Exercise modality and planned weekly exercise exposure for motor outcomes in Parkinson's disease: a systematic review, Bayesian network meta-analysis, and meta-regression.

In 30 seconds

This systematic review and Bayesian network meta-analysis synthesized 173 randomized trials of exercise in people with Parkinson’s disease, assessing motor symptoms, balance, walking speed, and Timed Up and Go (TUG). Mind-body exercise had the largest posterior median effect versus non-exercise control for UPDRS III (g = 0.65, 95% credible interval [CrI] 0.42-0.87). Trial-level analyses found higher planned weekly exercise exposure associated with greater average improvement in UPDRS III, balance, and TUG, but not walking speed. The evidence did not establish a universally best modality or optimal dose.

Key findings

• Mind-body exercise had the largest posterior median versus non-exercise control for UPDRS III (g = 0.65, 95% credible interval [CrI] 0.42-0.87).
• Per + 250 MET-min/week, trial-level exposure was associated with UPDRS III improvement of 0.121 SMD (95% CrI 0.055-0.194) and balance improvement of 0.111 (0.047-0.184).
• For TUG, the exposure association was 0.124 SMD per + 250 MET-min/week (95% CrI 0.058-0.190), but attenuated after P95 dose truncation.
• Walking speed showed no clear exposure association: 0.008 SMD per + 250 MET-min/week (95% CrI - 0.063 to 0.076).

Why it matters

The findings suggest that exercise modality and planned weekly exposure may relate differently to specific motor outcomes in Parkinson’s disease. However, prediction intervals crossed zero, confidence was low or very low, and randomized within-class dose contrasts were imprecise. These results therefore inform interpretation of the evidence rather than identifying a reliably superior exercise approach or a dose target.

What to keep in mind

Confidence in the evidence was low or very low. Within-class randomized dose-contrast estimates were imprecise for all outcomes, and the TUG exposure association was sensitive to the high-dose tail.