Background/Objectives: Parkinson's disease (PD) is a progressive neurodegenerative disorder often associated with cognitive decline, particularly executive dysfunction. Various exercise interventions have been explored to mitigate cognitive impairment in PD, but a comprehensive comparison of exercise modalities has yet to be conducted. This study aims to systematically evaluate the effectiveness of different exercise types in improving cognitive function, including global cognition and executive function, in patients with PD through a network meta-analysis of randomized controlled trials (RCTs). This systematic review and network meta-analysis adhered to PRISMA 2020 guidelines. Electronic searches were conducted in PubMed, Medline, Embase, Cochrane, and Web of Science until December 31, 2024. Eligible studies included RCTs involving adults with PD, comparing any form of exercise with no intervention or usual care, and reporting cognitive outcomes. A network meta-analysis was performed using random-effects models to compare the relative effects of interventions on cognitive outcomes, measured by standardized mean differences (SMDs) for global cognition and executive function. Forty RCTs involving 1582 PD patients were included. Motor-cognitive training (MCT) was the most effective modality for improving both global cognition (SMD = 1.77, 95% CI 0.60–2.95) and executive function (SMD = 0.97, 95% CI 0.14–1.81), with the highest probability of ranking first in both cognitive domains (SUCRA = 94.9% for global cognition, 85.3% for executive function). Aerobic exercise (AE) also significantly improved global cognition (SMD = 0.66, 95% CI 0.02–1.30) and executive function (SMD = 0.65, 95% CI 0.18–1.12), while Tai Chi and stretching/flexibility training (SFT) showed benefits for global cognition but limited effects on executive function. This analysis highlights MCT and AE as the most effective interventions for enhancing cognitive function in PD. MCT offers the greatest benefits across multiple cognitive domains, while AE provides a more accessible alternative with substantial cognitive improvements. Tai Chi and SFT may enhance global cognition but are less effective for executive function. These findings suggest that exercise interventions can be tailored to improve specific cognitive outcomes in PD, and future studies should focus on standardized protocols and long-term outcomes to refine treatment recommendations.
Wang et al. (Thu,) studied this question.