Upper Limb Exercises Reduce Non-motor Symptoms and Increase Cognitive Function in Parkinson’s Disease: Randomized Controlled Trial

Abstract

Background

Physical exercise is a promising approach to address non-motor symptoms (NMS) in Parkinson’s disease (PD), although the most effective modalities remain under investigation.

Objective

To compare the effects of three upper limb (UL) exercise modalities—resistance training (RES), aerobic exercise (AER), and task-specific training (TST)—on NMS in PD.

Methods

Thirty-seven community-dwelling individuals with PD (mean age = 62 ± 10 years; mean diagnosis duration = 7 ± 5 years; mean Hoehn & Yahr stage = 2 ± 0.4) were randomized into three intervention groups (RES, AER, TST) and a usual care control group. Interventions were performed three times per week, 40-50 minutes per session, over 8 weeks. Clinical outcomes included overall NMS (Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Part I, MDS-UPDRS I), global and domain-specific cognition (Mini-Mental State Examination [MMSE], Addenbrooke’s Cognitive Examination-Revised [ACE-R], Trail Making Test), depression (Geriatric Depression Scale [GDS]), and anxiety (Beck Anxiety Inventory [BAI]). Intervention effects were analyzed using mixed-effects models and non-parametric factorial analyses.

Results

Between-group analyses showed that UL exercises similarly reduced overall NMS severity and cognitive dysfunction, while maintaining baseline fatigue levels, in contrast to deterioration in the CON. RES and TST reduced anxiety (BAI), and RES also reduced apathy. Within-group improvements in cognitive domains, depression, hallucinations, and sleep problems were observed in the RES and TST groups.

Conclusions

This is the first study to demonstrate that isolated UL exercise modalities exert clinically relevant effects on NMS in PD. These modalities may be valuable additions to multidimensional rehabilitation strategies in PD care. [Brazilian Registry of Clinical Trials: RBR-7zjgnrx].