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Neurology · 5 min read · September 27, 2026
From the course: Exercise for Gait, Balance and Falls in Parkinson Disease: Two Network Meta-Analyses Compared · 1.0 contact hour
Listen while you read — the episodes from this course
Parkinson Exercise Rankings: What the Meta-Analysis Found Part 1 of 3 · 8 min
Which Exercise Works Best for Parkinson’s Motor Symptoms? Part 2 of 3 · 8 min
Parkinson Exercise Rankings: Why Two Reviews Disagree Part 3 of 3 · 8 min
Is there one best exercise for Parkinson's disease? Two network meta-analyses published in Frontiers in Neurology in 2025 ranked exercise approaches for people with the condition, and neither identified one. Mao and colleagues ranked nine exercise categories for balance, cognition, emotional function and quality of life. Tong and colleagues ranked seven exercise-based physical therapy approaches for gait stabilization, fall risk and postural control. In both reviews the approach ranked first changed with the outcome, and both author teams concluded that the choice of exercise should be matched to the problem being targeted.
A network meta-analysis combines direct head-to-head trials with indirect comparisons made through shared comparators, so approaches that were never tested against each other can still be placed in order. Both reviews summarized each approach's standing with a ranking score from 0 to 100, where a higher score means the approach sat nearer the top of the network more often.
A ranking score describes position. It does not say how much patients improved, and an approach can rank first while the comparisons underneath it remain uncertain. That distinction matters for both reviews described below.
Mao and colleagues searched six databases from January 2000 through June 2025 for randomized trials in adults aged 60 to 90 with diagnosed Parkinson's disease, and pooled data from 4,417 patients. The paper gives its trial count two ways, as 55 randomized trials in the title and 53 included articles in the results. Programs ran from 2 weeks to 12 months, with a median of 8 weeks, most often three sessions a week.
The comparison groups in these trials received other forms of exercise, mainly aerobic training and gait stability training. Every ranking in this review therefore reflects standing against another active exercise rather than against no treatment. In the network rankings:
The authors flagged that the quality-of-life estimate favoring resistance training was unusually large for behavioral research and may reflect outlier effects, and they advised against generalizing it until it is replicated.
Tong and colleagues searched five databases through May 15, 2025, and included 64 randomized trials from 54 studies published between 2008 and 2024. The abstract reports 3,740 patients and the results section reports 3,771. Control groups received usual care, conventional rehabilitation or other non-exercise care.
| Outcome | Ranked first | Ranking score (0 to 100) |
|---|---|---|
| Gait stabilization | Mind-body exercise training (yoga, Pilates) | 83.1 |
| Fall risk | Routine physical training | 97.4 |
| Postural control | Postural control training | 92.4 |
The head-to-head evidence did not always agree with these rankings, and the authors pointed out several of the mismatches themselves. Mind-body exercise ranked first for gait stabilization, but it showed no clear difference from routine physical training when the two were compared directly. The authors also reported moderate publication bias for gait stabilization and estimated that the benefit there may be overstated by 15 to 20 percent. They found no clear sign of publication bias for fall risk or postural control and described those results as more reliable.
The two reviews drew on similar trials from the same era, yet resistance training shows how far their placements can diverge. Mao and colleagues ranked it last of nine for balance and first for quality of life. Tong and colleagues ranked it second of seven for postural control and last of seven for gait stabilization.
The course that accompanies this post traces the divergence to four design choices, none of which requires either team to have made an error:
Both teams concluded that exercise benefit in Parkinson's disease depends on the outcome being measured, and neither named an overall best exercise. Both reported wide variation in exercise type, dose, session length and program length across the pooled trials, and both called for standardized protocols and longer trials before their rankings are treated as settled. Neither review reported how large a ranked advantage would need to be for a patient to notice it, and neither followed patients long enough to show whether the benefits last.
Neither of these 2025 network meta-analyses identified one. In Mao and colleagues' review, dance ranked first for balance, mind-body exercise for cognition and resistance training for quality of life. In Tong and colleagues' review, mind-body exercise ranked first for gait stabilization, routine physical training for fall risk and postural control training for postural control. Both teams recommended matching the exercise to the problem being targeted.
In Tong and colleagues' review, routine physical training, described as standardized motor control rehabilitation, ranked first for reducing fall risk. The authors found no clear sign of publication bias for that outcome. Mao and colleagues did not measure falls.
The two reviews grouped tai chi differently. Mao and colleagues included tai chi within mind-body exercise, which ranked first for cognitive function. Tong and colleagues placed it within traditional Chinese rehabilitation, which ranked second for gait stabilization and did better than routine physical training for that outcome in direct comparisons, although the trials behind that comparison disagreed sharply with one another.
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