ABSTRACT
HEALTH PROBLEM: Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity. CORPUS OF EVIDENCE: A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care. IMPLICATION FOR RESEARCH: Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease.
Subject(s)
Exercise Test , Parkinson Disease/rehabilitation , Physical Therapy Modalities , Walking , Disability Evaluation , Evidence-Based Medicine , Gait , Germany , Humans , Randomized Controlled Trials as Topic , Translational Research, BiomedicalABSTRACT
BACKGROUND AND OBJECTIVES: Professionals in the domain of swimming have a strong interest in implementing research methods in evaluating and improving training methods to maximize athletic performance and competitive outcome. Heart rate variability (HRV) has gained attention in research on sport and exercise to assess autonomic nervous system activity underlying physical activity and sports performance. Studies on swimming and HRV are rare. This review aims to summarize the current evidence on the application of HRV in swimming research and draws implications for future research. METHODS: A systematic search of databases (PubMed via MEDLINE, PSYNDEX and Embase) according to the PRISMA statement was employed. Studies were screened for eligibility on inclusion criteria: (a) empirical investigation (HRV) in humans (non-clinical); (b) related to swimming; (c) peer-reviewed journal; and (d) English language. RESULTS: The search revealed 194 studies (duplicates removed), of which the abstract was screened for eligibility. Fourteen studies meeting the inclusion criteria were included in the review. Included studies broadly fell into three classes: (1) control group designs to investigate between-subject differences (i.e. swimmers vs. non-swimmers, swimmers vs. other athletes); (2) repeated measures designs on within-subject differences of interventional studies measuring HRV to address different modalities of training or recovery; and (3) other studies, on the agreement of HRV with other measures. CONCLUSIONS: The feasibility and possibilities of HRV within this particular field of application are well documented within the existing literature. Future studies, focusing on translational approaches that transfer current evidence in general practice (i.e. training of athletes) are needed.
