Exercises for Parkinson’s Disease

If you’re living with Parkinson’s disease, exercise is a very important part of managing your symptoms and maintaining your independence. In fact, medication combined with Parkinson’s-specific exercises is your best tool to prevent progression of the disease.

Research supports that regular physical activity can help improve your walking, balance and strength. Exercise can even have neuroprotective benefits for your brain.

Neurologic physical therapist Amy Chan, PT, DPT, NCS, explains which exercises matter most and how to build a routine that works for you.

Why is exercise so important for Parkinson’s disease?

Parkinson’s causes a significant drop in dopamine, which is essential for performing smooth, coordinated movements. When dopamine declines, motor symptoms like stiffness, slower movement, poor posture, and balancing problems become more common.

Moderate-to-high intensity exercise can increase the amount of dopamine available in your nervous system.

“Exercise also helps improve non-motor symptoms like depression, difficulty sleeping, brain fog and other cognitive issues,” says Dr. Chan. “These are all areas that are affected by Parkinson’s, and the non-motor symptoms can greatly affect your quality of life.”

Research also suggests that exercise at a moderate or vigorous intensity may help your brain adapt and form new connections.

“In the last 20 years, we’ve learned that if you consistently do the right exercises, it can have this neuro-protective benefit,” she adds. “It causes your nervous system to change and possibly slow down the progression of Parkinson’s disease.”

Scientists continue to study whether exercise can reverse the effects of Parkinson’s. But there’s strong evidence that when it’s paired with medication, it can improve your quality of life.

“The earlier you start exercising, the more brain cells you can protect,” says Dr. Chan.

Best exercises for Parkinson’s

With Parkinson’s disease, aim for a well-rounded workout routine that includes four main types of exercise:

• Aerobic (cardio) exercises: High-intensity aerobic exercises — like brisk walking, cycling, swimming and rowing — can protect and change the way your brain works.
• Strength training: Weightlifting and functional strength training help preserve muscle mass and strength. “Your muscles get weak if you don’t use them,” warns Dr. Chan. “So, work on strengthening the muscles you use for everyday activities.”
• Flexibility: Parkinson’s causes rigidity in the muscles of your neck, back, arms and legs. This can affect your posture and make it harder to move or breathe. A consistent stretching routine and other flexibility exercises can improve posture and lung function to prevent secondary issues like pneumonia.
• Balance and agility: Parkinson’s can affect your balance and increase your risk of falls and injury. Proactive balance exercises with a neurologic physical therapist can help prevent falls. Exercises like yoga, tai chi and boxing can improve balance.

“When it comes to exercise, the most important thing is to have a well-rounded routine that you can do safely and consistently,” says Dr. Chan. “Having a daily routine can really make a difference.”

If you’re not sure where to start, a physical therapist can help create a plan that incorporates aerobic exercises and other physical activities. They may suggest some of the following, which can help improve the way you move and how you tackle everyday activities.

Trunk twists

“When we work on flexibility exercises, we focus a lot on the extension and rotation of your trunk,” says Dr. Chan. “Trunk rotation helps improve your flexibility and strengthen your muscles so you can sit up straight and feel less stiff when you’re turning or picking something up.”

1. Stand tall with your feet shoulder-width apart and your arms straight out at your sides in a “T” shape.
2. Keeping your right hand still, twist your trunk and hips to bring your left hand over to your right hand.
3. Hold this position for three to five seconds, then return to the starting position.
4. Repeat, alternating for five reps on both other sides.

Sit-to-stands

Your abdominal and back muscles play an important role in everyday tasks like bending over, getting in and out of bed and standing up from a chair. Functional exercises like sit-to-stands help ease those processes by strengthening your lower body.

1. Sit up straight at the edge of a chair, with your feet flat on the floor and shoulder-width apart.
2. Hinging at your hips, lean forward and reach as far out in front of you as you can.
3. Open your arms wide as you push through your heels to stand up tall — almost like you’re preparing to give someone a big hug.
4. Reach forward again and sit back down. Try to keep your movements slow and controlled.
5. Repeat five times.

Standing squats

Squats help strengthen major muscle groups, from your core and back to your glutes and hamstrings. These muscles help perform a variety of everyday movements — and this variation, designed specifically for people with Parkinson’s, also helps with posture.

1. Stand with your feet shoulder-width apart, with your hands down at your sides.
2. Perform a squat. As you bend at your hips and knees, reach your arms out in front of you with your hands open and fingers spread wide.
3. From the squat, straighten your legs to stand. As you do, swing your arms behind your back and squeeze your shoulder blades together to expand your chest. Hold that position for three to five seconds for a deep stretch.
4. Repeat five times.

Bird dogs

This exercise works out your core and hip strength. You’ll be down on the floor for this one, so make sure you use a yoga mat, pillow or other soft surface beneath your knees.

1. Start on all fours, with your knees shoulder-width apart and your back flat.
2. Tighten your stomach by drawing in your belly button toward your spine.
3. Slowly reach your right arm forward and your left leg backward until both are stretched out straight (as far as you feel comfortable). Try not to twist or turn while doing this movement.
4. Hold this position for two to three seconds, then slowly return to the starting position.
5. Switch sides and repeat five times on both sides.

Planks

Planks are another core total body workout. A strong core supports posture, balance and mobility.

1. Begin face-down on the floor with your forearms out in front of you and toes tucked. Your elbows should be tucked directly under your shoulders.
2. Engage your abdominal muscles and push through your forearms so that your hips and legs come up off the floor.
3. Hold this position for 20 seconds, then lower back down to the floor.
4. Repeat five to 10 times.

Tips for exercising with Parkinson’s

Building a consistent routine is just as important as choosing the right exercises. Dr. Chan recommends these tips:

• Exercise when you feel your best. Parkinson’s symptoms like stiffness tend to be worst in the morning. You may move more easily during the middle of the day after you’ve taken your medications.
• Exercise often. Gradually increase your aerobic exercises to 150 minutes each week, or 30 minutes of exercise five days a week. If that seems overwhelming, start small: Go on a 10-minute walk, and then build up from there.
• Stay hydrated. Dehydration can worsen lightheadedness and increase your risk of falling. So, drink plenty of water throughout the day.
• Warm up and cool down. Stretching before exercise can help you move more comfortably. Gradual warm-ups and cool-downs can help prevent dizziness, especially if you’re prone to drops in blood pressure.
• Find an exercise partner. “You’re much more likely to maintain an exercise program when you have someone to do it with,” says Dr. Chan. “Beyond motivation, group exercises also provide valuable social support.”
• Choose activities you enjoy. Whether it’s golfing, water aerobics or a brisk walk in the park, do what you love to boost your dopamine levels.

Most importantly, don’t wait until your Parkinson’s symptoms become severe to start exercising. The earlier you start a physical fitness routine, the more muscle and strength you preserve.

And remember: If something ever feels wrong or you experience pain while working out, stop what you’re doing and ask a professional for guidance.

“Everyone with Parkinson’s should have a physical therapy evaluation,” advises Dr. Chan. “That way you can learn how to exercise safely and stay ahead of the game.”