Date of Award

12-2023

Degree Name

Doctor of Philosophy

Department

Education and Human Development

First Advisor

Timothy Michael, Ph.D.

Second Advisor

Carol Weideman, Ph.D.

Third Advisor

Adam Coughlin, Ph.D.

Keywords

Complementary, exercise, mindfulness, neurodegenerative, parkinson's, PD

Abstract

Parkinson’s Disease (PD) is the second most common neurodegenerative disease affecting which affects motor control, emotional regulation, cognition, and sleep through degradation of dopaminergic neurons. As of 2019, PD affects approximately 8.5 million individuals worldwide, with prevalence estimated to increase to between 8.7 and 9.3 million by 2030. The primary therapeutic approach to PD management is pharmaceutical, relying on dopamine replacement therapy. However, recent research has identified promising complementary therapies such as exercise and mindfulness training.

This review was conducted to compile and present evidence related to the efficacy of exercise, mindfulness, and combined exercise and mindfulness protocols as complementary therapeutic approaches to the management of PD symptoms and disease progression. The aim of this review was two-fold: 1) to characterize the current evidence of the efficacy of exercise, mindfulness, and combined mindfulness and exercise protocols on PD symptoms and progression, and 2) present the characteristics of these therapies as it relates to efficacy via comprehensive discussion of researched protocols.

A database search was conducted in PubMed, Scopus, ERIC (EBSCOhost), and CINAHL from December 2022 until June 2023. Studies selected for inclusion were peer-reviewed randomized controlled trials (RCTs) that researched the influence of exercise, mindfulness, or combined mindfulness and exercise protocols on PD. The quality of evidence presented in selected studies was assessed via the PEDro Scale.

Twenty-four studies encompassing a total of 1,556 PD (846 males) patients were included in this review. Participants’ disease severity ranged from mild to severe (Hoehn & Yahr stages 1-4) and all underwent standard therapy throughout the duration of the studies. 17 studies researched exercise interventions, three studies researched mindfulness interventions, and four studies researched interventions combining mindfulness with exercise. Experimental outcomes that were measured assessed primary (motor) symptoms, secondary (nonmotor) symptoms, functional performance, quality of life (QoL), disease severity, and mindfulness.

The exercise protocols discussed in this review had generally positive, but varied, influences on PD symptoms and progression, evidenced by exercise interventions, with the exception of Tai Chi, having broad, positive effects on all experimental outcomes except for mindfulness. Mindfulness interventions had limited efficacy for the management of PD as the only outcome category within which this intervention was universally beneficial was that of mindfulness assessments. Combined mindfulness and exercise interventions, however, displayed promising results with regards to all outcome categories except mindfulness but may have produced undesirable effects on patients’ awareness of their symptoms. Interventions discussed in this review were too varied to identify distinct prescriptions for producing desirable results. However, it is clear from the reviewed studies that participation in exercise or combined mindfulness and exercise interventions is beneficial to PD symptoms and progression.

Access Setting

Dissertation-Open Access

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