Optimal exercise modalities and doses for improving quality of life in patients with Parkinson's disease: a network...

This study aims to systematically evaluate the relationships and effects of different exercise modalities and exercise doses on the quality of life in patients with Parkinson's disease (PD).

Randomized controlled trials published from database inception to November 2025 were identified by searching PubMed, Web of Science, Embase, and the Cochrane Library. The Cochrane Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the included studies. Stata version 17.0 and R version 4.4.3 were used to analyze and compare the relationships and effects of different exercise modalities and exercise doses on quality of life in patients with PD.

A total of 44 randomized controlled trials (RCTs), including 2,273 patients with PD, were analyzed. The network meta-analysis showed that aerobic exercise (AE) (SMD =  - 0.66; 95% CI: - 0.93 to - 0.39; P < 0.01), aerobic and resistance training (ART) (SMD =  - 0.71; 95% CI: - 1.09 to - 0.33; P < 0.01), mind-body exercise (MBE) (SMD =  - 0.73; 95% CI: - 1.04 to - 0.43; P < 0.01), and resistance training (RT) (SMD =  - 0.66; 95% CI: - 1.02 to - 0.29; P < 0.01) all significantly improved quality of life, whereas balance and resistance training (BRT) and stretching training (ST) showed no statistically significant effects. Cumulative ranking probabilities indicated that MBE had the highest probability of being the most effective intervention (80.6%), followed by ART (76.7%), AE (70.5%), and RT (69.7%), while ST (30.7%) and BRT (18.3%) ranked lower. Dose-response analysis revealed a nonlinear U-shaped relationship between total exercise dose and improvement in quality of life, with an optimal dose of 950 MET-min/week. The optimal doses varied across exercise modalities, ranging from 550 MET-min/week for MBE to 920 MET-min/week for AE.

Exercise interventions can significantly improve quality of life in patients with PD, with MBE demonstrating the greatest benefit. The U-shaped association between exercise dose and quality of life suggests that a moderate amount of exercise is most conducive to improving quality of life. This study provides evidence supporting non-pharmacological treatment strategies for PD and may inform the formulation of individualized exercise prescriptions.