The Effects of Aerobic Exercise on Motor and Non-motor Symptoms of Parkinson’s Disease Michelle Costa Professor Frank Wang, MS, MBA Sacred Heart University College of Health Professions Thomas More Honors Program Background: Results: Discussion: Motor Symptoms: Gait speed and postural control increased as a result of aerobic exercise (Abbruzzese et al., 2016). Aerobic exercise, including regular physical therapy sessions, show significantly decreased fall risk and increased balance in PD patients (Abbruzzeze et al., 2016), (Capato et al., 2015). Treadmill training used in conjunction with waster-based exercises showed a significant improvement in range of motion and endurance (Ayan, Varela, Vila, & Cancela, 2016). Non-motor Symptoms: The use of Nordic walking, physical therapy, and active theater showed significant improvements in global non-motor symptoms, including apathy, fatigue, sleep, and cognition (Amara & Memon, 2018). The use of Baduanjin Qigong, a type of Chinese exercise, showed significant improvements in daytime sleepiness (Amara & Memon, 2018). Depression was shown to decrease significantly with the use of physical activity as an intervention (Cusso et al., 2016). Parkinson’s disease (PD) is a progressive neurodegenerative disease that leads to many symptoms which affect an individual’s motor and non-motor functioning (Cusso, Donald, & Khoo, 2016), (Abbruzzese, Marchese, Avanzino, &Pelosin, 2016). Motor symptoms of Parkinson’s disease include poor balance, impaired gait, tremors, and muscle rigidity (Abbruzzese et al., 2016). Non-motor symptoms include depression, apathy, insomnia, fatigue, and anxiety (Cusso et al., 2016). Standard treatment of Parkinson’s disease primarily uses pharmacological methods (Cusso et al., 2016). Aerobic exercise is becoming more recognized as a treatment option for the management of both motor and non-motor symptoms of Parkinson’s disease (Cusso et al., 2016). Aerobic exercise was shown to be beneficial to both motor and non-motor symptoms of Parkinson’s disease. Many findings of the studies were statistically significant, including improved gait speed and postural control, decreased fall risk, and decreased depression. Interventions that showed significant improvements in symptoms include physical therapy, treadmill training, water-based exercises, Baduanjin Qigong, active theater, and Nordic walking. Limitations of this research include small sample sized in several of the studies. Future research should be conducted in order to determine the most effective exercise intervention type, frequency, and duration. Conclusion: Purpose: Research supports the use of exercise interventions as a non-pharmacological method in treating Parkinson’s disease. Motor symptoms, including gait speed, postural control, range of motion, activity endurance, and fall risk all showed improvements with the implementation of various forms of physical activity. Non-motor symptoms, including depression, fatigue, apathy, cognitive impairments, and sleep dysfunction improved overall as a result of physical activity. The use of exercise in the treatment for PD can improve the overall functioning and quality of life of Parkinson’s patients. The purpose of this research is to examine whether or not aerobic exercise has effects on motor and non-motor symptoms of Parkinson’s disease and examine the possible benefits of exercise as a non-pharmacological intervention for patients with PD. Methods: A literature search was conducted using databases including PubMed, Medline, and CINAHL. Search terms included “Parkinson’s disease,” “exercise,” and “symptoms.” Ten articles were selected for review. Four of the studies examine the effects of exercise on motor symptoms, two studies examine non-motor symptoms, and three studies examine both motor and non-motor symptoms. Studies selected used various types of aerobic exercise interventions to examine effects on motor and non-motor symptoms. References: Abbruzzese, G., Marchese, R., Avanzino, L., & Pelosin, E. (2016). Rehabilitation for Parkinson’s disease: Current outlook and future challenges. Parkinsonism & Related Disorders, 22, S60–S64. https://doi.org/10.1016/j.parkreldis.2015.09.005 Amara, A. W., & Memon, A. A. (2018). Effects of Exercise on Non-motor Symptoms in Capato, T. T. da C., Tornai, J., ÁviParkinson’s Disease. Clinical Therapeutics, 40(1), 8–15. https://doi.org/10.1016/j.clinthera.2017.11.004 Ayan, C., Varela, S., Vila, M. H., Seijo-Martinez, M., & Cancela, J. M. (2016). Treadmill training combined with water and land-based exercise programs: Effects on Parkinson’s disease patients. Neurorehabilitation, 39(2), 295–299. https://doi.org/10.3233/NRE- 161360 la, P., Barbosa, E. R., & Piemonte, M. E. P. (2015). Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson’s disease. BMC Neurology, 15, 162–162. https://doi.org/10.1186/s12883-015-0418-x Cusso, M. E., Donald, K. J., & Khoo, T. K. (2016). The Impact of Physical Activity on Non- Motor Symptoms in Parkinson’s Disease: A Systematic Review. Frontiers in Medicine, 3. https://doi.org/10.3389/fmed.2016.00035 Duchesne, C., Lungu, O., Nadeau, A., Robillard, M. E., Boré, A., Bobeuf, F., … Doyon, J. (2015). Enhancing both motor and cognitive functioning in Parkinson’s disease: Aerobic exercise as a rehabilitative intervention. Brain and Cognition, 99, 68–77. https://doi.org/10.1016/j.bandc.2015.07.005 Negrini, S., Bissolotti, L., Ferraris, A., Noro, F., Bishop, M. D., & Villafañe, J. H. (2017). Nintendo Wii Fit for balance rehabilitation in patients with Parkinson’s disease: A comparative study. Journal of Bodywork and Movement Therapies, 21(1), 117–123. https://doi.org/10.1016/j.jbmt.2016.06.001 Rosenfeldt, A. B., Rasanow, M., Penko, A. L., Beall, E. B., & Alberts, J. L. (2015). The cyclical lower extremity exercise for Parkinson's trial (CYCLE): methodology for a randomized controlled trial. BMC Neurology, 15(1), 63. doi:10.1186/s12883-015-0313-5 Tabak, R., Aquije, G., & Fisher, B. E. (2013). Aerobic Exercise to Improve Executive Function in Parkinson Disease. Journal Of Neurologic Physical Therapy, 37(2), 58-64. doi:10.1097/NPT.0b013e31829219bc Figure 1: Significant improvement was seen in functional gait analysis (FGA) scores before and after the balance training intervention (Atterbury & Welman, 2017).