Which type of mind–body exercise is most effective in improving functional performance and quality of life in patients with Parkinson's disease? A systematic review with network meta-analysis

Background: Several studies have investigated the effect of mind–body exercise (MBE) on functional performance and health-related quality of life (HRQoL) in Parkinson’s disease (PD), but it is still very difficult for clinicians to make informed decision on the best mind–body exercise for PD. Purpose: We analyzed the relative efficacy of MBE (yoga, Tai-Chi, Pilates, Qigong, and dance) in improving functional performance and HRQoL in patients with PD. Methods: A systematic review of randomized controlled trials (RCTs) was performed using network meta-analysis (NMA), searching the following databases: Cochrane, Web of Science, and PubMed using specific keywords until December 28, 2021, assessing the effects of MBE on functional performance and HRQoL in patients with PD. Results: This review included 60 RCTs with 2037 participants. A ranking of MBE for modifying various aspects of functional performance and HRQoL was achieved. Pairwise NMA showed Pilates to be the most effective in improving functional mobility (MD: − 3.81; 95% CI (− 1.55, − 6.07) and balance performance (SMD: 2.83; 95% CI (1.87, 3.78). Yoga (MD: − 5.95; 95% CI (− 8.73, − 3.16) and dance (MD: − 5.87; 95% CI (− 8.73, − 3.01) to be the most effective in improving motor function, whereas Qigong (MD: 0.32; 95% CI (0.00, 0.64) was most effective in improving gait speed. Considering HRQoL, dance was found to be the most effective (SMD: − 0.36; 95% CI (− 0.70, -0.01). Conclusion: MBE should be considered an effective strategy for improving functional performance and HRQoL in patients with PD. The most effective MBE intervention varied with the functional performance domain. Dance was an effective exercise for improving HRQoL among people with PD. PROSPERO registration ID: CRD42022301030.