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Can reduce muscle fatigue (Parkinson’s evidence)

Evidence Summary
Few researchers include fatigue in their review parameters but 2 RCTs have shown benefits to fatigue levels in Parkinson’s [1,2].
Aerobic walking performed over 45 minutes 3 times a week over 6 months was found to be safe well tolerated and improved muscle fatigue over time [1].
Most reviews have centred around medication changes for fatigue alleviation in Parkinson’s but activity programs may also be effective [2].
1 study looked at a novel high intensity combination activities and the effects within muscle as well as the perceived effects by people with Parkinson’s (n=15 P with matched controls) [3]. Individuals with Parkinson’s were capable of training at an intensity, volume, and frequency sufficient to achieve robust adaptations in skeletal muscle. Currently, most investigational treatments for Parkinson’s-related fatigue and fatigability centre on the use of various drugs, whereas results of this study indicate intensive training effectively reduces fatigue severity to an FSS score below that indicative of significant fatigue (average score of 4). This is a particularly valuable finding because until now it was unknown whether activity would improve or exacerbate Parkinson’s-related fatigue. By 16 weeks, the magnitude of improvement exceeded what we found in healthy older adults after resistance training suggesting the exercise training program induced remarkable alterations in motor unit recruitment patterns among Parkinson’s.
More research with larger numbers is required related to Parkinson’s specific fatigue.

Quality of Evidence
B – There is paucity of research related the effects of physical activity on fatigue in People with Parkinson’s (PwP). 2 RCTs and 1 small neurophysiological study report there is improvement with physical activity. More research with larger numbers is required related to Parkinson’s specific fatigue.

Strength of Recommendation
2 – Small amount of specific research into fatigue in People with PwP suggest benefits from Physical activity. An expert focus group commented that in their experience that physical activity does not increase fatigue of Parkinson’s.


Conclusion
Physical Activity in Parkinson’s can reduce fatigue over time. Regular intensive mixed activities may significantly reduce fatigue severity in Parkinson’s. Discussions from an expert workshop stated that fatigue due to Parkinson’s is not increased by physical activity.

References
[1] Uc et al. Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting, Neurology; Jul 2014; vol. 83 (no. 5); p. 413-25
[2] Lou J-S. Fatigue in Parkinson’s disease and potential interventions. Neurorehabilitation, Vol 37,no.1, pp.25-34,2015
[3] Kelly et al. Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson’s disease
J Appl Physiol 116: 582–592, 2014

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