The Effect of Exercise on Reducing Fatigue in Patients with Parkinson’s Disease: A Systematic Review

Abstract

Purpose/Hypothesis: Parkinson’s disease (PD) is a progressive neurodegenerative disease characterized by both motor and non-motor symptoms. Fatigue is one of the most common and disabling non-motor symptoms experienced by patients. Not only does fatigue negatively affect patients’ quality of life but also hinders their participation and compliance in rehabilitation. However, effective treatment of PD-fatigue is lacking. Evidence is mounting for beneficial effects of exercise for a variety of symptoms in patients with PD. The objective of this systematic review study was to evaluate the effect of exercise and physical therapy on reducing fatigue in PD. Materials and Methods: Databases including MEDLINE, PubMed, CINAHL Complete, and EMBASE were systematically searched. Eligibility criteria were that studies had: (1) enrolled patients with idiopathic PD, (2) administered exercise program as treatment for PD-fatigue, (3) compared the exercise intervention with usual care or conventional exercise, (4) measured fatigue, (5) used a design of randomized controlled trial, and (6) scored at least 4 out of 10 on Physiotherapy Evidence Database (PEDro) scale. Results: Twelve articles (N = 422) were included in this review, and all scored in the range from 4/10 to 8/10 with a mean of 6.3 (1.2) on the PEDro scale, indicating a fair to strong methodologic quality of the trials. Eight of the 12 studies showed significant improvements in fatigue scores (p < 0.05 to p < 0.000) in favor of intervention including but not limited to aerobic exercise, treadmill training, Nordic walking, exergaming, and home-based training program, as compared to controls. Discussion and Conclusions: Exercise and physical therapy are shown to be largely effective in reducing fatigue in patients with PD. Future studies using adequate sample sizes are needed to examine the optimal frequency, duration, and intensity of exercise to produce the most beneficial outcomes. Patients with PD may likely benefit from an integrated regimen of both PD-medication and physical therapy program. Clinical management of PD that will address both motor and non-motor symptoms is needed to maximize quality of life in people living with PD.