Fatigue in people with Parkinson's Disease: the effects of exercise

This thesis comprises a systematic review and an intervention study. The systematic review included a meta-analysis and investigated treatment methods for fatigue. Fourteen studies (n=1890) were included in the systematic review and results from the meta-analyses (mean difference -0.25; CI -0.67:0.16; z-score 1.20 and mean difference -0.36; CI -0.78:0.06; z-score 1.67) concluded that currently there are no effective methods for the treatment of fatigue in people with Parkinson’s disease. The intervention study (n=105; intervention group: n=54; control group: n=51) comprised three parts. In the first part different measures of fatigue were explored in relation to activity levels and exercise tolerance. The second part investigated the adherence to the community based six-month exercise programme. The final part of the main study explored the effects of the exercise programme in a single blinded randomised controlled trial. In the first part of the main study significant negative correlations were found between self-reported fatigue and respiratory exchange rate (r=-0.309; p=0.002); Rate of Perceived Exertion breath (r=-0.282; p=0.024); Rate of Perceived Exertion of the legs (r=-0.261; p=0.033) and GENEActiv light activity (r=-0.209; p=0.049). The correlation between self-reported fatigue and the respiratory exchange rate implies that self-reported fatigue may decrease if exercise tolerance is improved by for example an exercise programme. The second part of the main study demonstrated an adherence of 24 out of 54 in participants that were randomly assigned to the exercise programme, with no intervention-related adverse events, showing that the proposed programme was feasible for people with Parkinson’s disease. The final part of the study, exploring the effects of the exercise programme in all patients, showed a small reduction in disease severity (Unified Parkinson’s disease Rating Scale part III, Cohen’s d: 0.25; 95% confidence interval: 0.02-0.49) in the treatment group compared to the control group. Scores on the self-reported fatigue decreased slightly in both groups subsequent to the exercise programme, but did not reach significance. This is the first study to explore the effects of a combined (aerobic and anaerobic) exercise community based longer term (six months) exercise programme on fatigue in people with Parkinson’s disease. Results show that both arms of the interventions were adhered to reasonably well and small effects were found showing exercise improved disease severity in people with Parkinson’s disease; no effects were found in relation to fatigue