Objective: To investigate the impact of physiotherapy on mood disorders such as apathy, anxiety, and depression in patients with Parkinson’s disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP), and whether mood improvement correlates with increased physical activity and better motor function.

Background: PD, MSA, and PSP are neurodegenerative diseases primarily marked by motor symptoms. However, mood disorders, like apathy, depression and anxiety, are prevalent and associated with increased frailty and disability, rapid functional decline and increased mortality^1–4. Increasing evidence supports the efficacy of physiotherapy and exercise in improving motor and cognitive function which complement the pharmacological therapy^5–8.

Method: This project is part of the Mobility_APP-Study, a multicenter, randomized, controlled, double-blind interventional study, comparing two approaches of physiotherapy. The intervention consists of a 2-week daily in-patient physiotherapy session followed by 5 weeks of home-based training. The assessment includes motor and cognitive testing, questionnaires, an Instrumented Gait Analysis (IGA) and a 1-week sensor-based monitoring of physical activity at baseline and study end.

Results: We enrolled 72 PD patients, 51 patients with PSP and 44 with MSA.

Compared to PD, atypical PD (PSP&MSA) patients show worse cognition, mood and motor performance at baseline, and throughout the study. PSP patients globally improve in mood with the in-patient physiotherapy but then worsen, except for anxiety.

Depression improves in PD patients’ during home-training, whereas anxiety improves in MSA patients during inpatient physiotherapy.

All groups show significant improvement in UPDRS-II scores, with slight balance improvement (BBS) in MSA and PD patients and better postural stability and gait (PIGD) in patients with APD. MSA patients increase their moderate physical activity.

Globally, better mood correlates with better motor function. In contrast, anxiety appears to increase despite improvement in motor function in both MSA and PSP after inpatient physiotherapy.

Conclusion: Physiotherapy improves both motor symptoms and mood including apathy, anxiety and depression, which appear to be interlinked. This underlines the efficacy of non-pharmacological interventions in the treatment of patients with PD and APD.

References: 1. Hu WZ, Cao LX, Yin JH, et al. Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson’s disease and progressive supranuclear palsy. Front Neurol. 2023;13:1081219. doi:10.3389/fneur.2022.1081219
2. Chen JJ, Marsh L. Anxiety in Parkinson’s disease: identification and management. Ther Adv Neurol Disord. 2014;7(1):52-59. doi:10.1177/1756285613495723
3. Wu T, Wang L, Chen Y, Zhao C, Li K, Chan P. Changes of functional connectivity of the motor network in the resting state in Parkinson’s disease. Neurosci Lett. 2009;460(1):6-10. doi:10.1016/j.neulet.2009.05.046
4. Farajzadeh A, Hébert A, Lahart IM, Bilodeau M, Boisgontier MP. Apathy and Physical Activity: A Systematic Review and Meta-Analysis. Published online May 3, 2024. doi:10.1101/2024.05.01.24306712
5. Cusso ME, Donald KJ, Khoo TK. The Impact of Physical Activity on Non-Motor Symptoms in Parkinson’s Disease: A Systematic Review. Front Med. 2016;3. doi:10.3389/fmed.2016.00035
6. Smith PJ, Merwin RM. The Role of Exercise in Management of Mental Health Disorders: An Integrative Review. Annu Rev Med. 2021;72(1):45-62. doi:10.1146/annurev-med-060619-022943
7. Ahern L, Curtin C, Timmons S, Lamb SE, McCullagh R. “Exercise… to Me, It’s Freedom”: Motivation, Support, and Self-Management to Keep Physically Active with Parkinson’s Disease: A Qualitative Study. Geriatrics. 2024;9(4):92. doi:10.3390/geriatrics9040092
8. Wu PL, Lee M, Huang TT. Effectiveness of physical activity on patients with depression and Parkinson’s disease: A systematic review. Lebedev MA, ed. PLOS ONE. 2017;12(7):e0181515. doi:10.1371/journal.pone.0181515

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-physiotherapy-on-mood-disorders-in-patients-with-msa-psp-and-pd/