The Efficacy of Traditional Chinese Medical Exercise for Parkinson’s Disease: A Systematic Review and Meta-analysis

April The Efficacy of Traditional Chinese Medical Exercise for Parkinson's Disease: A Systematic Review and Meta-analysis Yan Yang 0 1 Wei Qing Qiu 0 1 Yan Lei Hao 0 1 Zhan Yun Lv 0 1 Shu Ji Jiao 0 1 Jun Feng Teng 0 1 Mikhail A. Lebedev, Duke University, UNITED STATES 0 1 Department of Neurology, Affiliated Hospital of Jining Medical University , Jining, Shandong , China , 2 Department of Neurology, Laizhou People's Hospital of Shangdong , Laizhou, Shandong , China , 3 Binzhou Medical University Hospital , Binzhou, Shandong , China , 4 Department of Neurology, The First People's Hospital of Hebi , Hebi, Henan , China 1 Funding: This study is supported by the National Natural Science Fund Projects of China (81271398). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Background and Objective Several studies assessed the efficacy of traditional Chinese medical exercise in the management of Parkinson's disease (PD), but its role remained controversial. Therefore, the purpose of this systematic review is to evaluate the evidence on the effect of traditional Chinese medical exercise for PD. - Competing Interests: The authors have declared that no competing interests exist. Seven English and Chinese electronic databases, up to October 2014, were searched to identify relevant studies. The PEDro scale was employed to assess the methodological quality of eligible studies. Meta-analysis was performed by RevMan 5.1 software. Fifteen trials were included in the review. Tai Chi and Qigong were used as assisting pharmacological treatments of PD in the previous studies. Tai Chi plus medication showed greater improvements in motor function (standardized mean difference, SMD, -0.57; 95% confidence intervals, CI, -1.11 to -0.04), Berg balance scale (BBS, SMD, -1.22; 95% CI -1.65 to -0.80), and time up and go test (SMD, -1.06; 95% CI -1.44 to -0.68). Compared with other therapy plus medication, Tai Chi plus medication also showed greater gains in motor function (SMD, -0.78; 95% CI -1.46 to -0.10), BBS (SMD, -0.99; 95% CI -1.44 to -0.54), and functional reach test (SMD, -0.77; 95% CI -1.51 to -0.03). However, Tai Chi plus medication did not showed better improvements in gait or quality of life. There was not sufficient evidence to support or refute the effect of Qigong plus medication for PD. In the previous studies, Tai Chi and Qigong were used as assisting pharmacological treatments of PD. The current systematic review showed positive evidence of Tai Chi plus medication for PD of mild-to-moderate severity. So Tai Chi plus medication should be recommended for PD management, especially in improving motor function and balance. Qigong plus medication also showed potential gains in the management of PD. However, more high quality studies with long follow-up are warrant to confirm the current findings. Parkinsons disease (PD) is a common neurodegenerative disorder with insidious onset. There is an estimation of at least 4 million people diagnosed as PD worldwide [1]. In China, PD is 1.70% in prevalence rate among people aged more than 65 years old [2]. Although the specific causes of PD are under investigation, incidence increases with age, especially after 50 years old [3]. The landmark symptoms of PD are resting tremor, bradykinesis, rigidity and decreased postural reflexes. These impairments lead to a decline in functional status as gait disturbance and balance decrements so that people with PD cannot cope with their daily tasks well [45]. It is reported that this decrease in functional status worsens as the disease progresses and often results in loss of independence and a decline in quality of life [6]. Although the precise reasons of the decrease in balance, gait and quality of life are still unknown, exercise is a preventive strategy that has demonstrated efficacy in PD [7,8]. Traditional Chinese medical exercise, including Qigong, Tai Chi, Wuqinxi, etc., combines body movements with mental focus. Tai Chi and Qigong, as representative traditional Chinese medical exercises, incorporate body movement, breath and mind training to maintain health and remove disease symptoms. Tai Chi, with slow body positions and dance-like movements that flow from one to the next continuously, promotes posture, flexibility, relaxation, well-being and mental concentration [9]. The difference between Qigong and Tai Chi is that Tai Chi is a martial art with movements practiced quickly which can provide self-defense and are externally focused. Meanwhile, Qigong cannot and it is internally focused [10]. In the last decade, Tai Chi and Qigong have been studied in the management of PD [11 15], but there were conflicting results. Li et al. reported significant improvements in balance, functional capacity and falls after Tai Chi exercise [14]. In contrast, Amano et al. concluded that Tai Chi was not effective in improving parkinsonian disability [15]. And previous reviews d (...truncated)