Progressive resistance training in Parkinson's disease: a systematic review and meta-analysis

OBJECTIVES: To investigate if there is evidence on effectiveness of progressive resistance training in rehabilitation of Parkinson disease. DESIGN: Systematic review and meta-analysis. Data sources: Central, Medline, Embase, Cinahl, Web of Science, Pedro until May 2014. Randomised controlled or controlled clinical trials. The methodological quality of studies was assessed according to the Cochrane Collaboration's domain-based evaluation framework. Data synthesis: random effects meta-analysis with test for heterogeneity using the I² and pooled estimate as the raw mean difference. PARTICIPANTS: Adults with primary/idiopathic Parkinson's disease of any severity, excluding other concurrent neurological condition. INTERVENTIONS: Progressive resistance training defined as training consisting of a small number of repetitions until fatigue, allowing sufficient rest between exercises for recovery, and increasing the resistance as the ability to generate force improves. COMPARISON: Progressive resistance training versus no treatment, placebo or other treatment in randomised controlled or controlled clinical trials. PRIMARY AND SECONDARY OUTCOME MEASURES: Any outcome. RESULTS: Of 516 records, 12 were considered relevant. Nine of them had low risk of bias. All studies were randomised controlled trials conducted on small samples with none or 1 month follow-up after the end of intervention. Of them, six were included in quantitative analysis. Pooled effect sizes of meta-analyses on fast and comfortable walking speed, the 6 min walking test, Timed Up and Go test and maximal oxygen consumption were below the level of minimal clinical significance. CONCLUSIONS: There is so far no evidence on the superiority of progressive resistance training compared with other physical training to support the use of this technique in rehabilitation of Parkinson's disease. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2014:CRD42014009844.