Rehabilitation guide
Parkinson's is a progressive condition, but alongside medication, regular exercise is one of the most important ways to improve movement symptoms and quality of life. The research has a common message: doing it regularly matters more than which exercise you choose.
Parkinson's disease develops as the cells in the brain that produce dopamine gradually decline. Slowness of movement, tremor, muscle stiffness, walking difficulties and balance problems are the best-known symptoms. Sleep problems, mood changes, pain and difficulties with thinking can also occur.
According to the World Health Organization, rehabilitation, including physiotherapy, can improve function and quality of life for people with Parkinson's and ease the burden on carers. It includes strength, walking and balance training and exercise in water.
A 2024 Cochrane review of 154 studies and 7,837 people found that dance and training in walking, balance and daily function probably bring a moderate benefit for movement symptoms, and that exercise in water clearly improves quality of life. There was no clear difference between types of exercise; according to the researchers, what matters most is doing exercise.
Intensity may matter too. In the SPARX trial of 128 people who had recently been diagnosed and were not yet taking medication, the group who did treadmill exercise three times a week, reaching 80–85% of their maximum heart rate, saw almost no change in their movement score over 6 months, while the score of those who did not exercise worsened by 3 points.
The 2022 guideline from the American Physical Therapy Association recommends a physiotherapy approach that includes aerobic exercise, strength and balance training, external cues such as a rhythm or lines on the floor while walking, practice of everyday tasks and, when needed, remote rehabilitation.
Exercises at home
In Parkinson's, movements tend to get smaller over time. So make your exercises deliberately “big”: lengthen your steps, open your arms and count to keep a rhythm. For standing exercises, stand next to something sturdy such as a kitchen counter, and if possible have someone with you at first.
Sit at the front of a sturdy chair with your feet slightly back. Lean forward until your nose is over your toes, count “one, two, up” to yourself and stand up powerfully in one movement. Sit back down with control.
10 reps, twice a dayStand with your hands on the back of your hips. Open your chest and lean back as far as is comfortable, keeping your eyes looking forward. A good habit against a stooped posture.
5–10 reps, several times a daySit on a low-backed chair and clasp your hands behind your neck. Open your elbows out to the sides, lift your chest towards the ceiling and lean back slightly. Make the movement big and slow.
10 repsStand holding on to the kitchen counter. Take as big a step to the side as you can, shift your weight onto that foot, then bring the other foot next to it. Count your steps to keep a rhythm.
10 steps each way, 2 roundsWalk along the counter, holding on lightly with one hand; with each step, place the heel of your front foot just in front of the toes of your back foot. Keep your eyes looking forward.
10 steps, 2–3 roundsStand facing the counter with your feet shoulder-width apart. Slowly shift your weight onto your right foot, then onto your left; then forwards and backwards. This matters in Parkinson's for turning and for starting to walk.
10 times in each directionSmall changes both improve safety and help you stay independent.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A standing programme of 10 exercises built on deliberately making your movements bigger.
The original version of the same approach; it focuses on making everyday movements bigger.
The findings are promising but not yet conclusive. In the SPARX trial of 128 people who had recently been diagnosed and were not taking medication, those who did treadmill exercise three times a week, reaching 80–85% of their maximum heart rate, saw almost no change in their movement score over 6 months, while the score of those who did not exercise worsened by 3 points. This finding is now being tested in a larger phase III trial (SPARX3).
A Cochrane review of 154 studies found no clear difference between types of exercise: dance and training in walking, balance and daily function probably bring a moderate benefit for movement symptoms. According to the researchers, what matters most is exercising; the type comes second. Choose an activity you enjoy and can keep up regularly.
This is called freezing. Stop, stand tall and shift your weight onto one foot, then start with a big step. Imagining stepping over a line on the floor or an obstacle in front of your foot, counting a rhythm silently or out loud, or listening to music can make it easier to start walking.
The times when your medication works best are usually the best times to exercise, as you will move more easily. What matters is moving regularly on most days of the week.
See your doctor without delay if you have:
Sources
İhsan Eren