Background and purpose: Balance and gait problems pose a significant burden in Parkinson’s disease (PD), and they are often poorly treated with levodopa. We intended to summarize evidence of mid- and long-term impact of various physiotherapeutic interventions (≥3 months post-intervention) on dynamic balance, gait, and general motor function in patients with PD. Method: A systematic search was conducted across the PubMed, Cochrane Library, and Scopus databases to identify controlled clinical trials on sustained effects of various exercise interventions in PD on the outcomes of interest (lasting ≥ 3 months after completion of the exercise program). We conducted meta-analyses on commonly used clinical measures of dynamic balance and gait ability, as well as on UPDRS-III scores using the Comprehensive Meta-Analysis Software (CMA). Results: A total of 26 studies were included in meta-analyses, with a total of 1261 participants in the experimental and 989 participants in the control groups. Positive cumulative effects at the post-exercise follow-up (3 to 23 months) were shown in favor of the intervention group regarding balance (SMD = 0.512, 95% CI [0.240, 0.785], p < 0.001, I² = 87%), gait (SMD = 0.614, 95% CI [0.301, 0.926], p < 0.001, I² = 75%), and general motor function (SMD = 0.922, 95% CI [0.559, 1.285], p < 0.001, I² = 87%). Heterogeneity among studies was high for all three outcomes, apparently reflecting diversity with regard to patient characteristics, type, and duration of intervention, as well as the method of outcome assessment. The certainty of evidence was consequently judged as ‘’low’’ to ‘’moderate,’’ according to the GRADE system. Subgroup analyses revealed that balance can sustainably improve mostly through multimodal rather than targeted balance-oriented exercise but also through dual-task exercise, tai chi, and Pilates. Gait showed improvement at follow-up mainly through multimodal exercise, aerobic exercise, dual-task exercise, and Pilates, with benefits confined to early- and mid-stage disease. Sustained UPDRS-III improvement could be achieved through multimodal exercise, which showed a large overall effect but also through aerobic, resistance, and dual-task training, tai chi and qigong. Conclusions: Exercise interventions can improve balance and gait, as well as preserve the overall motor function in patients with PD, also in the mid- and long-term post-intervention periods.

Frailty has emerged as a critical determinant of clinical outcomes in elderly patients, shaping postoperative recovery in crucial orthopedic events, such as hip fractures. The purpose of the present study is to examine the impact of frailty syndrome on muscle strength and joint range of motion in the non-fractured lower extremity and upper extremities of hospitalized older adults following hip fracture surgery. The sample consisted of 60 elderly patients recovering from either intracapsular or extracapsular hip fractures. Participants were categorized into either a frail or non-frail group, determined by the Clinical Frailty Scale. The outcome measures of muscle strength and range of motion of the upper and lower extremities were assessed by valid instruments, including a hand-held dynamometer, the Medical Research Council scale, and a digital goniometer. Statistical comparisons between groups were conducted using the independent samples t-test and the Mann–Whitney U test. The results showed that the non-frail group demonstrated greater active range of motion in the shoulder bilaterally (right: t = −2.85, left: U = 628.00, p < 0.05), elbow flexion bilaterally (right: U = 589.50, left: U = 592.50, p < 0.05), hip flexion (U = 679.50, p < 0.01), knee extension (t = −3.07, p < 0.05), and ankle dorsiflexion (t = −2.36, p < 0.05). Regarding the muscle strength, the non-frail group showed significantly higher grip strength bilaterally (right: U = 754.50, left: U = 713.50, p < 0.001), as well as greater strength in hip flexion (U = 641.00, p < 0.01) and ankle dorsiflexion (U = 619.50, p < 0.01). Frailty may negatively influence the muscle strength and joint mobility in non-fractured extremities, thereby hindering postoperative physical recovery in older adults with hip fractures. Further research involving a larger and more homogeneous sample may predict falls in elderly patients after hip or knee surgery using the Clinical Frailty Scale.