Objective: To investigate the effects of aerobic exercise on clinical symptoms and gut microbiota in Parkinson’s disease (PD) patients of different age groups.

Methods: This study included 21 PD patients, divided into age groups of <60 years and ≥60 years, and underwent an 8-week moderate intensity aerobic exercise intervention. Assess patients with relevant scales before and after intervention, and collect their feces for 16S ribosomal RNA amplicon sequencing and statistical analysis.

Results: Only UPDRS-III on-off and total scores showed statistically significant improvement in <60 years old PD patients after aerobic exercise intervention (P＝0.042, P＝ 0.021); UPDRS-II, UPDRS-III on, UPDRS-III off, UPDRS total scores, Berg Balance Scale (BBS) and Tinetti Performance Oriented Mobility Assessment (Tinetti POMA) improved in ≥60 years old PD patients (the P values were 0.029, <0.001, 0.025, <0.001, 0.008 and 0.023 respectively). In addition, after aerobic exercise intervention, the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), PD Questionnaire 39 (PDQ- 39), Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Scales for Outcomes in PD Autonomous (SCOPA-AUT), Gastrointestinal Dysfunction Score (Gastrointestinal Dysfunction Score), Gastrointestinal Dysfunction Score (GIDS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and Non Motor Symptoms Scale (NMSS) scores were improved in ≥60 years old PD patients (P values were 0.002, 0.006, 0.002, 0.016, 0.007, 0.029, 0.002, 0.008, and 0.003, respectively). The NMSS score of PD patients in the <60 age group improved and the difference was statistically significant (P＝0.044) after intervention. Gut microbiota analysis revealed the relative abundance of Fusicatenibacter and Erysipelotrichaceae_UCG-003 were increased in the PD group aged <60 years after aerobic exercise intervention, and the difference was statistically significant compared with the pre-intervention period (Z values were －2.201 and －2.207, and P values were 0.028 and 0.027, respectively).

Conclusion: Moderate-intensity aerobic exercise can improve motor symptoms as well as non-motor symptoms such as cognition, quality of life, sleep, autonomic function, anxiety and depression in PD patients of different age groups. Notably, moderate-intensity aerobic exercise can improve the relative abundance of beneficial gut microbiota, particularly in <60 years old patients .