Effects of mind–body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis

Highlights

• Mind–body exercises are feasible, safe, and acceptable complementary and alternative therapies for individuals with PD.

• Mind–body exercises demonstrate immediate beneficial effects in motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD.

• Evidence quantifying the positive effects of mind–body exercises in improving psychosocial well-being and quality of life for people with PD is inconclusive.

• Mind–body exercises demonstrate immediate beneficial effects in motor symptoms, gait and balance among individuals with mild to moderate PD.

Abstract

Objectives

The effects of mind–body exercises on individuals with chronic illnesses have attracted increasing attention. However, little effort had been made to systematically review the effects of these mind–body exercises on individuals with Parkinson’s disease (PD). This review aimed to appraise the current evidence of the effects of mind–body exercises on the physiological and psychological outcomes for the PD population.

Design

Systematic review and meta-analysis of randomized controlled trials.

Data sources

Four English databases, namely, the EMBASE, Ovid Medline, Psych Info, and Cochrane Library, were searched on January 2016.

Review methods

Studies involving participants with idiopathic PD were included if mind–body exercises were applied and compared with a non-exercise control to improve physiological and psychosocial well-being. The Effective Public Health Practice Project quality assessment tool was used for quality appraisal. RevMan 5.3 was employed to perform this meta-analysis. A subgroup analysis regarding the types and the dose of intervention was conducted to explore the sources of heterogeneity.

Results

Ten studies met the inclusion criteria for quality appraisal. The overall methodological rating of these studies indicated that one study was strong; five studies were moderate; and four studies were weak. Nine articles comprising five Tai Chi, two yoga, and two dance studies were included in the meta-analysis. The results of this review showed that mind–body exercises had a large, significant beneficial effect in motor symptoms in terms of UPDRS III for people with mild to moderate PD [SMD = −0.91, 95% CI (−1.37, −0.45), p < 0.05]. Significant subgroup differences were found among various types of mind–body exercises (p = 0.001). Yoga demonstrated the largest and most significant beneficial effect in reducing UPDRS III scores [SMD = −2.35, 95% CI (−3.21, −1.50), p < 0.01]. The pooled meta-analysis results showed that mind–body exercises had a large, significant effect in improving postural instability in terms of the Berg Balance Scale [SMD = 1.48, 95% CI (0.91, 2.06), p < 0.01] and Timed Up and Go test [SMD = −0.97, 95% CI (−1.46, −0.47), p < 0.01] and moderate, significant effect in improving functional mobility in terms of the Six-minute Walk test [SMD = 0.78, 95% CI (0.35, 1.21), p < 0.05].

Conclusions

This review found that mind–body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind–body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention. Future research should address the psychosocial effects of mind–body exercises on the PD population.

Introduction

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases affecting 1–2% of the population over the age of 65 years. With the increasing life expectancy and aging population, the estimated prevalence of PD is projected to double by 2050.¹ PD neuropathology has been established more than four decades ago. However, PD remains idiopathic and incurable, thereby contributing to tremendous health and socio-economic burden.²

PD is characterized by a four cardinal motor features, including rest tremor, stiffness, bradykinesia, and postural instability. As the disease progresses, patients encounter substantial motor impairment, which results in gait dysfunction, postural instability, reduced physical functioning, and difficulties in daily living.³ PD is also associated with non-motor symptoms, including psychological problems, cognitive impairment, and sleep disturbances.4, 5 Anxiety and depressive symptoms are common and result from frustration over the loss of body control and capacity to independently perform activities of daily living coupled with diminished feelings of mastery and expression.6, 7 The stress resulting from ineffective coping and uncertainty about life remain as major challenges for individuals with PD.8, 9, 10, 11 These impairments in physical, cognitive, and functional capacities prominently increase the need for assistance and cost of care for the PD population.

The National Institutes of Health has stated that mind–body intervention focuses on interactions among the mind, body, and behavior.¹² The interactions of emotional, mental, social, spiritual, and behavior factors are believed to directly affect our health. Mind–body interventions increase self-consciousness of the body, thereby increasing the energy, mental clarity, concentration, and ability of an individual to tolerate physical discomfort.¹³ Mind–body interventions could further be categorized into relaxation-, concentration-, or movement-based.¹⁴ Relaxation-based mind–body interventions usually require repetitive training of relaxation techniques, in which a physiological response is generated. This physiological response enhances body awareness and resilience to stress. Common examples include progressive muscle relaxation and biofeedback training. In concentration-based mind–body interventions, a high level of attentiveness is required to draw the mind to certain thoughts or imagery with minimal movement. Common examples include mindfulness, meditation, guided imagery, and hypnosis. Meanwhile, movement-based mind–body interventions comprise low-impact exercises, which enhance mind–body coordination and awareness through the practice of a sequence of controlled motions and focused attention.

A recent systematic review of non-pharmacological PD treatment has revealed that movement-based mind–body interventions, namely mind–body exercises, have been widely adopted by the PD population as a complementary and alternative therapy.¹⁵ The effects of mind–body exercises on disease management and promoting quality of life (QoL) have been demonstrated among individuals with various chronic illnesses, including depression, stress and anxiety, acute and chronic pain, cardiovascular disease, and hypertension.16, 17, 18, 19 Physical exercise is recommended for people with PD to help them maintain balance and functional mobility and improve their sense of well-being regardless of disease stage and severity.²⁰ However, the effects of mind–body exercises for the physiological and psychosocial well-being of patients with PD have not been adequately reviewed and remain inconclusive.

Although increasing attention has been paid to study the effects of mind–body exercises on individuals with chronic illnesses, little effort has been made to systematically review the effects of mind–body exercises on the PD population. Therefore, this review aims to appraise the current evidence of the effects of mind–body exercises on the physiological and psychological outcomes for the PD population. The findings of this review will help identify aspects for future research.