Effectiveness of virtual reality rehabilitation with exergames on functional rehabilitation in Parkinson's disease: a systematic review of chronic randomized controlled trials.

Introduction: Exergaming is increasingly used to target gait and balance impairments in Parkinson's disease (PD), but the durability of effects and comparative efficacy versus active controls remain uncertain. The aim of this work is to evaluate the effectiveness and clinical implications of exergame-based rehabilitation for individuals with PD in randomized controlled trials, including studies with and without follow-up assessments.

Methods: The authors conducted a PRISMA-guided systematic review (PROSPERO CRD42025642840). Eligible studies were RCTs in people with PD comparing exergaming programs with non-exergaming interventions.

Results: Eighteen RCTs (n = 699; 341 exergaming, 358 control) met inclusion criteria; Typical programs spanned 4-12 weeks with 15-60-min sessions, most commonly 6 weeks, delivered predominantly under supervision. The outcomes that improved most consistently were mobility/locomotion (TUG, 6MWT/10MWT, gait speed) and balance. When exergames were compared with active, non-exergaming therapy, effects were generally comparable. Adverse events were rare, and adherence was documented as high where reported; most trials were facility-based with professional supervision. Only three trials included follow-up (≈1-2 months), suggesting short-term retention (~30 days), whereas one 60-day assessment showed return to baseline.

Conclusion: Exergame is a safe, feasible, and effective adjunct for short-term improvement of mobility and balance in PD. However, scarce follow-up limit inferences on long-term maintenance.