Parkinson’s disease (PD) is a common progressive neurodegenerative disease whose disease-modifying treatment remains limited, posing an increasing challenge to public health [1]. According to data from the Global Burden of Disease Study 2019, the prevalence of PD has been increasing over the past 30 years, and the rate has increased particularly rapidly in the population over 80 years of age, highlighting the burden of the disease [2]. The main pathology of PD is related to dopaminergic neuronal cell loss in the substantia nigra pars compacta, with both motor and nonmotor deficits as its signs and symptoms [1]. Accordingly, in PD management, dopaminergic drugs such as levodopa and dopamine agonists are considered the most effective symptomatic treatments, but their use is somewhat limited due to side effects such as hallucinations, drowsiness, lower extremity swelling, and retroperitoneal, pleuropulmonary, and heart valve fibrosis [3]. Various nonpharmacological therapies have been studied for their effectiveness in alleviating PD symptoms, and a recent network meta-analysis found the superiority of mind-body exercises such as qigong, yoga, and tai chi among the nonpharmacological therapies [4].

Recently, Choi et al. [5] reported the effectiveness of a complex exercise combining acupoint stimulation and mind-body exercise, the so-called Meridian Activation Remedy System (MARS), on motor symptoms of PD in their prospective study. One of the unique features of MARS compared to conventional dopaminergic drugs is that it is designed to activate proprioception in patients with PD [6]. Although there is a case report on the use of MARS to improve motor symptoms in a patient with PD [7], this is the first time its effectiveness has been reported in a prospective study [5]. In Choi et al.’s [5] study, MARS was administered to 13 patients with PD at Hoehn and Yahr Stages 1-3, twice a week, for 8 weeks. This intervention produced significant improvement in motor symptoms among the participants, assessed by Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale Part III score (p = 0.003), 10-meter walk test speed (p = 0.040), and Timed Up and Go time (p = 0.040). No adverse reactions occurred during the intervention. One of the strengths of this study is that it observed cortical hemodynamic changes in the participants using functional near-infrared spectroscopy. The researchers found increased cortical activity in some areas related to walking and decision-making after the intervention, although the changes did not reach statistical significance.

The innovativeness of this intervention lies in the combination of mind-body exercises and acupoint stimulation, which are known to be effective in improving PD symptoms. Although the study reported the effectiveness of MARS on motor symptoms in patients with PD, the researchers explained that they developed this intervention to effectively alleviate various nonmotor symptoms, including pain relief and improved cognitive function, rather than being limited to motor symptoms in patients with PD [6]. This intervention also introduced meridian theory into mind-body exercise, which was combined with acupoint stimulation with the aim of producing a synergistic effect on PD treatment based on the theory of Korean medicine. However, one of the limitations of this study is that it is difficult to confirm the causal effect of the intervention due to the nature of the observational study. Specifically, the study participants were permitted to use any other combination of treatments, meaning that it is possible that the improvements found were due to treatments other than MARS. The small sample size of 13 is also one of the important limitations of this study.

The researchers revealed that they are currently conducting a randomized controlled clinical trial targeting patients with PD with this intervention (NCT05621772) and noted they also have plans to develop a home care program based on MARS for patients with PD. The development of effective and safe nonpharmacological therapies that expand patients’ treatment options is always welcome. We look forward to the results of high-quality studies of this intervention in the future.

The author declares no conflict of interest.