Finding Balance: Steps to Move Safely and Minimize Falls with Parkinson’s

Difficulty walking and maintaining stability can be common challenges for people with Parkinson’s disease (PD), increasing the risk of falls and impacting independence. While fall risks are more commonly associated with advanced Parkinson’s, fall prevention — including exercise tailored to your needs — should begin at diagnosis. Learn how Parkinson’s affects walking (gait) and balance and how you can harness movement as medicine. 

The following article is based on a Parkinson’s Foundation Expert Briefing  exploring how to improve movement and balance, hosted by Mitra Afshari, MD, MPH, director of the Neurointerventional Program for Movement Disorders at University of Illinois at Chicago. 

The Rise of Parkinson’s  

Parkinson’s is the world’s fastest-growing neurological disease. The number of people living with PD is expected to more than double between 2021 and 2050, reaching more than 25 million globally by 2050.   

Trouble walking (gait), balance and falls are some of the most frustrating Parkinson’s symptoms. Eighty percent of falls, which are the leading cause of hospital visits, nursing home placement and death in Parkinson’s, happen in the home. As Parkinson’s becomes more widespread, taking steps to address its impact on movement and safety is more important than ever. 

What causes falls in PD? 

Dopamine is a brain chemical involved in movement, coordination and the ability to make precise movements. Parkinson’s is linked to a progressive loss of dopamine and other chemicals. These brain changes affect the whole body — most noticeably movement. PD symptoms that impact how a person walks include:  

• Smaller, slower movements (bradykinesia) that lead to short, shuffling steps or foot dragging  

• Painful cramping or spasms (dystonia) 

• Erratic, writhing movements (dyskinesia) 

• Stooped posture 

• Reduced arm swing (rigidity) 

• Fear of falling 

• Loss of the ability to walk with minimal attention (gait automaticity) 

Some walking problems in PD can come and go, seemingly out of nowhere. These include:  

• Short, rapid acceleration of steps (festination) 

• Sporadic loss of balance (postural instability), often resulting in backwards falls 

• Temporary inability to start moving (freezing)  

Freezing, which affects 50% of all people with Parkinson’s, and 80% of people with advanced PD, is a major contributor to falls. Freezing can seem like a car stalling or failing to start — a person intends to move but their feet feel glued to the floor. This can happen when starting to walk or mid-walk, resulting in stuttering steps or a complete stop. 

Early Steps Toward Fall Prevention Are Crucial 

Studies show 60% of people with Parkinson's fall once in a year, while nearly 40% have recurring falls in a year. These can lead to injury and fractures— most commonly hip fractures — immobility, lower quality of life and loss of independence. Falls are the leading cause of nursing home placement. In the U.S., the cost for a single, fall-related hospitalization is nearly equivalent to the total annual financial cost for a person living with PD.  

There are no medications that slow the progression of Parkinson’s. Exercise, however, not only slows PD progression, but it can also maintain and improve mobility, flexibility and balance. Research shows regular exercise in Parkinson’s can also improve symptoms and enhance neuroplasticity, the brain’s ability to learn new pathways. 

How to Keep Moving, Safely 

Parkinson’s affects the body in different ways as time goes on — impacting stability, balance, turning ability, walking pace and more — so preventative treatment to maintain function needs to start early and often involves different strategies over time.  

A physical therapist with Parkinson’s experience can help target your specific needs through personalized exercises and program recommendations and can pivot when symptoms require.  

Symptom-management Strategies 

Usually, a combination of exercise techniques can help address movement symptoms, balance and gait. Tools and strategies shown to have short-term benefit include:  

• Martial arts, including Tai Chi and karate, and dance, including tango, ballroom dance and waltz 

• Conventional physical therapy 

• Pole walking, also called Nordic walking, and aerobic exercise 

• Exergaming (exercise combined with gaming or a reward) and combined gait and balance training  

• Strategy training (learning complex movement and cueing strategies), resistance training and hydrotherapy, or aquatic rehabilitation, can benefit balance. 

• Treadmill training can increase gait through stride length, improving mobility and walking speed. It may not benefit walking pace or distance.  

Studies show integrating cognitive engagement — using feedback, cues, reward and motivation — seems to provide added benefit to balance training exercises. 

Tips to Tackle Freezing 

Safely managing freezing episodes can also prevent injuries and falls. These tips can help: 

• Keep a tidy, organized home.  Learn more about Home Safety and Parkinson’s.  

• Create wide, clutter-free, level walking paths. 

• Minimize distractions, look forward, rather than at the freezing foot, and take extra care when turning or approaching thresholds.  

• Count your steps out loud, or marching to music, a metronome or another sound cue. 

• Imagine stepping over a line or use blue painters’ tape to navigate areas where freezing occurs frequently. 

• Reset by asking your care partner to touch your leg or take a step back with the foot that is freezing. 

“Off” time, when Parkinson's medications wear off and symptoms are stronger, can also increase freezing. Taking your prescribed medication on time, as directed can keep dopamine levels stable and increase safety.  

If you’re not sure what’s causing your freezing episodes, ask your doctor about an “on-off” exam. You may be asked not to take your PD medication before your visit so the doctor can see how symptoms affect you without it. 

Learn more about Freezing

How Science is Uncovering Hope in Exercise 

Researchers are exploring exercise as medicine for people with Parkinson’s, including the many possibilities of treadmill training with perturbations (introduced elements to challenge balance or gait) including: 

• Using a safety harness with a special treadmill and introducing added movements to create imbalance. A person adapts and adjusts to regain their balance. This can increase stability and improve gait. 

• Incorporating two independently moving belts to allow each side of the treadmill to operate at different speeds to improve gait. 

New studies that are showing benefits for people with Parkinson’s include: 

• SPARX3: This phase 3 clinical trial currently is enrolling people with early PD at 25 sites across the U.S. is exploring whether high-intensity aerobic exercise can slow Parkinson's progression in people not yet taking medication. Phase 2 showed preliminary evidence that high-intensity exercise may be neuroprotective. 

• Park-in-Shape: This phase 2 trial revealed that six months of exercise on a stationary bike using game-like elements to keep the rider engaged offered significant PD symptom relief. 

• CYCLE-II: Results for this phase 3 study, which looked at whether long-term, home-based aerobic exercise slows Parkinson’s progression, is pending. 

Other researchers are exploring new models of care. One possibility explores providing consultative physical therapy services over telemedicine to keep people moving well from diagnosis through the course of PD. Another explores implementing a home-based fall prevention program. 

Balance and Stability Resources 

• Check out Home Safety recommendations for ways to keep your home easily accessible. 

• Listen to the Stall the Fall podcast episode to learn more strategies to minimize falls. 

• Read the Physical Therapy and PD fact sheet to learn more about working with a physical therapist. 

• Keep moving with our on-demand PD Health @ Home Fitness Friday videos. 

• Read the Fall Prevention in Parkinson’s fact sheet. 

We are here to help. Call our Helpline at 1-800-4PD-INFO (1-800-473-4636) for referrals to professionals and resources in your area.