Aerobic exercise to improve cardiopulmonary function in Parkinson's: a systematic review

Purpose

Cardiopulmonary impairments are considered to be the main cause of mortality in the late stages of Parkinson’s. Aerobic exercise has been shown to improve pulmonary function in asthmatic patients and in healthy people. However, the effects of aerobic exercise on cardiopulmonary function in people with Parkinson’s have not been investigated. Therefore, this study aimed to review the effects of aerobic exercise on cardiopulmonary function in people with Parkinson’s and highlight pulmonary disease as a potential long-term non-motor symptom of Parkinson's.

Approach

A systematic search was conducted using MEDLINE, AMED, and CINAHL Plus, and relevant associated keywords, from January 1970 to January 2020. Inclusion criteria for the studies were: Parkinson's disease; aerobic exercise as part of the intervention; pulmonary function test and/or cardiopulmonary exercise test as outcome measures. Two reviewers independently screened for inclusion of studies. Data were extracted and a narrative synthesis was undertaken due to the heterogeneity of interventions and outcome measures.

Outcomes

Results: In total, 329 citations were identified from the search, of which nine randomised controlled trials were included in this review. In general, aerobic exercise was found to have positive effects on cardiac function for people with Parkinson’s, but there was inconsistency in terms of the type and dose of intervention, and the outcome measures used. Furthermore, the review identified a lack of studies on the effects of aerobic exercise on pulmonary function in Parkinson's.

Conclusion(s): Cardiopulmonary disease is a potential long-term complication and non-motor symptom that causes morbidity and mortality in the later stages of Parkinson's. People with early stages of Parkinson’s may experience positive effects of aerobic exercise on cardiac fitness. However, further research is needed, particularly into the effects of aerobic exercise on pulmonary function in early stages of the disease, and the potential for regular self-managed aerobic exercise programmes to limit secondary pulmonary complications in the later stages of the disease.

Cost and savings

The project costs were approximately £10,000, to cover trial registration, equipment, and participant travel costs.

Implications

The findings of this review underpin the rationale for a subsequent empirical feasibility and pilot study exploring the effects of a self-managed aerobic exercise programme on cardio-respiratory function in people with Parkinson's: the EXOCARP trial (ISRCTN14167992). The findings of that feasibility study will inform a subsequent larger trial of aerobic exercise to improve cardiorespiratory function for people with Parkinson's. The findings from the EXOCARP trial will also provide some provisional data on the prevalence of obstructive and restrictive patterns of respiratory disease in Parkinson's, and raise awareness of this under-explored aspect of the non-motor symptoms of Parkinson's, potentially impacting on rehabilitation approaches to Parkinson's and on self-management of the non-motor symptoms to prevent or limit secondary complications.

Top three learning points

No further information. 

Funding acknowledgements

This study has been funded as part of a PhD studentship from Isra University, Jordan.