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Aktuelle Neurologie 2012; 39(05): 236-247
DOI: 10.1055/s-0032-1308983
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Effektivität von Sport bei M. Parkinson

Efficacy of Exercise in Parkinson’s Disease
I. Reuter
1   Neurologische Klinik, Justus-Liebig Universität, Gießen
,
G. Ebersbach
2   Neurologische Fachklinik für Bewegungsstörungen und Parkinson Beelitz Heilstätten, Neurologie, Beelitz-Heilstätten
› Author Affiliations
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Publication History

Publication Date:
12 June 2012 (online)

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Zusammenfassung

Es gibt zunehmend Hinweise, dass der durch kognitiven Abbau und pharmakorefraktäre motorische Defizite bestimmte Langzeitverlauf der Parkinson-Erkrankung durch intensives körperliches Training verbessert werden kann. In Tiermodellen der Parkinson-Erkrankung hat körperliche Aktivität möglicherweise durch Freisetzung neurotropher Faktoren mediierte neuroprotektive und neuroplastische Effekte, die sich positiv auf die Motorik auswirken. Zahlreiche klinische Studien sprechen dafür, dass die Behinderung durch pharmakorefraktäre Bewegungseinschränkungen bei der Parkinson-Erkrankung durch aktivierende Therapie reduziert werden kann. Durch kurz- und mittelfristige Trainingsinterventionen (1–6 Monate) konnten positive Effekte auf Gang, Haltung, Gleichgewicht, Muskelkraft und in einigen Studien auch auf Parkinson-spezifische Defizite und die Lebensqualität erreicht werden. Auch Verbesserungen der kognitiven Leistungsfähigkeit durch körperliche Aktivität wurden sowohl im Tiermodell als auch in klinischen Studien nachgewiesen. Eingesetzt wurden Physiotherapie, Wandern, Nordic Walking und Krafttraining. Körperliche Aktivität im mittleren Lebensalter scheint das zukünftige Risiko an M. Parkinson zu erkranken zu mindern. Die neuronalen Mechanismen der aktivierenden Therapie bei IPS und die Auswirkungen auf Progression und Prognose der Erkrankung können vorerst nur spekulativ beurteilt werden. Trotzdem sollten aktivierende Therapien einschließlich der Sporttherapie aufgrund der positiven Ergebnisse von klinischer und Grundlagenforschung schon jetzt einen höheren Stellenwert in der alltäglichen Patientenversorgung bekommen. Die immer deutlicher werdenden neuroplastischen und neuroprotektiven Auswirkungen körperlichen Trainings sprechen dafür, aktivierende Therapien bei der Parkinson-Erkrankung früh im Krankheitsverlauf und nicht erst beim Auftreten funktionell relevanter Behinderungen einzusetzen.

Abstract

The major causes of disability in Parkinson’s disease (PD) are cognitive decline and motor aspects of the disease which are not improved by L-Dopa. There has been increasing evidence that vigorous exercise might favourably influence the course of Parkinson’s disease. In animal models of Parkinson’s disease physical exercise enhances the release of neurotrophic factors which is linked to neuroplasticity and neuroprotection leading to an improvement of motor symptoms. Numerous clinical studies suggest that the impairment caused by medication-refractory motor problems might be reduced by exercise therapy. Furthermore, exercised patients with PD can improve their cognitive scores. Exercise programmes lasting 1–6 months resulted in significant improvements of gait, posture, balance, and muscle strength. A few studies have shown positive effects on physical functioning and health-related quality of life. Most often, physiotherapy, walking, Nordic walking and high intensity resistance training have been applied. Beneficial effects of exercise on cognitive performance have also been shown in patients and in animal models of Parkinson’s disease. Higher levels of moderate to vigorous physical activities at ages 35–39 or in the past 10 years were associated with a future lower risk of PD. The neuronal mechanisms underlying the effects of exercise therapy on progression of PD are not completely understood. Nevertheless, based on the positive results of exercise therapy in clinical studies and basic research, exercise therapy should be implemented already in the early stages of Parkinson’s disease and not delayed to advanced stages.

Schlüsselwörter

Sport - M. Parkinson - Gang - Trainingsintensität - Funtionalität

Keywords

sports - Parkinson’s disease - gait - intensity of training - functionality
 

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