Table 3.
Summary of the included studies.
| Study. First author, year | Participants Sample size (E/C) PD duration (E/C) (range or mean ± SD) H&Y (range or mean ± SD) |
Intervention | Regimen | Control | Outcome measures | Adverse events |
|---|---|---|---|---|---|---|
| 1. Walking exercise | ||||||
| Canning, 2012 [23] | 20 (10/10) 6.1 ± 4.0/5.2 ± 4.1 N/A |
W: comfortable gait speed on treadmill (hold on to the handrails) | 30–40 min, 4 times/wk for 6 wks | Usual care | 6 MWT PS UPDRS III | No adverse events |
| Miyai, 2002 [24] | 20 (11/9) 4.1 ± 0.8/4.5 ± 0.7 2.9 ± 0.1/2.8 ± 0.1 | W: treadmill training (body weight supported) 10 min walking with 20% of BWS⟶10 min walking with 10% of BWS⟶10 min walking with 0% of BWS⟶15 min rest. Treadmill speed was initiated at 0.5 km/h and increased to 3.0 km/h by increments of 0.5 km/h as tolerated | 45 min, 3 times/wk for 1 Mon | Conventional physical therapy 45 min, 3 times/wk for 1 Mon | Total UPDRS UPDRS I UPDRS II UPDRS III | N/A |
| Picelli, 2016 [25] | 17 (9/8) 11.2 ± 5.6/10.8 ± 4.1 3 (all participants) |
W: treadmill training without body weight support. Each training session comprised three parts with a 5 min rest after each session. The speed of 1.0 km/h for 10 min ⟶ 1.5 km/h for 10 min ⟶ 2.0 km/h for 10 min | 45 min, 3 times/wk for 4 wks | Regular social interactions 45 min, 3 times/wk for 4 wks | 6 MWT PS | No adverse events |
|
| ||||||
| 2. Strength and flexibility exercise | ||||||
| Morris, 2015 [26] | 203 (70/68/65) 6.7 ± 5.6 (all participants) 1–4 (all participants) |
S: progressive resistance strength training. Exercises were progressed by increasing: repetitions to a maximum of 15, sets to a maximum of 3, or weights by 2% of the person's body weight | 2 hr, 1 time/wk for 8 wks | C1 : movement strategy training (active control) 2 hr, 1 time/wk for 8 wks C2 : life skills program 2 hr, 1 time/wk for 8 wks | UPDRS II UPDRS III PS TUGT | No serious adverse events |
| Li, 2015 [27] | 38 (19/19) 8.71 ± 6.23/7.21 ± 5.53 2–3 (all participants) |
S: physical exercises trunk stretching, section stretching, lower extremities stretching, hold knee in one's arms, upper extremities stretching, walking, turn waist, punching, running, athetotic gait exercise, and kinematic contact exercise | 120 min, 7 times/wk for 14 Mons | Usual care | UPDRS II UPDRS III | N/A |
| Wang, 2014 [28] | 64 (32/30) N/A N/A |
S: physical exercises divided into 8 methods | 30–45 min, 5 times/wk for 8 wks twice a day | Usual care | UPDRS III BBS | N/A |
| Yu, 2015 [29] | 71 (37/34) 3.9 ± 1.4/4.1 ± 1.3 3 (all participants) |
S: core muscular strengthening exercise. Trunk anteflexion, extension, lateroflexion, and rotation. Abdominal muscles exercise, hold knee in one's arms in the supine position, straight leg raising in the supine position, and Fowler's position change. Lumbodorsal strengthening exercise, gluteus strengthening exercise, and straight leg raising in the pronation position | 30 min, 2 times/d, 5-6 times/wk for 3 Mons | Usual care | BBS | N/A |
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| ||||||
| 3. Balancing exercise | ||||||
| Conradsson, 2015 [30] | 91 (47/44) 6.0 ± 5.1/5.6 ± 5.0 2-3 (all participants) | B: plus cognitive and/or motor tasks 1. Sensory integration (walking tasks on varying surfaces with or without visual constraints) 2. Anticipatory postural adjustments (voluntary arm/leg/trunk movements, postural transitions, and multidirectional stepping, and emphasizing movement velocity and amplitude) 3. Motor agility (interlimb coordination under varying gait conditions and quick shifts of movement characteristic during predictable and unpredictable conditions) 4. Stability limits (controlled leaning tasks performed while standing with varying bases of support, stimulating weight shifts in multiple directions) |
60 min, 3 times/wk for 10 wks | Usual care | UPDRS II PS | Total 13 adverse events (fallings during training) |
| Gu, 2013 [31] | 38 (20/18) 5.8 ± 1.9/6.2 ± 2.1 1–3 (all participants) |
B: 1. Standing with gathering legs, standing after tandem gait, stand on one foot, standing for a long time, and standing with eyes closed. 2. Standing holding a thing. 3. Walking with spreading legs, walking fast. 4. Walking fast changing direction, passing obstacle. 5. Sitting up and standing up, crossed arms on the chest. 6. Standing with lift the heel. 7. Hang a wooden board on the legs to load weight, increasing the weight. 8. Sitting up and standing up, putting the back on the wall |
40∼60 min, 3 times/wk for 8 wks | Usual care | UPDRS I UPDRS II UPDRS III | N/A |
|
| ||||||
| 4. Aerobic exercise | ||||||
| Duncan, 2012 [32] | 62 (32/30) 5.8 ± 1.1/7.0 ± 1.0 2.6 ± 0.1/2.5 ± 0.1 | A: dance both leader and follower roles, change partners frequently, and learn new steps and/or integrated previously learned steps in new ways at each class throughout the 12 months | 1 hr, 2 times/wk for 12 months | Usual care | MDS-UPDRS III | N/A |
| Hashimoto, 2015 [33] | 59 (19/21/19) 6.3 ± 4.6/7.8 ± 6.2/6.9 ± 4.0 2–4 (all participants) |
A: combinations of steps and movements from aerobic, jazz, and tango dances and movements from classical ballet | 60 min, 1 time/wk for 12 wks | C1: Parkinson disease exercise 2 hr, 1 time/wk for 12 wks. C2: usual care | TUGT BBS total UPDRS | N/A |
| Ma, 2011 [34] | 33 (17/16) 5.32 ± 4.43/5.16 ± 3.43 2-3 (all participants) |
A: virtual reality training. Reaching for 60 fast-moving balls with the right hand | 10 min training (once) | Placebo exercise. (Turning wooden cylinders with their nondominent hand) | FS | Fatigue |
| Romenets, 2015 [35] | 33 (18/15) 5.5 ± 4.4/7.7 ± 4.7 1.7 ± 0.6/2.0 ± 0.5 | A: traditional Argentine tango. Each class consisted of a review of the previous class, plus a new step or elements, followed by improvisation activities | 1 hr, 2 times/wk for 12 wks | Usual care | MDS-UPDRS III TUGT | Falling, respiratory infection (unrelated with training) and fatigue |
|
| ||||||
| 5. Complex exercise | ||||||
| Ashburn, 2007 [36] | 130 (65/65) 7.7 ± 5.8/9.0 ± 5.8 2–4 (all participants) | S: muscle strengthening (knee and hip extensors and hip abductors), range of movement (ankle, pelvic tilt, trunk, and head). B: static, dynamic and functional. W: inside and outside. A: U/A |
60 min, daily for 6 wks | Usual care | BBS | N/A |
| Frazzita, 2014 [37] | 25 (15/10) N/A N/A |
W/B: balance and gait using a stabilometric platform with a visual cue and treadmill. All treadmill therapies were aerobic with a heart rate reserve ≤ 60% and a maximum speed of treadmill scrolling of 3.5 km/h. A: occupational therapy: transferring from sitting to standing position, rolling from supine to sitting position and from sitting to supine, dressing, use of tools, and exercises to improve hand functionality and skills. S: U/A |
3 hr, 5 times/wk for 4 wks | Usual care | UPDRS III | N/A |
| Goodwin, 2011 [38] | 130 (64/66) 9.1 ± 6.4/8.2 ± 6.4 2.6 ± 0.9/2.4 ± 0.9 | B: side steps, side taps, side sway, lunges, toe walk, heel walk, and tandem walk. S: heel raise, toe raise, sit to stand, seated leg press with band, seated upper back strengthener with band, and seated outer leg strengthener with band. W: U/A A: U/A |
60 min, 1 time/wk for 10 wks | Usual care | BBS TUGT | No adverse events |
| Ma, 2006 [39] | 50 (25/25) 3.6 ± 1.8/3.5 ± 2.0 3.3 ± 0.4/3.3 ± 0.3 | S: breathing training, spinal joint distraction training, changing of position, sitting up, and standing up. B: standing balance training, trunk anteflexion, extension, lateroflexion, rotation, keeping the balance during perturbed by shoulder pulls from the trainer, using weight loss device, using visual disturbance device, and standing on one foot. W: walking, walking position correcting training, and whole body training. A: U/A |
30 min, 5 times/wk for 3-4 wks | Usual care | BBS TUGT | N/A |
| Zhang, 2013 [40] | 60 (30/30) 5 Mon-6 yr (all participants) 1–5 (all participants) | S: stretching of range of motion and strengthening training (joint distraction). B: walking posture correction practice, and balance training. W: standing up training and walking training. A: U/A |
8 wks | Usual care | UPDRS | N/A |
E, exercise group; C, control group; H&Y, Hoehn and Yahr scale; W, walking exercise; B, balance exercise; S, strength and flexibility exercise; A, aerobic exercise; UPDRS, the Unified Parkinson's Disease Rating Scale; BBS, Berg Balance Scale; TUGT, Timed Up and Go Test; PS, preferred speed (m/s), walking on preferred velocity; FS, fast speed (m/s), walking on peak velocity; Wk, weeks; 6 MWT, 6-minute-walking-test; U/A, unapplicable; N/A, no answer.