra resulting in the decline in production of dopamine. Dopamine is a hormone associated with smooth controlled movements, and a decline causes a difficulty in movement control and can cause symptoms such as pain, depression, immobility and tremors. There is no cure for Parkinson’s Disease, however exercise interventions have shown to improve quality of life and motor control and function. There is rowing evidence indicating that exercise effects release of neurotrophic factors and promotes greater cerebral oxygenation, which results in new cell growth and repair. Symptoms of Parkinson’s disease are also reduced through dopamine synthesis, which is simulated by exercise.

What kind of research was this?
The article chosen is a systematic review and meta-analysis on the effectiveness of exercise interventions for people with Parkinson’s Disease. The article has been written by a research group from Peninsula Medical school and University of Exeter in the United Kingdom. A meta analysis allows for the integration of findings from a number of different independent studies, in this case there are 14 studies. This allows a comparison of results from different studies which in tern helps identify patterns and similarities among study results. A meta-analysis helps increase the accuracy of results as more data is used and results obtained can be generalised to a larger population.

What did the research involve?
Each study involved exercise interventions with individuals suffering from Parkinson’s Disease. The stage of the disease was described in 13 of the 14 studies, 12 of the 14 studies included individuals with stage 2 ad 3 of the disease. One study only included participants with stage 1 and 2 of the disease and three studies included participants with stage 4 of the disease. Fourteen studies were compared in the meta-analysis. Five studies compared the exercise intervention with no intervention, two studies compared an exercise intervention with a no exercise control, four studies compared two different exercise interventions and one study compared results between three different exercise interventions.

Each study varied in terms of type of exercise, duration, frequency and follow up. Each intervention involved a control and trial group, where studies were carried out over a space of 6-36 hours spread over 4-12 weeks. Exercises involved in the interventions included stretching (passive and active), aerobic exercise, core balance exercises, gait training and general treadmill walking. There was total of 495 participants in this meta-analysis, with a minimum of 11 and a maximum of 142 participants involved in each study. There were 282 female participants and 423 male participants.

Results
Results indicated that physical functioning, quality of life, muscle strength (particularly in legs), balance and gait showed a significant benefit through the use of exercise interventions. However falls incidence and improvement in depression did not show a significant improvement as a result of exercise. The follow up of each study was over different time frames, but most studies assessed results in at least three different follow ups post exercise intervention. Results in all followups demonstrated significant improvement in physical functioning in the intervention group in comparison to the control groups.

What conclusions should be taken away from this research?
Through the meta-analysis, the researchers were able to identify that exercise is of great benefit to individuals suffering with PD in respect to physical functioning, quality of life, muscle strength, balance and gait speed. There is unsubstantial evidence that suggests exercise reduces the likelihood of falls and depression in PD sufferers, however it is acknowledged that there is potential for publication bias as only English written studies were chosen for the analysis. The researchers also acknowledged that exercise and its link to prevention of falls and depression should be further investigated.

Limitations
The methodological details reported in the case studies were poor. A majority of the studies included presented a poor description of their methods, and had a very low participant numbers. Overall the percentage of men to women was considerably higher, and no studies reported ethnicity of participants. Often the interventions were only spaced out over eight weeks or less, questioning if the time frame was sufficient to attain substantial results. Follow up is very important in clinical practice, the length of follow up varied widely with each study.

Implications of this research
The conclusion that can be drawn from this article is that exercise plays a very important roll in the minimisation of Parkinson’s Disease symptoms. Exercise is associated with greater quality of life and physical functioning across all stages of the disease. Exercise interventions have demonstrated not only short term, but also long term improvement and benefits of exercising with Parkinson’s. These studies have shown benefits in symptom management but also suggest that exercise could be potentially slowing disease progression.