Effects of exercise interventions on gait, motor function, and balance in patients with Parkinson’s disease: A meta-analysis with clinical implications

Objective: Evidence regarding the effects of exercise interventions on gait-related symptoms, motor function, and balance in patients with Parkinson’s disease (PD) remains uncertain across outcome measures and intervention characteristics. This study aimed to evaluate the effects of exercise interventions on the Freezing of Gait Questionnaire (FOGQ), Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest), and to explore potential sources of heterogeneity. Methods: Standardized mean differences (SMDs; Hedges’ g) with 95% confidence intervals (CIs) were pooled using random-effects restricted maximum likelihood models. Exploratory subgroup analyses examined age, disease duration, intervention duration, training frequency, single-session duration, and exercise modality as potential sources of heterogeneity. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. This review was registered in PROSPERO (CRD420261281718). Results: The meta-analysis included 20 randomized controlled trials published between 2009 and 2024, involving 714 patients with PD, including 372 participants in the exercise intervention groups and 342 in the control groups. Sixteen trials were judged as having some concerns and four as having a high overall risk of bias; none was rated as low risk. Compared with control conditions, exercise interventions were associated with lower FOGQ scores (SMD = −0.62, 95% CI −1.06 to −0.18) and UPDRS-III scores (SMD = −0.80, 95% CI −1.02 to −0.59), and higher BBS scores (SMD = 0.85, 95% CI 0.27 to 1.42). The pooled effect for Mini-BESTest was not statistically significant (SMD = 0.23, 95% CI −0.24 to 0.70). Exploratory subgroup analyses did not establish differential effects according to exercise modality, dose parameters, age, or disease duration. The certainty of evidence was moderate for UPDRS-III and low for FOGQ, BBS, and Mini-BESTest. Conclusion: Exercise interventions may improve freezing-of-gait symptoms, overall motor function, and some aspects of balance performance in patients with PD, although evidence for Mini-BESTest outcomes remains inconclusive. Given the limited certainty of evidence and methodological limitations of the included trials, these findings warrant cautious interpretation.