INTRODUCTION

Parkinson’s disease (PD) is commonly treated with pharmacological agents (including levodopa), which effectively improve motor and nonmotor symptoms. As various populations age (particularly in Asia), the prevalence of PD is expected to double by 2030, with significant implications possibly occurring for the health care system [1]. However, there are no curative or disease-modifying therapies available for slowing the progression of PD [2]. Exercise has gained attention as a nonpharmacological treatment option that plays a crucial role in managing PD. Exercise for PD has been reported to both improve motor and nonmotor symptoms and alleviate the progression of symptoms [3]. Numerous studies have demonstrated that most types of exercise (including aerobic, strength, endurance, and balance training) can improve motor symptoms in PD patients. Yoga and dance also have positive effects on nonmotor symptoms, including depression and anxiety. A meta-analysis demonstrated that aerobic, anaerobic, and endurance exercises are beneficial for motor and various nonmotor symptoms [4]. In addition, a significant number of different types of exercise interventions have been investigated, and similar effects have been reported [5]. Regardless of the type of exercise that is performed, benefits have been observed, particularly for moderate- to high-intensity exercise [6]. Although exercise is a crucial intervention in the treatment guidelines for PD, few studies have investigated the types of exercise that are most effective or preferred. Several studies have attempted to compare the differences in the effectiveness of different types of exercise for specific symptoms using network meta-analysis, due to the fact that no studies have directly compared the various types of exercise [7,8]. However, the heterogeneity of the exercise types, intensities, and durations across various studies has yielded inconsistent results, thereby underscoring the need for a standardized exercise regimen. In clinical practice, patients with PD are often advised to engage in moderate- to high-intensity exercise from an early stage, despite the existence of an insufficient standardized exercise protocol [9]. Nevertheless, patients often inquire about which particular type of exercise could offer them the greatest benefit

In this study, we aimed to conduct a prospective investigation to directly compare the effects of various exercises in a similar environment in patients with PD.

MATERIALS & METHODS

Study design

This study was a multicenter, comparative, four-arm, openlabel, randomized clinical trial designed to evaluate the efficacy of various exercise programs. We selected three types of exercise (including tai chi, strength exercises, and yoga) based on the previous literature. Due to the fact that there are no reports of direct comparisons among various types of exercise or metaanalyses, we chose the exercise modality that was determined to result in the most well-designed clinical investigation via a narrative review [10-13]. We also performed home exercises for participants who could not visit the center on a regular basis. Five movement centers in tertiary hospitals participated in this study. Participants who could not visit the center were assigned to the home exercise group and conducted self-guided exercise by themselves according to the guidelines. The participants who could regularly visit the center were randomly assigned to one of three types of group exercise: tai chi, strength training, or yoga.

Participants

This pilot study was performed to evaluate comparisons among different types of exercise, and the target sample size was set at 30 participants per group (assuming a normal distribution). The following inclusion criteria were used for this study: 1) participants aged between 40 and 80 years; 2) participants diagnosed with PD according to MDS diagnostic criteria [14]; and 3) participants who were able to walk independently and safely participate in an exercise program. The following exclusion criteria were used: 1) participants who were at risk of falling during exercise; 2) participants with other diseases affecting gait and balance, including orthopedic diseases, neuromuscular diseases, vestibular disorders, and stroke; 3) patients diagnosed with both PD and dementia according to the MDS clinical criteria [15]; 4) patients taking medications for depression; and 5) patients who exhibited motor fluctuations. The dropout criteria were as follows: 1) participants with less than 80% attendance in the exercise sessions; and 2) patients who were considered to be unable to continue with the exercise regimen. The screening tests for enrollment in the study included the Korean version of the Mini-Mental State Estimation (K-MMSE), the Korean version of the Montreal Cognitive Assessment (MOCA-K), and the Beck Depression Inventory (BDI). All of the participants provided informed consent, and the study was approved by the Institutional Review Board of Haeundae Paik Hospital (HPIRB 2022-09-011).

Exercise intervention

Exercise regimen

The overall study process is illustrated in Figure 1. Among the 120 participants who were initially enrolled, 99 completed the study. The dropout rates were 6.67% in the home exercise group, 3.37% in the tai chi group, 33.34% in the strength group and 24.67% in the yoga group. The reasons for dropout included insufficient participation rates (defined as a failure to meet the minimum required attendance) and refusal to undergo postintervention follow-up assessments. The reported reasons for noncompliance included the occurrence of physical discomfort after exercise sessions, lack of motivation or personal interest, scheduling conflicts, transportation issues, and acute medical conditions unrelated to the study.

The three groups (the tai chi, strength exercise, and yoga groups) received guided exercise interventions by a trainer, and the group that was assigned to home exercise followed a self-administered exercise program at home. Due to the long distance from their homes to the exercise centers, participants who were unable to attend group exercise sessions were assigned to the home exercise group. To control for center bias, all of the sessions were performed at the same location, and each session was supervised by a single trainer. The exercises were conducted in groups of 10 participants per session. The exercise regimens were designed based on previous reports [11,16,17]. Additionally, the exercise sessions were conducted twice a week for 60 minutes over a period of 12 weeks, followed by a subsequent 12-week period in which the participants continued to independently exercise. Each exercise program was designed by the trainers based on prior research that was specific to each type of exercise for PD. Each supervised session involved a structured format comprising a warm-up phase, main exercise phase, and cool-down phase. However, detailed exercise regimens were tailored to address specific motor and nonmotor PD symptoms, with adjustments being made based on individual capabilities and progression.

The participants in the home exercise group were instructed to perform the same exercise using a home-based exercise booklet. The distributed booklet was a home exercise guidebook that was developed over the course of one year by the Korean Movement Disorder Society Task Force Team based on published clinical studies.

The exercise regimens of each group were as follows.

• Home exercise: The home exercise program was structured into four stages based on the American College of Sports Medicine guidelines [18] and utilized body weight exercises that could be performed at home with video instructions and without the need for special equipment. The exercise program included a warm-up phase, main exercise phase, and cool-down phase, with a total duration of 60 minutes. The exercises focused primarily on bodyweight strength training aimed at enhancing core stability and lower limb strength, with an intensity rated at perceived exertion (RPE) of 11–15. The program progressed from simple movements to more harmonious exercises, with gradual increases in the difficulty of balance tasks, repetitions, and sets.

• Tai chi: The tai chi program consisted of three stages: the warm-up exercise, walking practice, and practice for gait improvement. The warm-up exercises were designed to engage the joints rather than the muscles, whereas the walking practice focused on coordinated limb movement in place, forward and backward, as well as in both the left and right directions. The exercises adhered to the following principles: 1) assuming a preparatory stance, 2) stepping forward, 3) shifting weight and completing the movement, and 4) attaching the rear foot, thereby breaking down the walking process into detailed steps for practice.

• Strength exercise: Strength exercises included resistance training using elastic bands and dumbbells, with the intensity determined via the RPE. The warm-up and cool-down sessions were set at an RPE of 11–13, whereas the main exercises were set at an RPE of 13–15, with progressive increases in the resistance of the bands (based on color), weights of the dumbbells (kg), number of repetitions, and number of sets being conducted. The colors of the bands and weights of the dumbbells were adjusted every four weeks based on the participants’ subjective assessments and the judgment of the exercise instructor. The main exercise program was structured to include movements that strengthened the shoulders, chest, back, arms, thighs, calves, and ankles.

• Yoga: The yoga program was designed to focus on the therapeutic effects of gentle yoga, which emphasized two main aspects: connecting breathing with movement and incorporating diverse movements. The yoga program primarily consisted of three stages: breathing, asanas, and meditation. The breathing stage introduced various breathing techniques to prepare patients to meditate via controlled breathing. The asanas were structured into three phases: phase 1 (supine posture), phase 2 (seated posture), and phase 3 (standing posture). As the program progressed, the asanas gradually evolved from phase 1 to phase 3. Once the participants became familiar with the movements, they were guided to synchronize their breaths with the movements, thus allowing them to experience moving meditation. Notably, the asanas progressed from phase 1 to phase 3 due to the participants expanding their movements from small movements in the extremities to larger motions involving the major joints, spine, and core, thereby creating increasingly dynamic and centered movements.

Outcome measurements

The clinical outcomes focused on the motor symptoms of PD. The outcome measurements were composed of clinical scales for assessing motor symptoms of PD and physical activity and objective quantification for gait using inertial sensing technology. Although the overall study process involved an openlabel trial, a blinded rater assessed the outcome measures. All of the outcome measurements were performed at baseline, 12 weeks postintervention, and 24 weeks postintervention. Moreover, all of the assessments were performed in the “on” state.

Assessment of Parkinson’s symptoms

We evaluated the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and Hoehn and Yahr (H&Y stage) scores of all of the participants before and after implementation of the exercise program [19]. To assess freezing of gait (FOG), the New Freezing of Gait Questionnaire (NFOGQ) was used [20].

Physical activity and balance

To assess physical activity, a short physical performance battery (SPPB) assessment and the Mini-BEST test were performed. The SPPB is a valid tool for assessing muscle mass, physical performance, fall risk prediction, and functional status [21]. The SPPB can be used to analyze appendicular skeletal muscle mass with high validity, thus making it a useful tool for diagnosing conditions such as sarcopenia. The Mini-BEST is a 14-item scale that is widely used as a valuable tool for assessing balance and falling in various neurological diseases [22]. We also performed the 6-minute walk test (6MWT), which is a widely recognized submaximal exercise assessment used to evaluate exercise tolerance and functional capacity, particularly in patients with respiratory and cardiovascular conditions [23]. This assessment measures the distance that an individual can walk in six minutes, thus providing insights into aerobic capacity.

Objective measurement of the TUG test using an inertial sensor

A commercial wearable inertial sensor (BTS G-WALK, BTS Bioengineering) was used to perform a timed up-and-go (TUG) test. The sensor has a built-in accelerometer and gyroscope and measures and analyzes spatiotemporal variables of walking by utilizing changes in the center of gravity acceleration in the x-, y-, and z-axes. The sensor was attached to the 2nd lumbar vertebra of each subject using Velcro to distinguish movements and changes in the center of gravity during walking. The participants sat slightly in front of the center of the chair and placed both hands on their legs. At the start of the test, each subject stood up from the chair, walked around the cone located 3 m in front of the chair, and sat back down on the chair at the typical walking speed; this process was performed twice, and the average value was used as the representative value. The information (which was obtained via a sensor) was transmitted via Bluetooth to a laptop computer for acquisition and processing by using a dedicated software package (BTS®GStudio; BTS Bioengineering) and was used to subdivide the TUG test results into the following six sequential subcomponents: sitting to standing, walking forward, turning, walking-returning, final turning, and standing to sitting. In this study, the total duration and the durations of each of the six subcomponents of the TUG test were analyzed to evaluate each exercise group.

Satisfaction and preference survey

Three self-administered questionnaires were used to estimate satisfaction, preference, and hindrance. The surveys for satisfaction, preference, and hindrance comprised nine, 13, and nine items, respectively. These surveys are presented in Supplementary Material (in the online-only Data Supplement).

Statistical analysis

Variables are presented as frequencies and percentages for the categorical data and mean values±standard deviations for the quantitative data. Group differences were analyzed using the chi-square test or Fisher’s exact test for the categorical data and analysis of variance or the Kruskal–Wallis test for the quantitative data (as appropriate). To compare paired outcomes within the groups, the paired t-test or Wilcoxon signed-rank test was performed (as appropriate). The Shapiro–Wilk test was used to verify the normality of the quantitative data distribution.

All of the statistical analyses were performed using SPSS 26.0 (IBM SPSS Statistics for Windows, Version 26.0.; IBM Corp.).

RESULTS

Demographic data

The mean age of the participants was 68.4±7.5 years. The average H&Y stage score and MDS-UPDRS Part III score were 1.88±0.71 and 51.4±23.6, respectively. None of the demographic factors (including age, sex, or body mass index) differed among the four groups. Additionally, baseline clinical characteristics (including MOCA-K, BDI, H&Y stage, and MDS-UPDRS Part III scores) were not significantly different. The K-MMSE score was slightly different among the groups but did not reach statistical significance (Table 1).

Changes in and comparison of motor symptoms following exercise intervention

Table 2 provides a comprehensive analysis of the effects of the various exercises on motor symptoms and physical activity over the course of 12 and 24 weeks. The home exercise, tai chi, and strength training groups exhibited significant reductions in the MDS-UPDRS Part III score at 12 and 24 weeks. For the assessment of the effect of exercise on FOG, the tai chi and strength training groups demonstrated significant improvements, with a noticeable reduction being observed in the NFOGQ scores over the course of 12 weeks. However, this effect did not persist for more than 24 weeks.

The SPPB score significantly improved (particularly in the home exercise group) at 12 weeks. Over the course of 24 weeks, participants in the yoga group exhibited a marked increase in SPPB scores. With respect to the Mini-BEST, significant improvements were observed in the strength exercise and yoga groups at 12 weeks. The home exercise and tai chi groups also demonstrated significant improvements in their 6-minute walking times over the course of 12 weeks. However, this effect did not persist for 24 weeks.

In the between-group comparison, the MDS-UPDRS Part III scores were significantly better in the home exercise and tai chi groups than in the other groups at 24 weeks. However, no significant differences were observed between the groups in the other exercise-related assessments.

Changes in and comparison of gait analyses following exercise intervention

Differences among the four groups were observed regarding the gait analysis, especially in the turning movement during the TUG test. Table 3 provides the outcomes of the gait analysis, especially with consideration of turning dynamics, with particular attention being given to two key parameters (turning duration and speed) across the various exercise interventions over the course of 12 and 24 weeks.

After 12 weeks, only the yoga group exhibited a significant decrease in turning duration, which persisted for 24 weeks. Moreover, there were no significant changes observed in turning speed across most of the groups at 12 weeks. However, at 24 weeks, the strength exercise group exhibited an increase in turning speed from 0.82±0.20 to 0.98±0.31 meters per second, whereas the other groups did not demonstrate significant decreases.

The home exercise and tai chi groups also demonstrated significant reductions in total TUG duration and TUG-forward at 12 weeks. The yoga group exhibited improvements in forward movement and return movement at 12 weeks in the TUG test. Moreover, the home exercise group demonstrated a significant decrease in the sitting to standing time at 12 weeks.

In the between-group comparisons, the yoga group exhibited a significantly greater improvement in turning duration at 24 weeks compared to the other groups, whereas the strength exercise group demonstrated a marked improvement in turning speed.

Satisfaction, preference, and hindrance

In the 31-item questionnaire assessing satisfaction, preference, and hindrance factors, there were no significant differences observed among the exercise groups across all of the items, except for a greater preference for exercising together in the home exercise group.

DISCUSSION

This study demonstrated that different types of exercise have varying effects on specific symptoms in patients with PD. With respect to the outcome measures, home exercises and tai chi were remarkably effective in improving the motor symptoms of PD, whereas strength exercises were effective in addressing FOG. Physical activity capacity was improved with home exercises, tai chi, and strength exercises, whereas balance was enhanced by both strength exercises and yoga. Moreover, turning movements were positively influenced by strength exercises and yoga, whereas gait performance during the TUG test was improved with home exercises and tai chi.

To date, many studies have primarily focused on the efficacy of various exercises in PD patients and have often conducted meta-analyses based on these findings. Moreover, a previous study conducted a network meta-analysis to compare the effects of the different exercises [8]. Therefore, treatment guidelines do not recommend any specific type of exercise for patients with PD. Instead, these guidelines encourage consistent engagement in any form of exercise or physical therapy beginning from the early stages of the disease. In this context, the present study provides crucial evidence for the development of exercise strategies for patients with PD.

The results of this study demonstrated that home exercises and tai chi exercise resulted in broad improvements in motor symptoms, turning performance, and physical fitness compared with other types of exercise. Home exercise programs and tai chi are composed of multiple exercise modalities, including aerobic and anaerobic exercises, stretching activities, and strength exercises. We postulated that combined exercise integrating both aerobic and resistance training may be beneficial for overall motor symptoms and turning movements in PD patients [24].

However, the findings of the present study regarding the effects of exercise do not completely align with those of previous studies. Yoga and strength exercises have been reported to be as effective as home exercise, and tai chi has also been proven to improve motor symptoms in PD patients [25,26]. The conclusion of this study does not imply that only home exercise and tai chi are effective for improving motor symptoms in PD patients, whereas yoga is only beneficial for balance or physical activity. The strength training group demonstrated a higher dropout rate compared with the other groups, thus resulting in a relatively small sample size, which limited the generalizability of the findings. To address this concern and ensure the robustness of the findings, we performed a sensitivity analysis using an intention-to-treat (ITT) approach, with the last observation carried forward method being used for missing data. The ITT analysis yielded results consistent with those of the per-protocol analysis, thereby reinforcing the validity of our main findings. Nonetheless, the dropout disparity highlights the importance of considering adherence and feasibility when specific exercise modalities are recommended for clinical practice.

Notably, the magnitude of the improvement in the MDS-UPDRS Part III scores observed in the home exercise and tai chi groups (approximately 10 points) was notably greater than that reported in previous landmark studies, which have generally reported improvements of 3 to 6 points following structured exercise interventions. This discrepancy may be attributed to several factors, including the relatively mild disease severity of our participants at baseline, the carefully structured and supervised nature of the exercise programs, and the potentially greater intrinsic motivation (particularly in the home exercise group). Such real-world factors may enhance adherence and engagement, thereby amplifying the therapeutic impact. These findings underscore the need to interpret exercise efficacy not only within the constraints of randomized trials but also based on patient characteristics and contextual influences.

Our results suggest that the effect of physical activity on motor symptoms may vary depending on the type of exercise that is performed in a specific setting. Although all types of exercise are known to be effective for treating motor symptoms in PD patients, patient adherence and the effectiveness of exercise may significantly vary depending on the type of exercise and specific exercise regimen utilized in real-world settings [27]. This highlights the importance of personalized exercise programs that consider the type and intensity of exercise tailored to the specific symptoms of each patient.

This study was a randomized controlled trial; however, only the participants in the home exercise group were permitted to choose their group. In the initial survey assessing patients’ exercise preferences, there were no significant differences observed in preferences among the groups, except for the preference for exercising with others. Similarly, a post-study survey regarding satisfaction with exercise and barriers to exercise revealed no significant differences among the groups. Thus, in addition to the preferences for group or individual exercises, there were no notable differences observed in preference, satisfaction, or hindrance regarding the type of exercise. However, the home exercise group may have included participants with relatively greater motivations, thereby potentially leading to selection bias. This scenario represents a significant limitation of this study, which requires cautious interpretation. The remarkable improvement observed in the MDS-UPDRS Part III scores compared with those reported in previous studies may also be attributed to this issue. However, the different types of exercise utilized in this study (with the exception of home exercise) were randomly assigned, and the bias was minimized. The variation observed in the improvement in motor symptoms suggested that the type or intensity of exercise (rather than patient-specific factors) likely influenced the clinical improvement observed in PD patients.

This study has several limitations. For example, due to the fact that this was not a randomized controlled trial, we cannot exclude selection bias in the interpretation of the results. The favorable outcomes observed in the participants in the home exercise group may be attributed to the inclusion of individuals with a proactive attitude, as they are more likely to have chosen this type of exercise. However, due to the fact that the other exercise groups (with the exception of home exercise) were randomly assigned, we were able to confirm that different types of exercise yielded distinct outcomes, despite possessing similar exercise regimens. Second, the sample size of this study was small. This pilot study investigated the differences in the effects of exercise on various symptoms of patients with PD. Due to the small sample size and unequal dropout rates observed among the groups, our study was not able to demonstrate a meaningful difference in the primary outcome among the groups. Third, exercise regimens for PD have not been validated. To date, there are no consensus exercise guidelines for PD. Although we attempted to create an exercise program based on prior research, the results differed from those of previous reports, which was likely due to the implementation of an invalidated exercise program. Finally, the absence of a control group demonstrates a limitation, thus making it impossible to rule out a potential placebo effect in our findings. However, our primary objective was to compare the differential effects of various types of exercise in PD patients. Therefore, this limitation does not compromise the main purpose of our study.

In conclusion, this pilot study aimed to prospectively investigate the differences among various exercises that have been proven to affect PD. Although the effectiveness of exercise in improving the motor symptoms of PD is well established, variations in adherence and outcomes have been observed in real-world settings. These outcomes were demonstrated to be independent of the satisfaction, preference, and hindrance of the participants. Our results suggest that it is crucial to adopt a personalized approach for choosing exercises by tailoring interventions according to each patient’s specific symptoms and disease severity status.

Supplementary Materials

Notes

Conflicts of Interest

The authors have no financial conflicts of interest.

Funding Statement

The present study was supported by the “Korea National Institute of Health” research project (2022-ER1005-00).

Acknowledgments

We would like to express our sincere gratitude to Won kyung Yi, Ki-young Eom, Hyeryun Sung, and Jeongwon So for their invaluable contributions in conducting the exercise program.

Author Contributions

Conceptualization: Sang-Myung Cheon. Data curation: Myung Jun Lee. Funding acquisition: Sang-Myung Cheon. Investigation: Sang-Myung Cheon. Methodology: Jinse Park. Project administration: Myung Jun Lee. Resources: Dong-Woo Ryu, Dallha Yoo. Software: Jinse Park. Visualization: Jinse Park. Writing—original draft: Jinse Park. Writing—review & editing: Sang-Myung Cheon.

Figure 1.

Study flowchart for the exercise intervention. The flowchart outlines the recruitment and completion of the 24-week exercise program with 99 participants. Group-based interventions (including tai chi, strength training, and yoga) were conducted with supervised sessions for 12 weeks, followed by independent exercise. The home-based exercise group followed a self-administered program due to geographical constraints.

REFERENCES

• 1. Tan L. Epidemiology of Parkinson’s disease. Neurology Asia 2013;18:231–238.
• 2. Menozzi E, Schapira AHV. Prospects for disease slowing in Parkinson disease. Annu Rev Pharmacol Toxicol 2025;65:237–258.ArticlePubMed
• 3. Costa V, Suassuna AOB, Brito TSS, da Rocha TF, Gianlorenco AC. Physical exercise for treating non-motor symptoms assessed by general Parkinson’s disease scales: systematic review and meta-analysis of clinical trials. BMJ Neurol Open 2023;5:e000469. ArticlePubMedPMC
• 4. Zhang M, Li F, Wang D, Ba X, Liu Z. Exercise sustains motor function in Parkinson’s disease: evidence from 109 randomized controlled trials on over 4,600 patients. Front Aging Neurosci 2023;15:1071803.ArticlePubMedPMC
• 5. Lorenzo-García P, Núñez de Arenas-Arroyo S, Cavero-Redondo I, Guzmán-Pavón MJ, Priego-Jiménez S, Álvarez-Bueno C. Physical exercise interventions on quality of life in Parkinson disease: a network meta-analysis. J Neurol Phys Ther 2023;47:64–74.ArticlePubMed
• 6. Sena IG, Costa AVD, Santos IKD, Araújo DP, Gomes FTDS, Cavalcanti JRLP, et al. Feasibility and effect of high-intensity training on the progression of motor symptoms in adult individuals with Parkinson’s disease: a systematic review and meta-analysis. PLoS One 2023;18:e0293357. ArticlePubMedPMC
• 7. Yang Y, Wang G, Zhang S, Wang H, Zhou W, Ren F, et al. Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis. BMC Geriatr 2022;22:813.ArticlePubMedPMCPDF
• 8. Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, et al. Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2023;1:CD013856.ArticlePubMed
• 9. Barbieri FA, Kalva-Filho CA, Torriani-Pasin C. What does characterize exercise guidelines for Parkinson’s disease? Aging Clin Exp Res 2021;33:2611–2612.ArticlePubMedPDF
• 10. David FJ, Robichaud JA, Leurgans SE, Poon C, Kohrt WM, Goldman JG, et al. Exercise improves cognition in Parkinson’s disease: the PRET-PD randomized, clinical trial. Mov Disord 2015;30:1657–1663.ArticlePubMedPMCPDF
• 11. Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012;366:511–519.ArticlePubMedPMC
• 12. van der Kolk NM, de Vries NM, Kessels RPC, Joosten H, Zwinderman AH, Post B, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial. Lancet Neurol 2019;18:998–1008.ArticlePubMed
• 13. Mailankody P, Varambally S, Thennarasu K, Pal PK. The rationale of yoga in Parkinson’s disease: a critical review. Neurol India 2021;69:1165–1175.PubMed
• 14. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30:1591–1601.ArticlePubMed
• 15. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord 2007;22:1689–1707.quiz 1837. ArticlePubMed
• 16. Corcos DM, Robichaud JA, David FJ, Leurgans SE, Vaillancourt DE, Poon C, et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson’s disease. Mov Disord 2013;28:1230–1240.ArticlePubMedPMCPDF
• 17. Kwok JYY, Kwan JCY, Auyeung M, Mok VCT, Lau CKY, Choi KC, et al. Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with Parkinson disease: a randomized clinical trial. JAMA Neurol 2019;76:755–763.ArticlePubMedPMC
• 18. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2025.
• 19. Park J, Koh SB, Kwon KY, Kim SJ, Kim JW, Kim JS, et al. Validation study of the official Korean version of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale. J Clin Neurol 2020;16:633–645.ArticlePubMedPMCPDF
• 20. Hulzinga F, Nieuwboer A, Dijkstra BW, Mancini M, Strouwen C, Bloem BR, et al. The new freezing of gait questionnaire: unsuitable as an outcome in clinical trials? Mov Disord Clin Pract 2020;7:199–205.ArticlePubMedPMCPDF
• 21. de Fátima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. Int J Environ Res Public Health 2021;18:10612.ArticlePubMedPMC
• 22. Mak MK, Auyeung MM. The Mini-BESTest can predict parkinsonian recurrent fallers: a 6-month prospective study. J Rehabil Med 2013;45:565–571.ArticlePubMed
• 23. Falvo MJ, Earhart GM. Six-minute walk distance in persons with Parkinson disease: a hierarchical regression model. Arch Phys Med Rehabil 2009;90:1004–1008.ArticlePubMed
• 24. Chen Y, Chen Y. The impact of combined aerobic and resistance exercise on the prognosis of early Parkinson’s disease patients. Technol Health Care 2025;33:205–214.ArticlePubMedPDF
• 25. Yang CL, Huang JP, Wang TT, Tan YC, Chen Y, Zhao ZQ, et al. Effects and parameters of community-based exercise on motor symptoms in Parkinson’s disease: a meta-analysis. BMC Neurol 2022;22:505.ArticlePubMedPMCPDF
• 26. Wu C, Xu Y, Guo H, Tang C, Chen D, Zhu M. Effects of aerobic exercise and mind-body exercise in Parkinson’s disease: a mixed-treatment comparison analysis. Front Aging Neurosci 2021;13:739115.ArticlePubMedPMC
• 27. Ahmad SO, Stiles D, Born E, Scheffler J, Vogel K. Commentary on a meta-analysis of exercise intervention and the effect on Parkinson’s disease symptoms: what activities are best? Appl Sci 2024;14:7236.Article

Figure & Data

References

Citations

Citations to this article as recorded by  

Comments on this article