Parkinson’s Disease: Effectiveness of Physiotherapy According to Contemporary Research

Introduction

Parkinson’s disease (PD) is a chronic neurodegenerative disorder characterised by progressive motor impairments, including bradykinesia, rigidity, tremor, gait disturbances, and balance deficits. In addition to pharmacological treatment, physiotherapy plays an important role in patient management, aiming to maintain motor function, independence, and quality of life.

Over recent years, a substantial body of scientific evidence has accumulated, including systematic reviews and meta-analyses of randomised controlled trials, allowing for an objective assessment of the effectiveness of various physiotherapeutic approaches in Parkinson’s disease.

Methods Used to Evaluate Physiotherapy Effectiveness

Contemporary reviews have included randomised controlled trials in which physiotherapy was compared with no intervention or placebo. The analyses encompassed dozens to hundreds of studies, with total participant numbers ranging from several thousand to nearly 8,000 patients.

A wide range of physiotherapy modalities was examined, including:

• conventional physiotherapy;

• strength and aerobic training;

• treadmill training;

• movement strategy training;

• dance-based interventions;

• martial arts (e.g. Tai Chi);

• mind–body exercises;

• balance and gait training;

• hydrotherapy;

• exergaming;

• Nordic walking;

• dual-task training.

Primary outcomes assessed included motor symptoms (UPDRS / MDS-UPDRS), gait parameters and walking speed, balance, functional mobility, and quality of life.

Main Findings

Overall Effectiveness of Physiotherapy

Systematic reviews and meta-analyses demonstrate that physiotherapy has a significant positive short-term effect on the course of Parkinson’s disease. Compared with no intervention, physiotherapy leads to measurable improvements in:

• motor symptoms;

• gait parameters;

• balance;

• functional abilities;

• patient-reported quality of life.

Clinically meaningful improvements have been observed, in particular, on the UPDRS, Berg Balance Scale, and walking speed.

Effectiveness of Specific Physiotherapy Approaches

The strongest evidence of benefit has been reported for the following interventions:

• Conventional physiotherapyImproves motor symptoms, gait, and quality of life.

• Strength and aerobic trainingEnhances motor performance and gait parameters; aerobic exercise appears particularly beneficial when applied regularly and over longer periods.

• Dance, martial arts, and Nordic walkingImprove motor symptoms, balance, and gait by combining physical activity with coordination and cognitive engagement.

• Mind–body exercises (Tai Chi, yoga, etc.)Demonstrate clinically significant improvements in motor symptoms, balance, and functional mobility and are considered among the most promising approaches.

• ExergamingShows positive effects on balance and quality of life.

• HydrotherapyImproves balance-related outcomes.

By contrast, dual-task training has not consistently demonstrated statistically significant benefits across most analyses.

Long-Term Physiotherapy: A Clinical Perspective

Several meta-analyses suggest that long-term physiotherapy programs (six months or longer) may contribute to:

• more sustained control of motor symptoms, including during “off” periods;

• maintenance of functional capacity as the disease progresses;

• optimisation of pharmacological therapy in selected patients.

Variability in long-term outcomes highlights the importance of regularity, gradual progression, and individual adaptation of physiotherapy programs according to disease stage and clinical response.

Why an Individualised Approach Is Especially Important

Evidence indicates that the effectiveness of physiotherapy in Parkinson’s disease largely depends on:

• the type and combination of exercises used;

• program duration and intensity;

• disease stage and symptom severity;

• the patient’s overall physical and functional status.

The absence of a universal protocol reflects not a limitation of physiotherapy itself, but the need for a personalised approach, in which physiotherapy is integrated into an overall management strategy and adjusted over time as clinical needs evolve.

Conclusion

Current scientific evidence clearly supports physiotherapy as an effective and essential component of comprehensive Parkinson’s disease management. Physiotherapy improves motor symptoms, gait, balance, and quality of life, particularly in the short to medium term.

The greatest benefits are associated with regular physical activity, including aerobic exercise, strength training, and mind–body approaches. No single physiotherapy modality demonstrates absolute superiority; therefore, intervention selection should be individualised, taking into account disease stage, functional capacity, and patient preferences.

Physiotherapy should already be regarded as an integral part of Parkinson’s disease care.

Discuss an individualised support program for Parkinson’s disease. Physiotherapy may form part of a comprehensive medical approach aimed at maintaining mobility, balance, and daily functional activity. An individual medical consultation allows assessment of which support format may be appropriate in a specific clinical situation.

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