title: Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The effects of mind-body exercises on individuals with chronic illnesses have attracted increasing attention. However, little effort had been made to systematically review the effects of these mind-body exercises on individuals with Parkinson's disease (PD). This review aimed to appraise the current evidence of the effects of mind-body exercises on the physiological and psychological outcomes for the PD population.
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials.
  
  
  METHODS
  Four English databases, namely, the EMBASE, Ovid Medline, Psych Info, and Cochrane Library, were searched on January 2016.
  
  
  METHODS
  Studies involving participants with idiopathic PD were included if mind-body exercises were applied and compared with a non-exercise control to improve physiological and psychosocial well-being. The Effective Public Health Practice Project quality assessment tool was used for quality appraisal. RevMan 5.3 was employed to perform this meta-analysis. A subgroup analysis regarding the types and the dose of intervention was conducted to explore the sources of heterogeneity.
  
  
  RESULTS
  Ten studies met the inclusion criteria for quality appraisal. The overall methodological rating of these studies indicated that one study was strong; five studies were moderate; and four studies were weak. Nine articles comprising five Tai Chi, two yoga, and two dance studies were included in the meta-analysis. The results of this review showed that mind-body exercises had a large, significant beneficial effect in motor symptoms in terms of UPDRS III for people with mild to moderate PD [SMD=-0.91, 95% CI (-1.37, -0.45), p<0.05]. Significant subgroup differences were found among various types of mind-body exercises (p=0.001). Yoga demonstrated the largest and most significant beneficial effect in reducing UPDRS III scores [SMD=-2.35, 95% CI (-3.21, -1.50), p<0.01]. The pooled meta-analysis results showed that mind-body exercises had a large, significant effect in improving postural instability in terms of the Berg Balance Scale [SMD=1.48, 95% CI (0.91, 2.06), p<0.01] and Timed Up and Go test [SMD=-0.97, 95% CI (-1.46, -0.47), p<0.01] and moderate, significant effect in improving functional mobility in terms of the Six-minute Walk test [SMD=0.78, 95% CI (0.35, 1.21), p<0.05].
  
  
  CONCLUSIONS
  This review found that mind-body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind-body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention. Future research should address the psychosocial effects of mind-body exercises on the PD population.
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region. Electronic address: jojo.yykwok@gmail.com.
authors.forename: JoJo Yan Yan
authors.initials: JY
authors.lastname: Kwok
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
authors.forename: Kai Chow
authors.initials: KC
authors.lastname: Choi
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
authors.forename: Helen Yue Lai
authors.initials: HY
authors.lastname: Chan
mesh_terms: D000368:Aged; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D026441:Mind-Body Therapies / Q000379:methods; D010300:Parkinson Disease / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
keywords: Chronic illness; Exercise; Mind-body; Parkinson; Systematic review