Exercise as a potent antidepressant intervention in Parkinson's disease: a systematic review and meta-analysis of...

Among the non-motor symptoms of Parkinson's disease, depression ranks as one of the most common and debilitating, affecting roughly 40% of patients and substantially diminishing quality of life. Pharmacological treatments are often limited by side effects and variable efficacy, highlighting the need for effective non-pharmacological interventions. Although exercise has been proposed as a promising strategy, the optimal exercise prescription parameters for alleviating depressive symptoms in this population remain unclear.

Five databases were searched from inception to December 15, 2025. Randomised controlled trials comparing exercise with non-exercise control groups in adults with Parkinson's disease were included, with the primary outcome being change in depressive symptoms.

Twenty-one studies with 24 intervention arms comprising 1,010 participants were included. Exercise significantly reduced depressive symptoms compared with control groups (SMD = -0.93; p < 0.00001). Subgroup analyses showed that multicomponent exercise yielded the largest effect size (SMD = -1.22; p < 0.00001), followed by resistance exercise and aerobic exercise. Favorable parameters included session durations ≥ 60 min (SMD = -1.03; p < 0.00001), intervention durations > 8 weeks (SMD = -1.07; p < 0.00001), session frequencies < 3 times per week (SMD = -1.23; p < 0.00001), and total weekly exercise time < 180 min (SMD = -1.03; p < 0.00001). The overall certainty of evidence was moderate according to GRADE assessment.

Exercise significantly alleviates depressive symptoms in people with Parkinson's disease. For people with mild to moderate Parkinson's disease with depression, multicomponent exercise appeared to be the most effective intervention type among those examined; however, aerobic and resistance exercise also significantly improved depressive symptoms. Favorable dosing was observed for sessions of 60 min or longer, program duration exceeding 8 weeks, and a frequency of less than three times per week with total weekly time under 180 min. Importantly, lower doses-including sessions shorter than 60 min, program duration of 8 weeks or less, frequency of three or more times per week, and total weekly time of 180 min or more-also produced significant antidepressant effects, demonstrating the flexibility of exercise prescription for this population. These findings support the incorporation of structured exercise programs into standard care for Parkinson's disease with depressive symptomatology. Clinicians may consider these evidence-based parameters when prescribing exercise to this patient population while recognizing that multiple effective dosing options exist.

Identifier CRD 420261350303.