Table 4 Main findings of the included studies

Alkan et al. [23] 2020

A significant decrease in PB, CAL, serum leptin, GCF tumor necrosis factorα and leptin, and a significant increase in GCF resistin were observed in the chronic periodontitis.

Regular exercise exerts different impacts with respect to clinical and biochemical aspects of periodontal and systemic conditions in obese women.

Almohamad et al. [24] 2022

Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence.

Higher sedentary behaviour is associated with higher odds of periodontal disease.

Al-Zahrani et al. [25] 2005

Prevalence of periodontitis was higher among inactive individuals than partially active individuals and those who met the recommended level of exercise.

Engaging in the recommended level of

exercise is associated with lower periodontitis prevalence, especially among never and former smokers.

Al-Zahrani et al. [26] 2005

Individuals who maintained normal weight, engaged in the recommended level of exercise, and had a high-quality diet were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors.

An increased number of health-enhancing behaviors is associated with a lower periodontitis prevalence.

Bawadi et al. [27] 2011

Individuals who were highly physically active had a significantly lower average PI, GI, CAL and percentage of sites with CAL > 3 mm compared to individuals with a low level of physical activity and individuals with a moderate level of physical activity.

A low physical activity level and a poor diet were significantly associated with increased odds of periodontal disease.

Bazyar et al. [28] 2019

The results of the study showed that there is a significant inverse correlation between physical activity and weight, BMI, BOP, PI, PDD and CAL.

Reduction of metabolic and anthropometric parameters can improve periodontal status in T2DM patients with PD.

Cueto et al. [29] 2005

No association was found between regular practice of physical exercise and periodontitis.

There is evidence of an association between periodontitis and acute myocardial infarction.

Han et al. [30] 2010

An underlying relationship was found between physical activity in a week and periodontitis.

Metabolic syndrome might be associated with periodontitis.

Han et al. [31] 2016

There was associations between exercise and periodontal disease and severe periodontitis

Excessive consumption of green tea may be considered as a risk factor for periodontal disease.

Han et al. [32] 2017

An underlying relationship was found between regular exercise and the presence of periodontal disease.

The association between oral health behavior and periodontitis was proven.

Han et al. [33] 2018

Exercise was associated with periodontitis in men. By contrast, exercise was not associated with periodontitis in women.

Long sleep duration was associated with periodontitis.

Han et al. [34] 2019

In all models, subjects who walked regularly had signifcantly lower risks of periodontitis.

Regular walking is associated to lower prevalence of periodontitis.

Hasan et al. [35] 2021

The odds of periodontal disease increased with unfavourable glycaemic control, and decreased by 85% with adherence to physical activity.

Self-care practices, and oral hygiene practices must be taken into consideration for prevention of periodontal disease in patients with diabetes.

Hoppe et al. [36] 2017

No association was found between regular exercise and periodontitis.

The results suggest that oral inflammatory burden was associated with physical fitness.

Hwang et al. [37] 2022

Each of the HLS (diet quality, physical activity, normal body weight) practices was significantly associated with periodontal diseases.

In addition to improving oral hygiene, improving HLS should be emphasized for patients with periodontal diseases.

Iwasaki et al. [38] 2023

Total physical activity was inversely associated with the presence and severity of periodontitis in women. By contrast, physical activity was not associated with periodontitis in men.

Total physical activity had an inverse, linear association with the presence and severity of periodontitis in Japanese women but not in Japanese men.

Kongstad et al. [39] 2017

There was no statistically significant relationship of the lifestyle factors, alcohol consumption, diabetes, physical inactivity, BMI, WC, body fat, triglycerides, total cholesterol, or CRP and periodontitis

Regression analyses showed little difference in OR across the five periodontitis case definitions, however, the level of significance did show some variation.

Marruganti et al. [40] 2022

A high physical activity was significantly associated with a lower prevalence of Stage III/IV periodontitis compared to low/moderate physical activity.

Individuals conducting a lifestyle characterized by lack of regular exercise had 10 times the odds to have severe forms of periodontitis.

Marruganti et al. [41] 2023

High leisure-time physical activity as protective indicator for periodontitis, while high Occupational Physical Activity resulted as a significant risk

indicator.

Leisure-time and occupational physical activity demonstrated divergent associations with periodontitis.

Mendoza-Núñez et al. [42] 2014

A statistically significant decrease in the PDI was observed in subjects who performed Tai Chi during a period of 6 months.

Practice of Tai Chi has both antioxidant and anti-inflammatory effects that are linked to the improvement of PD in older adults.

Merchant et al. [43] 2003

Compared to men in the lowest quintile of

physical activity, those in the highest quintile had a 13% lower risk of periodontitis.

An inverse, linear association between sustained physical activity and periodontitis independent of known risk factors.

Munther et al. [44] 2019

The mean of PI was significantly higher among those who did not exercise compared to those who exercised. Smoking and physical exercises recorded a significant effect on the mean of the PI.

Physical exercise may alter total salivary antioxidants activity and the periodontal health status.

Sakki et al. [45] 1995

Lifestyle had an independent association with periodontal health. Periodontal pocketing increased with an unhealthier lifestyle.

Lifestyle could explain some of the social and sex differences in periodontal health.

Sanders et al. [46] 2009

Those meeting a prescribed threshold for leisure-time physical activity had lower adjusted odds of elevated IL-1b and detectable CRP than less active adults.

Leisure-time physical activity may protect against an excessive inflammatory response in periodontitis.

Samnieng et al. [47] 2013

Subjects who had no regular physical activity had a significantly higher prevalence of periodontal disease and lower salivary flow rate than their counterpart.

Good health practices were related with good oral health behaviors. Improving general health habits are suggested to lead to better oral health for the elderly, and vice versa.

Schmidt et al. [48] 2022

Physical activity in a sports club was associated with lower caries experience and periodontal health score.

Physical activity and high socioeconomic status are potentially protective with unfavorable oral health conditions.

Oliveira et al. [49] 2015

A 1 mm increment in PDD or CAL significantly decreased the chance of reaching the highest PFT score by 69% or 75%, respectively. Individuals presenting at least one tooth with AL ≥ 4 mm had significantly lower PFT scores compared with those without this status.

Periodontal disease may be considered a risk

indicator for poor physical fitness in males.

Omori et al. [50] 2018

In the exercise intervention group, the number of teeth with a PPD ≥ 4 mm significantly decreased from 14.4–5.6%, and the number of teeth with BOP significantly decreased from 39.8–14.4%.

Exercise might contribute to improvements in periodontal disease.

Wernicke et al. [51] 2021

Both the BOP and the severity of periodontitis were significantly reduced in the intervention group compared to the control group.

Physical activity over a period of 6 months is a health promoting measure for patients with T2DM and improves periodontal health.

Yu et al. [52] 2011

The trends toward disability in general physical activities were statistically significant across increasing severity of oral health problems.

Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability.