Parkinson's disease motor intervention patterns: a network meta-analysis based on patient motor function

Abstract

Background: Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients.

Methods: A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool.

Results: The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84).

Conclusion: Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.

Keywords: Parkinson’s disease; exercise intervention; motor function; network meta-analysis; randomized controlled trial.

Figure 1

The process of selection of the eligible studies.

Figure 2

Analysis of the risk of bias in accordance with the Cochrane collaboration guideline.

Figure 3

The NMA figure for MDS-UPDRS-III (A). The SUCRA plot for MDS-UPDRS-III (B). GE, gait exercise; RC, routine care; RE, resistance exercise; BE, balance exercise; HT, hydrotherapy; AH, archery; ST, stretching training; TC, shadowboxing; NW, Nordic walking; YG, yoga; TTC, treadmill training category; TB, treadmill balance; DA, dance; SG, sports game; MM, mindfulness meditation; DTT, dual task training; FQ, fitness qigong; HAS, high strength and agility; SC, sport climbing; SST, sports strategy training; Da2, dance2 (Duality Rhythm Dance); Bo, boxing; MIT, moderate intensity training; STT, sensory attention training; ESP, elastic strap pilates; RAB, ride a bike; AE, aerobic exercise.

Figure 4

The NMA figure for TUG (A). The SUCRA plot for TUG (B). GE, gait exercise; RC, routine care; BE, balance exercise; ST, stretching training; TTC, treadmill training category; RAB, ride a bike; YG, yoga; NW, Nordic walking; TC, shadowboxing, ESP, elastic strap pilates; Bo, boxing; DA, dance; RE, resistance exercise; CD, couple dance; MM, mindfulness meditation; AH, archery; SG, sports game; HT, hydrotherapy, TB, treadmill Balance; FQ, fitness qigong; AE, aerobic exercise; WLR, weight lifting resistance; BK, kick boxing; HAS, high strength and agility; STT, sensory attention training; DTT, dual task training.

Figure 5

Funnel plot on publication bias of MDS-UPDRS-III (A), TUG (B), 6MWT (C), BBS (D), and Mini BES Test (E).

Figure 6

The NMA figure for BBS (A). The SUCRA plot for BBS (B). GE, gait exercise; RC, routine care; RE, resistance exercise; BE, balance exercise; HT, hydrotherapy; ST, stretching training; TC, shadowboxing; NW, Nordic walking; YG, yoga; TB, treadmill balance; DA, dance; FQ, fitness qigong; ESP, elastic strap pilates; AE, aerobic exercise; WLR, weight lifting resistance; EAR, elastic band resistance; CD, couple dance; DTT, dual task training.

Figure 7

The NMA figure for Mini-BES Test (A). The SUCRA plot for Mini-BES Test (B). GE, gait exercise; RC, routine care; BE, balance exercise; ST, stretching training; TTC, treadmill training category; RAB, ride a bike; YG, yoga; ESP, elastic strap pilates; DA, dance; RE, resistance exercise; TB, treadmill balance; WLR, weight lifting resistance; FQ, fitness qigong; DTT, dual task training.

Figure 8

The NMA figure for 6MWT (A). The SUCRA plot for 6MWT (B). GE, gait exercise; RC, routine care; BE, balance exercise; ST, stretching training; TTC, treadmill training category; RAB, ride a bike; Bo, boxing; YG, yoga; DA, dance; RE, resistance exercise; WLR, weight lifting resistance; TC, shadowboxing; HAS, high strength and agility; NW, Nordic walking; AE, aerobic exercise.