Parkinson’s Exercises: Everything you need to know

Exercise is a healthy component in the management of any medical condition—Parkinson’s disease included! Parkinson’s disease is a neurodegenerative disorder of the central nervous system that effects motor muscle movement. Maintaining muscle mass with Parkinson’s exercises is essential to preserving motor function. Read further to learn about the types and modifications of Parkinson’s exercises.

Parkinson’s exercises: Basics of Parkinson’s Disease

Parkinson’s disease is a neurogenerative disorder of the central nervous system. Connected by nerves extending throughout the body, the central nervous system is comprised of the brain and spinal cord. In Parkinson’s disease, nerve cells in the brain (neurons) are damaged and eventually die off. Neurons lose the ability to produce dopamine, which is a chemical neurotransmitter the brain uses to communicate. The lack of dopamine produces changes in motor movement, cognition, and behavior. However, symptoms are typically slow to progress and develop after the age of 60. Although environmental factors and genetic mutations have been associated with Parkinson’s, the cause is unknown.

Parkinson’s Exercises: Common Symptoms of Parkinson’s Disease

While each patient differs in presentation, common symptoms of Parkinson’s disease affect a variety of body systems.

• Tremors—Involuntary shaking of the muscles in hands, feet, legs, jaw, chin, and the mouth.
• Rigidity—Stiffness or tension of the muscles.  
• Bradykinesia—Slow movements impacting daily activities such as writing, walking, speaking, and turning over in bed.
• Autonomic dysfunction—
• Poor balance—Postural instability that causes changes in gait and difficulty walking.
• Impaired speech—Loss of voice, sot tone, and stuttering while speaking.
• Depression—Unexplainable sadness lasting longer than 2 weeks.
• Anxiety—Persistent worry out of proportion to the situation.
• Dementia—A group of symptoms related to a decline in thinking, memory, and cognitive skills.
• Dystonia—A movement disorder characterized by involuntary, repetitive movements of the muscles that form a painful abnormal posture.  
• Fatigue—An overwhelming sense of tiredness and no energy to complete daily activities.
• Gastrointestinal issues—Gastrointestinal complaints are frequently documented in Parkinson’s patients like nausea, vomiting, and constipation.
• Psychosis—Disconnection from reality that manifests with hallucinations and delusions.  
• Sleep disorders—Sleep problems entail difficulty falling asleep (insomnia) and vivid dreams.
• Urinary Frequency—The need to urinate often despite the fullness of the bladder.

Parkinson’s Exercise: Why

When feeling ill, exercise is not always a priority. Yet, an active lifestyle is important to manage Parkinson’s. It cannot prevent the progression, but according to the Parkinson’s Outcome Project by The Parkinson’s Foundation, studies show exercise may slow the decline of motor symptoms.

Light exercise improves quality of life for many Parkinson’s patients simply by facilitating neuroplasticity—a process which entails teaching the brain new patterns.

Deconditioning from being sedentary only furthers the effects of the disease. If the muscles remain in an unused state, they become more stiff, prone to tremors, and are weaker overall. Physical activity combats the signs of deconditioning, encourages the circulation of blood throughout the cardiovascular system, and counteracts a portion of the stiffness and muscle rigidity common in Parkinson’s.

Parkinson’s Exercises and the Brain

Along with the symptoms of motor involvement, Parkinson’s exercises also benefit cognitive symptoms such as attention, processing speed, memory, and other executive functions. During exercise, the body makes new blood vessels and there is enhanced blood flow to the brain, which provides the oxygen necessary to perform cognitive functions. Neuronal connections that the brain uses to communicate grow, and dopamine, the neurotransmitter lacking in Parkinson’s disease, is utilized to its fullest potential.

Parkinson’s exercise: How Often Should I Exercise?

As stated again by the Parkinson’s Foundation, the Parkinson’s Outcomes Project suggests at least 2.5 hours of exercise a week to improve symptoms. However, Parkinson’s patients vary on the amount of exercise that can be done safely. Start slow and increase the amount of exercise as tolerated.

Finding a Physical Therapist for Parkinson’s Exercises

Parkinson’s exercises are best done under the care of a physical therapist. A physical therapist is a professional who helps those with injuries or long-term illnesses. Their job is to create an exercise program custom to a patient’s needs. This includes workouts, stretches, and ways to reduce pain while partaking in physical activity.

To determine the extent of therapy, they review a patient’s medical history, consult with the patient’s medical team, and assess the patient’s abilities in daily tasks (i.e. walking, etc.). In cases of Parkinson’s, physical therapists are an excellent tool to determine what exercises are within safe parameters and to see that exercise is done correctly to avoid injury.

Physical therapy interventions take place in a series of four stages:

1. Pre-habilitation—Preventing problems before symptoms occur
2. Rehabilitation—Actively using therapy to fix symptoms
3. Preservation—Maintaining current progress
4. Prevention—Continue to engage in preventative therapy.

Parkinson’s Exercises: Flexibility

Parkinson’s exercises for flexibility are stretches that reduce stiffness in the muscles. They improve mobility, balance, gait abnormalities, and relieving tension from overactive muscles induced by dystonia. Incorporate flexibility exercises into your workout routine 2 to 3 days per week in sets of three to four. For best results, stretch muscles after the body is primed from other Parkinson’s exercises.

Unless stated otherwise, hold the following stretches for 30-60 seconds:

Walking with Toes Up

Walking with the toes pointed upward is a basic dynamic stretch for the lower limbs. Locate a flat surface with sufficient space for walking. At a slow pace, walk so that your heels are the first part of your foot touching the ground. Roll your toes. For additional balance, spread your legs slightly farther than normal walking. Repeat this action for 10 to 15 minutes.

Seated Torso Stretch

The seated torso stretch targers the upper back. While sitting with your weight equally distributed in a chair, grab your elbow with the opposite hand and move your arms towards your chest. Twist your head, shoulders, waist, and torso to the left.

Knees-to-Chest

Lay flat on your back on an exercise mat or another leveled, flat surface. Grab your knees with both hands and draw them to your chest. Hold that position for the duration of the stretch.

Neck Stretch

From a seated position, tilt your head forward and backward, side to side, and then move your chin forward and backward.

Hamstring Stretch

Sitting on the floor, extend both legs in front of your body. Try to touch your toes with your fingertips. Ensure your legs remain as straight as possible. You can bend at the waist and lean forward to accomplish this. The hamstring stretch is a safe active stretch to help daily activities like walking and bending.

Parkinson’s Exercises: Endurance and Cardio

Parkinson’s exercises for endurance and the cardiovascular system are not as low in intensity as strength and balance activities. These Parkinson’s exercises include aerobic activities that increase heart rate, respiration and burn calories. Medical professionals recommend a minimum of 2 hours and 30-minutes of moderate intensity endurance exercise. Moderate intensity is defined by the talk test—one should be able to talk during moderate intensity exercise, but not sing.

Many of the following examples of endurance Parkinson’s exercises are easily achieved at home.

Walking

Walking is perhaps the simplest form of endurance exercise. Changes in walking are inevitable in Parkinson’s disease. Patients usually notice a slower pace, a decrease in stride and arm swing, and muscle weakness. Brisk walking is crucial to preserve independence in getting around. To include variation in your walking routine, walk to music, swing your arms, land on your heel, and take larger steps.

Water Aerobics

Aquatic exercise is an ideal method of activity that is less strenuous on the body because it limits stress on the joints. The water offers an increased range of motion know to abate stiffness and pain. Symptoms of dystonia, the involuntary writhing contractions of the muscles, are particularly alleviated by water aerobic exercises.

Besides regular swimming, water aerobics can include:

• Water walking—Walk as normal in a shallow pool. Water adds resistance to basic walking, increasing endurance.
• Water treading—Treading water gets the heart rate up without contributing to muscle stiffness. This should be done with supervision.
• Flutter kicking—Flutter kicking is performed with a kick board. Hold the kick board in front of you. While leaning on the board for some support, kick your legs to swim across the pool.  
• Arm curls—Stand in a pool with your arms in front of your body with palms facing out. Curl your arms up towards you and then straighten them back down. Water weights provide extra resistance if the resistance from the water is too little.  
• Leg lifts—Kick your leg out to the side and back down. Repeat with each leg.

Chair Aerobics

Chair aerobics are endurance and cardiovascular exercises done from the comfort of a chair. They do not require high exertion like standing exercises.

• Seated jumping jacks—While seated, begin with your arms resting at your side and your legs bent at the knees. Extend your legs wide with your heels on the floor while raising your arms to form a V.
• Toe taps—Tap your toes up and down quickly.
• Leg marches—Lift your legs so that your feet are 2 to 3 inches from the floor. Alternate legs every 30 seconds. Incorporate your arms as you would in typical “marching.”
• Forearm extensions—With shoulders and elbows parallel to the floor and your forearms create a goalpost with your arms. Bring your forearms inward until they meet together.
• Arm raises—Sit upright with your arms at your side. Raise both arms outward to the side and then upward. Return to your original posture.

Parkinson’s Exercises: Strength Training

In Parkinson’s disease, the muscles work to compensate for abnormal postures and motor movements become more difficult. Strength training builds muscle mass to support the muscles in adopting a correct posture.

Experts suggest that each major muscle group is trained 2 to 3 days a week. Do not train the same muscle groups consecutively to allow for proper recovery. Strength training exercises focus on boosting muscle strength while simultaneously improving balance and endurance. The majority of the below strength training exercises are done in two sets of 8 to 12 repetitions and are completed with either weights, resistance bands, body weight, or gym equipment. Start slowly and increase as tolerated.

Squat

Squats focus on the large muscle groups in the legs. There are three types of squats depending on the level of strength.

1. The first is an assisted squat. Using a chair placed against a wall, stand 6 inches from the chair with your feet hip distance apart. Put your arms out in front of your body with your palms down. Lower your buttocks onto the chair into a seated position, and slowly return to standing.
2. The next is a mini squat. Place a standard chair against the wall. Ensure your feet are in the same position 6-inches away from the chair. Squat like you are sitting but stop midway before returning to the standing position. You never come in contact with the chair.
3. Lastly, the full squat is unassisted without the chair for guidance. Lower your body as if to sit, but stop and return to standing.

Bridge

Lay on your back with your feet on the floor, knees bent, and arms at your side. Put a pillow or folded towel under your head for neck support. Raise your hips up and down—lifting up your buttocks with your leg muscles—while your shoulders and feet stay in the original position. Be cautious not to lift your upper back from the floor. To increase the intensity, do the bridge exercise with your arms straight up or out to the side.

Hip Rotation

Rest on your side with your head on a pillow. Bend your knees at the hips to form a line spanning from your shoulders to your hips to your feet. Put your feet together. Lift your top knee upwards and back down. For a challenge, try the hip rotation on all fours with your knees and palms on the floor. Rotate your hip out while your leg is still bent. Repeat on both sides.

Ball Squeezing with Hands

Squeezing a ball with your hands is not the most rigorous of Parkinson’s exercises, but it is exceptionally effective! Whether in a sitting, standing, or laying down position, hold a small ball in your hand and repetitively squeeze it to strengthen hand muscles. Ball squeezing is also good for coordination.

Strength Training

Some patients with Parkinson’s disease includes weights to fully work out the muscle groups. With dumbbells or gym equipment, other strength training exercises are: chest press, lateral pull down, calf raises, should press, bicep curls, leg press, and reverse fly’s.

Parkinson’s Exercises: Balance and Posture

Balance, agility, and coordination are motor functions that decline in Parkinson’s disease. Engage in balance exercises for 20 to 30 minutes 2 to 3 days per week. These exercises promote balance through muscle strength and in improving flexibility in the muscle groups. Many balance and posture exercises are enjoyable activities that encompass all aspects of Parkinson’s exercises, which is why there is an overlap between categories. For example, walking targets balance and endurance, and yoga poses are for balance and flexibility.

• Walking
• Tai Chi
• Yoga
• Dancing
• Boxing
• Rowing
• Cycling
• Swimming

Tandem Stance

Stand beside a sturdy, stationary object (i.e. table, chair, counter, etc.). Holding onto that object, place one foot in front of the other in a heel-to-toe stance. Release your hold on the support while maintaining the posture for 30 second intervals.

Multitask Movement and Cognition

Multitasking challenges balance and coordination by adding multiple components to any Parkinson’s exercise. Physical coordination results from exercises such as raising a leg in an up and down motion from a seated position while moving arms in the opposite direction.

Cognitive tasks can be incorporated into physical activities to further enhance coordination. For example, count backward, sing a song, or recite the alphabet during any exercise.

“Rolling a Ball”

This exercise does not require an actual ball—just your body and an eager imagination! Stand with your feet hip distance apart and your arms out in front of you near your chest. Pretend you are grasping an imaginary ball. Start with your right hand on top of the ball and the left hand on the bottom. Roll your hands around the ball so that your hands alternate. At the end of this exercise, your right hand will be on the bottom and the left on top. Repeat that motion.

Rocking on Your Feet

Stand with your feet hip distance apart like in the previous exercise. Relax your shoulders. Your arms should be at your side. Rock forward in a controlled manner shifting your weight from the balls of your feet to your heels. If doing this exercise correctly, your heels and toes will not leave the floor.

Modifications for Parkinson’s Exercises

Exercise is as significant as medication in the treatment of Parkinson’s disease, so it is imperative patients stick to their workout regimen. Those in the advanced stages of the disease can struggle with traditional exercise, but there are modifications.

• Limited mobility—Exercise in a seated position from a chair rather than standing or from the bed instead of an exercise mat on the floor.
• Poor balance—If balance is compromised, exercise while holding on to a safety rail or a study object.
• Freezing of gait—Freezing of gait is when your feet feel “stuck” to the floor despite efforts to walk. Freezing is an effect that stems from symptoms of slow movement and can be overcome by taking larger steps. If freezing impacts exercise, modify the exercise with a metronome (i.e. walking to the beat).
• Anxiety—Patients might have anxiety over their limited mobility. They fear falling and harming themselves accidentally. Exercising with a friend, relative, or physical therapist relieves those nervous emotions.
• Inflexibility—Warm up before and after Parkinson’s exercises to improve flexibility.

References

Cianci, H. (2018). Fitness Counts: A Body Guide to Parkinson’s Disease [PDF file]. Retrieved from https://www.parkinson.org/sites/default/files/Fitness_Counts.pdf

Ellis, T., DeAngelis, T.R., Dalton, D., & Venne, J. (2016). A Guide to Exercise and Wellness for People with Parkinson’s Disease [PDF file]. Retrieved from https://www.apdaparkinson.org/uploads/files/Be-Active-Book_For-Web-90o.pdf

Oliveira de Carvalho, A., Filho, A., Murillo-Rodriguez, E., Rocha, N. B., Carta, M. G., & Machado, S. (2018). Physical Exercise For Parkinson’s Disease: Clinical And Experimental Evidence. Clinical practice and epidemiology in mental health : CP & EMH, 14, 89–98. doi:10.2174/1745017901814010089

Patel, B. Exercise. Parkinson’s Foundation. Retrieved from https://parkinson.org/Understanding-Parkinsons/Treatment/Exercise

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.