OBJECTIVE: To systematically evaluate the effects of aquatic exercise on balance function and motor ability in elderly patients with Parkinson's disease. METHODS: A comprehensive search for randomized controlled trial studies of aquatic exercise interventions for elderly patients with Parkinson's disease was conducted in Chinese databases such as CNKI, WanFang, and VIP, as well as English databases including Web of Science, PubMed, EMBASE, ScienceDirect, and the Cochrane Library. The search period ranged from January 2000 to March 2024. The intervention group received aquatic exercise or combined aquatic and terrestrial exercise modalities, while the control group engaged in routine rehabilitation or land-based exercises. Outcome measures included the score of Part III of the Unified Parkinson's Disease Rating Scale, the Berg Balance Scale score, the Timed Up and Go test, the Parkinson's Disease Questionnaire-39 score, and the results of the 5-Minute Sit-to-Stand test. Two researchers independently extracted the data and assessed the risk of bias for each included study according to the Cochrane Handbook 5.3 criteria. Meta-analysis was performed using RevMan 5.3 statistical software. RESULTS: A total of 7 high-quality randomized controlled trials, involving 241 patients, were included in this meta-analysis. The results indicated that, compared with the control group, the intervention group showed significantly higher scores on the Berg Balance Scale (mean difference (MD) 5.30, 95% confidence interval (CI) 2.55 to 8.06, p = 0.000 (2) and the 5-Minute Sit-to-Stand test (MD 3.79, 95% CI 1.84 to 5.75, p = 0.0001) after the intervention. Additionally, the Timed Up and Go test time was significantly shorter in the intervention group (MD -1.93, 95% CI -2.64 to -1.22, p < 0.00001). However, there were no statistically significant differences between the two groups in the Part III of the Unified Parkinson's Disease Rating Scale scores (MD -1.31, 95% CI -3.90 to 1.28, p = 0.32) or the Parkinson's Disease Questionnaire-39 scores (MD -3.64, 95% CI-9.77 to 2.49, p = 0.24) after the intervention. CONCLUSIONS: Aquatic exercise significantly improves balance function, lower limb muscle strength, gait speed, and mobility in elderly patients with Parkinson's disease. However, its effects on overall motor functions such as upper limb coordination and fine motor skills, as well as on quality of life, remain unclear. Further studies with rigorous methodologies and longer intervention periods are warranted to validate these findings.

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