Apathy is a frequently reported neuropsychiatric symptom in Parkinson's disease (PD), but its prevalence and clinical correlates are debated. We aimed to address these issues by conducting a systematic review and meta-analysis. Embase, Medline/PubMed, and PsychINFO databases were searched for relevant studies. Data were extracted by two independent observers, using predefined extraction forms tailored specifically to the research question. From 1,702 titles and abstracts, 23 studies were selected. Meta-analysis showed a prevalence of apathy in PD of 39.8% (n = 5,388, 905% CI 34.6-45.0%). Apathy was associated with higher age (3.3 years, 95% CI = 1.7-4.9), lower mean Mini-Mental State Evaluation (MMSE) score (-1.4 points, 95% CI = -2.1 to -0.8), an increased risk of co-morbid depression (relative risk [RR] = 2.3, 95% CI = 1.9-2.8), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (6.5 points, 95% CI = 2.6-10.3), and more severe disability (Hedges-G = 0.5, 95% CI = 0.3-0.6). Half of the patients with apathy had concomitant depression (57.2%, 95% CI = 49.4-64.9%), and this estimate was similar after exclusion of patients with cognitive impairment (52.5%, 95% CI = 42.2%-62.8%). In conclusion, we found that apathy affects almost 40% of patients with PD. Several factors influence reported prevalence rates, contributing to the considerable heterogeneity in study results. Half of patients with apathy do not suffer from concomitant depression or cognitive impairment, confirming its status as a separate clinical syndrome in PD. The pervasiveness of apathy in PD warrants research into its treatment, although different underlying pathophysiological mechanisms may require different treatment strategies. Treatment of apathy could improve patient quality of life, reduce caregiver burden, alleviate disability by increasing motivation for self-care, and reduce cognitive impairment by improving executive functioning. (c) 2015 International Parkinson and Movement Disorder Society.

Apathy in Parkinson's disease: A systematic review and meta-analysis.

To test the hypothesis that longer and more intense exercise will enhance long-term weight loss, 201 sedentary women 27 to 40 years of age were enrolled in a randomized trial. The participants, whose baseline body mass index ranged from 27 to 40 kg/m 2 , were in a university-based weight control program. They were assigned to 1 of 4 groups that exercised at moderate or vigorous intensity for a moderate to long duration. Estimated energy expenditure was 1000 or 2000 kcal per week. All women were asked to reduce their energy intake to 1200 to 1500 kcal per day and their dietary fat intake to 20% to 30% of total energy intake. Nearly 95% of participants completed 12 months in the study. All participants were sedentary at the outset, exercising less than 3 days per week for less than 20 minutes. They were instructed to exercise, unsupervised, for 5 days a week, primarily by walking; motorized treadmills were provided. Bouts of exercise lasting at least 10 minutes were prescribed in terms of both percentage of age-predicted maximal heart rate and perceived exertion using the Borg scale. The women attended an average of 79% of group sessions in the first 6 months and 71% over the entire 12-month study period. Mean weight loss was significant in all groups, ranging from 8.9 kg with long-lasting vigorous exercise to 6.3 kg with moderate exercise of moderate duration. There were no significant between-group differences. Mean cardiorespiratory fitness also increased significantly in all groups, most markedly (22%) with vigorous, high-duration exercise. The least improvement, an increase of 13.5%, was in the group exercising at moderate intensity for a moderate time. Again, there were no differences between groups. Weight loss at 12 months correlated with the level of physical activity at both 6 and 12 months. Women exercising less than 150 minutes per week lost a mean of 4.7% body weight, contrasting with 13.6% for those exercising at least 200 minutes per week. There were no significant group differences in energy intake. The authors recommend that sedentary adults who are overweight begin by exercising at moderate intensity for at least 150 minutes per week. When appropriate, higher exercise levels should be adopted, aiming at an hour a day as advised by the Institute of Medicine.

Effect of Exercise Duration and Intensity on Weight Loss in Overweight, Sedentary Women: A Randomized Trial

Background: Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. Objectives: The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice. Methods: The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, P...

https://www.tandfonline.com/doi/pdf/10.3109/00952990.2014.976708

Exercise-based treatments for substance use disorders: evidence, theory, and practicality

Physical exercise is a cornerstone in the management of many neurodegenerative disorders, such as Parkinson's disease, dementia, and stroke. However, much of its beneficial effects on improving motor functions and cognition as well as decreasing neurodegeneration and neuroinflammation are not yet well understood. The obvious limitations of studying the protective mechanisms behind exercise, for example, brain plasticity and neurodegeneration, could be overcome by generating novel animal models of neurodegenerative disorders. In this narrative review, we discuss the beneficial effects of exercise performed in animal models of neurodegenerative disorders and how the results from animal studies can be used in clinical settings. From preclinical studies, the positive effects of exercise have been related to increased levels of neurotrophic factors, elevated expression of anti-inflammatory cytokines, and reduced levels of pro-inflammatory cytokines and activated microglia. It is clear that parameters influencing the effect of exercise, such as intensity, still remain to be investigated in animal studies in order to find the optimal program that can be translated into exercise interventions for patients with neurodegenerative diseases.

https://journals.sagepub.com/doi/pdf/10.1177/1545968314562108

Effects of Physical Exercise on Neuroinflammation, Neuroplasticity, Neurodegeneration, and Behavior: What We Can Learn From Animal Models in Clinical Settings.

Objective To assess the effect of exercise training by using the Nintendo Wii Fit video game and balance board system on balance and gait in adults with Parkinson disease (PD). Design A prospective interventional cohort study. Setting An outpatient group exercise class. Participants Ten subjects with PD, Hoehn and Yahr stages 2.5 or 3, with a mean age of 67.1 years; 4 men, 6 women. Interventions The subjects participated in supervised group exercise sessions 3 times per week for 8 weeks by practicing 3 different Wii balance board games (marble tracking, skiing, and bubble rafting) adjusted for their individualized function level. The subjects trained for 10 minutes per game, a total of 30 minutes training per session. Main Outcome Measurements Pre-and postexercise training, a physical therapist evaluated subjects' function by using the Berg Balance Scale, Dynamic Gait Index, and Sharpened Romberg with eyes open and closed. Postural sway was assessed at rest and with tracking tasks by using the Wii balance board. The subjects rated their confidence in balance by using the Activities-specific Balance Confidence scale and depression on the Geriatric Depression Scale. Results Balance as measured by the Berg Balance Scale improved significantly, with an increase of 3.3 points ( P  = .016). The Dynamic Gait Index improved as well (mean increase, 2.8; P  = .004), as did postural sway measured with the balance board (decreased variance in stance with eyes open by 31%; P  = .049). Although the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points, improvements neared significance only for eyes closed ( P  = .07 versus P  = .188). There were no significant changes on patient ratings for the Activities-specific Balance Confidence (mean decrease, −1%; P  = .922) or the Geriatric Depression Scale (mean increase, 2.2; P  = .188). Conclusions An 8-week exercise training class by using the Wii Fit balance board improved selective measures of balance and gait in adults with PD. However, no significant changes were seen in mood or confidence regarding balance.

Wii Fit Balance Board Playing Improves Balance and Gait in Parkinson Disease

Exercise preferences of patients in substance abuse treatment.

Neuropsychiatric symptoms of Parkinson disease (PD) such as fatigue, depression, and apathy are common and detract from quality of life. There is little published on the impact of physical activity on the neuropsychiatric symptoms of PD. A convenience sample of 45 patients with PD (mean age = 66.1 years; 33% female) completed questionnaires on physical activity, neuropsychiatric symptoms, and specific exercise preferences. Covarying for age and gender, higher levels of physical activity were associated with significantly less fatigue, as well as a trend for less apathy and depression and greater positive affect. Exercise preferences included moderate intensity (73%), at home (56%), in the morning (73%), scheduled (69%), options for varied activities (73%), and preference for both structured/supervised (50%), and unsupervised/self-paced (50%) programs. Preferred activities included the use of aerobic exercise equipment, resistance training, and yoga. Developing and tailoring exercise programs that incorporate specific preferences may result in more effective interventions for patients with PD.

Physical Activity and Neuropsychiatric Symptoms of Parkinson Disease

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Exercise preferences of patients in substance abuse treatment.

Physical Activity and Neuropsychiatric Symptoms of Parkinson Disease