“We counsel people to get into an exercise regimen right at diagnosis,” says Indu Subramanian, MD, a neurologist at Ronald Reagan UCLA Medical Center in Los Angeles who specializes in wellness and integrative medicine approaches. “There have been studies showing that exercise can slow the progression of the condition and, in general, make you feel better.” However, when you have Parkinson’s disease, starting a healthy and effective exercise regimen isn’t as simple as going to the nearest gym. Certain types of exercises are better than others, and it’s important to work with your care team to put together a physical activity plan that’s right for you. Here’s what you need to know.
The Benefits of Exercise for People With Parkinson’s
Research conducted by the Parkinson’s Foundation has shown that increasing physical activity to at least 2.5 hours per week can slow decline in quality of life in people with Parkinson’s disease.
How Exercise Helps With Parkinson’s Symptom Management
In general, the Parkinson’s Foundation says, exercise helps improve gait, balance, flexibility, and grip strength while reducing tremors. A review of existing research published in the August 2016 edition of the journal Frontiers in Medicine found that exercise may also improve cognition, while reducing depression and fatigue.
The Potential Neuroprotective Effect of Exercise
Arguably the most important benefit of exercise if you have Parkinson’s disease is its “neuroprotective” effects. The Parkinson’s Foundation defines neuroprotection as defenses against the damage, degeneration, and/or death of neurons, or the cells in your nervous system. This is important, given that Parkinson’s interferes with the neurons in your brain that control body movement. In fact, the Parkinson’s Foundation says that interventions that provide “neuroprotective” benefits, including exercise, can “change the course” of Parkinson’s disease — in other words, slow the progression of symptoms.
Creating an Exercise Plan With a Physical Therapist
Before beginning a new workout regimen, the American Parkinson Disease Association (APDA) recommends consulting with a physical therapist who has experience treating your condition, such as a board-certified neurologic specialist (NCS). A physical therapist can help you select the right routines and exercises to increase mobility, strength, and balance. They can also tailor a plan to your specific symptoms and lifestyle needs. For example, to improve your performance on a routine skill, like walking, your physical therapist may have you work on what’s called “dual-task practice,” during which they ask you to practice walking while bouncing a ball or counting backward. The idea is to get your mind used to focusing on two tasks simultaneously. Similarly, if you’re having problems getting up from a seated position, your therapist may have you target muscle strength in your legs and ask you to practice sitting and standing with seats at different heights, while counting or answering questions. “There are physical therapists who specialize in neurological conditions, including Parkinson’s disease,” Dr. Subramanian notes. “Having access to someone who knows about the disease helps. In fact, research has shown that working with a physical therapist trained in the needs of people with Parkinson’s disease can reduce the number of therapy visits needed and, therefore, patient costs. Given how expensive care for Parkinson’s disease can be, that’s important.”
Suggested Exercises That Are Effective for Parkinson’s Disease
The Parkinson’s Foundation says that the general goal of an exercise program should be to improve strength and your sense of balance; this way, you can continue doing the activities you enjoy. A safe and effective exercise plan for people with Parkinson’s disease includes the following exercises.
Stretching and Flexibility Exercises Help Keep You Limber
The Parkinson’s Foundation says that stretching and flexibility exercises should be “the first step in your exercise program.” These exercises help offset the muscle rigidity that comes with Parkinson’s disease, and people who are more flexible tend to have an easier time with everyday movements like walking, the Parkinson’s Foundation adds. Although there’s no standard stretching regimen for people with Parkinson’s, the Foundation suggests:
Performing stretching routines lasting at least 10 minutes at a timeStretching at least three to four times per week (and ideally, daily)Holding stretches (remaining motionless) for 10 to 30 seconds and performing three to four repetitions of each stretchBreathing evenly in and out during each stretch (don’t hold your breath)Not stretching to the point of pain — instead, each stretch should feel like a “gentle pull”
In addition, a flexibility program should focus on areas of the body most affected by symptoms, including the chest wall, shoulders, elbows, back of the thighs (hamstrings) and knees, calves, wrists and palms, lower back, and neck. Stretches and flexibility exercises can be performed while seated or lying down, to avoid strain on your muscles and fatigue.
Strength Training Helps Build Muscle Mass
Strength training can involve lifting weights, using machines at the gym, using your own body weight for resistance, or even using common household items like a milk jug filled with sand, the Parkinson’s Foundation notes. Your strength training should focus on the following muscle groups:
Core muscles (abdominals)Thigh muscles (quadriceps)Buttocks (gluteals)Back musclesArm muscles (triceps)Hands and wrists
In general, strength training should be done two to three times per week, but scheduled so that you’re not targeting the same muscles on consecutive days, as your muscles need to rest and recover, the foundation advises. As with stretching exercises, strength training can be performed while standing, sitting, or while “on the ground.” The Wisconsin Parkinson Association (WPA) recommends several exercises to help strengthen your grip and improve your reach. Tasks such as handwriting and reaching for items on higher shelves can be a challenge for people with Parkinson’s disease, and hand exercises can help minimize these issues. “In general, resistance training helps build and maintain muscle mass,” Subramanian says. “The stronger you are, the more independent you’ll be.”
Aerobic Exercise Helps You Maintain a Healthy Weight
Aerobic exercise helps keep your heart healthy while helping your body burn calories and maintain a healthy weight. Examples of aerobic exercises include walking, jogging, running, swimming, dancing, water aerobics, chair aerobics, and biking. The Parkinson’s Foundation recommends doing 30 minutes of aerobic exercise a day, five times a week. Your routines are up to you, and you can design them around any physical limitations. “I really encourage my patients to get out into nature, go for a walk in the park with a friend or spend time in the garden,” Subramanian notes. “Being outside in the sunshine is healthy, as long as you don’t get too much sun, and walking or hiking can get your heart rate up. Doing these activities with friends or caregivers is also fun and helps avoid the isolation some people with Parkinson’s experience.”
Aquatic Exercise Can Improve Your Balance
According to the APDA, exercising in water (a pool or a warm-water lake, with lifeguard supervision) is a safe and effective way to improve balance and strength in people with Parkinson’s disease. In general, the organization says, buoyancy from simply standing in the pool can help support weaker muscles and improve a person’s balance and posture. Swimming, or even performing some strength and flexibility exercises in the water — with the water providing “resistance” — enhances muscle tone, balance, and mobility with minimal stress on the body. The APDA offers a brochure with suggested aquatic exercise routines and general tips.
Range-of-Motion Therapy Can Improve Your Joint Mobility
Two of the hallmark symptoms of Parkinson’s disease, bradykinesia (slowness of movement) and rigidity (stiffness), can affect overall range of motion and mobility. This may cause you to take smaller steps as you walk or have trouble moving your arms and legs in different directions, the APDA says. Strength and flexibility training can help here, but there are actually several exercises targeted specifically toward improving range of motion in people with Parkinson’s disease. For example, the APDA recommends the “trunk twist,” which is designed to improve range of motion in your neck, trunk, and shoulders, all of which are often compromised in people with Parkinson’s disease.
Balance Exercises Can Improve Your Mobility
Balance is an important aspect of mobility, and people with Parkinson’s commonly experience balance problems when standing or moving around, the APDA notes. Dance and tai chi are two activities that can help you improve balance, and the APDA recommends performing balance-related activities two to three days a week for 20 to 30 minutes each time. “Balance training can help you prevent falls,” Subramanian notes.
Boxing Can Give You a Mental and Physical Workout
Yes, boxing can be a fun and beneficial type of exercise for Parkinson’s disease, according to the Parkinson’s Foundation. However, your boxing routine should be “noncontact” (meaning no hitting others or being hit by others) and performed in a safe and proper setting. Boxing is a workout that combines aerobic activity, strength training, balance movements, and agility exercise all in one. Plus, it also provides a mental workout, challenging both the body and the brain, the foundation adds.
Try Seated Exercises if You Have Limited Mobility
Performing strength and flexibility exercises while sitting can help you stay fit and (safely!) improve your range of motion — all with minimal stress and wear and tear on your muscles and joints. An example of a seated stretching routine recommended by the Parkinson’s Foundation is the “hamstring stretch.” To do this stretch: An example of a strength exercise you can perform while sitting down is the “shoulder blade squeeze.” To perform this exercise: Your physical therapist can recommend additional seated exercises.
The Benefits of Yoga for Parkinson’s Disease
According to the Parkinson’s Foundation, yoga can help with flexibility, breathing, and posture as well as relaxation and stress reduction. Best of all, it’s “a self-paced activity,” the foundation adds, which means you don’t have to perform certain exercises if your physical limitations get in the way. Bonus: Your routine can be modified depending on your needs — for example, doing seated yoga in a chair. “Yoga is really my go-to,” Subramanian says. “Mind-body exercises are really beneficial for mental health, which is important given the risk for anxiety and depression in Parkinson’s disease.”
Tips for Exercising Safely
Before starting an exercise program, consult with your neurologist and primary care doctor about any health concerns and ask for recommendations, the Parkinson’s Foundation advises. Ask your doctor to refer you to a physical therapist who knows about Parkinson’s; together, the two of you can identify any concerns and physical limitations you may have. Your exercise regimen should be targeted to address your symptoms and physical limitations. You should stop any exercise or stretch that causes pain, and take steps to prevent falls while exercising, such as:
If indoors, remove area or throw rugsWork out in well-lit areasDon’t use rolling chairsWork out with friends or “buddies,” particularly when performing outdoor activitiesStay hydratedAvoid overexertion
When Should Someone With Parkinson’s Start Exercising?
After you’ve been diagnosed with Parkinson’s, try to start an exercise regimen as soon as possible, says the Parkinson’s Foundation. The foundation calls this the “pre-habilitation stage,” and warns against waiting until you start to have pain or problems with your movements to begin an exercise regimen. Still, it’s never too late to start. People who have advanced Parkinson’s and exercise have better health-related quality of life than people who don’t exercise, so it’s important to stay active and even try new routines as your condition progresses. “There are so many benefits to exercise with Parkinson’s disease,” Subramanian says. “In addition to all the positive effects on symptoms and progression, there are other benefits as well, including social ones, if you work out as part of a group. Exercising will also likely help you to sleep better, which is important for overall health.” “Really,” she continues, “the more physical activity the better, as long as you’re safe. And if you’re worried about staying motivated, a general rule is that any exercise that you love is something you’re going to keep doing.” Don’t hesitate to try different things, too, which will challenge your brain and your body. “You’ll see the positives right away,” she says.
