파킨슨병 환자의 비운동증상 개선을 위한 운동 중재에 대한 우산형 검토: 임상 효과와 도파민-세로토닌-GABA 신경전달물질 네트워크 기전에 대한 고찰
An Umbrella Review of Exercise-Based Interventions for Non-Motor Symptoms in Parkinson's Disease : Clinical Effectiveness and a Discussion on Potential Dopamine-Serotonin-GABA Network Mechanisms
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This umbrella review aimed to synthesize and critically appraise existing systematic reviews and meta-analyses on the effectiveness of exercise interventions for improving non-motor symptoms in Parkinson's disease (PD) patients and to discuss the potential underlying mechanisms involving dopamine-serotonin-GABA neurotransmitter networks and to provide evidence-based personalized exercise prescription guidelines. A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and KoreaMed databases for published systematic reviews and meta-analyses (not primary studies) published between 2015-2024, following PRISMA and umbrella review guidelines. From 1,247 initially identified records, 50 systematic reviews and meta-analyses were included for qualitative and quantitative synthesis. No new meta-analysis was conducted; instead, effect sizes reported in the included reviews were extracted and narratively synthesized. Mind-body exercises showed superior effects on depression (SMD=-1.61, 95% CI: -2.65 to -0.57, p=.002) and quality of life (SMD=.66, 95% CI: .41 to .91, p<.001) as reported by Jin et al. (2020). Combined non-pharmacological interventions produced the most comprehensive benefits across multiple domains: depression (MD=-2.98, 95% CI: -4.29 to -1.67, p < .00001), anxiety (MD =-2.00, 95% CI: -2.83 to -1.17, p<.00001), and sleep quality (MD=-19.35, 95% CI: -30.4 to -8.28, p<.0006) according to Zhang et al. (2024). Resistance training showed significant effects on quality of life (SMD=-.48, 95% CI: -.86 to -.10, p=.01) as demonstrated by Gollan et al. (2022). This umbrella review confirms that exercise interventions effectively improve PD non-motor symptoms, which may be mediated by integrated neurotransmitter network modulation as suggested by preclinical and mechanistic studies, supporting personalized exercise prescriptions for optimal therapeutic outcomes.
Abstract
This umbrella review aimed to synthesize and critically appraise existing systematic reviews and meta-analyses on the effectiveness of exercise interventions for improving non-motor symptoms in Parkinson's disease (PD) patients and to discuss the potential underlying mechanisms involving dopamine-serotonin-GABA neurotransmitter networks and to provide evidence-based personalized exercise prescription guidelines. A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and KoreaMed databases for published systematic reviews and meta-analyses (not primary studies) published between 2015-2024, following PRISMA and umbrella review guidelines. From 1,247 initially identified records, 50 systematic reviews and meta-analyses were included for qualitative and quantitative synthesis. No new meta-analysis was conducted; instead, effect sizes reported in the included reviews were extracted and narratively synthesized. Mind-body exercises showed superior effects on depression (SMD=-1.61, 95% CI: -2.65 to -0.57, p=.002) and quality of life (SMD=.66, 95% CI: .41 to .91, p<.001) as reported by Jin et al. (2020). Combined non-pharmacological interventions produced the most comprehensive benefits across multiple domains: depression (MD=-2.98, 95% CI: -4.29 to -1.67, p < .00001), anxiety (MD =-2.00, 95% CI: -2.83 to -1.17, p<.00001), and sleep quality (MD=-19.35, 95% CI: -30.4 to -8.28, p<.0006) according to Zhang et al. (2024). Resistance training showed significant effects on quality of life (SMD=-.48, 95% CI: -.86 to -.10, p=.01) as demonstrated by Gollan et al. (2022). This umbrella review confirms that exercise interventions effectively improve PD non-motor symptoms, which may be mediated by integrated neurotransmitter network modulation as suggested by preclinical and mechanistic studies, supporting personalized exercise prescriptions for optimal therapeutic outcomes.