Effects of aerobic exercise compared to conventional physical therapy on patients with Parkinson's disease: A systematic review and meta-analysis

Aerobic exercise and conventional physical therapy are widely used for motor rehabilitation in patients with Parkinson’s disease (PD), but their comparative efficacy remains unclear. This systematic review and meta-analysis aimed to compare the effects of these two active rehabilitation strategies on motor function, balance, functional mobility, gait performance, and quality of life in patients with PD. The review was conducted in accordance with the PRISMA2020 statement. Randomized controlled trials were systematically searched in PubMed, Web of Science, the Cochrane Library, and Scopus from inception to February 2026. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool, and the certainty of evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Review Manager 5.3 and Stata 14.0 were used to calculate pooled effect sizes, assess publication bias, and perform subgroup analyses, with Hedges’g used as the effect measure. Twelve randomized controlled trials involving 559 patients with PD were included. Compared with conventional physical therapy, aerobic exercise was associated with greater improvements in UPDRS-III scores [Hedges’g = −0.64, 95% CI: −1.04 to −0.24, p < 0.01, I² = 57%; low-certainty evidence], 10-meter walk test performance [Hedges’g = −1.39, 95% CI: −1.91 to −0.88, p < 0.01, I² = 0%; very low-certainty evidence], and functional reach test performance [Hedges’g = 0.86, 95% CI: 0.46 to 1.26, p < 0.01, I² = 0%; very low-certainty evidence]. By contrast, conventional physical therapy showed a small but statistically significant advantage in improving Berg Balance Scale (BBS) scores [Hedges’g = 0.20, 95% CI: 0.01 to 0.39, p = 0.04, I² = 41%; low-certainty evidence]. No significant between-group differences were observed for the Timed Up and Go (TUG) test or the PDQ-39 Summary Index. Exploratory subgroup analyses suggested that intervention duration, weekly frequency, and treatment cycle might partly influence the pooled effects for BBS and UPDRS-III outcomes; however, these findings should be interpreted cautiously because of the limited number of studies within several subgroup categories. Overall, aerobic exercise and conventional physical therapy may provide different but complementary benefits for patients with PD. Aerobic exercise appears to be associated with greater improvements in motor symptoms, gait performance, and functional reach, whereas conventional physical therapy may confer a small advantage in BBS-assessed balance function. However, given the limited evidence base and the low or very low certainty of evidence for several outcomes, these findings should be interpreted with caution. Further well-designed randomized controlled trials are needed to confirm the comparative effects and optimal application of these rehabilitation strategies.