Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson's disease: a network meta-analysis.

OBJECTIVE: To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson's disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG). DESIGN: Network meta-analysis. METHODS: The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise. RESULTS: Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (-0.54; 95% CI -0.82, -0.26), balance (-0.42; 95% CI -0.75, -0.08), resistance (-0.60; 95% CI -0.89, -0.31), and sensorimotor training including endurance interventions (-0.61; 95% CI -0.95, -0.27) vs control comparisons. CONCLUSION: Balance interventions improve balance, postural stability, and general mobility in people with Parkinson's disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.

Effects of exercise interventions to reduce chemotherapy-induced peripheral neuropathy severity: A meta-analysis.

OBJECTIVES: The two aims of this systematic review and meta-analysis were to (1) analyze the effect of exercise on chemotherapy-induced peripheral neuropathy (CIPN) severity and (2) determine the best type of exercise for the management of CIPN. METHODS: We systematically searched the MEDLINE, WOS, Sportdiscus, Scopus, and Cochrane databases from inception to December 2020 for experimental studies addressing the effect of exercise on CIPN severity, as measured by symptom severity (SSS) and peripheral deep sensitivity (PDS). The DerSimonian and Laird method was used to compute pooled estimates of the standardized mean differences (SMDs) and its respective 95% confidence intervals (CIs). Subgroup analyses were performed based on the types of exercise and the frequency and length of the interventions. RESULTS: Thirteen studies were included in this meta-analysis. In the analyses comparing exercise interventions versus controls, there was an improvement in the SSS (SMD = -0.21; 95% CI: -0.40 to -0.01; %change: -20.34%) and the PDS (SMD = 0.49; 95% CI: 0.06 to 0.91; %change: 31.64%) in favor of the intervention group. In the pre-post analyses, there was an improvement in the SSS (SMD = -0.72; 95% CI: -1.10 to -0.34; %change: -15.65%) and the PDS (SMD = 0.47; 95% CI: 0.15 to 0.79; %change:18.98%). CONCLUSIONS: This meta-analysis provides an overview of the evidence supporting exercise as a suitable intervention to reduce the severity of CIPN by reducing the severity of the symptoms and the peripheral deep sensitivity among patients with cancer or cancer survivors. Furthermore, sensoriomotor training and mind-body exercises appear to be more effective in reducing symptom severity, and active nerve-specific exercises and mind-body exercises seem to be more effective in improving peripheral deep sensitivity.

Physical Exercise Interventions on Quality of Life in Parkinson Disease: A Network Meta-analysis.

BACKGROUND AND PURPOSE: Physical exercise is considered an effective intervention for maintaining or improving quality of life (QoL) in patients with Parkinson disease (PD), but there is no evidence showing which type of physical exercise intervention has more positive effects. This systematic review and meta-analysis aimed to synthesize the evidence regarding the effectiveness of exercise interventions on improving QoL in patients with PD, comparing different types of exercise interventions. METHODS: A literature search was conducted through January 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool RoB2. For the meta-analysis, physical exercise interventions were classified into 5 training categories: resistance, endurance, alternative exercises, dance, and sensorimotor interventions. A standard meta-analysis and network meta-analysis were carried out to evaluate the efficacy of the different types of physical exercise interventions. RESULTS: The search retrieved 2451 studies, 48 of which were included in this network meta-analysis with a total of 2977 patients with PD. The indirect effects of the network meta-analysis showed positive results for alternative exercises (-0.46; 95% confidence interval [CI]: -0.76, -0.16), dance (-0.63; 95% CI: -1.08, -0.17), and sensorimotor interventions (-0.23; 95% CI: -0.40, -0.07) versus control comparisons. DISCUSSION AND CONCLUSIONS: More research is needed to determine the types of physical exercise interventions that are most beneficial and for which conditions of the disease they have the most positive effects.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A398 ).

Comparative Effectiveness of Manual Therapy Interventions on Pain and Pressure Pain Threshold in Patients With Myofascial Trigger Points: A Network Meta-analysis.

OBJECTIVES: Myofascial trigger points (MTPs) are one of the most important causes of musculoskeletal pain. Evidence has suggested a positive effect of manual therapy in the treatment of MTPs. However, a comprehensive review comparing the effect of different manual therapy techniques are lacking. Thus, we conducted a network meta-analysis of randomized controlled trials to determine the type of manual therapy technique that has the greatest positive influence in patients with MTPs. MATERIALS AND METHODS: PubMed, Web of Science, Cochrane Library, and Scopus databases were searched to identify direct and indirect evidence comparing the effectiveness of different types of manual therapy interventions on pain intensity and pressure pain threshold (PPT) in patients with MTPs. Risk of bias was assessed using the Cochrane RoB2 tool. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out. RESULTS: A total of 37 studies were eligible for analysis. Combined interventions had the highest effect size for pain (-1.40; 95% CI, -2.34, -0.47), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (64.7% and 87.9%, respectively). Afferent reduction techniques, understood as the interventions aimed to restore muscle spindles helping to dictate sarcomere length and tone in MTPs, had the highest effect size for PPT (0.93; 95% CI, 0.47, 1.39), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (34.7% and 71.2%, respectively). The results were consistent in sensitivity analyses, with minimal inconsistencies between direct and indirect results. DISCUSSION: Manual therapy interventions should be considered an effective strategy for pain and PPT in patients with MTPs. The results suggest that among the different manual therapy modalities, combined and afferent reduction techniques are the most effective for pain and PPT, respectively.

Efficacy of Different Types of Physical Activity Interventions on Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Network Meta-Analysis.

AIM: A network meta-analysis (NMA) was performed to determine the effects on the exercise capacity, measured by the 6 MWT, of patients with COPD of (i) different physical activity interventions and (ii) supervised or unsupervised programs. METHODS: A literature search was carried out from inception to April 2022. Randomized controlled trials of the effectiveness of physical activity on exercise capacity in patients with COPD were included. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and the Grading of Recommendations, Assessment, Development, and Evaluation tool (GRADE) was used to assess the quality of the evidence. A pairwise meta-analysis for direct and indirect effects was carried out. RESULTS: A total of 41 studies were included in this NMA. The highest effects were for urban training pulmonary rehabilitation (PR) programs (ES, 1.50; 95% CI: 0.46 and 2.55) versus the control group. For supervised and unsupervised PR and home-based PR programs, the highest effects were found for supervised PR (ES, 0.85; 95% CI: 0.46 to 1.23) versus the control group. CONCLUSIONS: PR implemented with urban circuit training should be considered the most effective strategy to improve exercise capacity in patients with COPD. Supervision of the programs improves exercise capacity.

Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses.

OBJECTIVE: To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD). DATA SOURCES: A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD. DATA EXTRACTION: The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS). DATA SYNTHESIS: Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I2=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I2=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I2=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I2=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I2=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I2=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I2=51.8%, P=.042). CONCLUSIONS: Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.