Systematic review and meta-analysis of 26 controlled trials (≈2,250 participants) found sustained (≥3 months) improvements in balance, gait, and UPDRS-III after various physiotherapy/exercise interventions, though study heterogeneity was high and evidence rated low-to-moderate.

Demonstrates durable, clinically meaningful functional benefits from multimodal and specific exercise programs that can inform patient care, endpoint selection, and adjunctive non-pharmacological strategies in PD, but provides little direct mechanistic or drug-discovery insight.

BACKGROUND AND PURPOSE: Balance and gait problems pose a significant burden in Parkinson's disease (PD), and they are often poorly treated with levodopa. We intended to summarize evidence of mid- and long-term impact of various physiotherapeutic interventions (≥3 months post-intervention) on dynamic balance, gait, and general motor function in patients with PD. METHOD: A systematic search was conducted across the PubMed, Cochrane Library, and Scopus databases to identify controlled clinical trials on sustained effects of various exercise interventions in PD on the outcomes of interest (lasting ≥ 3 months after completion of the exercise program). We conducted meta-analyses on commonly used clinical measures of dynamic balance and gait ability, as well as on UPDRS-III scores using the Comprehensive Meta-Analysis Software (CMA). RESULTS: A total of 26 studies were included in meta-analyses, with a total of 1261 participants in the experimental and 989 participants in the control groups. Positive cumulative effects at the post-exercise follow-up (3 to 23 months) were shown in favor of the intervention group regarding balance (SMD = 0.512, 95% CI [0.240, 0.785], p < 0.001, I2 = 87%), gait (SMD = 0.614, 95% CI [0.301, 0.926], p < 0.001, I2 = 75%), and general motor function (SMD = 0.922, 95% CI [0.559, 1.285], p < 0.001, I2 = 87%). Heterogeneity among studies was high for all three outcomes, apparently reflecting diversity with regard to patient characteristics, type, and duration of intervention, as well as the method of outcome assessment. The certainty of evidence was consequently judged as ''low'' to ''moderate,'' according to the GRADE system. Subgroup analyses revealed that balance can sustainably improve mostly through multimodal rather than targeted balance-oriented exercise but also through dual-task exercise, tai chi, and Pilates. Gait showed improvement at follow-up mainly through multimodal exercise, aerobic exercise, dual-task exercise, and Pilates, with benefits confined to early- and mid-stage disease. Sustained UPDRS-III improvement could be achieved through multimodal exercise, which showed a large overall effect but also through aerobic, resistance, and dual-task training, tai chi and qigong. CONCLUSIONS: Exercise interventions can improve balance and gait, as well as preserve the overall motor function in patients with PD, also in the mid- and long-term post-intervention periods.