Therapeutic yoga versus physiotherapy-based balance and proprioceptive neuromuscular facilitation training for stability and fall outcomes in older adults with early-stage Parkinsonism: A systematic review protocol

OBJECTIVE: The objective of this review is to evaluate the effectiveness of therapeutic (structured asana- and pranayama-based) yoga versus physiotherapy-based balance and proprioceptive neuromuscular facilitation (PNF) training in improving postural stability and fall-related outcomes in older adults with early-stage Parkinsonism. INTRODUCTION: Parkinsonism in older adults is characterized by postural instability and gait impairment, increasing risks of falls, fractures, and loss of independence. Physiotherapy interventions, particularly balance training and PNF, remain the clinical standard for fall prevention. Therapeutic yoga integrating asana (postural practice) and pranayama (breath regulation) may provide complementary benefits through improved proprioception, sensorimotor integration, core strength, and attentional control. However, evidence is fragmented due to variability in yoga styles, intervention intensity, and outcome measures. ELIGIBILITY CRITERIA: Randomized controlled trials published between 2015 and 2025 involving adults aged ≥60 years with early-stage Parkinsonism (Hoehn and Yahr stage ≤2 or disease duration ≤5 years) will be included. Eligible interventions will involve structured therapeutic yoga integrating asana and pranayama, which will be compared with physiotherapy-based balance or PNF training. METHODS: This protocol follows JBI guidance. Searches will be conducted in MEDLINE, ScienceDirect, Cochrane CENTRAL, Web of Science, PEDro, and PsycINFO, with supplementary searches in trial registries and gray literature. Two reviewers will independently screen studies, extract data, and assess bias. Meta-analysis will use a random-effects model, and evidence will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). REVIEW REGISTRATION: PROSPERO CRD420251149898.