The effects of exercise-based rehabilitation on the gait of patients with Parkinson's disease: a systematic review
DOI:
https://doi.org/10.33233/fb.v23i1.5003Keywords:
Parkinson disease; gait analysis; exercise therapyAbstract
Introduction: More than 85% of people with Parkinson's Disease (PD) develop walking difficulties within three years of diagnosis, with gait disturbances being considered the most disabling motor symptoms of PD, leading to a substantial decline in mobility and independence. Objective: To carry out a systematic review of the effects found after exercise-based rehabilitation on gait in patients with PD. Methods: A systematic review was carried out searching for articles in the PubMed, Lilacs, PEDro, Scielo, and Scopus databases, with published studies in the last ten years. The expressions used for research were chosen according to the DeCS/MeSH (Health Science Descriptors/ Medical Subject Headings). Results: The search resulted in 514 studies, and 58 of these studies were suitable for inclusion. After the methodological evaluation of the 58 studies, only papers classified as having high methodological quality were included. It was found that a program with gait training, strengthening, dual task, balance and endurance showed mostly positive effects on speed, cadence, stride length, step length, gait capacity and resistance. Conclusion: The studies presented in this review illustrate mostly positive results after exercise-based rehabilitation on the gait of patients with PD.
References
Kalia LV, Lang AE. Evolving basic, pathological and clinical concepts in PD. Nat Rev Neurol 2016;12(2):65-6. doi: 10.1038/nrneurol.2015.249
Jagadeesan AJ, Murugesan R, Devi SV, Meera M, Madhumala G, Padmaja MV, et al. Current trends in etiology, prognosis and therapeutic aspects of Parkinson’s disease: a review. Acta Biomed 2017;88(3):249-262. doi: 10.23750/abm.v88i3.6063
Muthukrishnan N, Abbas JJ, Shill HA, Krishnamurthi N. Cueing paradigms to improve gait and posture in Parkinson’s Disease: a narrative review. Sensors (Basel) 2019;19(24):5468. doi: 10.3390/s19245468
Kang GA, Bronstein JM, Masterman DL, Redelings M, Crum JA, Ritz B. Clinical characteristics in early Parkinson’s disease in a central California population-based study. Mov Disord 2005;20(9):1133-42. doi: 10.1002/mds.20513
Trindade MFD, Viana RA. Effects of auditory or visual stimuli on gait in Parkinsonic patients: a systematic review. Porto Biomed J 2021;6(4):e140. doi: 10.1097/j.pbj.0000000000000140
Capecci M, Pournajaf S, Galafate D, Sale P, Le Pera D, Goffredo M, et al. Clinical effects of robot-assisted gait training and treadmill training for Parkinson’s disease. A randomized controlled trial. Ann Phys Rehabil Med 2019;62(5):303-12. doi: 10.1016/j.rehab.2019.06.016
Picelli A, Melotti C, Origano F, Neri R, Waldner A, Smania N. Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson’s disease: A randomized controlled trial. Parkinsonism Relat Disord 2013;19(6):605-10. doi: 10.1016/j.parkreldis.2013.02.010
Canning CG, Ada L, Johnson JJ, McWhirter S. Walking capacity in mild to moderate Parkinson’s disease. Arch Phys Med Rehabil 2006;87(3):371–5. doi: 10.1016/j.apmr.2005.11.021
Azevedo R, Caetano A, Gomes MC, Tavares CF. Atividade física e doença de Parkinson. Revista Digital Buenos Aires 2006 [Internet];11(101). [cited 2022 Jan 11]. doi: http://www.efdeportes.com/efd101/parkins.htm
Bacanoiu MV, Mititelu RR, Danoiu M, Olaru G, Buga AM. Functional recovery in Parkinson’s Disease: current state and future perspective. J Clin Med 2020;9(11):3413. doi: 10.3390/jcm9113413
Ni M, Hazzard JB, Signorile JF, Luca C. Exercise guidelines for gait function in Parkinson’s Disease: a systematic review and meta-analysis. Neurorehabil Neural Repair 2018;32(10):872-86. doi: 10.1177/1545968318801558
Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar revisões sistemáticas e meta-análises: A recomendação PRISMA. Epidemiol Serv Saúde 2015;24(2):335-42. doi: 10.5123/S1679-49742015000200017
Grobbelaar R, Venter R, Welman KE. Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial. Gait & Posture 2017;58:294-9. doi: 10.1016/j.gaitpost.2017.08.019
Steib S, Klamroth S, Gaßner H, Pasluosta C, Eskofier B, Winkler J, et al. Perturbation during treadmill training improves dynamic balance and gait in Parkinson’s disease: a single-blind randomized controlled pilot trial. Neurorehabil Neural Repair 2017;31(8):758-68. doi: 10.1177/1545968317721976
Shen X, Mak MKY. Technology-assisted balance and gait training reduces falls in patients with Parkinson’s disease: a randomized controlled trial with 12-month follow-up. Neurorehabil Neural Repair 2015;29(2):103-11. doi: 10.1177/1545968314537559
Canning CG, Allen NE, Dean CM, Goh L, Fung VS. Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial. Clin Rehabil 2012;26(9):817-26. doi: 10.1177/0269215511432652
Strouwen C, Molenaar EALM, Münks L, Keus SHJ, Zijlmans JCM, Vandenberghe W, et al. Training dual tasks together or apart in Parkinson’s disease: Results from the DUALITY trial: training dual tasks together or apart in PD. Mov Disord 2017;32(8):1201-10. doi: 10.1002/mds.27014
Schaible F, Maier F, Buchwitz TM, Schwartz F, Hoock M, Schönau E, et al. Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson’s disease: a randomized controlled study comparing three exercise models. Ther Adv Neurol Disord 2021;14:175628642098674. doi: 10.1177/1756286420986744
Rosenfeldt AB, Penko AL, Streicher MC, Zimmerman NM, Koop MM, Alberts JL. Improvements in temporal and postural aspects of gait vary following single- and multi-modal training in individuals with Parkinson’s disease. Parkinsonism Relat Disord 2019;64:280-5. doi: 10.1016/j.parkreldis.2019.05.021
Flynn A, Preston E, Dennis S, Canning CG, Allen NE. Home-based exercise monitored with telehealth is feasible and acceptable compared to centre-based exercise in Parkinson’s disease: A randomised pilot study. Clin Rehabil 2021;35(5):728-39. doi: 10.1177/0269215520976265
Galli M. Robot-assisted gait training versus treadmill training in patients with Parkinson's disease: a kinematic evaluation with gait profile score. Funct Neurol 2016;31(3):163-70. doi: 10.11138/fneur/2016.31.3.163
Shen X, Mak MKY. Balance and gait training with augmented feedback improves balance confidence in people with Parkinson’s disease: a randomized controlled trial. Neurorehabil Neural Repair 2014;28(6):524-35. doi: 10.1177/1545968313517752
Landers MR, Hatlevig RM, Davis AD, Richards AR, Rosenlof LE. Does attentional focus during balance training in people with Parkinson’s disease affect outcome? A randomised controlled clinical trial. Clin Rehabil 2016;30(1):53-63. doi: 10.1177/0269215515570377
Geroin C, Nonnekes J, de Vries NM, Strouwen C, Smania N, Tinazzi M, et al. Does dual-task training improve spatiotemporal gait parameters in Parkinson’s disease? Parkinsonism Relat Disord 2018;55:86-91. doi: 10.1016/j.parkreldis.2018.05.018
Melo GEL, Kleiner AFR, Lopes JBP, Dumont AJL, Lazzari RD, Galli M, et al. Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson’s disease. NeuroReabilitation [Internet] 2018 [cited 2022 Jan 11];42(4):473-80. Available from: https://pubmed.ncbi.nlm.nih.gov/29660956/
Cheng F-Y, Yang Y-R, Wu Y-R, Cheng S-J, Wang R-Y. Effects of curved-walking training on curved-walking performance and freezing of gait in individuals with Parkinson’s disease: A randomized controlled trial. Parkinsonism Relat Disord 2017;43:20-6. doi: 10.1016/j.parkreldis.2017.06.021
Giardini M, Nardone A, Godi M, Guglielmetti S, Arcolin I, Pisano F, et al. Instrumental or physical-exercise rehabilitation of balance improves both balance and gait in Parkinson’s disease. Neural Plasticity 2018;2018:1-17. doi: 10.1155/2018/5614242
Shen X, Mak M. Repetitive step training with preparatory signals improves stability limits in patients with Parkinsonâ€TMs disease. J Rehabil Med 2012;44(11):944-9. doi: 10.2340/16501977-1056
Yang W-C, Wang H-K, Wu R-M, Lo C-S, Lin K-H. Home-based virtual reality balance training and conventional balance training in Parkinson’s disease: A randomized controlled trial. J Formos Med Assoc 2016;115(9):734-43. doi: 10.1016/j.jfma.2015.07.012
Serrao M, Pierelli F, Sinibaldi E, Chini G, Castiglia SF, Priori M, et al. Progressive modular rebalancing system and visual cueing for gait rehabilitation in Parkinson’s disease: a pilot, randomized, controlled trial with crossover. Front Neurol 2019;10:902. doi: 10.3389/fneur.2019.00902
San Martín Valenzuela C, Moscardó LD, López-Pascual J, Serra-Añó P, Tomás JM. Effects of dual-task group training on gait, cognitive executive function, and quality of life in people with Parkinson disease: results of randomized controlled DUALGAIT trial. Arch Phys Med Rehabil 2020;101(11):1849-56. doi: 10.1016/j.apmr.2020.07.008
Rafferty MR, Prodoehl J, Robichaud JA, David FJ, Poon C, Goelz LC, et al. Effects of 2 years of exercise on gait impairment in people with parkinson disease: The PRET-PD randomized trial. J Neurol Phys Ther 2017;41(1):21-30. doi: 10.1097/NPT.0000000000000163
Arcolin I, Pisano F, Delconte C, Godi M, Schieppati M, Mezzani A, et al. Intensive cycle ergometer training improves gait speed and endurance in patients with Parkinson’s disease: A comparison with treadmill training. Restor Neurol Neurosci 2016;34(1):125-38. doi: 10.3233/RNN-150506
Wallén MB, Hagströmer M, Conradsson D, Sorjonen K, Franzén E. Long-term effects of highly challenging balance training in Parkinson’s disease - a randomized controlled trial. Clin Rehabil 2018;32(11):1520-9. doi: 10.1177/0269215518784338
Leal LC, Abrahin O, Rodrigues RP, Silva MC, Araújo AP, Sousa EC, et al. Low‐volume resistance training improves the functional capacity of older individuals with Parkinson’s disease. Geriatr Gerontol Int 2019;19(7):635-40. doi: 10.1111/ggi.13682
Hass CJ, Buckley TA, Pitsikoulis C, Barthelemy EJ. Progressive resistance training improves gait initiation in individuals with Parkinson’s disease. Gait Posture 2012;35(4):669-73. doi: 10.1016/j.gaitpost.2011.12.022
Schlick C, Ernst A, Bötzel K, Plate A, Pelykh O, Ilmberger J. Visual cues combined with treadmill training to improve gait performance in Parkinson’s disease: a pilot randomized controlled trial. Clin Rehabil 2016;30(5):463-71. doi: 10.1177/0269215515588836
Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk J, et al. The effects of highly challenging balance training in elderly with Parkinson’s disease: a randomized controlled trial. Neurorehabil Neural Repair 2015;29(9):827-36. doi: 10.1177/1545968314567150
Harro CC, Shoemaker MJ, Frey OJ, Gamble AC, Harring KB, Karl KL, et al. The effects of speed-dependent treadmill training and rhythmic auditory-cued overground walking on gait function. NeuroRehabilitation 2014;34(3):557-72. doi: 10.3233/NRE-141048.
Smaili SM, Bueno MEB, Barboza NM, Terra MB, Almeida IA, Ferraz HB. Efficacy of neurofunctional versus resistance training in improving gait and quality of life among patients with Parkinson’s disease: a randomized clinical trial. Motriz: Rev Educ Fis 2018;24(2). doi: 10.1590/S1980-6574201800020004
Medijainen K, Pääsuke M, Lukmann A, Taba P. Versatile guideline-based physiotherapy intervention in groups to improve gait speed in Parkinson’s disease patients. NeuroRehabilitation 2019;44(4):579-86. doi: 10.3233/NRE-192723
Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, et al. Gait impairments in Parkinson’s disease. The Lancet Neurology 2019;18(7):697-708. doi: 10.1016/S1474-4422(19)30044-4
Renfro M, Bainbridge DB, Smith ML. Validation of evidence-based fall prevention programs for adults with intellectual and/or developmental disorders: a modified Otago exercise program. Front Public Health 2016. doi: 10.3389/fpubh.2016.00261
Royal Dutch Society. KNGF Guidelines for physical therapy in patients with Parkinson´s disease. Dutch Journal of Physiotherapy [Internet] 2004 [cited 2022 Jan 12];114(3). Available from: http://www.ergod.org/download/Guideline%20Parkinsons%20disease.pdf
Luna NMS, Brech GC, Canonica A, Ernandes R de C, Bocalini DS, Greve JMD, et al. Effects of treadmill training on gait of elders with Parkinson’s disease: a literature review. Einstein (São Paulo) 2020;18. doi: 10.31744/einstein_journal/2020RW5233
Roiz RM, Cacho EWA, Pazinatto MM, Reis JG, Cliquet Junior A. Barasnevicius-Quagliato EMA. Gait analysis comparing Parkinson’s disease with healthy elderly subjects. Arq Neuropsiquiatr 2010;68(1):81-6. doi: 10.1590/S0004-282X2010000100018
Additional Files
Published
Issue
Section
License
Copyright (c) 2022 Karine Santos Brito, Tatiana Raquel dos Santos, Alessandra Tanuri Magalhães
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
