Are power training and yoga effective in improving motor function among older patients with Parkinson disease?
Date of publication of randomized controlled trial: March 2016
Design
Randomized controlled trial (RCT).
Participants
37 older patients (mean age range: 64.7 to 83.2 years, 64.9% male) with idiopathic Parkinson disease (PD) who were mildly to moderately impaired (Hoehn and Yahr Scale I–III).
Intervention
Intervention 1: Power training consisted 24 sessions of weight exercise and were provided twice a week for 12 weeks.
Intervention 2: Yoga was provided as a group class. The training course consisted 24 sessions and were provided twice a week for 12 weeks. Each session lasted for 60 minutes.
Comparator
Comparison 1: Power training versus health education;
Comparison 2: Yoga versus health education.
Major Outcomes
Outcome 1: Unified Parkinson Disease Rating Scale motor score (UPDRSMS) measured at the end of treatment; high score indicated lower motor function.
Outcome 2: Berg Balance Scale (BBS) measured at the end of treatment; higher score indicated lower fall risk.
Outcome 3: Mini-Balance Evaluation Systems Test (Mini-BESTest) measured at the end of treatment; higher score indicated better balance.
Outcome 4: Timed Up and Go measured at the end of treatment;
Outcome 5: Functional reach measured on less affected side at the end of treatment.
Settings
This trial was conducted in an outpatient setting.
Comparison    Power training versus health education
Main Results
Compared to health education, power training provided significant improvements in UPDRSMS (mean difference (MD): −11.1, 95% CI: −14.1 to −8.1). Significantly better performance on BBS (MD: 4.0, 95% CI: 2.4 to 5.6), Mini-BESTest (MD: 2.7, 95% CI: 1.3 to 4.0), Timed Up and Go (MD: -1.6, 95% CI: -2.9 to -0.4), and functional reach on the less affected side (MD: 5.5, 95% CI: 2.6 to 8.5) were observed in power training group.
Comparison 1: Power training versus health education for older patients with Parkinson disease
Outcomes No. of studies (Total number of participants) Mean/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1(24) -10.7/14 0.4/10 Not applicable as there is only 1 trial −11.1 (−14.1 to −8.1) <0.001 Moderate
2 1(24) 4.4/14 0.4/10 Not applicable as there is only 1 trial 4.0 (2.4 to 5.6) <0.001 Moderate
3 1(24) 3.4/14 0.7/10 Not applicable as there is only 1 trial 2.7 (1.3 to 4.0) <0.001 Moderate
4 1(24) -1.3/14 0.3/10 Not applicable as there is only 1 trial −1.6 (−2.9 to −0.4) 0.014 Moderate
5 1(24) 4.8/14 0.6/10 Not applicable as there is only 1 trial 5.5 (2.6 to 8.5) <0.001 Moderate
Keys: MD = mean difference; CI = confidence interval.
Comparison    Yoga versus health education
Main Results
Compared to health education, yoga showed significant improvements in UPDRSMS (mean difference (MD): −11.3, 95% CI: −14.7 to −7.9). Significantly better performance on BBS (MD: 3.8, 95% CI: 2.0 to 5.5), Mini-BESTest (MD: 3.3, 95% CI: 2.2 to 4.4), Timed Up and Go (MD: -2.6, 95% CI: -4.6 to -0.6) and functional reach on the less affected side (MD: 3.9, 95% CI: 1.6 to 6.3) were observed in yoga group.
Comparison 2: Yoga versus health education for older patients with Parkinson disease
Outcomes No. of studies (Total number of participants) Mean/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1(23) -10.9/ 13 0.4/ 10 Not applicable as there is only 1 trial −11.3 (−14.7 to −7.9) <0.001 Moderate
2 1(23) 4.2/ 13 0.4/ 10 Not applicable as there is only 1 trial 3.8 (2.0 to 5.5) <0.001 Moderate
3 1(23) 4.0/ 13 0.7/ 10 Not applicable as there is only 1 trial 3.3 ( 2.2 to 4.4) <0.001 Moderate
4 1(23) -2.3/ 13 0.3/ 10 Not applicable as there is only 1 trial -2.6 (-4.6 to -0.6) 0.013 Moderate
5 1(23) 3.3/ 13 0.6/ 10 Not applicable as there is only 1 trial 3.9 (1.6 to 6.3) 0.002 Moderate
Keys: MD = mean difference; CI = confidence interval.
Comparison    Power training versus health education
Main Results
Compared to health education, power training provided significant improvements in UPDRSMS (mean difference (MD): −11.1, 95% CI: −14.1 to −8.1). Significantly better performance on BBS (MD: 4.0, 95% CI: 2.4 to 5.6), Mini-BESTest (MD: 2.7, 95% CI: 1.3 to 4.0), Timed Up and Go (MD: -1.6, 95% CI: -2.9 to -0.4), and functional reach on the less affected side (MD: 5.5, 95% CI: 2.6 to 8.5) were observed in power training group.
Comparison 1: Power training versus health education for older patients with Parkinson disease
Outcomes 1 2 3 4 5
No. of studies (Total number of participants) 1(24) 1(24) 1(24) 1(24) 1(24)
Mean/ No. of participants Intervention -10.7/14 4.4/14 3.4/14 -1.3/14 4.8/14
Comparator 0.4/10 0.4/10 0.7/10 0.3/10 0.6/10
MD (95% CI) −11.1 (−14.1 to −8.1) 4.0 (2.4 to 5.6) 2.7 (1.3 to 4.0) −1.6 (−2.9 to −0.4) 5.5 (2.6 to 8.5)
p value <0.001 <0.001 <0.001 0.014 <0.001
Overall quality of evidence* Moderate Moderate Moderate Moderate Moderate
Keys: MD = mean difference; CI = confidence interval.
Comparison    Yoga versus health education
Main Results
Compared to health education, yoga showed significant improvements in UPDRSMS (mean difference (MD): −11.3, 95% CI: −14.7 to −7.9). Significantly better performance on BBS (MD: 3.8, 95% CI: 2.0 to 5.5), Mini-BESTest (MD: 3.3, 95% CI: 2.2 to 4.4), Timed Up and Go (MD: -2.6, 95% CI: -4.6 to -0.6) and functional reach on the less affected side (MD: 3.9, 95% CI: 1.6 to 6.3) were observed in yoga group.
Comparison 2: Yoga versus health education for older patients with Parkinson disease
Outcomes 1 2 3 4 5
No. of studies (Total number of participants) 1(23) 1(23) 1(23) 1(23) 1(23)
Mean/ No. of participants Intervention -10.9/ 13 4.2/ 13 4.0/ 13 -2.3/ 13 3.3/ 13
Comparator 0.4/ 10 0.4/ 10 0.7/ 10 0.3/ 10 0.6/ 10
MD (95% CI) −11.3 (−14.7 to −7.9) 3.8 (2.0 to 5.5) 3.3 ( 2.2 to 4.4) -2.6 (-4.6 to -0.6) 3.9 (1.6 to 6.3)
p value <0.001 <0.001 <0.001 0.013 0.002
Overall quality of evidence* Moderate Moderate Moderate Moderate Moderate
Keys: MD = mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to health education, both power training and yoga showed significant improvements in UPDRSMS. Significantly better performance on BBS, Mini-BESTest, Timed Up and Go and functional reach on the less affected side were also observed. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events related to power training and yoga were reported in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26546987
The synopsis is based on the following article:
Ni M, Signorile JF, Mooney K, Balachandran A, Potiaumpai M, Luca C, Moore JG, Kuenze CM, Eltoukhy M, Perry AC. Comparative Effect of Power Training and High-Speed Yoga on Motor Function in Older Patients With Parkinson Disease. Archives of physical medicine and rehabilitation. 2016 Mar 31;97(3):345-54.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.