Exercise for Parkinson's Disease

Why exercise matters in Parkinson's

• Bigger, faster, more automatic movement. Exercise that emphasises large, deliberate movements helps counter the tendency to shrink movement.
• Walking and balance: targeted practice reduces the risk of falls; see balance exercises for seniors and Parkinson's freezing and falls.
• Strength and flexibility: counter weakness, stiffness and a stooped posture.
• Heart and lung fitness, which are often reduced through inactivity.
• Mood, sleep and thinking: exercise helps with low mood, anxiety, fatigue and constipation in many people.
• Independence: easier dressing, rising from a chair, turning in bed.

Exercise is recommended from diagnosis onwards, and at every stage, adapting as needed. See Parkinson's disease home care guide and caring for a parent with Parkinson's.

Check with the doctor first

Ask the neurologist or doctor before starting or changing exercise, particularly if there is:

• heart disease, uncontrolled blood pressure, or breathlessness; see exercise with heart disease;
• low blood pressure on standing or fainting; see dizziness and low blood pressure when standing;
• frequent falls or freezing episodes;
• a recent fracture or surgery, including deep brain stimulation;
• osteoporosis; see exercise for osteoporosis;
• memory or thinking problems or hallucinations that affect safety;
• a pacemaker or other implanted device.

A physiotherapist who knows Parkinson's can assess movement, balance and fall risk and teach specific strategies. Ask for a referral.

Timing exercise with medicines

Many people with Parkinson's have "on" times, when medicines are working and movement is easier, and "off" times, when they are slow, stiff and unsteady.

• Exercise in the "on" period, often about an hour after a dose, when movement is best.
• Avoid vigorous exercise in "off" times, when falls are more likely.
• Keep a simple diary of when you move best, and share it with the neurologist, who may adjust medicine timing; see care diary and handover notes.
• Do not change medicines or timing yourself.
• Some people take protein-rich meals that interfere with levodopa absorption; ask your doctor about timing meals and medicine; do not restrict protein without advice.

Types of exercise that help

A good programme mixes several types. Examples, in words:

1. Big, loud, deliberate movement. Exercises with exaggerated amplitude: take big steps, swing the arms, reach high and wide, stand tall, speak loudly. Therapists use special amplitude-focused programmes for this; ask whether one is available locally. At home, practise bigger movements in daily tasks: standing up fully, stepping with the heel first, swinging the arms in walking, writing in larger letters.

2. Walking practice. - Walk tall with eyes forward, not at the feet. - Take big steps, landing on the heel, and swing the arms. - Use a regular rhythm, counting aloud ("one, two, one, two"), walking to music or a metronome beat, or using a marching rhythm. - Walk with a companion and on a clear, flat path. - Use a stick or walker only if advised, as walking aids can alter gait in some people; wheeled walkers and rollators are sometimes used; see walking aids for Parkinson's, rollator buying guide and walking programme for older adults.

3. Balance and posture. Weight shifts, standing with feet together then staggered, stepping practice, reaching, turning with small steps instead of pivoting, and posture work to counter stooping, such as standing against a wall with the head, shoulder blades and buttocks touching it. Do with a support nearby. See balance exercises for seniors.

4. Strength. Chair rises, heel raises, leg and arm exercises with bands or light weights, two to three days a week; see resistance band routine for seniors and strength training after 60: how much is enough. Focus on back, hip and leg muscles to help posture and rising.

5. Flexibility. Gentle stretching of the chest, shoulders, hips, hamstrings and calves, daily, to counter stiffness; see stretching for stiff older bodies.

6. Aerobic exercise. Cycling (stationary or pedal exerciser), brisk walking, water exercise, dancing; building up to about 150 minutes a week as allowed; see pedal exerciser guide.

7. Rhythm-based activities. Dance, tai chi, boxing-style non-contact classes, singing and drumming have been studied in Parkinson's and are enjoyed by many; look for classes designed for Parkinson's with trained instructors.

8. Voice and swallowing exercises, taught by a speech and language therapist.

9. Fine motor and hand practice: large-grip writing, buttons, putty; see grip strength and hand exercises.

10. Rolling and getting out of bed, practised with a therapist.

Cueing: strategies for freezing and slow starts

Freezing, when the feet feel glued to the floor, is common, especially in doorways, narrow spaces, turns, crowds and when anxious or hurried. Therapists teach cues to restart walking.

• Visual cues: a line of tape or a stripe on the floor to step over; a laser cue on some walkers or canes; a bright mat at doorways.
• Auditory cues: counting aloud, a metronome app, music with a steady beat, or a clapping rhythm.
• Mental cues: think "big step", imagine stepping over a line, or shift weight from side to side before stepping.
• Physical cues: rock gently side to side, lift the foot high, march in place, then step.
• Do not rush, stop, take a breath, and restart with a cue.
• Turn in a wide arc, using small steps, not a pivot.
• Tell family what helps, so they can cue, without pushing or pulling.

Cues that work for one person may not work for another; a physiotherapist can help find them. See Parkinson's freezing and falls and bathroom safety for Parkinson's disease.

Safety at home

• Support nearby for standing exercises: a counter or sturdy chair; a helper for the first sessions.
• Clear floors, no rugs or clutter, wide paths, good light; see flooring, rugs and trip hazards.
• Non-slip, supportive footwear with a thin, firm sole; avoid very thick soles that may catch; see choosing shoes for older feet.
• Rise slowly and pause before walking.
• Avoid exercising when dizzy, very tired, "off" or after a heavy meal.
• Stay hydrated, particularly in the heat.
• Have a phone or alarm close; see panic pendant buying guide.
• Mind the surfaces: polished marble, wet bathrooms and doorway thresholds are hazards; see portable ramps for thresholds.
• Stop if chest pain, severe breathlessness, fainting feelings or sudden new weakness occur; call 112 for emergencies.

Common challenges

• Fatigue: short sessions, regular rest, best time of day; discuss with the doctor.
• Low motivation or low mood: exercise with others, music, and a regular routine; see motivating a parent to exercise and depression in older adults.
• Anxiety about falling: start seated, build confidence, work with a therapist.
• Orthostatic dizziness: slow position changes; keep hydrated; ask the doctor.
• Dyskinesia (extra movements) at peak dose: take care; ask the doctor.
• Cognitive difficulties: simple instructions, a set routine, a helper; see dementia daily routines if relevant.
• Constipation, sleep and pain: exercise often helps; discuss with the doctor.
• Heat: exercise in cool hours; see exercising indoors in Indian summer and monsoon.

Advanced stages

In later stages, when walking is limited, exercise continues in seated and bed-based forms: range-of-motion, posture, breathing, seated strength and rolling practice, with a carer's help and therapist guidance. Prevent pressure sores and contractures with positioning; see positioning a bedridden parent. Safety during transfers matters for carers; see how to lift and transfer safely.

Carers

• Learn the cues and safe support from the physiotherapist.
• Exercise together where you can; it benefits you too.
• Avoid rushing or finishing tasks for them unnecessarily.
• Keep patient; slowness is part of the condition.
• Look after yourself; see caregiver burnout signs and prevention.

When to ask a professional

Ask a neurologist or doctor about medicines, fluctuations, dizziness and exercise safety. A physiotherapist experienced in Parkinson's can design and supervise a programme. An occupational therapist can adapt the home and daily tasks. A speech and language therapist can help voice and swallowing. A Parkinson's nurse specialist or support organisation can help. In an emergency, call 112.