Exercise as a Form of Therapy to Alleviate Anxiety and Depression in Parkinson’s Disease Individuals. Literature Project

Writing a Research Proposal
The purpose of a proposal is to convince someone else to let you (and usually give you money to)
do something.
Your proposal will include the following labeled sections:
Title page
III. Literature References
Title Page
The title page should be formatted in a normal 12pt font, and include the project title, whether this
is a literature or hands-on project, your name and contact information (college email address),
current date, and supervisor’s name.
Summary
The summary is a single paragraph that summarizes the key objectives, rationale and methodology
of the proposal. It should serve to quickly familiarize the reviewer with the salient features of the
proposal.
Proposal Draft
The draft proposal that you will
turn in should contain all
sections and follow all
formatting guidelines.Guidelines for the Capstone Research Proposal
Background Information should briefly summarize the work in the field that is directly
relevant to the proposed project. Assume the reviewer is a knowledgeable scientist but not
an expert in the field, so you will not have to explain every technical term. The review
should not provide unnecessary information (it is not a general review of the field), but
provide a context for the proposed work so that the reviewer will know exactly how the
proposed work will correspond to what is already known in the field. Sources should be
fully cited in the standard format used in all biology coursesClearly stating the objectives of your project is essential.Literature research capstone projects are not simply a general review of the literature. Your
literature review project must be directed toward addressing a particular question – which
is the goal – and there needs to be a preliminary expected conclusion – the hypothesis. The
best literature review projects tackle a complex issue on which there is no current scientific
consensus. For example, you may be very interested in drugs used to regulate cholesterol
levels; and your goal might be “to determine which class of drugs poses the highest benefit
relative to risk of dangerous side effects.” A meaningful hypothesis might be based upon a
preliminary review of the literature or a discussion with a physicianConclude the introduction by explaining the relevance of the project. This should place the
project in context of a larger sphere of issues so the reviewer knows why the project is
important. Thus, an investigation of mouse sarcoma would be relevant to a better
understanding of the causes, effects and potential therapies for human cancers; an
investigation of chipmunk mating calls might be placed in context of the potential impacts
of population size reductions due to habitat destruction.Methodology:
It is obvious that the nature of methodology you describe will depend upon the type of project you
are proposing. Unlike a lab report, the methodology section should not be written in the third
person, past tense, passive voice. It should be written in the future tense, since you are telling the
reviewer what you plan to do.The methodology will focus on the literature research itself, and how the literature will be used to
address your objectives. You will need to describe a thorough approach for searching different
research databases, identifying which ones will be most relevant, how you plan to get literature
that is not available on campus, etc. This section should demonstrate that you have a solid
understanding of how to perform a thorough literature search. In this section you will also
describe how your literature sources will be used to evaluate your hypothesis. Remember, the
body of your paper will focus on articles from the primary literature and a discussion of specific
experimental methodologies and results, and you might indicate that you plan to “compare the
results of clinical studies of cholesterol-lowering drugs for people in different age groups…-aim for about 20 references with a literature cited section at the end. Here is what I currently have belowSummary:
This literature-based project serves to compare the effects of a multitude of exercise
modalities, specifically aerobic, resistance training, and mind-body practices, on anxiety,
depression, and neurological function in individuals with Parkinson’s disease, which affects an
estimated 1 million people in the United States (National Institute of Neurological Disorders and
Stroke, n.d.). Depression and anxiety are common mental health issues for at least half of these
people (Remy et al., 2005, 1314). The purpose of this research is to identify effective and safe
non-pharmacological interventions that can enhance the overall well-being of Parkinson’s
disease patients, given the high prevalence of mental health challenges associated with this
disease. The methodology involves a comprehensive literature review of existing studies,
focusing on the psychological and physiological outcomes associated with each exercise type.
By integrating and critically analyzing findings from diverse studies, this project seeks to answer
the question of which type of exercise (aerobic, resistance training, mind-body practices) is most
effective in improving anxiety and depression in individuals with Parkinson’s disease, with the
goal of improving the quality of life and guiding clinical practices.
Background Information:
Parkinson’s disease is a neurological disorder that is progressive and manifests through a
broad spectrum of symptoms such as resting tremors, bradykinesia (slowness of movement),
postural instability, and rigidity which impact an individual’s ability to complete tasks
(Parkinson’s Disease Foundation, 2014). These symptoms arise due to the gradual loss of nerve
cells in the brain that produce dopamine, a chemical that helps to control movement (Parkinson’s
Disease Foundation, 2014). Over time the progressions of the disease will greatly impact manyaspects of the individual’s daily life including quality of life, self-care, and community
independence (Lawrence et al.,2014). Various interventions can be utilized by individuals with
Parkinson’s disease in order to decelerate the progression and effects of Parkinson’s disease,
with Levodopa being the most commonly prescribed treatment (Parkinson’s Disease Foundation,
2014).
Levodopa, while considered the gold standard treatment for Parkinson’s disease, has
limitations, particularly over time (Paoletti et al.,2019). Although it significantly improves motor
symptoms during the initial “on time” period, long-term use leads to motor complications such
as dyskinesia (involuntary muscle movements) and motor fluctuations (Paoletti et al.,2019).
Studies show that more than 50% of Parkinson’s disease patients experience these complications
about four years into levodopa treatment with a 400mg dose taken daily (Paoletti et al.,2019).
Despite its effectiveness over other treatments, levodopa does not address the underlying disease
progression, and there is no evidence that the drug slows down the disease (Paoletti et al.,2019).
Given the limitations and side effects of pharmacological treatments, exercise is becoming
increasingly recognized as an alternative treatment in managing Parkinson’s disease.
Non-motor symptoms such as depression affect roughly 50% of all PD patients (Prange
et al., 2022, 418). Depression often precedes the clinical diagnosis of Parkinson’s disease, with
individuals having a 2.4 times higher risk of depression even before diagnosis, especially in the
three years leading up to it (Prange et al., 2022, 418). Current research suggests that experiencing
depression early in the disease may be directly due to chemical changes in the brain that affect
mood regulation, energy, appetite, and sleep (Prange et al., 2022, 419). Chemicals involved in
these processes include serotonin, dopamine, and norepinephrine (Prange et al., 2022, 418). The
frontal lobe of the brain, which is involved in mood regulation becomes less active because ofthese chemical changes, which increases the prevalence of depression (Prange et al., 2022, 418).
Anxiety, another common non-motor symptom, coexists with depression in many
individuals with Parkinson’s disease. These non-motor symptoms not only affect emotional well-
being but also significantly impair the ability to manage the motor symptoms of Parkinson’s
disease (Prange et al., 2022, 419). Effective management of these symptoms can enhance the
patient’s ability to engage in daily activities and slow the progression of the disease (Prange et
al., 2022, 420). One promising approach is the use of targeted exercise modalities, which have
shown potential in alleviating both the psychological and physical challenges of Parkinson’s
disease.
Moderately recent research highlights the positive effects of a structured exercise
program on both motor function and neuroplasticity in individuals with early-stage Parkinson’s
disease (Fisher et al., 2008, 1222). Neuroplasticity refers to the ability of the brain to reorganize
its structure and function in response to new experiences (Fisher et al., 2008, 1222). High-
intensity aerobic conditioning, specifically body weight supported treadmill training, led to
significant improvements in gait performance and motor function in Parkinson’s disease
individuals, while the low to zero intensity groups had very little improvement (Fisher et al.,
2008, 1222). As stated by Fisher et al, high intensity aerobic conditioning allows for more active
muscle engagement, which leads to a neurological role of promoting neuroplasticity and repair in
the brain within individuals with Parkinson’s disease (Fisher et al., 2008, 1222). Regardless of
the intensity of the exercise, some improvement will occur in the deceleration of progressive
symptoms in individuals with Parkinson’s disease (Fisher et al., 2008, 1222). However, the
higher the intensity and the more activation of muscles and joints, the longer these beneficial
effects remain in the individual (Fisher et al., 2008, 1221). This study supports the project beingconducted by demonstrating how high-intensity aerobic exercise, which promotes neuroplasticity
and motor function, may also alleviate anxiety and depression in individuals with Parkinson’s
disease (Fisher et al., 2008, 1221).
Another study conducted by Hirsch et al. emphasizes the importance of combining
balance training and resistance training in exercise programs designed for Parkinson’s disease
patients (Hirsch et al., 2003, 1109). Their results found that participants who engaged in a
regimen that included both types of training showed significant improvements in muscle strength
and balance, leading to reduced fall risk (Hirsch et al., 2003, 1113). Specifically, this group
resulted in a 52 percent increase in total muscle strength and a 20 percent decrease in the
percentage of trials resulting in falls (Hirsch et al., 2003, 1114). These findings highlight the
importance of integrating both types of training into rehabilitation programs for Parkinson’s
disease patients. Another study showed that resistance training exercise performed at least four
times per week for 60-90 minutes for up to a total of 12 weeks was most effective in improving
depression in individuals with Parkinson’s disease that had a disease duration of more than five
years (Tian et al., 2022).
Furthermore, a more recent study that leveraged data from the Park-in-Shape trial
examined the effects of aerobic exercise on changes in brain structure and function in individuals
with Parkinson’s disease (Johansson et al., 2022, 203). The study found that aerobic exercise led
to an increase in functional connectivity within brain regions associated with cognitive
processing (anterior putamen), as opposed to stretching exercises, which enhanced connectivity
with motor-related areas (posterior putamen) (Johansson et al., 2022, 203). This shift in
connectivity suggests that aerobic exercise may promote adaptive neuroplasticity, potentially
stabilizing motor symptoms and improving cognitive function (Johansson et al., 2022, 203).Additionally, the aerobic exercise group experienced reduced global brain atrophy and
enhanced cognitive control, which was proven by improved performance on an oculomotor task
(Johansson et al., 2022, 214). The substantia nigra, a key brain region involved in the production
of dopamine (a neurotransmitter critical for motor control), is significantly affected in
Parkinson’s disease, as dopaminergic neurons in this area degenerate over time (Johansson et al.,
2022, 214). Despite the improvements in brain connectivity and cognitive function observed in
the study, no noteworthy changes were observed in the structural integrity of the substantia nigra
(Johansson et al., 2022, 214). This suggests that while aerobic exercise can enhance certain brain
functions, it may not directly reverse or alter the structural change in the substantia nigra
(Johansson et al., 2022, 214). These findings highlight aerobic exercise as a promising
therapeutic strategy, improving not only motor function but also cognitive processes in
individuals with Parkinson’s disease.
Individuals with Parkinson’s disease experience severe depression at a rate that is two
times higher than that of patients with similar levels of disability due to other conditions (Remy
et al., 2005, 1314). Research conducted by Remy et al. aimed to further understand the causes of
high depression frequency and anxiety in individuals with Parkinson’s disease (Remy et al.,
2005, 1314). Two groups of Parkinson’s disease patients participated in the study; one group
consisted of patients that have experienced major episodes of depression while the other group
consisted of patients who had not (Remy et al., 2005, 1315). Researchers concluded that these
mood disorders were linked to a reduction in catecholaminergic innervation (reduction in nerve
fibers that release neurotransmitters, including norepinephrine, epinephrine, and dopamine),
which is essential for brain areas associated with emotional regulation, such as the amygdala
(Remy et al., 2005, 1317). Neuroimaging studies were done using a radioligand called [11C]RTI-32, which showed a decrease in binding potential in these brain regions among depressed
Parkinson’s disease patients (Remy et al., 2005, 1317). Reduced binding suggests that there may
be fewer transporters available in that brain region, which can imply a loss of the neurons that
produce dopamine and norepinephrine. This correlates with increased severity of anxiety and
depression. Decreased binding potential of [11C] RTI-32 was also reported in the substantia
nigra, which suggests a loss of dopaminergic neuron function in this crucial part of the brain
(Remy et al., 2005, 1317).
These findings from the research of Remy et al. highlight the necessity for integrative
treatment approaches for depressed Parkinson’s disease patients, including structuralized
exercise programs. Different exercise modalities have been shown to improve motor function
and potentially improve mood by promoting neuroplasticity and supporting neurotransmitter
systems such as the dopaminergic and noradrenergic systems (Remy et al., 2005, 1317).
Objectives/Hypothesis:
The objectives of this proposed research are to identify effective exercise methods that
alleviate anxiety and depression in individuals with Parkinson’s disease. The primary goal of the
study is to evaluate and compare the impacts of aerobic, resistance-training, and mindfulness
exercises on mental health outcomes. The research aims to assess both psychological benefits,
such as reducing anxiety levels, alongside physiological benefits, which will focus mostly on
improvements in motor functionality and overall neurological health. Furthermore, this research
will examine the practicality and safety of incorporating these exercise modalities into the daily
routines of patients with Parkinson’s disease. Therefore, it is crucial to ensure that the exercises
researched can be safely incorporated into their treatment plans.This project will also blend findings from diverse studies to form a logical understanding
of the relationship between exercise and mental health in the Parkinson’s disease population,
addressing gaps in current literature. The hypothesis driving this research is that different
exercise modalities, particularly aerobic exercise, will lead to significant reductions in anxiety
and depression symptoms in individuals with Parkinson’s disease, with aerobic exercise having
the most pronounced positive impact on mental health. By focusing on the role of exercise in
managing mental health challenges in Parkinson’s disease, this research seeks to offer valuable
insights and potential therapeutic approaches for improving the quality of life for affected
individuals.
Relevance:
Parkinson’s disease, the second-most common neurodegenerative disorder in the United
States following Alzheimer’s disease, currently has no cure, making the exploration of effective
non-pharmacological interventions, such as exercise, critically important for improving the
quality of life of affected individuals (National Institute of Neurological Disorders and Stroke,
n.d.). In the United States, there are over one million people living with Parkinson’s disease
(Parkinson’s Disease Foundation, 2014). The onset of PD usually occurs at 60 years of age. The
prevalence of Parkinson’s disease increases with age and is said to be diagnosed in 4% of
individuals before the age of 50 (Parkinson’s Disease Foundation, 2014). Men are one and a half
times more likely to be diagnosed with Parkinson’s than women (Parkinson’s Disease
Foundation, 2014).
As the prevalence of Parkinson’s disease continues to rise, it poses a significant public
health challenge. In the United States, the cost of treating Parkinson’s disease is estimated to be
about 14 billion dollars annually (Parkinson’s Disease Foundation, 2014). On top of that, indirectcosts, such as those associated with a decrease in productivity, total 6.3 billion dollars annually
(Parkinson’s Disease Foundation, 2014). Additionally, individuals with Parkinson’s disease
receive 4.8 billion dollars in disability income, further exacerbating the financial burden on both
individuals and the healthcare system (Parkinson’s Disease Foundation, 2014). As the U.S.
population ages, these figures are expected to increase rapidly, with the number of people
diagnosed with Parkinson’s disease projected to double by 2040 (Parkinson’s Disease
Foundation, 2014).
Methodology:
The literature search strategy will focus on a comprehensive analysis of various academic
research databases to gather relevant and insightful studies on different exercise modalities and
their effects on mental health in individuals with Parkinson’s disease. Key databases that will be
the most relevant to this topic include Medline and the Science Citation Index from Marietta
College’s library website. These databases will be used due to their extensive coverage of both
medical and psychological research. Regular searches of these databases will be made
throughout the year to ensure that the most recent and relevant studies are considered. This
continuous process will allow for the inclusion of important research findings, keeping the
analysis up to date and comprehensive.
In order to find the most relevant articles a set of carefully selected keywords and phrases
will be employed. These will include terms such as Parkinson’s disease, aerobic exercise,
resistance training, cognitive function, anxiety, depression, and many others. Key terms will be
tested and refined based on initial search results to maximize relevancy. Additionally, Boolean
operators (AND, NOT, OR) will be utilized to further refine search results and ensure a reliable
collection of studies that specifically address the relationship between mental health outcomesand exercise in individuals with Parkinson’s disease. The mechanisms behind how mood
disorders become common in Parkinson’s disease patients will also be studied to help establish a
better understanding of why these symptoms become exceptionally common after the diagnosis.
The researcher’s academic background provides a solid foundation for this project. Prior
coursework in anatomy and physiology has provided an understanding of the functions of the
different brain structures and the neurotransmitters involved in regulating motor control,
emotional processing, and cognitive functions, which are often affected in individuals with
Parkinson’s disease. Psychology 101 has offered a foundational understanding of mental health
conditions such as depression and anxiety, which are commonly observed in this population.
Following the initial search process, I will establish inclusion and exclusion criteria to
filter out articles that may not relate to the problem being researched or that are less ethical.
Articles published in the last 10-20 years will be prioritized to ensure that the research reflects
the most current understanding and technological advancements in the field. Studies will be
included if they have a well-defined sample size and focus on adults who have been diagnosed
with Parkinson’s disease.
Additionally, only studies that specifically investigate the effects of various exercise
modalities on mental health outcomes will be considered. Each study must report clear results
that include psychological and neurological outcomes (such as changes in depression scores)
associated with the exercise modalities to provide an analysis of their overall effectiveness.
Articles that consist of randomized control trials will be frequently used, because they minimize
bias and allow for a clear comparison between groups. Review articles that synthesize findings
across multiple studies will also be included, because they offer valuable insights into broader
result trends in the literature, however these results will not be used in the project. Studies will beexcluded if they involve patients with a history of a major disorder, such as individuals with a
history of major depression prior to the onset of Parkinson’s disease, or a current medication that
may cause conflicting results. Most individuals with Parkinson’s disease currently rely on
treatment to lessen their motor symptoms, therefore studies that include individuals taking drugs
will be included. However, studies that modify the Parkinson’s disease medication regimen or
introduce a new drug will be excluded to avoid confounding factors that could interfere with
results.
To access literature, on-campus resources and interlibrary loans will be used. Research
databases will give access to full-length articles, however interlibrary loan services will be
employed to obtain literature unavailable on campus. Required subscriptions for access to
interlibrary loan articles will be obtained with the library staff’s help.
Literature that is gathered will be analyzed to evaluate the hypothesis that different
exercises will have varying effects on reducing depression and anxiety symptoms in patients
with Parkinson’s disease, with aerobic exercise producing the most significant improvements.
Studies pertaining to exercise will be categorized into distinct categories based on the type of
exercise performed, the methodology employed, and the outcomes reported. This will benefit me
in identifying which exercises are most effective, supporting the overarching goal of identifying
viable non-pharmacological interventions for enhancing mental health in the Parkinson’s disease
population.
Ultimately, this methodology will ensure a thorough examination of the existing
literature, contributing to a well-rounded understanding of the relationship between exercise and
mental health outcomes in individuals with Parkinson’s disease. The findings from the literature
will be discussed in relation to the objectives outlined earlier in the proposal, with the goal ofgaining knowledge that can guide future research on examining effective exercise programs that
can alleviate common mental disorders for individuals with Parkinson’s disease.