Effects and parameters of community-based exercise on motor symptoms in Parkinson's disease: a meta-analysis

Abstract Background Community-based exercise is a continuation and supplement of Parkinson's hospital rehabilitation and is a type of unsupervised exercise. The effects, parameters, and forms of each study were diverse. The effect is affected by many factors. In this paper, a Meta-analysis was conducted to determine the effect and the best parameters for improving motor symptoms and explore the possible factors affecting the effect. Methods We conducted a comprehensive search of six databases: PEDro, PubMed, CENTRAL, Scopus, Embase, and WOS. Studies comparing community-based exercise with usual care were included. The intervention mainly included dance, Chinese martial arts, Nordic walking, and home-based exercise. The primary outcome measure was the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Mean difference (95% CI) was used to calculate treatment outcomes of continuous outcome variables, and I2 was used to estimate the heterogeneity of the statistical analysis. We conducted subgroup analysis and meta-regression analysis to determine the optimal parameters and the most important influencing factors of exercise effect. We previously registered the proposal of the meta-analysis on the PROSPERO website (NO. CRD42022327162) and strictly reported it according to PRISMA's stated terms. Results Twenty-two studies enrolling a total of 809 subjects were included in the analysis. Exercise had a positive effect on UPDRS-III (MD= -5.83; 95% CI, -8.29 to -3.37), Timed Up and Go Test (MD= -2.22; 95% CI -3.02 to -1.42), UPDRS ((MD= -7.80; 95% CI -10.98 to -6.42), 6-Minute Walk Test (MD = 68.81; 95% CI, 32.14 to 105.48), and Berg Balance Scale (MD = 4.52; 95% CI, 2.72 to 5.78). However, the heterogeneity of each study included was obvious. Weekly frequency, age, and location are all factors potentially affecting the effect. Conclusions This meta-analysis suggests that community-based exercise may benefit motor function in patients with PD. The most commonly used modalities of exercise are Tango and Tai Chi, and The most common prescription is 60 minutes twice a week. Future studies should consider the influence of age, region, and weekly frequency on the effect. PROSPERO trial registration number CRD42022327162.