Document Detail

Exercise and motor training in people with Parkinson's disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials.
Jump to Full Text
MedLine Citation:
PMID:  22191077     Owner:  NLM     Status:  In-Data-Review    
There is research evidence that exercise and motor training are beneficial for people with Parkinson's disease (PD), and clinicians seek to implement optimal programs. This paper summarizes important factors about the nature and reporting of randomized controlled trials of exercise and/or motor training for people with PD which are likely to influence the translation of research into clinical practice. Searches identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 (SD 4.2) weeks. Most interventions were fully supervised (74%) and conducted at a facility (79%). Retention rates were high with 69% of interventions retaining ≥85% of their participants; however adherence was infrequently reported, and 72% of trials did not report adverse events. Overall, the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to balance benefits and costs when selecting protocols that translate to sustainable clinical practice for people with PD.
Natalie E Allen; Catherine Sherrington; Gayanthi D Suriyarachchi; Serene S Paul; Jooeun Song; Colleen G Canning
Related Documents :
21688867 - Influence of exercise on skill proficiency in soccer.
21660947 - The effect of exercise training on transverse tubules in normal, remodeled, and reverse...
22174407 - Endurance training stimulates growth and survival pathways and the redox balance in rat...
6496357 - Changes in rest and exercise myocardial perfusion and left ventricular function 3 to 26...
12592297 - 6. asthma.
3883077 - Physical activity levels and coronary heart disease. analysis of epidemiologic and supp...
Publication Detail:
Type:  Journal Article     Date:  2011-11-16
Journal Detail:
Title:  Parkinson's disease     Volume:  2012     ISSN:  2042-0080     ISO Abbreviation:  Parkinsons Dis     Publication Date:  2012  
Date Detail:
Created Date:  2011-12-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101539877     Medline TA:  Parkinsons Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  854328     Citation Subset:  -    
Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Parkinsons Dis
Journal ID (publisher-id): PD
ISSN: 2090-8083
ISSN: 2042-0080
Publisher: Hindawi Publishing Corporation
Article Information
Download PDF
Copyright © 2012 Natalie E. Allen et al.
Received Day: 13 Month: 7 Year: 2011
Accepted Day: 18 Month: 8 Year: 2011
Print publication date: Year: 2012
Electronic publication date: Day: 16 Month: 11 Year: 2011
Volume: 2012E-location ID: 854328
ID: 3236465
PubMed Id: 22191077
DOI: 10.1155/2012/854328

Exercise and Motor Training in People with Parkinson's Disease: A Systematic Review of Participant Characteristics, Intervention Delivery, Retention Rates, Adherence, and Adverse Events in Clinical Trials
Natalie E. Allen1*
Catherine Sherrington2
Gayanthi D. Suriyarachchi1
Serene S. Paul1
Jooeun Song1
Colleen G. Canning1
1Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
2Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW 2050, Australia
Correspondence: *Natalie E. Allen:
[other] Academic Editor: Gammon M. Earhart

1. Introduction

In recent years there have been an increasing number of randomized controlled trials assessing the effects of exercise and/or motor training in people with Parkinson's disease (PD). Overall, these trials support exercise and motor training as beneficial in improving walking, balance, muscle strength, and the performance of functional tasks in people with mild-to-moderate PD [111]. In order for findings from this research to be of general benefit to people with PD, therapists need to be able to translate the protocols used in the research into clinical practice [12].

Evidence-based practice aims to incorporate and apply high-quality clinical research findings in clinical policy and practice [13, 14]. However, this can be a challenging task as health practitioners may find it difficult to assess, interpret, and implement research evidence [13]. While evidence about beneficial outcomes is paramount in therapists' decisions to implement a particular intervention, there are other factors that affect how the overall impact of the intervention is interpreted and its potential for widespread clinical application [1317]. For example, therapists need to consider how the characteristics of participants included in a trial may affect their decision regarding the applicability of the trial intervention with their patients [14]. It is likely that the way in which the intervention was applied in terms of its duration, level of supervision, delivery (i.e., individual versus group), and location (e.g., facilities and equipment required) will influence therapists' decisions to implement that intervention. A research protocol that has been shown to be effective may not be implemented by therapists if they cannot provide adequate supervision over the required time frame or they do not have access to necessary facilities or equipment. Finally, information regarding retention, adherence, and adverse events is required so that therapists and patients can weigh up the effectiveness of the intervention against its acceptability and any risks associated with implementation [14].

Therefore, in order to examine the information available to guide the translation of research into clinical practice, we searched randomized controlled trials of exercise and/or motor training for people with PD to determine the

  1. disease severity and cognitive status of the included participants,
  2. duration, supervision, delivery, and location of the interventions,
  3. rates of retention, adherence, and adverse events.

2. Methods
2.1. Data Sources and Searches

Randomized controlled trials of exercise and/or motor training for people with PD were identified via database searches of MEDLINE, EMBASE, AMED, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL. The initial search was conducted in 2009, with a subsequent search conducted over 5 days from the 7th of April, 2011. The electronic search strategy used has been previously reported [2]. The Physiotherapy Evidence Database (PEDro; was also searched, and the reference lists of previously published systematic reviews [4, 5, 8, 9, 1830] were checked for any trials not identified with the database search.

2.2. Study Selection

Trials included were published randomized (or quasi randomized, i.e., not truly random but intended to produce similar groups, such as allocation by odd and even birth dates [31]) controlled trials of people with PD where at least one of the interventions was an ongoing program of exercise and/or motor training. All forms of exercise (e.g., aerobic, strength, and treadmill walking) and motor training (e.g., cueing and movement strategy training) were included. Whole-body vibration was not considered to be exercise or motor training. Trials were excluded if the intervention was multidisciplinary or was primarily occupational therapy.

The eligibility of trials was determined in a two-stage process. Firstly, all trial titles and abstracts were screened independently by two investigators (N. E. Allen and G. D. Suriyarachchi). Trials were excluded if it was clear that they did not meet the inclusion criteria. Secondly, the full article was obtained for the remaining trials and each trial was assessed independently by at least two investigators (N. E. Allen, C. G. Canning or J. Song), using a standardized form containing the details of the inclusion criteria. Care was taken to identify trials that had been reported in more than one journal article. Where this occurred, the multiple articles were counted as one trial and all articles were used to collect data for that trial.

2.3. Data Extraction

A data collection form was developed, tested on five randomly selected trials and then modified accordingly. All investigators were involved in data extraction, and all data was double-checked by an investigator not involved in its initial extraction (N. E. Allen or J. Song). Discrepancies were resolved by discussion.

Information extracted from each trial included a description of participants (including cognitive status), details of the exercise and motor training program and how it was administered, as well as details regarding retention rates, adherence to the intervention, and monitoring and reporting of adverse events. Retention was defined as the number of participants who completed the trial (i.e., undertook the first or only post-intervention assessment excluding further follow-up assessments) expressed as a percentage of the number of participants who began the trial. Adherence was defined as the number of intervention sessions attended by participants expressed as a percentage of the number of intervention sessions prescribed [15].

3. Results

Searching identified 3,539 records, of which 53 trials involving 1,940 participants were found to be eligible for inclusion in the paper (Figure 1) [32]. There were no disagreements between reviewers regarding the inclusion of any articles. The characteristics of the included trials [1, 3, 6, 7, 10, 11, 3385] are summarised in Table 1.

3.1. Participant Characteristics

Forty (75%) of the reviewed trials included participants with mild-to-moderate PD (i.e., equivalent to Hoehn and Yahr stage I to III [86]). Seven trials (13%) included participants with mild-to-moderately severe PD (i.e., Hoehn and Yahr stage I to IV), while four trials (8%) included only participants with mild PD and two trials (4%) included only participants with moderate PD (Table 1). Most trials stipulated the cognitive status of included participants. Twenty-nine trials (55%) used the Mini-Mental State Examination [87] to screen potential participants' cognitive abilities, with the minimum score for inclusion varying between 20 and 28 out of the maximum of 30 [1, 3, 6, 7, 10, 11, 34, 36, 39, 4143, 45, 4750, 56, 58, 60, 6365, 69, 71, 7678, 80, 85]. One trial (2%) [70] specified that participants required at least moderate scores on the Neurobehavioural Cognitive Status Examination [88]. Thirteen trials (25%) made a statement to the effect that included participants had no dementia and/or reasonable cognition [35, 46, 51, 52, 57, 59, 62, 66, 67, 79, 81, 83, 84]. Ten trials (19%) did not give a clear indication of the participants' cognitive abilities [33, 37, 40, 53, 55, 68, 72, 74, 75, 82].

3.2. Exercise and/or Motor Training Program Characteristics

In the 53 trials, there were 90 intervention groups that involved exercise and/or motor training (including two intervention groups for the cross-over trials where one intervention was a control [11, 42, 47]) (Table 1). Average intervention duration was 8.3 weeks (SD = 4.2, range = 2 to 26 weeks), with 37 trials (70%) conducting an intervention of 10 weeks or less. The total number of hours of intervention was not clearly reported in all studies (see Table 1); however, from the available data, an average of approximately 20 hours (SD approximately 11, range = 4 to 65 hours) appears broadly representative of the included trials. Sixty-seven of the 90 intervention groups (74%) involved full supervision of exercise and/or motor training. Participants in 18 (27%) of the fully supervised intervention groups received one-on-one supervision and 20 (30%) received supervision in small groups but the intervention delivery (one-on-one or small group supervision) was unclear in the remaining 29 (43%) intervention groups. Participants in most intervention groups (71; 79%) were required to attend a facility for all or the majority of the intervention sessions.

3.3. Retention, Adherence, and Adverse Events

Retention was generally well reported and was high, with 62 (69%) of the 90 intervention groups retaining at least 85% of participants (Table 1). Seventeen (32%) of the 53 included trials reported that at least one participant dropped out for a reason related to the intervention (Table 2). Difficulties with transport and disinterest/poor adherence were the most common intervention-related reasons for dropouts.

Overall, adherence and adverse events were infrequently reported in the included trials (Table 1). Adherence was reported in some form in 26 (49%) of the included trials. However, 11 (42%) of these trials only reported adherence for those participants who completed the intervention. Most trials (38; 72%) did not report monitoring for adverse events. Across the remaining 15 trials, 11 adverse events occurred (Table 1). Four participants from two separate trials [41, 80] experienced cardiac problems. Two of these participants, one from each group in a trial comparing physical therapy with and without mental practice [80], withdrew from the study. The two participants from the other trial [41] were able to continue safely with treadmill training. Other adverse events reported included a fall [81] and muscle cramps and tiredness [43] in trials involving cued overground walking, knee pain during a dancing program [52], muscle soreness and shoulder pain [56] following resistance training, and a hernia [57] subsequent to muscle strength assessment.

4. Discussion

A substantial number of randomized controlled trials of exercise and/or motor training for people with PD have been published. However, the nature and reporting of these trials are likely to provide challenges for therapists aiming to implement the interventions into clinical practice [17]. Most trials involved only cognitively intact participants with mild-to-moderate PD. Trials tended to be of short duration, highly supervised, and conducted at a facility. Furthermore, the reports for many trials were lacking important details, with adherence and adverse events particularly being inadequately reported.

On the whole, trials included in this paper included only participants with mild-to-moderate PD who were without significant cognitive impairment. Including only these types of participants not only makes it easier to conduct trials of exercise and motor training interventions but also aids interpretation of the results. However, cognitive impairment is now recognised as a common problem in PD, with over 80% of people with PD ultimately developing dementia [89]. Further work is needed to determine the effectiveness of exercise and motor training in people with more severe cognitive impairment and/or more advanced disease.

Most of the reviewed trials were of short duration, highly supervised, and facility based (Table 1). Interventions lasted an average of around two months. Seventy-four percent of the intervention groups were fully supervised, with no reported expectation for participants to undertake unsupervised exercise. Furthermore, 79% of intervention groups were mainly conducted at a facility such as a hospital or university. Such brief, highly supervised interventions conducted in controlled environments are likely to improve the adherence of participants to exercise and motor training programs and to ensure that interventions are being performed optimally. In this regard, these trials are useful and important for determining the short-term efficacy of an intervention. However, given that PD is a long-term, neurodegenerative condition, the capacity of therapists and patients to sustain the intervention over the long term needs to be considered. Furthermore, such brief and highly supervised interventions are costly and less likely to give information about the effectiveness of the intervention when implemented into usual practice [13, 17]. For example, the requirement for participants to travel to a facility was a common reason for withdrawal from the included trials (Table 2). Moreover, the neurodegenerative nature of PD and the limited resources available to healthcare systems mean that such labor-intensive programs are unlikely to be sustained or afforded by most health-care providers. Additionally, as PD is a progressive disease it is important that people with PD are empowered to self-manage their disease to some extent [90, 91]. To this end, trials of more pragmatic and sustainable exercise and motor training interventions, with the potential for direct translation into clinical practice and including cost-effectiveness analysis, are needed.

The likely adherence to an exercise and motor training program is an important factor to consider when prescribing such a program for an individual with PD. Adherence to the intervention was reported in less than half of the included trials, and some reports of adherence are artificially elevated by including only those participants who completed the trial (Table 1). Some trials were able to effectively maximise adherence by providing a flexible timeframe for participants to complete the intervention [46, 51, 52, 74, 76] and so allow participants more options in fitting their exercise and/or motor training program around their daily lives. This pragmatic approach is likely to more closely reflect therapy attendance patterns and is therefore likely to be helpful for therapists considering translating the research into their clinical practice.

Given the importance of adherence to exercise and motor training programs, strategies to promote adherence in people with PD need to be considered. Providing a high level of supervision seems likely to promote adherence in the short term, as it may enhance participants' commitment to the program. However, a Cochrane review comparing home and centre-based exercise programs for older adults found that, in the long term, participants were more likely to adhere to home-based programs [92]. Furthermore, the reviewers noted a trend toward more sustained improvements in the home-based than in the centre-based programs and suggested that this was attributable to the higher adherence in home-based programs. In the present paper, three of the included trials report high levels of adherence with minimally supervised home-based programs [40, 43, 81]. Common to all three of these trials was a requirement for participants to keep a daily record of what exercise/motor training they had performed. It seems likely that this simple strategy assisted in promoting adherence in these trials. Other strategies with the potential to improve adherence in sustainable, minimally supervised trials, such as participant involvement in goal setting [93, 94], flexibility to allow programs to be modified for individuals [1, 91, 93, 94], and intermittent followup [91, 94], warrant exploration.

The issue of adverse events was inadequately addressed in the trials included in this paper, with only 15 trials reporting monitoring for adverse events. In these 15 trials, 11 adverse events were reported, most of which were minor in nature (Table 1). However, when discussing and planning exercise and motor training options with people with PD, therapists need to be informed not only about the effectiveness of a given intervention but also about the nature and likelihood of any potential adverse events [95]. Similarly poor reporting of adverse events was found in a recent Cochrane review of progressive resistance training for older adults [95]. Notably, the Cochrane review found that adverse events were more likely to be detected in trials that used a clear definition of adverse events than in trials which did not use a definition. In the same way, the use of a definition for adverse events is likely to improve the assessment and reporting of adverse events in trials of exercise and motor training for people with PD.

This paper has examined several factors in the nature and reporting of trials of exercise and/or motor training which are likely to influence the way research is applied by therapists in clinical practice. However, this paper did not address whether or not trial protocols were reported in sufficient detail to allow therapists to emulate the research intervention in the clinic. This detailed reporting of trial interventions is critical in enabling research to be clinically applied [96]. The ability of many journals to provide online material which supplements the published article will aid the provision of such details despite the necessary word count limitations placed on authors.

5. Conclusions

Clinicians seeking to use research to inform their clinical practice rely heavily on the design and reporting of randomized controlled trials to reach their decisions. However, the nature and reporting of trials of exercise and/or motor training for people with PD are likely to provide challenges for therapists aiming to implement the interventions into clinical practice. The short duration, highly supervised and facility-based nature of many of the interventions, coupled with the tendency to include only cognitively-intact participants with mild-to-moderate disease, mean that findings may not generalise when therapists set out to apply them in the long-term management of people with PD. Infrequent reporting of adherence and adverse events compounds this problem and makes cost-benefit balancing more difficult. It is recommended that these issues be taken into account in the design and reporting of future trials.

1. Allen NE,Canning CG,Sherrington C,et al. The effects of an exercise program on fall risk factors in people with Parkinson’s disease: a randomized controlled trialMovement DisordersYear: 20102591217122520629134
2. Allen NE,Sherrington C,Paul SS,Canning CG. Balance and falls in Parkinson's disease: a meta-analysis of the effect of exercise and motor trainingMovement DisordersYear: 20012691605161521674624
3. Ashburn A,Fazakarley L,Ballinger C,Pickering R,McLellan LD,Fitton C. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s diseaseJournal of Neurology, Neurosurgery and PsychiatryYear: 2007787678684
4. de Goede CJ,Keus SHJ,Kwakkel G,Wagenaar RC. The effects of physical therapy in Parkinson’s disease: a research synthesisArchives of Physical Medicine and RehabilitationYear: 200182450951511295012
5. Dibble LE,Addison O,Papa E. The effects of exercise on balance in persons with parkinson’s disease: a systematic review across the disability spectrumJournal of Neurologic Physical TherapyYear: 2009331142619265767
6. Ebersbach G,Ebersbach A,Edler D,et al. Comparing exercise in Parkinson’s disease—the Berlin BIG studyMovement DisordersYear: 201025121902190820669294
7. Ebersbach G,Ebersbach A,Edler D,et al. Comparing exercie in Parkinson's disease—the Berlin LSVT®BIG studyMovement DisordersYear: 20102514p. 2478
8. Goodwin VA,Richards SH,Taylor RS,Taylor AH,Campbell JL. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysisMovement DisordersYear: 200823563164018181210
9. Mehrholz J,Friis R,Kugler J,Twork S,Storch A,Pohl M. Treadmill training for patients with Parkinson’s diseaseCochrane Database of Systematic ReviewsYear: 20101 Article ID CD007830..
10. Morris ME,Iansek R,Kirkwood B. A randomized controlled trial of movement strategies compared with exercise for people with Parkinson’s diseaseMovement DisordersYear: 2009241647118942100
11. Nieuwboer A,Kwakkel G,Rochester L,et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: The RESCUE trialJournal of Neurology, Neurosurgery and PsychiatryYear: 2007782134140
12. Brownson RC,Jones E. Bridging the gap: translating research into policy and practicePreventive MedicineYear: 200949431331519555708
13. Haynes B,Haines A. Getting research findings into practice. Barriers and bridges to evidence based clinical practiceBritish Medical JournalYear: 199831771532732769677226
14. Herbert R,Jamtvedt G,Mead J,Birger Hagen K. Practical Evidence-Based PhysiotherapyYear: 2005Edinburgh, UKElsevier
15. Cyarto EV,Brown WJ,Marshall AL. Retention, adherence and compliance: important considerations for home- and group-based resistance training programs for older adultsJournal of Science and Medicine in SportYear: 20069540241216911871
16. Quinn L,Busse M,Khalil H,Richardson S,Rosser A,Morris H. Client and therapist views on exercise programmes for early-mid stage Parkinson’s disease and Huntington’s diseaseDisability and RehabilitationYear: 2010321191792819874213
17. Sheldon TA,Guyatt GH,Haines A. Getting research findings into practice. When to act on the evidenceBritish Medical JournalYear: 199831771511391429657797
18. Crizzle AM,Newhouse IJ. Is physical exercise beneficial for persons with Parkinson’s disease?Clinical Journal of Sport MedicineYear: 200616542242517016120
19. Deane KH,Jones D,Ellis-Hill C,Clarke CE,Playford ED,Ben-Shlomo Y. A comparison of physiotherapy techniques for patients with Parkinson’s diseaseCochrane Database of Systematic ReviewsYear: 20011 Article ID CD002815..
20. Deane K,Jones D,Playford E,Ben-Shlomo Y,Clarke C. Physiotherapy versus placebo or no intervention in Parkinson's diseaseCochrane Database of Systematic ReviewsYear: 20013 Article ID CD002817..
21. Deane KHO,Ellis-Hill C,Jones D,et al. Systematic review of paramedical therapies for Parkinson’s diseaseMovement DisordersYear: 200217598499112360547
22. Gage H,Storey L. Rehabilitation for Parkinson’s disease: a systematic review of available evidenceClinical RehabilitationYear: 200418546348215293481
23. Jöbges M,Spittler-Schneiders H,Renner CIE,Hummelsheim H. Clinical relevance of rehabilitation programs for Parkinson’s disease. I: non-symptom-specific therapeutic approachesParkinsonism and Related DisordersYear: 200713419520217055765
24. Jöbges EM,Spittler-Schneiders H,Renner CIE,Hummelsheim H. Clinical relevance of rehabilitation programs for patients with idiopathic Parkinson syndrome. II: symptom-specific therapeutic approachesParkinsonism and Related DisordersYear: 200713420321317055766
25. Keus SHJ,Bloem BR,Hendriks EJM,Bredero-Cohen AB,Munneke M. Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and researchMovement DisordersYear: 200722445146017133526
26. Kwakkel G,de Goede CJT,van Wegen EEH. Impact of physical therapy for Parkinson’s disease: a critical review of the literatureParkinsonism and Related DisordersYear: 200713supplement 3S478S48718267287
27. Lim I,van Wegen E,de Goede C,et al. Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic reviewClinical RehabilitationYear: 200519769571316250189
28. Nieuwboer A. Cueing for freezing of gait in patients with Parkinson’s disease: a rehabilitation perspectiveMovement DisordersYear: 200823supplement 2S475S48118668619
29. Rubinstein TC,Giladi N,Hausdorff JM. The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson’s diseaseMovement DisordersYear: 20021761148116012465051
30. Suchowersky O,Gronseth G,Perlmutter J,Reich S,Zesiewicz T,Weiner WJ. Practice parameter: Neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review)NeurologyYear: 200666797698216606908
31. Higgins JPT,Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0Year: 2009The Cochrane Collaboration
32. Liberati A,Altman DG,Tetzlaff J,et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaborationJournal of Clinical EpidemiologyYear: 20096210e1e3419631507
33. Bergen JL,Toole T,Elliott RG Jr.,Wallace B,Robinson K,Maitland CG. Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patientsNeuroRehabilitationYear: 200217216116812082243
34. Blackinton M,Summerall L,Waguespack K. Tertiary prevention in Parkinson disease: results from a preliminary studyNeurology ReportYear: 2002263160165
35. Bloomer RJ,Schilling BK,Karlage RE,Ledoux MS,Pfeiffer RF,Callegari J. Effect of resistance training on blood oxidative stress in Parkinson diseaseMedicine and Science in Sports and ExerciseYear: 20084081385138918614956
36. Braun S,Beurskens A,Kleynen M,Schols J,Wade D. Rehabilitation with mental practice has similar effects on mobility as rehabilitation with relaxation in people with Parkinson's disease: a multicentre randomised trialJournal of PhysiotherapyYear: 2011571273421402327
37. Bridgewater KJ,Sharpe MH. Aerobic exercise and early parkinson's diseaseNeurorehabilitation and Neural RepairYear: 1996104233241
38. Bridgewater KJ,Sharpe MH. Trunk muscle training and early Parkinson’s diseasePhysiotherapy Theory and PracticeYear: 1997132139153
39. Burini D,Farabollini B,Iacucci S,et al. A randomised controlled cross-over trial of aerobic training versus Qigong in advanced Parkinson’s diseaseEuropa MedicophysicaYear: 200642323123817039221
40. Caglar AT,Gurses HN,Mutluay FK,Kiziltan G. Effects of home exercises on motor performance in patients with Parkinson’s diseaseClinical RehabilitationYear: 200519887087716323386
41. Cakit BD,Saracoglu M,Genc H,Erdem HR,Inan L. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson’s diseaseClinical RehabilitationYear: 200721869870517846069
42. Comella CL,Stebbins GT,Brown-Toms N,Goetz CG. Physical therapy and Parkinson’s disease: a controlled clinical trialNeurologyYear: 1994443, part 13763788145901
43. de Bruin N,Doan JB,Turnbull G,et al. Walking with music is a safe and viable tool for gait training in parkinson’s disease: the effect of a 13-week feasibility study on single and dual task walkingParkinson’s DiseaseYear: 201020109 pages Article ID 483530..
44. de Goede CJT,Ellis T,Wagenaar RC. Effecten van een fysiotherapie-groepsbehandeling Parkinson-patienten: een cross-over trialNederlands Tijdschrift voor FysiotherapieYear: 200411437882
45. Dereli EE,Yaliman A. Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson's diseaseClinical RehabilitationYear: 201024435236220360152
46. Dias N,Fraga D,Cacho E,Oberg T. Training of gait with visual cues in the patient with Parkinson’s diseaseFisioterapia em MovimentoYear: 20051844351
47. Ellis T,de Goede CJ,Feldman RG,Wolters EC,Kwakkel G,Wagenaar RC. Efficacy of a physical therapy program in patients with Parkinson’s disease: a randomized controlled trialArchives of Physical Medicine and RehabilitationYear: 200586462663215827910
48. Fisher BE,Wu AD,Salem GJ,et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's diseaseArchives of Physical Medicine and RehabilitationYear: 20088971221122918534554
49. Frazzitta G,Maestri R,Uccellini D,Bertotti G,Abelli P. Rehabilitation treatment of gait in patients with Parkinson’s disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill trainingMovement DisordersYear: 20092481139114319370729
50. Guo L,Jiang Y,Yatsuya H,Yoshida Y,Sakamoto J. Group education with personal rehabilitation for idiopathic Parkinson’s diseaseCanadian Journal of Neurological SciencesYear: 2009361515919294889
51. Hackney ME,Earhart GM. Tai Chi improves balance and mobility in people with Parkinson diseaseGait and PostureYear: 200828345646018378456
52. Hackney ME,Earhart GM. Effects of dance on movement control in Parkinson’s disease: a comparison of Argentine tango and American ballroomJournal of Rehabilitation MedicineYear: 200941647548119479161
53. Hackney ME,Earhart GM. Effects of dance on gait and balance in Parkinsons disease: a comparison of partnered and nonpartnered dance movementNeurorehabilitation and Neural RepairYear: 201024438439220008820
54. Hackney ME,Earhart GM. Health-related quality of life and alternative forms of exercise in Parkinson diseaseParkinsonism and Related DisordersYear: 200915964464819329350
55. Hackney ME,Kantorovich S,Levin R,Earhart GM. Effects of tango on functional mobility in Parkinson’s disease: a preliminary studyJournal of Neurologic Physical TherapyYear: 200731417317918172414
56. Hass CJ,Collins MA,Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trialNeurorehabilitation and Neural RepairYear: 200721210711517312085
57. Hirsch MA,Toole T,Maitland CG,Rider RA. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s diseaseArchives of Physical Medicine and RehabilitationYear: 20038481109111712917847
58. Keus SHJ,Bloem BR,van Hilten JJ,Ashburn A,Munneke M. Effectiveness of physiotherapy in Parkinson’s disease: the feasibility of a randomised controlled trialParkinsonism and Related DisordersYear: 200713211512117055767
59. Kurtais Y,Kutlay S,Tur BS,Gok H,Akbostanci C. Does treadmill training improve lower-extremity tasks in Parkinson disease? A randomized controlled trialClinical Journal of Sport MedicineYear: 200818328929118469574
60. Lehman DA,Toole T,Lofald D,Hirsch MA. Training with verbal instructional cues results in near-term improvement of gait in people with Parkinson diseaseJournal of Neurologic Physical TherapyYear: 20052912816386155
61. Lim I,van Wegen E,Jones D,et al. Does cueing training improve physical activity in patients with parkinson’s disease?Neurorehabilitation and Neural RepairYear: 201024546947720179328
62. Mak MKY,Hui-Chan CWY. Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson’s disease: a randomized controlled trialMovement DisordersYear: 200823450150918074365
63. Marchese R,Diverio M,Zucchi F,Lentino C,Abbruzzese G. The role of sensory cues in the rehabilitation of Parkinsonian patients: a comparison of two physical therapy protocolsMovement DisordersYear: 200015587988311009194
64. Miyai I,Fujimoto Y,Ueda Y,et al. Treadmill training with body weight support: its effect on Parkinson’s diseaseArchives of Physical Medicine and RehabilitationYear: 200081784985210895994
65. Miyai I,Fujimoto Y,Yamamoto H,et al. Long-term effect of body weight-supported treadmill training in Parkinson’s disease: a randomized controlled trialArchives of Physical Medicine and RehabilitationYear: 200283101370137312370870
66. Müller V,Mohr B,Rosin R,Pulvermüller F,Müller F,Birbaumer N. Short-term effects of behavioral treatment on movement initiation and postural control in Parkinson's disease: a controlled clinical studyMovement DisordersYear: 19971233063149159724
67. Pacchetti C,Mancini F,Aglieri R,Fundaró C,Martignoni E,Nappi G. Active music therapy in Parkinson’s disease: an integrative method for motor and emotional rehabilitationPsychosomatic MedicineYear: 200062338639310845352
68. Palmer SS,Mortimer JA,Webster DD,Bistevins R,Dickinson GL. Exercise therapy for Parkinson’s diseaseArchives of Physical Medicine and RehabilitationYear: 198667107417453767624
69. Pelosin E,Avanzino L,Bove M,Stramesi P,Nieuwboer A,Abbruzzese G. Action observation improves freezing of gait in patients with Parkinson’s diseaseNeurorehabilitation and Neural RepairYear: 201024874675220453155
70. Protas EJ,Mitchell K,Williams A,Qureshy H,Caroline K,Lai EC. Gait and step training to reduce falls in Parkinson’s diseaseNeuroRehabilitationYear: 200520318319016340099
71. Qutubuddin AA,Cifu DX,Armistead-Jehle P,Carne W,McGuirk TE,Baron MS. A comparison of computerized dynamic posturography therapy to standard balance physical therapy in individuals with Parkinson’s disease: a pilot studyNeuroRehabilitationYear: 200722426126517971615
72. Ridgel AL,Vitek JL,Alberts JL. Forced, not voluntary, exercise improves motor function in Parkinson’s disease patientsNeurorehabilitation and Neural RepairYear: 200923660060819131578
73. Rochester L,Baker K,Hetherington V,et al. Evidence for motor learning in Parkinson’s disease: acquisition, automaticity and retention of cued gait performance after training with external rhythmical cuesBrain ResearchYear: 2010131910311120064492
74. Sage MD,Almeida QJ. Symptom and gait changes after sensory attention focused exercise vs aerobic training in Parkinson’s diseaseMovement DisordersYear: 20092481132113819373930
75. Sage MD,Almeida QJ. A positive influence of vision on motor symptoms during sensory attention focused exercise for Parkinson’s diseaseMovement DisordersYear: 2010251646919938164
76. Schenkman M,Cutson TM,Kuchibhatla M,et al. Exercise to improve spinal flexibility and function for people with Parkinson’s disease: a randomized, controlled trialJournal of the American Geriatrics SocietyYear: 19984610120712169777901
77. Schmitz-Hübsch T,Pyfer D,Kielwein K,Fimmers R,Klockgether T,Wüllner U. Qigong exercise for the symptoms of Parkinson’s disease: a randomized, controlled pilot studyMovement DisordersYear: 200621454354816229022
78. Smania N,Corato E,Tinazzi M,et al. Effect of balance training on postural instability in patients with idiopathic parkinsong’s diseaseNeurorehabilitation and Neural RepairYear: 201024982683421045119
79. Stallibrass C,Sissons P,Chalmers C. Randomized controlled trial of the Alexander Technique for idiopathic Parkinson’s diseaseClinical RehabilitationYear: 200216769570812428818
80. Tamir R,Dickstein R,Huberman M. Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson’s diseaseNeurorehabilitation and Neural RepairYear: 2007211687517172556
81. Thaut MH,McIntosh GC,Rice RR,Miller RA,Rathbun J,Brault JM. Rhythmic auditory stimulation in gait training for Parkinson’s disease patientsMovement DisordersYear: 19961121932008684391
82. Toole T,Hirsch MA,Forkink A,Lehman DA,Maitland CG. The effects of a balance and strength training program on equilibrium in Parkinsonism: a preliminary studyNeuroRehabilitationYear: 200014316517411455079
83. Toole T,Maitland CG,Warren E,Hubmann MF,Panton L. The effects of loading and unloading treadmill walking on balance, gait, fall risk, and daily function in ParkinsonismNeuroRehabilitationYear: 200520430732216403997
84. Yang YR,Lee YY,Cheng SJ,Wang RY. Downhill walking training in individuals with parkinson’s disease: a randomized controlled trialAmerican Journal of Physical Medicine and RehabilitationYear: 201089970671420581650
85. Yousefi B,Tadibi V,Khoei AF,Montazeri A. Exercise therapy, quality of life, and activities of daily living in patients with Parkinson disease: a small scale quasi-randomised trialTrialsYear: 200910, article 67
86. Hoehn MM,Yahr MD. Parkinsonism: onset, progression and mortalityNeurologyYear: 19671754274426067254
87. Folstein MF,Folstein SE,McHugh PR. ’Mini mental state’. A practical method for grading the cognitive state of patients for the clinicianJournal of Psychiatric ResearchYear: 19751231891981202204
88. Oehlert ME,Hass SD,Freeman MR,Williams MD,Ryan JJ,Sumerall SW. The neurobehavioral cognitive status examination: accuracy of the ’Screen-Metric’ approach in a clinical sampleJournal of Clinical PsychologyYear: 19975377337379356903
89. Hely MA,Reid WGJ,Adena MA,Halliday GM,Morris JGL. The Sydney Multicenter Study of Parkinson’s disease: the inevitability of dementia at 20 yearsMovement DisordersYear: 200823683784418307261
90. Guyatt G,Cook D,Haynes B. Evidence based medicine has come a long wayBritish Medical JournalYear: 2004329747399099115514320
91. Morris ME,Martin CL,Schenkman ML. Striding out with Parkinson disease: evidence-based physical therapy for gait disordersPhysical TherapyYear: 201090228028820022998
92. Ashworth NL,Chad KE,Harrison EL,Reeder BA,Marshall SC. Home versus center based physical activity programs in older adultsCochrane Database of Systematic ReviewsYear: 20051 Article ID CD004017..
93. Schenkman M,Hall D,Kumar R,Kohrt WM. Endurance exercise training to improve economy of movement of people with Parkinson disease: three case reportsPhysical TherapyYear: 2008881637617940108
94. van Nimwegen M,Speelman AD,Smulders K,et al. Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patientsBMC NeurologyYear: 201010, article 70
95. Liu CJ,Latham NK. Progressive resistance strength training for improving physical function in older adultsCochrane Database of Systematic ReviewsYear: 20093 Article ID CD002759..
96. Wade DT,Smeets RJEM,Verbunt JA. Research in rehabilitation medicine: methodological challengesJournal of Clinical EpidemiologyYear: 201063769970419788953

Article Categories:
  • Review Article

Previous Document:  Feasibility, safety, and compliance in a randomized controlled trial of physical therapy for Parkins...
Next Document:  Community walking in people with Parkinson's disease.