## 1 Introduction  
Progressive supranuclear palsy (PSP) is the most frequent form of atypical Parkinsonism, with a prevalence of 5-6 cases per 100,000 patients [1, 2]. People living with PSP have various symptoms, such as movement disorders mainly affecting balance, functional inability with an increased risk of falls, and dexterity. Also, they demonstrate facial and cervical dystonia and oculomotor disorders [3, 4]. Cognitive impairment, dementia, and depression are also associated with the overall progression of PSP [5, 6]. Finally, they also often present with other comorbidities, such as cardiovascular, neurological, muscular, and neurological disorders [7]. Early-stage PSP often manifests as behavioral changes, such as irritability and agitation, as well as subtle motor impairments, such as postural instability and falls, gait instability,and gaze abnormalities [8], which may affect an individual's quality of life and functional independence. This early phase of the disease may present a critical window of opportunity for interventions that could potentially maintain or even improve functional abilities. Few studies have investigated the role of exercise in PSP. Exercise is defined as a repetitive, planned, structured activity aimed at improving and maintaining muscle strength, function, and fitness [9]. Exercise interventions have been shown to play a crucial role in improving balance and gait in patients with PSP. A pilot study reported improvements on balance performance after a therapeutic exercise program in PSP patients within a short duration of 4 weeks [10]. Similarly, other studies have reported that a structured physical therapy program is thought to be beneficial for individuals living with PSP [11; 12; 13]. Moreover, a case report showed the effectiveness of long-term locomotor training, stretching and strengthening exercises in enhancing balance, slowing the rate of gait decline, preventing wheelchair dependence, and reducing falls in a patient with mixed PSP and corticobasal degeneration features [14]. Due to the initial symptoms of PSP resembling those of idiopathic Parkinson's Disease (PD), physiotherapists often implement rehabilitation programs similar to those targeted at PD, focusing on increasing strength [15; 16; 17] and balance [18; 19]. Commonly applied aerobic exercises for PD patients, such as cycling and dancing, may have potential applications for PSP as well [20; 21]. However, the existing research is limited, and there is a need for further exploration of exercise-based approaches tailored to individuals with early-stage PSP. The results of the present study provide a unique contribution to the field by examining the effects of a supervised exercise program on balance, functional ability, quality of life, and depression in an individual with early-stage of PSP. This approach contrasts with previous studies, which have predominantly focused on exercise interventions for individuals with moderate-to-advanced stages of the disease [10; 22; 23]. In contrast, the existing literature has tended to focus on single outcome measures, limiting the ability to capture the multifaceted impact of the disease and the diverse effects of exercise interventions [10]. Furthermore, the detailed description of an exercise program, encompassing warm-up, main exercises, and recovery components, provides valuable information for clinicians and researchers seeking to replicate or adapt successful exercise strategies for individuals with an early-stage PSP. This level of programmatic detail is often lacking in the current literature, hindering the translation of research findings into clinical practice. By addressing these gaps in the existing literature, the results of the present study have the potential to inform the development of more effective, stage-appropriate exercise interventions for individuals with early-stage PSP, ultimately contributing to improved clinical outcomes and enhanced quality of life for this clinical population.