Impacts of Codependent Cognitive-Motor Training on Balance and Cognition in Individuals With Parkinson Disease: A Systematic Review and Meta-analysis

Abstract

Objective: The study aimed to explore the effectiveness of codependent cognitive-motor training (CMT) focused on stepping movements in improving balance and cognitive function in individuals with Parkinson disease (PD).

Data sources: CINAHL, Cochrane Library, MEDLINE (Ovid), PEDro, PubMed, Embase, and Web of Science were systematically searched up to April 2025 for relevant studies, limited to human studies published in English.

Study selection: Randomized controlled trials comparing codependent CMT with either conventional physiotherapy (active control) or usual care (passive control) in individuals with PD were included. Eligible outcomes included balance, cognition, motor impairments, functional mobility, and quality of life.

Data extraction: Four researchers independently reviewed eligible studies for study design, participant characteristics, intervention details, and outcome measures, and also assessed study quality. Three researchers independently extracted the data, which was then double-checked by a fourth researcher.

Data synthesis: Eighteen randomized controlled trials were included in the meta-analysis. Codependent CMT significantly improved balance [standardized mean difference (SMD)=0.579; 95% confidence interval (CI)=0.340 to 0.817; P<.001], the Montreal Cognitive Assessment (SMD=0.353; 95% CI=0.047 to 0.660; P=.024), part III of the Unified Parkinson Disease Rating Scale (SMD=-0.306; 95% CI=-0.582 to -0.031; P=.029), and the timed Up and Go test (SMD=-0.395; 95% CI=-0.619 to -0.171; P=.001) compared with active or passive controls in individuals with PD.

Conclusions: Codependent CMT was found to be a beneficial intervention for improving balance, cognitive function, and functional mobility in individuals with PD.

Keywords: Cognition; Dual-task; Exercises; Functional balance; Mobility limitation; Parkinson disease; Rehabilitation.