Unconventional exercises for motor function in Parkinson’s disease: an umbrella review of meta-analyses

Abstract

BACKGROUND: Unconventional exercises were initially used in the clinical treatment of Parkinson's disease (PD). However, clarity regarding their efficacy and credibility in clinical settings is lacking. OBJECTIVES: To summarise and evaluate the effectiveness of various unconventional exercises on motor function in people with PD (PwPD). METHODS: We searched multiple databases up to 31 July 2024, for relevant randomised controlled trials to identify associations between nontraditional exercise and PD outcome evaluations and meta-analyses. The effect sizes were recalculated as mean difference or standardised mean difference with 95% confidence interval and prediction interval. Systematic review quality was assessed using A MeaSurement Tool to Assess systematic Reviews 2, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessments, Developments, and Evaluations system. RESULTS: We included 39 associations from nine meta-analyses. Outcomes of PD motor function, including motor impairment, balance, walking and endurance, were examined. Of the 39 associations, 25 were statistically significant, and one was supported by high-certainty evidence. Robotic-assisted gait training improved motor function compared with conventional interventions. Nine associations of significance were supported by moderate-certainty evidence. Baduanjin, exergaming rehabilitation and dancing also showed significant improvements in motor function. CONCLUSIONS: Unconventional exercises demonstrated advantages for PwPD compared to conventional exercises and passive interventions. However, these results should be cautiously interpreted due to variations across studies and differing certainty levels. More high-quality randomised controlled trials are needed to strengthen the evidence base for these interventions in clinical application. SYSTEMATIC REVIEW REGISTRATION: PROSPERO; identifier: CRD42024555058.