THE EFFECT OF PHYSICAL EXERCISE ON ANXIETY IN PEOPLE WITH PARKINSON’S DISEASE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROL TRIALS

T. Hartley¹, A. Mohamed¹, R. Abuouf¹, R. Al-Kaabi¹, U. Zerough¹, S.-M. van Niekerk¹, L.D. Morris¹, H.W.S. Khalil¹

¹Qatar University, Physical Therapy and Rehabilitation Sciences, Doha, Qatar

Background: Parkinson’s Disease (PD) is one the most common neurodegenerative diseases and is characterized by motor and non-motor symptoms. Discussions regarding non-motor symptoms in people with Parkinson’s (PwP) have recently gained more attention, as these symptoms can be more disabling than motor symptoms. Anxiety is of the most prominent non-motor neuropsychiatric complications of PD. Common pharmacological treatments for PD and anxiety have drug interactions and negative side effects. Therefore, nonpharmacological interventions such as physical exercise can be an adjunct therapy to reduce anxiety in PwP.

Purpose: This systematic review aimed to explore the available evidence in relation to physical exercise programs and anxiety in PwP.

Methods: The data sources for the Systematic Review of Randomized Control Trials were four databases (PubMed, Embase, Scopus, Ebscohost) which were searched in February 2022; only English studies were included with no restrictions to the date of publication. Inclusion criteria were: participants’ age were ≥ 18 with PD at any stage, physical exercise type as intervention, anxiety as one of the outcome variables, studies that compared physical exercise intervention with another type of physical exercise or with any type of control were, and randomized control trial design. Two independent reviewers assessed the papers. The quality appraisal was assessed by two independent reviewers using the adapted 9-point PEDro scale.

Results: Based on the search strategy 5547 studies were identified. Only 5 studies used physical exercise in relation to anxiety and were included in this review. The sample size was between 11 and 152 participants, totaling 328 participants with the majority being males. The PD stage ranged from early to moderate, and the mean disease duration ranged from 2.9 to 8.0 years. All studies measured anxiety at baseline and at various points post-intervention. Based on an adapted 9-point PEDro scale, the studies' score on average was 7 out of 9 (76%).

Conclusions: Based on the results of this systematic review, there is insufficient evidence to support or refute the effect of exercise on anxiety in PwP. The interpretation of the result was difficult due to the noted limitations of the included studies (small sample size, noted bias, high heterogeneity). Overall, this review found that there is a need for high-quality RCTs on physical exercises and their potential effect in decreasing anxiety symptoms in PwP.

Implications: Although the results of the current study were inconclusive in determining the effects of physical exercise on anxiety in PwP, studies demonstrated a significant improvement in physical activity. Given the merits of exercise benefits in older adults in the general population, exercise has the potential to be used as an adjunct to pharmacological treatment aimed at reducing anxiety in PwP. This area warrants further investigation.

Funding acknowledgements: This work was not funded.

Keywords:
Anxiety
Exercise
Parkinson’s disease

Topics:
Neurology: Parkinson's disease
Disability & rehabilitation
Mental health

Did this work require ethics approval? No

Reason: The study design was a systematic review, hence not requiring ethical approval.