Physical Exercise for Treating the Anxiety and Depression Symptoms of Parkinson's Disease: Systematic Review and Meta-Analysis.

BACKGROUND: Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD. METHODS: Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate. RESULTS: Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety. CONCLUSION: Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.

The cerebellum and its connections to other brain structures involved in motor and non-motor functions: A comprehensive review.

The cerebellum has a large network of neurons that communicate with several brain structures and participate in different functions. Recent studies have demonstrated that the cerebellum is not only associated with motor functions but also participates in several non-motor functions. It is suggested that the cerebellum can modulate behavior through many connections with different nervous system structures in motor, sensory, cognitive, autonomic, and emotional processes. Recently, a growing number of clinical and experimental studies support this theory and provide further evidence. In light of recent findings, a comprehensive review is needed to summarize the knowledge on the influence of the cerebellum on the processing of different functions. Therefore, the aim of this review was to describe the neuroanatomical aspects of the activation of the cerebellum and its connections with other structures of the central nervous system in different behaviors.

Neuronal activation of cerebellum functional circuits in motor and non-motor functions in mice.

The cerebellum is involved in the control of balance, movement and the acquisition of motor skills. Scientific and technological advances have shown that the cerebellum also participates in non-motor functions, such as emotional control, memory and language. However, which cerebellar areas and functional circuits are predominantly activated in these different functions is not known. The current study analyzed the neuronal activation of cerebellar areas and other brain structures (e.g., hippocampus, amygdala, prelimbic cortex and infralimbic cortex) after exposure to rotarod and inhibitory avoidance behavioral models to establish possible neuronal circuits for motor and non-motor functions. Naïve male Swiss albino mice weighing 25 to 35 g were used. The animals were subjected to three conditions for behavioral evaluation: inhibitory avoidance, which is a model used to infer emotional memory; rotarod, which assesses motor performance and motor learning; and housing box/control. The mice remained in their housing box in Condition 1. Mice in Condition 2 were exposed to the inhibitory avoidance box for 2 days, and mice in Condition 3 were exposed to the rotarod for 3 days. The animals were euthanized after the last exposure to the apparatus then perfused with paraformaldehyde. Brains were extracted and sectioned for immunofluorescence analysis of c-Fos protein in pre-established structures. Images of the brain structures were obtained, and neuronal activation was analyzed microscopically. One-way analysis of variance was used, followed by Tukey's post-hoc test. There was no significant difference in c-Fos expression in lobe VI of the cerebellum between the different conditions. Differences in c-Fos expression were observed in the basolateral amygdala, infralimbic cortex and prelimbic cortex, which are relevant to emotional processes, after exposure to the evaluation apparatuses. Pearson's r correlation coefficient test showed a positive correlation between the variables of structures related to emotional processes. We concluded that there was no significant difference in c-Fos expression in lobe VI of the cerebellum after exposure of the animals to the evaluation apparatus. However, there was a difference in c-Fos expression in other brain structures related to emotional processes after exposure of animals to the apparatus.