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to reduce levels of physical activity more*Correspondence to: Victoria Goodwin, Research Fellow, Peninsula
Medical School, Primary Care Research Group, Smeall Building, StLuke’s Campus, Exeter, EX1 2LU, United Kingdom.
E-mail: victoria.goodwin@pms.ac.uk
Received 4 June 2007; Revised 16 November 2007; Accepted 27November 2007
Published online January 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/mds.21922Movement Disorders
Vol. 23, No. 5, 2008, pp. 631–640
© 2008 Movement Disorder Society
631
quickly than their healthy peers8 and have lower levels ofstrength and functional ability.9,10 However, the observationof muscle weakness is not simply a secondaryconsequence of ageing and inactivity, but also a primarysymptom of PD.11 This is due to impaired basal gangliahaving an inadequate effect on the cortical motor centerswhich in turn lead to less activation of motor neuronesand therefore muscle weakness.10,12 This mechanismalso contributes to impaired balance, falls, and disability.13 People with PD are three times more likely tosustain a hip fracture as a result of a fall when comparedto those without the condition.14,15
A number of systematic reviews16-18 and a meta-analysis19have been undertaken to investigate the efficacy of
physiotherapy among people with PD. The earlier reviews,with literature searches up until 199919 and2000,16,17 evaluated a range of physiotherapeutic techniquesincluding nonexercise interventions, such as sensorycueing and behavioral therapy, in addition to exercisestrategies. The Cochrane reviews16,17 were limited torandomized controlled trials and reported that they wereunable to combine the studies for meta-analysis given theclinical and methodological heterogeneity. The studieswere not conclusive in respect to the physiotherapy managementof people with PD. De Goede at al19 includedstudies that adopted a quasi-experimental design. They
reported significant benefits in respect of activities ofdaily living, walking speed, and stride length. However,only one study in each of these domains was a randomizedcontrolled trial evaluating an exercise intervention,with the others using less rigorous study designs or otherphysiotherapy techniques.
A recent review of physiotherapy for people with PD(literature searches to June 2006) concluded that therewere positive benefits associated with gait, transfers,balance and functional ability.18 However, by including arange of management strategies, such as exercise and
cueing, under the umbrella of “physiotherapy ” it isdifficult to extract information regarding the contribution
of individual therapeutic components. Lim et al.,20 forexample, reviewed https://www.51lunwen.org/ygbylw/2011/0706/1158265604.htmlthe literature on the effects of cueingon gait in people with PD and reported that while auditorycueing may be beneficial to gait speed, no conclusions
could be made as to the effects of visual cueing dueto a lack of evidence. Nieuwboer et al.21 recently reportedsignificant improvements is gait and balance usingexternal cueing devices and recommended cueingtraining as an adjunct to gait management.
This systematic review examines the potential benefitof exercise interventions for people with PD, focusing
specifically on evaluations adopting experimental, randomizeddesigns. We did not include studies explicitly
evaluating cueing strategies as cueing itself is not anexercise but an external temporal本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。