Effects of mindfulness-based exercise on Parkinson's disease and Alzheimer's disease: a systematic review and meta-analysis.

OBJECTIVE: Currently, there is a lack of robust evidence demonstrating the efficacy of mindfulness-based exercise (MBE) on motor and cognitive outcomes in individuals with Parkinson's disease (PD) and Alzheimer's disease (AD), resulting in the absence of standardized and effective MBE treatment protocols. This systematic review and meta-analysis summarizes the available evidence to evaluate the therapeutic effects of MBE on motor and cognitive function in PD and AD. METHODS: For two common neurodegenerative diseases, PD and AD, we searched PubMed, Embase, Cochrane Library, and Web of Science to identify studies published from inception to January 30, 2026. Search terms included neurodegenerative diseases, Parkinson's disease, Alzheimer's disease, mindfulness, Tai Chi, yoga, and Qigong. Two independent reviewers assessed the risk of bias of included studies, performed data extraction, and evaluated the evidence. Treatment effects were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS-III), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Parkinson's Disease Sleep Scale (PDSS), Activities of Daily Living (ADL), and Parkinson's Disease Questionnaire-39 (PDQ-39). Data analysis was performed using Review Manager 5.4 software to evaluate effect sizes and 95% confidence intervals (CIs). Heterogeneity tests were conducted to assess differences in treatment effects among Tai Chi, yoga, and Qigong. RESULTS: We screened 4,576 articles and identified 28 studies that met the inclusion criteria. Of the included studies, 23 focused on PD and 5 on AD. Only 7 reported adequate allocation concealment, and 2 implemented participant blinding. GRADE assessment indicated moderate certainty of evidence for UPDRS-III, TUG, BBS, MoCA, and MMSE. BDI, PDSS, ADL, and PDQ-39 were rated as low-quality evidence. The pooled results showed significant effects: UPDRS-III (MD: -4.74, 95% CI [-6.78, -2.70], p < 0.00001); TUG(MD: -1.63, 95% CI [-2.41, -0.85], p < 0.0001); BBS(MD:2.80, 95% CI [1.54, 4.06], p < 0.0001); MoCA (MD: 1.93, 95% CI [1.12, 2.74], p < 0.00001); MMSE (MD: 2.80, 95% CI [0.32, 5.29], p = 0.03); BDI (SMD: -0.18, 95% CI [-0.47, 0.12], p = 0.24); PDSS (SMD: -0.31, 95% CI [-0.91, 0.28], p = 0.30); ADL (MD: -0.59, 95% CI [-3.49, 2.31], p = 0.69); and PDQ-39 (MD: -2.85, 95% CI [-6.36, 0.67], p = 0.11). CONCLUSION: MBE demonstrated statistically significant improvements in motor function and certain cognitive domains in PD patients, suggesting its potential as a beneficial adjunctive non-pharmacological intervention for ameliorating motor symptoms and delaying cognitive decline, whereas evidence for non-motor symptom improvement remains insufficient. Subgroup analysis further indicated a favorable signal of MBE on cognitive function in AD patients; however, the current evidence is preliminary and warrants validation through additional high-quality studies. Given the inherent challenges in implementing double-blinding due to the nature of MBE interventions, coupled with inadequate allocation concealment, the present findings should be interpreted with caution owing to the substantial risks of performance and selection bias.