PD is the second most prevalent neurodegenerative disorder characterized by motor activity deterioration, resulting from damage to the dopaminergic nigrostriatal system (Pajares et al., 2020; Simon et al., 2020). The incidence of PD correlates directly with age (Hallett et al., 2019). PD diagnoses are projected to double from 6 million in 2015 to 12 million in 2040, coinciding with approximately 1% of the global population exceeding 60 years of age (Ascherio and Ma, 2016; Tysnes and Storstein, 2017; Dorsey and Bloem, 2018). Gait abnormality represents a primary cause of motor dysfunction in PD patients (Frazzitta et al., 2009). These gait abnormalities manifest primarily as postural irregularities, diminished muscle strength in major limb and trunk muscle groups, reduced balance function, initiation difficulties, decreased stride length, inability to halt at will, turning challenges, and bradykinesia. This walking dysfunction in PD patients elevates fall risk and significantly impairs daily living capabilities.

Current PD treatment strategies aim to alleviate symptoms and decelerate disease progression (Raza et al., 2019). The prevailing PD treatment model involves anti-Parkinson’s medications or Deep Brain Stimulation, which often prove inadequate, yielding minimal or no long-term patient improvement (Scelzo et al., 2019). Adjunctive and complementary treatments, such as exercise, can mitigate side effects of anti-Parkinson’s drug therapy and have demonstrated efficacy in improving movement disorders including balance, gait, fall risk, and physical function while reducing fall incidence (Feng et al., 2020; Mak and Wong-Yu, 2019). An increasing body of evidence supports the crucial role of exercise therapy (Tomlinson et al., 2013; Abbruzzese et al., 2016). Dance exercise (DE) can down-regulate α-Syn protein level to a certain extent, inhibit neuronal apoptosis, improve mitochondrial dysfunction, and thus restore the motor function of early patients (Koo et al., 2017). Resistance training (RT) is a strength exercise that can enhance muscle strength by overcoming resistance in local muscle groups. It can also improve the body’s neuroplasticity, up-regulate the expression level of dopaminergic neurotransmitters and receptors, promote the release of non-dopaminergic transmitters such as norepinephrine and 5-hydroxytryptamine (Qian et al., 2024), and improve the motor symptoms of Parkinson’s patients. Aerobic exercise (AE) can improve motor function in patients with Parkinson’s disease by regulating neurotrophic factors to support synaptic formation and angiogenesis, inhibit oxidative stress and improve mitochondrial function (Feng et al., 2020). However, the optimal exercise type for treating gait in PD patients remains unclear. According to Jiang’s traditional meta-analysis, Robotic Assisted Gait Training (RAGT) can effectively enhance PD patients’ walking function and gait performance (Jiang et al., 2024). In a conventional meta-analysis, Bishnoi found that Treadmill Training improved step and stride lengths in PD patients (Bishnoi et al., 2022). Nevertheless, a direct comparison between RAGT and Treadmill Training is currently lacking.

Network meta-analysis (NMA) has gained prominence in evaluating medical interventions due to its capacity to estimate the relative effectiveness and ranking of interventions, even in the absence of direct comparisons (Bafeta et al., 2014). Although Yang explored the influence of exercise patterns on Parkinson’s patients, the exercise was classified into 24 categories, and there was a lack of research on six-minute walk test (6MWT) and Step-length outcome indicators (Yang et al., 2022). Victor explored the intervention measures to improve gait in Parkinson’s disease, but there was a lack of studies on Stride length, 6MWT, and Step length (Hvingelby et al., 2022). Therefore, our study made a detailed division of movement modes, compared the gait forms of more PD patients, determined the best exercise mode to improve the gait of PD patients, and guided PD patients to choose the best exercise mode.

Gait disorder is one of the common manifestations of motor symptoms in PD patients, which often leads to loss of motor ability and increased mortality. It is one of the essential reasons for the decline in quality of life in PD patients. Therefore, it is of great significance to improve the movement mode of PD patients with gait disorders clearly. A total of 3,114 PD patients were included in our study, and 29 exercise methods were explored to enhance the improvement of gait disorders in PD patients.

Gait velocity and step length are frequently utilized as indicators to monitor the progression of gait disorders and treatment efficacy in patients with PD (Chien et al., 2006). Our study revealed that DE demonstrated superior efficacy compared to the Control group (CON), Walking exercise (WE), Home exercise (HE), Aerobic exercise (AE), Other exercise (OE), Boxing exercise (BE), and Traditional Rehabilitation (TR) in enhancing gait velocity among PD patients. Dance, as an art form, integrates aesthetic imagery, musicality, and goal-setting. It typically begins with a gradual warm-up, potentially improving strength, flexibility, and coordination. Furthermore, improvisation, co-creation, and aesthetic interpretation stimulate participants’ creativity and imagination. The music incorporated in dance provides essential auditory cues for movement through rhythmic and speed variations (Batson et al., 2016). Tactile feedback can also facilitate movement. For instance, when partnered with a submissive individual, rhythmic auditory cues and attention strategies prove more advantageous in improving walking speed during dual tasks (Baker et al., 2007; Westheimer, 2008). Research indicates that DE can mitigate progressive neuronal axon degeneration, promote dendritic formation of new synapses, establish novel neural connections, activate or create new neural pathways, enhance the brain’s regulatory role on limbs, improve joint flexibility, and alleviate movement disorders (Huang and He, 2016). Ashoori et al. (2015) suggested that basal ganglia lesions in PD patients may be associated with reduced internal rhythm, leading to impaired motor initiation and rhythm control. Basal ganglia activity increases during dance, particularly in the core-shell region (Brown et al., 2006). This suggests that dance may beneficially stimulate the basal nucleus in PD patients, enabling them to execute relatively complex movements and enhance their motor abilities. Our meta-analysis demonstrated that exercise interventions can improve step length in PD patients. Interestingly, our study only found DE to be superior to CON in improving step length in PD patients. This implies that most intervention studies in this meta-analysis had negligible or statistically insignificant effects on the step length parameter. Consequently, we recommend that future studies increase their focus on step length in PD research. In addition, our study also found that DE was better than CON in improving step length, but the results may be unstable. Considering that we may have many dances (tango, waltz, samba, Irish dance, ballroom dance, etc.), we suggest a detailed division of dance types for future research. Exploring which kind of dance improves stride length in patients with Parkinson’s disease.

Our results indicate that FAE is superior to Control group (CON), Stretch exercise (SE), Baduanjin (BDJ), Robotic Assisted Gait Training (RAGT), Treadmill training (TT), Dance exercise (DE), Traditional Rehabilitation (TR), Aerobic exercise (AE), and Other exercise (OE) in improving Gait velocity. FAE, a traditional Chinese exercise, primarily emulates the movements of tigers, deer, bears, apes, and birds. This practice effectively stretches muscles and joints, engages various muscle groups, and involves alternating the body’s center of gravity from front to back and left to right, thereby improving movement ability, balance, and coordination. Patients with PD typically exhibit a stooped posture, reduced arm swing, decreased lower limb motion range, slower stride speed, shorter stride length, reduced ground clearance, and prolonged double support period, increasing their susceptibility to falls (Cc and Rc, 2018; Wassom et al., 2015). FAE’s efficacy in improving stride length for PD patients may be attributed to its emphasis on forward stride movements. The exercise requires patients to lift their hips while stepping forward, lunge, swing their arms, and shift their center of gravity between stride types, effectively enhancing their ability to take longer strides and mitigating stride ability decline (Xiaofei and Jinggang, 2018). Given its distinct cultural characteristics, promoting FAE warrants consideration. Strategies for promotion could include organizing basic FAE courses, offering accessible introductory sessions, and providing easily comprehensible multi-language or online courses through digital platforms.

6MWT is a 6-min walking test for patients, which can well reflect the walking endurance and cardiopulmonary function level of patients. Our NMA found that Robotic Assisted Gait Training (RAGT) was superior to Combined therapy (CT), Tai Chi (TC), Other exercise (OE), Stretch exercise (SE), Walking exercise (WE), Traditional Rehabilitation (TR), Aerobic exercise (AE), Fitness exercise (FE), Baduanjin (BDJ), Boxing exercise (BE), Control group (CON), Balance training (BT), Whole body vibration training (WBV), Dual task training (DTT) in improving 6MWT in PD patients. RAGT intervention is grounded in the theory of central nervous system plasticity and functional reorganization. Repetitive, purposeful weight-bearing walking training can enhance balance, facilitating gait automation and improved step speed (Aprile et al., 2019; Toole et al., 2005). Janssen’s study found that enhancing patients’ attention through sensory stimulation increased their walking speed in a straight line (Janssen et al., 2017). RAGT provides diverse sensory stimulation and continuous treatment (Mehrholz et al., 2017), promoting comprehensive motor function recovery and increasing motor ability in PD patients. Furthermore, external rhythm can compensate for defective internal rhythm in the basal ganglia, serving as proprioceptive cues (Nieuwboer et al., 2009), This allows for earlier, more targeted balance training, improving balance and subsequently increasing PD patients’ motor ability (Capecci et al., 2019). Ongoing robot research optimization, exemplified by the new Lokomat robot integrating weight reduction, platform running, and gait correction, enhances timely feedback and evaluation. This enables patients to simulate normal walking under weight reduction conditions (Zhao et al., 2024). Suspension weight reduction maintains patients’ upright posture for balance and reduces walking effort. The WalkBotS robot, supplemented with virtual reality games, achieves direct human-environment interaction. Virtual reality technology provides visual stimulation, better approximating real-life conditions, improving training engagement, and enhancing patient compliance (You et al., 2022). Future research will further explore the effectiveness of this robot-assisted gait training.

Our study revealed that DE demonstrated superior efficacy in improving gait speed and step length among PD patients compared to other exercise modalities. Furthermore, FAE and RAGT exhibited greater effectiveness in enhancing step length and 6MWT performance, respectively, in individuals with PD. Overall, exercise interventions show significant benefits in improving gait parameters in PD patients. While exercise demonstrates a substantial impact on ameliorating PD symptoms, further investigation is needed to elucidate the underlying molecular mechanisms and neural circuit connections and regulation. Additionally, our quality evaluation highlighted that many studies lacked blinding procedures and randomized grouping, resulting in generally low certainty of evidence. Consequently, we recommend stricter quality control measures in future research, along with increased sample sizes, to further validate the findings of this study. While our study identifies the best form of exercise, safety is a critical consideration for people with Parkinson’s when choosing a form of exercise. To ensure safety, the condition of patients with Parkinson’s disease can be comprehensively considered when choosing exercise methods.