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Background: Parkinson's disease (PD) is a prevalent neurodegenerative disorder characterized by progressive impairments in balance, gait, and quality of life (QoL). Exercise interventions have emerged as complementary therapies, but their effectiveness remains unclear. This meta-analysis aimed to systematically evaluate the effects of exercise interventions on balance, gait speed, QoL, and symptom relief among older adults with PD. Methods: Following Cochrane Collaboration and PRISMA guidelines, randomized controlled trials (RCTs) published in peer-reviewed journals up to November 2023 were identified (n = 388) through PsycINFO, Scopus, PubMed, and Web of Science databases. Studies included adults aged ≥60 with PD, assessing exercise interventions compared to control conditions. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Random-effects models with standardized mean differences (SMD) were used to analyze the effectiveness of exercise interventions on balance, gait speed, QoL, and symptom relief. Results: Eleven RCTs were analyzed. Exercise interventions showed no significant effect on balance (SMD = -0.06, p = 0.41), QoL (SMD = 0.06, p = 0.33), or PD symptom relief (SMD = 0.10, p = 0.45). However, a significant improvement in gait speed was observed (SMD = -0.90, p = 0.001). Conclusions: In older adults with PD, exercise significantly enhances gait speed only; evidence for balance, QoL, and symptom relief is non-significant, and interpretation is limited by between-study heterogeneity and small samples. Since various measurement tools across studies may have influenced the outcomes, future research should incorporate repeated measurements using more specific and consistent assessment tools to clarify the effectiveness of exercise interventions for older adults with PD.
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