Objective To investigate the effects of gut microbiota regulation combined with exercise rehabilitation on non-motor symptoms and neurological function in Parkinson's disease patients. Methods A total of 154 Parkinson's disease patients admitted to our hospital from January 2022 to January 2024 were selected as the subjects of the study. Using a random number table， these 154 patients were evenly divided into a control group and a treatment group， with 77 patients in each group. Both groups received standard treatments， but the control group also underwent exercise rehabilitation therapy， while the treatment group received probiotic supplementation and exercise rehabilitation therapy. The effectiveness of the two groups was then compared. Results Following the 12 weeks， 24 weeks therapeutic regimen， The treatment group showed significantly better outcomes （P < 0.05）.Clinically meaningful reductions were observed in Hoehn-Yahr staging， alongside decreased scores on standardized instruments assessing psychiatric symptoms HAMA， HAMD， SCOPA-AUT， UPDRS Ⅰ-IV and PDSS （P < 0.05）.Concurrently， the study group exhibited enhanced MMSE （P < 0.05）. Fecal microbiome analyses revealed a favorable ecological shift characterized by increased colonization of beneficial genera Bifidobacterium and Lactobacillus， with concomitant suppression of pathobionts Enterococcus and Enterobacteriaceae.Gait analysis revealed increased step length， speed， and frequency in the treatment group （P < 0.05）. Conclusion Patients with Parkinson's disease who received probiotics combined with exercise rehabilitation treatment could effectively improve non-motor symptoms and neurological function， while promoting the balance of intestinal flora， and reduce clinical symptoms.