The effect of physical activity on Parkinson’s disease outcomes in patients with bilateral subthalamic nucleus deep brain stimulation: a systematic review

Background Subthalamic nucleus deep brain stimulation (DBS-STN) is a recognized treatment for advanced Parkinson’s disease. While it improves some clinical symptoms, especially bradykinesia and rigidity, it has limited application for late motor symptoms. Moreover stimulation-related motor adverse effects can increase the motor burden. There is a clear need to develop additional therapies that complement deep brain stimulation in controlling late motor symptoms. Physical activity is a commonly used and recommended form of therapy for patients with Parkinson’s disease, supplementary to pharmacological therapy. However, there are no clear recommendations including patients after implantation of DBS-STN stimulators in the group undergoing physiotherapy. Objective The objective of this study is to systematically review the literature on physiotherapy interventions for patients who have undergone DBS-STN implantation and their influence on motor outcomes. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and a total of 10 studies were included. Results Despite heterogeneous physiotherapy protocols, the main outcomes (balance, postural stability, gait speed, functional mobility) improved consistently, while motor severity scores and cognitive or neurophysiological effects remain underexplored. Conclusion Current evidence supports the use of physiotheruapy as a potentially effective and safe addition to the management of motor symptoms in patients after DBS-STN. Future trials with standardized physiotherapy protocols and uniform outcome measures are needed to create overall recommendations.