Optimal dose and type of exercise to improve motor symptoms in adults with Parkinson's disease : A network meta-analysis: A network meta-analysis

Objectives: This study aimed to evaluate the dose-response relationship between different exercise types and the alleviation of motor symptoms in Parkinson's Disease patients. Design: A systematic review and network meta-analysis were conducted to compare the effects of 12 exercise types on motor symptoms in Parkinson's Disease patients using randomized controlled trials. Methods: A systematic search was conducted across PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science until September 10, 2024. A total of 81 trials involving 4596 patients were included. Mean differences with 95 % credible intervals were calculated, and evidence quality was assessed using Confidence in Network Meta-Analysis. The Minimum Clinically Important Difference was used to assess clinical efficacy. Results: The optimal exercise dose for overall motor symptom improvement was 1300 MET-min/week (mean difference: − 6.07, 95 % credible intervals: − 8.10 to − 4.01). Dance at 850 MET-min/week provided the greatest improvement (mean difference: − 11.18, 95 % credible intervals: − 16.01 to − 6.22). Significant improvements were seen with doses as low as 60–100 MET-min/week for body weight support training, dance, resistance training, and sensory exercise. The Minimum Clinically Important Difference was achieved with doses exceeding 670 MET-min/week for overall exercise, and at lower doses for specific types: aerobic exercise (1100 MET-min/week), body weight support (420 MET-min/week), and dance (230 MET-min/week). Conclusions: The optimal exercise dose for alleviating motor symptoms in Parkinson's Disease patients is 1300 MET-min/week, with dance being most effective at 850 MET-min/week. These findings provide evidence-based recommendations for Parkinson's Disease management.