Parkinson’s disease (PD) is a progressive disorder that affects the nervous system, which functions as the “command center” for your body. Classified as a movement disorder, PD can cause tremor, stiffness, slowness, and issues with balance and walking.

The disease can also cause nonmotor symptoms (symptoms not associated with movement), including cognitive impairment, psychosis, depression and anxiety, and sleep problems.

PD is a lifelong disease, with symptoms that worsen over time. While medications can help manage the most common Parkinson’s symptoms, research has shown that the only treatment that improves sleep, slows disease progression, and improves cognitive function is exercise.

An effective way to get started is to work with a physical therapist (PT). A PT can identify exercises that will counter the walking, balance, and posture issues often associated with Parkinson’s, as well as pain and any other symptoms that are limiting your mobility, according to the Parkinson’s Foundation.

Exercise Is an Important Part of an Overall PD Wellness Plan

“Aerobic exercise as well as strength, balance, and flexibility training are the key parts of a well-balanced exercise program for all of us, but particularly for people with Parkinson’s,” says Tami DeAngelis, DPT, a doctor of physical therapy who specializes in geriatric rehabilitation and Parkinson’s disease.

If possible, people with Parkinson’s should aim to meet the national guidelines for physical activity, which is 150 to 300 minutes of moderate-intensity aerobic exercise per week, along with two days of strength training, says Dr. DeAngelis.

“A few sessions of stretching and neuromotor activities, such as tai chi, which incorporates movement and balance, can also provide benefits to people with Parkinson’s,” she says.

Of course, it’s hard for people in the general population to get the recommended amount of exercise and strength training, and people with Parkinson’s often have additional barriers, says DeAngelis.

“It’s a challenge. People with Parkinson’s not only have more difficulty moving, but other symptoms of the disease, like apathy and fatigue, can be barriers as well. That’s why we encourage people with Parkinson’s to do physical therapy or physical activity classes in the local community,” she says.

Physical Therapy Can Be Valuable Even Before Problems Emerge

Many people with Parkinson’s wait until they’re having problems with walking and balance before they seek out the assistance of a physical therapist, says DeAngelis.

“Ideally, physical therapy and an exercise program would be onboard at the time of PD diagnosis. When you have minimal symptoms, that’s the ideal time to get on a good established exercise program. As the disease progresses, the therapist can help modify the program,” she says.

DeAngelis suggests an early evaluation with a PT to establish a baseline and identify any areas that could be addressed through a program. “For example, identifying balance issues early — before any falls have occurred — will make them easier to treat,” she says.

The best and most effective physical therapy exercises for people with Parkinson’s vary according to your symptoms, how advanced your disease is, and what you enjoy doing, she says.

“The exercise program should be tailored to each individual's needs and abilities. Keep in mind that with any type of therapy, consistency is key for it to be effective. People with Parkinson’s who are moving around, who are less sedentary, and who are more active tend to do better,” says DeAngelis.

To help people with Parkinson’s find knowledgeable exercise professionals and programs that will meet their needs, the Parkinson’s Foundation has developed an accreditation program to identify those programs that meet its guidelines. Two of the exercise programs that have been accredited are PWR!Moves and Rock Steady Boxing, both of which are widely available in the United States as well as elsewhere in the world.

LSVT Big and LSVT Loud

The LSVT (Lee Silverman Voice Therapy) programs are evidence-based interventions to improve movement and speaking ability in people with Parkinson’s.

Parkinson’s typically causes physical movements to become slower and smaller. For example, the length of a person’s stride while walking often gets shorter, and their walking takes on a shuffling quality.

LSVT Big focuses on showing people how to make their movements bigger and more emphatic so they are, in fact, more normal.

LSVT Big training starts with a four-week intensive training course, which ideally is followed by daily practice, periodic tune-ups with a PT, and possibly group classes with others who have done the training.

Strength Training Aids Functional Movement

Strength training a couple of times a week is safe and beneficial for people with PD, says DeAngelis.

“For example, even early on, some people might have trouble getting up from lower chairs or seats. Incorporating something like squats can strengthen those muscles” making that task easier, she says.

Lower-body resistance training like squats and lunges can improve muscle strength, mobility, and quality of life in people with PD, according to a review of 31 studies that was published in November 2020 in Frontiers in Neurology.

Upper-body exercises, such as biceps curls, triceps extensions, and shoulder presses can also help with arm function, handgrip strength, and quality of life, according to research published in July 2022 in Clinical Neurology and Neurosurgery.

Aerobic Exercise Improves Heart Health and Mood

After a fitness assessment, a PT can work with you to find a safe and enjoyable way to get your heart rate up, says DeAngelis.

Aerobic exercise, such as walking, cycling, or swimming, has the potential to improve balance, gait, and motor function in people with Parkinson’s, according to a meta-analysis published in the October 2022 NPJ Parkinson’s Disease.

All types of physical activity helped with depression and quality of life, with aerobic training producing the best results, according to a systematic review of 11 studies published in July 2017 in PLoS One.

A Walking Program Can Counteract Parkinson’s Effects

Walking can become more difficult for people with PD. As the disease progresses, movements become smaller and slower, including walking, according to the American Physical Therapy Association.

In studies, maintaining their walking has been shown to be one of the key areas of importance for people with Parkinson’s, says DeAngelis. “This is something that should be addressed early with a physical therapist. People with Parkinson’s should practice elements of walking — working on big steps, upright posture, and speed of walking,” she says.

Reciprocal movement training, which focuses on side-to-side movements such as swinging the arms while walking, is another aspect of a walking program, says DeAngelis.

Stretching Exercises Protect Range of Motion and Functional Fitness

Stretching exercises can improve flexibility and range of motion, which can help with stiffness and rigidity in people with Parkinson’s, says DeAngelis.

A small, randomized study published in August 2020 in Sensors found that people with PD who completed a 12-week program of trunk resistance and stretching exercises had improvements in functional fitness, standing balance, and dynamic stability, which refers to maintaining one’s balance while in motion.

Balance Exercises May Reduce Falls

If you have balance concerns, it’s important to be assessed by your doctor and by a physical therapist, says DeAngelis. “Balance is so complicated, and balance issues could be caused by a variety of things and so the first step is to figure out what’s causing it,” she says.

For example, some people need to work on lower-extremity strengthening to improve balance, says DeAngelis. “For others, it could be an inner ear problem needs addressing.”

For some people, balance training is just the ticket.

A three-month program of progressive, highly challenging balance exercises in people with PD was effective in reducing falls, improving balance, and reducing fear of falling, according to research published in the Journal of Neurology and Physical Therapy.

Tai Chi Shows Multiple Benefits

Tai chi is a form of mind-body exercise that involves slow, flowing movements and deep breathing.

Practicing tai chi a few times a week significantly decreases fall rates and significantly improves balance and functional mobility in people with PD, according to a review published online in February 2019 in the journal Parkinson’s Disease.

In people with mild to moderate Parkinson’s disease, tai chi may slow down disease progression, according to a study published in the February 2020 Brazilian Journal of Medical and Biological Research. There were improvements in walking speed, fall incidence, balance, and confidence.

During the follow-up, 9 percent of the people in the tai chi group successfully withdrew from levodopa treatment, and the remainder of the group decreased their dose.

Physical Activity Can Help People With Parkinson’s Live Their Best Life

“We find that these different types of physical activity can help people with Parkinson’s disease live their best life and often with better outcomes. People who remain active tend not to accumulate as much disability as time goes on,” says DeAngelis.

Activity doesn’t have to always be with a physical therapist or at a gym or rehab center, she says. “Find ways to keep moving throughout the day. You can go to the gym for an hour every day, but then if you go home and sit the rest of the day, that’s not good either,” she says.

Physical therapy is one piece of the puzzle, she says. “Participating in social activities, leaving your house, decreasing sedentary time, being well-rested, eating a healthy diet — all of those things together go into living well with Parkinson’s,” says DeAngelis.

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