Mechanisms of Exercise-Mediated Regulation of the Gut–Brain Axis in Parkinson’s Disease

Parkinson’s disease (PD) is a progressive neurodegenerative disorder that is closely associated with dysfunction of the gut–brain axis. Exercise and diet exert neuroprotective effects on PD by regulating the gut–brain axis, yet the overall mechanisms underlying this regulation remain to be systematically elucidated. This article reviews the characteristic changes in gut microbiota during the progression of PD and the pathological mechanisms involving gut–brain axis dysfunction. It systematically outlines the intrinsic mechanisms by which gut microbiota modulate the onset and development of PD from the perspectives of metabolism, immunity and inflammation, neuroendocrinology, and the temporal and causal relationships between gut microbiota and PD. On this basis, the discussion focuses on the regulation of the gut–brain axis through exercise to improve PD, with emphasis on remodelling the composition and diversity of gut microbiota, enhancing gut barrier and blood–brain barrier (BBB) functions, regulating immune and inflammatory homeostasis, upregulating the expression of neurotrophic factors and promoting neuroplasticity, as well as the synergistic effects of exercise and diet. In parallel, the independent and synergistic effects of dietary interventions (e.g., high-fibre and Mediterranean diets) are discussed. In addition, the effects of different types of exercise on alleviating PD by regulating gut–brain axis are analysed. This review aims to provide new insights and a scientific basis for the prevention and intervention of PD.