Effectiveness of exercise-based rehabilitation for the treatment of axial rigidity in people with Parkinson’s disease: A Scoping Review

Abstract

Background: Axial rigidity is a common symptom in people with Parkinson’s disease (PD) and is believed to contribute towards mobility problems and leads to an increased risk of falling. To date, effective treatment interventions to improve axial rigidity in PD have yet to be confirmed. Therefore, the aim of this scoping review was to identify and summarize the findings of exercise-based rehabilitation that have been successfully used to reduce axial rigidity in people with PD.

Methods and analysis: Fourteen studies from the following databases were identified systematically: Cochrane Library, PEDro, Scopus, Web of Science and PubMed. Articles comparing the effects of exercise-based treatment as an experimental intervention with a non-physiotherapy intervention as the control were described using the synthesis method.

Results: Four out of fourteen studies eligible for inclusion focussed explicitly on exercise-based treatment for axial rigidity in people with PD. Two studies suggested beneficial results of exercise in improving axial rigidity as evidenced by: improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS), axial rotation range, spinal flexibility and motion of the neck and trunk. Three further studies provided evidence for improvement of functional problems related to axial rigidity.

Conclusion: The information about exercise-based rehabilitation for axial rigidity in people with PD is very limited. This review suggests that interventions aimed at reducing axial rigidity yield positive outcomes on functional performance i.e. improve trunk mobility, turning, balance and gait patterns, as well as reducing the risk of falls in people with PD. However, the association between axial rigidity and performance following specific exercise treatments has not been explored. Furthermore, there is still a lack of evidence for the effectiveness of specific home-based exercise programmes on alleviating axial rigidity in people with PD. Therefore, there is a need for well-designed large-scale studies to elucidate these questions.

Keywords:

• Functional performance
• trunk mobility
• the unified Parkinson’s disease rating scale
• exercise

Acknowledgement

The authors would like to thank Professor Jim Richards, School of Sport and Health Sciences University of Central Lancashire, UK for suggesting, proofreading, gramma checking, and editing throughout the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Fuengfa Khobkhun

Fuengfa Khobkhun, Ph.D. The lecturer of Faculty of Physical Therapy, Mahidol University. Research goals are about analysis of movement and physiotherapy in movement disorders, especially in Parkinson's disease and stroke.

Kristen Hollands

Kristen Hollands, Ph.D. Senior Research Fellow of Centre for Health Sciences Research, University of Salford, Manchester, UK. Research goals are to translate a better understanding of the underlying principles of the control of walking to its rehabilitation. My work spans basic laboratory based experiments (to identify impairments in walking and their putative mechanisms), systematic reviews (to examine the current statue-of-the-art in clinical evidence bases for neurorehabilitation) and randomised control trial methodologies (to test the effectiveness of new rehabilitation treatment paradigms targeted at the cause of impairments and to stimulate neuro-plasticity and functional recovery).

Mark Hollands

Prof. Mark Hollands, Ph.D. Professor of Movement Neuroscience and Assistant Head of Research Institute, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University. UK. Research goals are: first, to determine the mechanisms underlying the sensory motor transformations serving locomotion and how they are adversely affected by the aging process and disease and second, to apply knowledge of these mechanisms to the development of novel diagnostic tests, technologies and rehabilitation techniques for improving functional mobility and preventing falls in frail individuals.

Amornpan Ajjimaporn

Amornpan Ajjimaporn, Ph.D. Associated Professor of Sports Neuroscience and Chairman of MSc. Program in Sports Science and Deputy Dean for Graduate Studies, College of Sports Science and Technology, Mahidol University. My research interests include in both areas; human physiology and neuroscience, both of which involve studying the interplay between physiological processes and neuroscience response to either sports or exercise. My recent work focuses on brain wave activity, endocrine hormones and physical performance which are induced by various events such as injury, aging or hot and cold temperature using both physiological methods ,i.e., EMG, VO2 max, Reaction Time, EEG and molecular method ,i.e., ELISA technique to explore my work.