---
title: "Exercise Interventions Improve Gait, Motor Function, and Some Balance Measures in Parkinson’s Dise"
id: "plos-one-14-effects-of-exercise-interventions-on-gait-motor-function-and-balance-in"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-14-effects-of-exercise-interventions-on-gait-motor-function-and-balance-in"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359274"
published_at: "2026-09-25T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Exercise Interventions Improve Gait, Motor Function, and Some Balance Measures in Parkinson’s Dise
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-14-effects-of-exercise-interventions-on-gait-motor-function-and-balance-in
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359274)
- **Published At:** 2026-09-25T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This meta-analysis pooled 20 randomized controlled trials (2009–2024) including 714 patients with Parkinson’s disease (372 in exercise arms, 342 controls) to assess effects of **exercise interventions** on gait, motor function, and balance. - Primary outcomes were the **Freezing of Gait Questionnaire (FOGQ)**, **UPDRS-III** (motor examination), **Berg Balance Scale (BBS)**, and **Mini-BESTest**; immediate post-intervention measures were analyzed. - Exercise was associated with lower FOGQ scores (SMD = −0.62, 95% CI −1.06 to −0.18), indicating improvement in freezing of gait symptoms relative to control. - Exercise was associated with lower **UPDRS-III** scores (SMD = −0.80, 95% CI −1.02 to −0.59), suggesting improved overall motor function with low heterogeneity. - Exercise was associated with higher **BBS** scores (SMD = 0.85, 95% CI 0.27 to 1.42), though heterogeneity was high across studies. - The pooled effect for **Mini-BESTest** did not reach statistical significance (SMD = 0.23, 95% CI −0.24 to 0.70), so evidence for this balance measure is inconclusive. - Exercise modalities across trials included dance, Tai Chi/Qigong/yoga, treadmill, resistance, aquatic, walking, balance/gait training, and multimodal approaches; subgroup analyses did not identify differential effects by modality, dose, age, or disease duration. - Risk-of-bias assessment (RoB 2) found 16 trials with some concerns and 4 with high overall risk; none were rated low risk. Main concerns were deviations from intended interventions, incomplete randomization reporting, missing outcome data, and outcome measurement. - Certainty of evidence per GRADE: moderate for **UPDRS-III**, low for FOGQ, BBS, and Mini-BESTest. Findings should be interpreted cautiously given methodological limitations and limited certainty. - The review followed PRISMA guidelines and was registered in PROSPERO (CRD420261281718).
## Clinical Analysis & Structured Key Points
Effects of exercise interventions on gait, motor function, and balance in patients with Parkinson’s disease: A meta-analysis with clinical implications | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract 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. Citation: Zhang C, Jia Z, Wang Y, Zang W (2026) Effects of exercise interventions on gait, motor function, and balance in patients with Parkinson’s disease: A meta-analysis with clinical implications. PLoS One 21(9): e0359274. https://doi.org/10.1371/journal.pone.0359274 Editor: Assoc. Prof. Phakkharawat Sittiprapaporn, Mae Fah Luang University School of Anti Aging and Regenerative Medicine, THAILAND Received: April 13, 2026; Accepted: September 11, 2026; Published: September 25, 2026 Copyright: © 2026 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data underlying the findings of this study are contained within the manuscript and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abbreviations: PD, Parkinson’s disease; PICOS, Population, Intervention, Comparator, Outcomes, and Study design; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO, International Prospective Register of Systematic Reviews; RCT, randomized controlled trial; SMD, standardized mean difference; UPDRS-III, Unified Parkinson’s Disease Rating Scale Part III; Mini-BESTest, Mini-Balance Evaluation Systems Test; GRADE, Grading of Recommendations Assessment, Development and Evaluation; FOGQ, Freezing of Gait Questionnaire; CENTRAL, Cochrane Central Register of Controlled Trials; BBS, Berg Balance Scale; CI, Confidence interval; REML, Restricted maximum likelihood; RoB 2, Cochrane Risk of Bias 2. Introduction Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra and the deposition of Lewy bodies [ 1 ]. With the accelerating aging of the global population, the burden of PD continues to increase. In 2021, there were approximately 11.9 million patients worldwide, and it is projected to rise to about 25.2 million by 2050 [ 2 ]. Besides the typical symptoms such as resting tremor, bradykinesia and rigidity, PD patients often experience gait abnormalities, impaired postural control and an increased risk of falls [ 3 , 4 ], which significantly affect their mobility, independence in daily life and quality of life. Therefore, rehabilitation strategies targeting gait impairment, postural instability, and motor dysfunction are clinically important in the comprehensive management of PD [ 5 ]. Although drug therapy remains the fundamental treatment strategy for PD, its effects on gait impairment, balance dysfunction, and postural instability are often limited, and long-term application may be accompanied by end-of-dose phenomenon, dyskinesia and symptom fluctuations, etc. [ 6 , 7 ]. In contrast, exercise interventions have advantages such as a favorable safety profile, long-term feasibility, and broad applicability [ 8 ], and can provide support for motor function recovery by improving lower limb muscle strength, walking ability and balance control [ 9 ]. Therefore, exercise intervention has become an important part of PD functional rehabilitation. Previous systematic reviews and meta-analyses have evaluated the efficacy of exercise therapy or physical therapy in patients with PD, but there are still deficiencies. Some studies have focused on a single exercise modality or specific training domains, which limits the integration of evidence from different intervention strategies [ 10 ]. At the same time, existing reviews lack systematic analysis of dose parameters such as intervention duration, training frequency, and duration of each training session, making it difficult to generate hypotheses for future research on exercise prescription [ 11 ]. In addition, the outcome measures used in different studies are not consistent, and different scales have differences in measurement dimensions and psychometric properties, which may also affect effect estimation and evidence interpretation [ 12 ]. Accordingly, this systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on gait-related symptoms, overall motor function, and balance in people with PD. The principal outcomes were 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). We also explored potential sources of heterogeneity and assessed the certainty of evidence for each outcome. Materials and methods Study framework This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and was prospectively registered in PROSPERO (CRD420261281718) [ 13 ]. The population, intervention, comparator, outcomes, and study design (PICOS) criteria are presented in Table 1 . Download: PNG larger image TIFF original image Table 1. PICOS criteria for study inclusion. https://doi.org/10.1371/journal.pone.0359274.t001 Ethics approval and consent to participate were not applicable because this study was based on previously published studies and did not involve direct recruitment of human participants or collection of identifiable personal data. Literature search strategy We systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from the establishment of each database until January 10, 2026. The search terms included Parkinson’s disease, exercise intervention, and randomized controlled trials. The complete search strategies for each database, including database platform, exact search terms, search date, restrictions, language limits, and manual and citation-search methods, are provided in Appendix 1. In addition, we conducted a backward search of the references of the included studies and related reviews, and supplemented with necessary manual searches. Eligibility criteria Inclusion criteria (PICOS) : (P) adults aged ≥18 years with idiopathic PD diagnosed according to accepted clinical criteria (diagnostic criteria and staging were as reported in the original studies), with medication status/stability reported where available; (I) the intervention group received exercise-only interventions, defined as structured physical training without additional non-exercise therapeutic components as the active experimental element; in multi-arm trials that included both an exercise-only arm and a combined-intervention arm, eligibility was determined at the arm level, and only the separately extractable exercise-only arm was eligible for inclusion; (C) the control group received usual care/usual rehabilitation or no structured exercise intervention; (O) at least one of the following outcomes was reported: FOGQ, UPDRS-III, BBS, or Mini-BESTest; (S) randomized controlled trials (RCTs). Exclusion criteria: (1) motor/gait impairment due to other neurological disorders (e.g., stroke, multiple sclerosis, dementia); (2) interventions including non-exercise components or combined treatments that could not be disentangled from the exercise effect (e.g., medication adjustment, electrical stimulation, cognitive training, or music therapy); studies with mixed interventions were excluded unless data for an exercise-only arm could be extracted separately; (3) missing key data, non-convertible statistics, or inability to extract effect sizes; (4) duplicate publications (retaining the most complete report or the one with the largest sample size); (5) abstract-only reports or unavailable full texts (e.g., conference abstracts, registration records only). Study selection and data extraction All retrieved records were imported into EndNote X20 for management, and duplicates were removed by software and manual checking. Two reviewers independently screened titles, abstracts, and full texts according to the prespecified eligibility criteria. Disagreements were resolved by discussion or by a third reviewer. Reasons for full-text exclusion were recorded and summarized in the PRISMA 2020 flow diagram. Data were extracted independently by two reviewers using a standardized form. Extracted information included study characteristics, participant characteristics, intervention and control details, exercise dose, outcome data for FOGQ, UPDRS-III, BBS, and Mini-BESTest, adverse events, and information required for risk-of-bias assessment. For each outcome, data measured immediately after completion of the intervention were extracted for the primary meta-analysis; follow-up data were not pooled because follow-up timing and reporting were inconsistent across trials. Methodological quality assessment The Cochrane Risk of Bias 2 (RoB 2) tool was used to assess risk of bias in the included RCTs [ 14 ]. The RoB 2 assessment comprised five bias domains and an overall risk-of-bias judgment: (1) bias arising from the randomization process, (2) bias due to deviations from intended interventions, (3) bias due to missing outcome data, (4) bias in measurement of the outcome, (5) bias in selection of the reported result, and (6) overall risk of bias. Each component was judged as “low risk of bias”, “some concerns”, or “high risk of bias”. Two reviewers independently assessed the included studies, and disagreements were resolved through discussion or consultation with a third reviewer. Statistical analysis Meta-analyses were conducted using Stata 17.0. Continuous outcomes were pooled as standardized mean differences (SMDs, Hedges’ g) with 95% confidence intervals (CIs). Random-effects restricted maximum likelihood (REML) models were used for all analyses. Heterogeneity was assessed using Cochran’s Q test and quantified using I 2 and τ 2 , and the heterogeneity results were used for interpretation rather than model selection [ 15 ]. Prediction intervals were considered for outcomes with moderate or high heterogeneity; however, they were not reported because the number of included studies for these outcomes was limited, which could make prediction interval estimates unstable and potentially misleading. Prespecified subgroup analyses were conducted according to age, disease duration, intervention duration, training frequency, single-session duration, and exercise modality. Sensitivity analyses were performed using leave-one-out analyses. Publication bias and small-study effects were assessed using funnel plots and Egger’s regression test [ 16 ]. Formal assessment was performed for outcomes with at least 10 comparisons, whereas outcomes with fewer than 10 studies were interpreted cautiously. A two-sided P < 0.05 was considered statistically significant. Certainty of evidence assessment The certainty of evidence for each primary outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, considering risk of bias, inconsistency, indirectness, imprecision, and publication bias [ 17 ]. Evidence certainty was classified as high, moderate, low, or very low, and the results are presented in the Summary of Findings table. Results Database searches identified 9,298 records. After 4,636 duplicate records were removed, 4,662 records underwent title and abstract screening, of which 4,259 were excluded. The remaining 403 reports were retrieved and assessed for eligibility. Citation searching identified six additional reports, all of which were retrieved and assessed for eligibility. Thus, a total of 409 full-text reports were assessed, of which 389 were excluded. Finally, 20 RCTs met the eligibility criteria and were included in the meta-analysis, as shown in Fig 1 . Download: PNG larger image TIFF original image Fig 1. PRISMA 2020 flow diagram of literature search and study selection. https://doi.org/10.1371/journal.pone.0359274.g001 Risk of bias in included studies Risk of bias in the included studies is summarized in Fig 2 . Four of the 20 included RCTs had a high overall risk of bias, while the remaining 16 had some concerns; none was rated as low risk. For the randomization process, six studies were rated as low risk and 14 as having some concerns. For deviations from the intended interventions, most studies were judged as having some concerns, mainly because blinding of participants and intervention providers was difficult in exercise-intervention trials. For missing outcome data, seven studies were rated as low risk, 11 as having some concerns, and two as high risk. For measurement of the outcome, 14 studies were rated as low risk, four as having some concerns, and two as high risk. For selection of the reported result, six studies were rated as low risk and 14 as having some concerns. Overall, the main sources of bias were deviations from intended interventions, incomplete reporting of randomization procedures, missing outcome data, and outcome measurement. Download: PNG larger image TIFF original image Fig 2. Risk of bias assessment using the Cochrane Risk of Bias 2 tool. (A) Traffic-light plot of study-level risk-of-bias judgments. (B) Summary plot of risk-of-bias judgments across RoB 2 domains. https://doi.org/10.1371/journal.pone.0359274.g002 Characteristics of included studies Twenty RCTs published between 2009 and 2024 were included, comprising 714 patients with PD, of whom 372 were assigned to exercise intervention groups and 342 to control groups [ 18 – 37 ]. The exercise interventions included dance-based training, Tai Chi, Qigong, yoga, treadmill training, balance/gait training, resistance training, aquatic exercise, walking training, and multimodal exercise. The outcome measures used in the meta-analysis included FOGQ, UPDRS-III, BBS, and Mini-BESTest, as shown in Table 2 . Download: PNG larger image TIFF original image Table 2. Basic characteristics of the included studies. https://doi.org/10.1371/journal.pone.0359274.t002 Meta-analysis FOGQ. Nine studies reported FOGQ outcomes in patients with PD [ 18 – 26 ]. Results were pooled using a prespecified random-effects REML model. Compared with control, exercise interventions were associated with a significantly lower FOGQ score [SMD=−0.62, 95% CI (−1.06, −0.18), P = 0.01]. Heterogeneity was moderate (I² = 64.52%, τ² = 0.28,P = 0.01). Fig 3A . Download: PNG larger image TIFF original image Fig 3. Meta-analysis of the effects of exercise interventions on gait-related, motor-function, and balance outcomes in patients with PD. Chang 2024a and Chang 2024b refer to two eligible exercise-intervention arms from the same multi-arm trial reported by Chang et al. 2024. (A) FOGQ; (B) UPDRS-III; (C) BBS; (D) Mini-BESTest. https://doi.org/10.1371/journal.pone.0359274.g003 In the leave-one-out analysis for FOGQ, sequential omission of each study yielded pooled estimates ranging from −0.67 to −0.41, and all remained statistically significant (all P ≤ 0.017). Further details are provided in Appendix Fig 1 . UPDRS-III. Thirteen comparisons reported UPDRS-III outcomes in patients with PD [ 18 , 20 , 22 , 23 , 27 , 29 , 30 , 32 , 34 – 37 ]. Results were pooled using a prespecified random-effects REML model. Compared with control, exercise interventions were associated with a significantly lower UPDRS-III score [SMD=−0.80, 95% CI (−1.02, −0.59), P < 0.001]. Heterogeneity was low (I² = 0.00%, τ² = 0.00,P = 0.66). Fig 3B . In the leave-one-out analysis for UPDRS-III, sequential omission of each comparison yielded pooled estimates ranging from −0.85 to −0.75, and all remained statistically significant (all P < 0.001). Further details are provided in Appendix Fig 2 . BBS. Eight studies reported BBS outcomes in patients with PD [ 18 , 27 – 30 , 32 – 34 ]. Results were pooled using a prespecified random-effects REML model. Compared with control, exercise interventions were associated with a significantly higher BBS score [SMD = 0.85, 95% CI (0.27, 1.42), P = 0.004]. Heterogeneity was high (I² = 77.51%, τ² = 0.50,P = 0.00). Fig 3C . In the leave-one-out analysis for BBS, sequential omission of each study yielded pooled estimates ranging from 0.69 to 0.99, and all remained statistically significant (all P ≤ 0.017), indicating that the overall result was not driven by any single study. Further details are provided in Appendix Fig 3 . Mini-BESTest. Four studies reported Mini-BESTest outcomes in patients with PD [ 23 , 26 , 31 , 35 ]. Results were pooled using a prespecified random-effects REML model. Exercise interventions showed a trend towards improved Mini-BESTest scores but did not reach statistical significance [SMD = 0.23, 95% CI (−0.24, 0.70), P = 0.34]. Heterogeneity was moderate (I 2 = 53.59%, τ² = 0.12,P = 0.08). Fig 3D . In the leave-one-out analysis for Mini-BESTest, sequential omission of each study yielded pooled estimates ranging from −0.03 to 0.44. However, statistical significance was not consistently maintained across iterations: only one omitted-study model remained sig
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