Nutrition is a vital component of maintaining and preserving good health. It may be an especially important consideration when one has a disease or other health condition that may impose certain dietary requirements or restrictions. At the same time, the standard recommendations for good health still stand – heart healthy eating, weight control, adequate fluid intake, limiting alcohol consumption, and more. With Parkinson’s disease, dietary choices and habits can help alleviate some symptoms. For example, fluid and fiber intake may help with constipation, increasing fluid intake may alleviate orthostatic hypotension, the feeling of dizziness when standing up, and a high protein meal can interfere with levodopa absorption, leading to fluctuations in medication effectiveness. In this second of two episodes with Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, he tells what he recommends about diet and nutrition for his Parkinson’s patients, including when to look for organically grown produce.
Released: March 9, 2021
John Duda, MD is the Director of the Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Co-Director of the Center for Neurotrauma, Neurodegeneration and Restoration of the Cpl. Michael J. Crescenz VA Medical Center and a Professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania. For the past 19 years, he has worked with his colleagues in Philadelphia to provide state-of-the-art care for thousands of Veterans with PD and related disorders.
His research activities have included basic science investigations into the role of Lewy pathology in the pathophysiology of Parkinson’s disease and related disorders as well as investigations into the mechanisms involved in traumatic brain injury. He has also conducted clinical research in Parkinson’s disease with studies of deep brain stimulation therapy, transcranial magnetic stimulation, the benefits of a plant-based, whole food diet, and the use of olfaction as a biomarker of disease diagnosis and progression. He has received research grants from the Department of Veterans Affairs, NIH, the Michael J. Fox Foundation for Parkinson Research, and the Department of Defense. He has been recognized as a BLR&D Senior Clinical Research Scientist and authored more than 120 scientific publications including articles in JAMA, Science, Neuron, The New England Journal of Medicine and Neurology.
A major thrust of Parkinson’s research today is exploring potential ways to slow the progression of the disease. Exercise may be one way and is recommended. Another possible approach is nutrition, although the evidence is not as solid as for exercise. Nonetheless, there is evidence that good nutrition and dietary practices can have beneficial effects for people with Parkinson’s, including lessening digestive symptoms, as well as preserving quality of life by lowering the risk of heart disease, stroke, diabetes, high blood pressure, and dementia. Improving digestive function may even improve the absorption and actions of medications. Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, recommends a plant-based, whole foods diet. In this podcast, the first of two with Dr. Duda, he explains what a whole foods diet is, how it differs from a standard American diet, and how people can reliably and comfortably change the way they eat.
Released: February 23, 2021
John Duda, MD is the Director of the Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Co-Director of the Center for Neurotrauma, Neurodegeneration and Restoration of the Cpl. Michael J. Crescenz VA Medical Center and a Professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania. For the past 19 years, he has worked with his colleagues in Philadelphia to provide state-of-the-art care for thousands of Veterans with PD and related disorders.
His research activities have included basic science investigations into the role of Lewy pathology in the pathophysiology of Parkinson’s disease and related disorders as well as investigations into the mechanisms involved in traumatic brain injury. He has also conducted clinical research in Parkinson’s disease with studies of deep brain stimulation therapy, transcranial magnetic stimulation, the benefits of a plant-based, whole food diet, and the use of olfaction as a biomarker of disease diagnosis and progression. He has received research grants from the Department of Veterans Affairs, NIH, the Michael J. Fox Foundation for Parkinson Research, and the Department of Defense. He has been recognized as a BLR&D Senior Clinical Research Scientist and authored more than 120 scientific publications including articles in JAMA, Science, Neuron, The New England Journal of Medicine and Neurology.
Episode 70: The Role of the Microbiome in PD: Part Two
Our bodies contain more than just our own human cells. We normally live in harmony with a vast array of microorganisms occupying specific spaces, or niches, on and within us. These bacteria, fungi, viruses, and protozoa form the human microbiome. The ones in the gut, mainly within the colon (large intestine), normally maintain a health balance and keep “bad” microbes from overpopulating that area of the digestive system. The normal gut organisms, consisting of around 1,000 different species of bacteria as well as other microbes, outnumber all the human cells in our bodies.
The gut microbiome acts locally and systemically, meaning it interacts with other parts of the body. Locally in the gut, the microbiome digests foods, helps to regulate the immune system, and produces vitamins that our bodies need for metabolism, nerve function, and blood clotting but that they cannot produce on their own.
There is mounting evidence that the gut microbiome also interacts with the nervous system, including the brain, in health and disease. Its effects also reach beyond the gut. Evidence points to a role for it in the faulty regulation of the immune system, leading to such diseases as rheumatoid arthritis, multiple sclerosis, diabetes, and allergies.
In this episode, Ai Huey Tan of the University of Malaya in Kuala Lumpur, Malaysia discusses what is known about the role of the gut microbiome as it affects Parkinson’s disease and its treatment and what researchers are continuing to investigate.
Released: December 17, 2019
Dr. Tan Ai Huey is a Senior Lecturer and Consultant Neurologist at the University of Malaya Medical Centre, Malaysia. She completed her specialty training in Neurology at the University of Malaya, Malaysia. Her main areas of research are in Parkinson's Disease and Movement Disorders, with a particular interest in exploring the role of gut infections and neuro-inflammation in Parkinson's Disease, and the characterization of rare/"orphan" diseases. She has numerous peer-reviewed journal publications and book chapters and has been awarded the Best Neuroscience Publication Award (UM Faculty of Medicine), and the International Scholarship Award from the American Academy of Neurology.
Dr. Tan has served as a Council Member of the Malaysian Movement Disorder Council since 2013 and was Co-Author of the National Consensus Guidelines for the treatment of Parkinson's disease. Currently, she is the Honorary Secretary of the Malaysian Society of Neurosciences (MSN), the professional body that represents Malaysian clinicians and scientists in the neurology/neuroscience field. At the international level, she serves on several committees in the International Parkinson’s and Movement Disorder Society (MDS) including the MDS Education Committee, which oversees the planning of movement disorder education programs around the world.
Episode 68: The Role of the Microbiome in PD: Part One
How and why Parkinson’s disease (PD) starts and progresses is still not exactly known, but active research points to genetics and environment, among other factors. The environment is both external and internal – external in terms of what people encounter outside their bodies and internal in terms of what is inside their bodies. Researchers studying a variety of diseases have learned the importance of the microbiome in health and disease. The microbiome consists of all those bacteria, fungi, and viruses that occupy niches on and inside of people, such as on the skin, in the nose and mouth, and in the gut. These organisms can have far reaching effects in the body, distant from their own locations. Some of these interactions can affect the brain.
Ali Keshavarzian, MD, Chief of the Division of Digestive Diseases and Nutrition at Rush University in Chicago has been studying the role of the gut microbiome and its relation to inflammation, such as in inflammatory bowel disease, in addition to more distant sites including in the brain. His research includes the role of the gut microbiome as a contributing factor to the development and progression of PD as well as the potential to manipulate it to help manage the disease. He conducts both basic science research using animal models and clinical research with people with PD.
Released: November 19, 2019
Ali Keshavarzian, MD, FRCP, FACP, MACG, AGAF the Josephine M. Dyrenforth Chair of Gastroenterology, Professor of Medicine and the Graduate College, Director of the Division of Digestive Diseases and Nutrition (1999) and Director of the Institute for Advanced Study of the Gut, Chronobiology and Inflammation (2017) at Rush University Medical Center in Chicago, Illinois has been a practicing gastroenterologist with a specialty in managing patients with inflammatory bowel disease for over 30 years.
As a clinician scientist, he has been studying the impact of environmental factors [stress, alcohol, sleep and circadian disruption] on intestinal barrier function host/microbe interaction that promote intestinal and systemic [gut-derived] inflammation leading to initiation and/or progression of inflammatory disorders including IBD, IBS, food allergy, metabolic syndrome, alcoholic cirrhosis, NASH and Parkinson’s disease. He has contributed to over 350 published articles [h-index of 77] and book chapters. His works have been supported by multiple NIH, DoD, NASA and USDA grants. He was one of the first investigators to report the key role of oxygen free radicals in tissue injury in inflammatory bowel disease and one of the first investigators to begin to focus on the role of intestinal microbiota in health and disease in alcoholism, IBD, cancer, HIV and Parkinson. He is one of the early investigators to examine the effects of circadian and sleep disruption on GI tract and to report the negative impact of sleep and circadian disruption in IBD.
The focus of this webinar will be to address the needs of veteran’s living with Parkinson’s disease (PD). A healthy lifestyle is an important part of living well with Parkinson’s. Physical exercise is well-established as beneficial for symptom control and possibly disease modification, and physicians regularly counsel patients to increase overall fitness. Similarly, diet and overall brain health can be another tool to fight PD. This webinar will explore how exercise, dietary choices, stress management, sleep and social connection can affect your brain health and PD care.
John Eric Duda, MD
Professor of Neurology at the Veteran's Administration Medical Center
Director, Parkinson's Disease Research, Education and Clinical Center of the Michael J. Crescenz VA Medical Center, University of Pennsylvania
Co-Director, Center for Neurotrauma, Neurodegeneration and Restoration of the Michael J. Crescenz VA Medical Center, University of Pennsylvania
James F. Morley, MD, PhD
Assistant Professor of Neurology at the Veteran's Administration Medical Center Staff Neurologist, Philadelphia VA Medical Center
Associate Director, University of Pennsylvania/PADRECC Movement Disorders Fellowship Program. Co-director, Parkinson's Disease Research, Education and Clinical Center, Crescenz VA Medical Center
Podcasts
Episode 93: Benefits of Practicing Tai Chi Chuan Exercises
Many people find that Eastern mind-body practices complement Western medicine well and produce additional benefits. One Eastern system of mind-body integration is tai chi and its martial art practice of tai chi chuan. Using continuous, flowing movements, this moving meditation addresses flexibility through stretching and involves aerobic activity and relaxation as well. Through the practice of tai chi, people can develop better awareness of movement and actions, develop better body alignment, posture, core strength, and breath support and control. Studies have shown physical benefits on balance and slowing the decline in motor control as well as mental health benefits in terms of stress management, possibly cognition, and quality of life for people with Parkinson’s and their care partners. In this episode, Dr. Pei-Fang Tang, professor of physical therapy in the School of Physical Therapy at National Taiwan University, says tai chi is based on ancient Chinese philosophy, part of which is a dynamic balance between yin and yang, which are invoked by the movements in its practice and which bring balance to one’s life.
Released: November 17, 2020
Professor Tang earned her BS degree in physical therapy from National Taiwan University, MS degree in physical therapy from University of North Carolina at Chapel Hill, and PhD degree in Exercise and Movement Science from University of Oregon. Her research interests focus on the influences of aging processes and neurologic disorders, especially stroke and degenerative ones, on the cognitive control, neuromuscular control, and brain mechanisms of motor control and motor learning. She also is interested in studying the efficacy and neural mechanisms of different forms of exercise interventions in the promotion of cognitive and motor functions, as well as neuroplasticity, and in the prevention of dementia and disability in middle-aged and older adults and in people with neurologic disorders. The primary research tools her lab uses are movement analysis, biomechanics, and neuroimaging techniques.
Steve Fischlin’s journey with Parkinson’s disease (PD) started with a tremor in his foot, followed by his right arm not swinging while he walked. His next symptom was a stoic expression that left his wife, Lisa, asking if he wasn’t having fun — she noticed he wasn’t smiling. Two appointments with different neurologists and a series of tests confirmed Steve had PD and left him and his family with more questions than answers.
One thing Steve did know was that exercise is proven to help ease Parkinson’s symptoms, so he got moving.
“That first year he was walking every day,” Lisa said. “Rain or shine, he went out walking. His friends at work made sure he walked during his lunch hour. We walked together, our neighbor walked with him, it was a consistent routine.”
All this walking made Steve and Lisa wonder if there was a race or walk that supported the Parkinson’s community, which led them to Moving Day, A Walk for Parkinson’s.
“We immediately got on the committee and started making connections,” Lisa said. “We were both working at the time and had a fairly large Moving Day team, and we were one of the top fundraising teams for the last four or five years for Sacramento. It was a great way for all of us to come together and support Steve and his diagnosis.”
Steve retired in 2020 to focus on his health, and Lisa joined him when she retired in 2023. They wanted to dive deeper into the Parkinson’s community and became members of the Parkinson’s Foundation California Chapter Board. They continued fundraising for Moving Day, but they wanted to do more.
They created the non-profit, FISCH 4 Parkinson’s, a Steven J. Fischlin Charity, dedicated to raising awareness and supporting people with Parkinson’s. They launched a signature fundraising event through the non-profit, the annual FISCH 4 Parkinson’s Golf Tournament. The first tournament, held in August 2024, raised more than $26,000, which they donated to the Parkinson’s Foundation. The event returned in August 2025, raising $35,000 to support the Foundation.
“In the second year we were able to expand the tournament, get sponsorships and really reach out to the wider Parkinson’s community beyond our family and friends,” Lisa said. “It took some time to explain what we were trying to accomplish, and for Steve to feel comfortable telling his story and making connections.”
This tournament has helped Steve and Lisa support the Parkinson’s Foundation and has helped them create their own support network of people near them in the Parkinson’s community.
Parkinson’s Foundation friends at the 2025 FISCH 4 Parkinson’s Golf Tournament, including Vikas Chinnan, Donna Cline and Jeff Bell.
“Last year we had several golfers at the tournament who had Parkinson’s,” Steve said. “Now we meet up with them and their wives three or four times a year. We get dinner and catch up and talk about how we’re doing and things about Parkinson’s we can all relate to. We’re always trying to find more people to join our group.”
Steve and Lisa are passionate about supporting the Parkinson’s Foundation because of the resources and information they have received.
“When you find out you or a loved one has Parkinson’s, you have to just start digging in and learning about it,” Lisa said. “We use the Parkinson’s Foundation website, attend webinars and Steve participated in PD GENEration because his kids were wondering if this was something they could be passed down.”
“The Foundation doesn’t just support people with Parkinson’s, it supports the whole family and care partners, and that’s so important.” - Lisa
Steve and Lisa have also found a great deal of support through the University of California (UC) Davis Health Center for Movement Disorders & Neurorestoration, a Parkinson’s Foundation Center of Excellence. In 2024, the center opened a multidisciplinary clinic that brings together care providers from several specialties, including neurology, speech therapy, physical therapy, nutrition and more.
“To be able to have one stop and ask all these experts questions and find support is incredible,” Lisa said. “We’ve made really strong connections through UC Davis, and we’re able to talk to them throughout the year. This clinic is possible because of the Parkinson’s Foundation, and it makes us feel like we are never alone.”
The next FISCH 4 Parkinson’s golf tournament is scheduled for August 10, 2026 at Catta Verdera Country Club in Lincoln, CA. Steve and Lisa’s goal is to raise $40,000 this year, and are excited that 100% of the money will go to the Parkinson’s Foundation, with 50% going to the multidisciplinary clinic they have found so much support through.
“Right now, the multidisciplinary clinic is only open on Tuesdays, and it runs on donation, so we want to make a difference and support it,” Lisa said. “We’re proud to support the Parkinson’s Foundation and everything it does for people with Parkinson’s, while also supporting this resource right in our own community. We want to be loud about this disease, share our story and raise money to find better treatments and a cure.”
“I’ve met other people who have Parkinson’s, and I will always talk to anyone about it,” Steve said. “It’s a small world and we want to meet with people, do whatever we can to help. We want to talk about it, and we want to help find a cure.”
Create your own Parkinson’s fundraiser! Visit Parkinson.org/DIY to get started.
This article shares real experiences from people living with Parkinson’s and highlights what helps them maintain quality of life. It highlights how:
Staying physically active and mentally engaged can improve movement, mood and cognitive function.
A positive mindset and sense of purpose help people cope with challenges and live more fully.
Building community and support systems reduces isolation and provides encouragement.
Learning about Parkinson’s empowers individuals to better understand symptoms and manage their care.
Parkinson’s disease (PD) looks different for everyone. Symptoms vary, as do the ways people maintain and improve their quality of life. People with Parkinson’s often discover strategies that work best for them, whether it’s staying physically active, keeping mentally engaged, connecting with others or practicing gratitude.
The Parkinson’s Foundation offers a wide range of resources to help people manage their symptoms. Additionally, some of the most meaningful insights come from those living with Parkinson’s themselves.
We asked our social media community to share what has helped them live well with Parkinson’s. Here’s what they had to say:
Exercise and Movement
Staying physically active was one of the most popular strategies. Research shows that regular exercise can improve mobility, balance, mood and even cognitive function for people living with Parkinson’s. Many described movement not just as therapy, but as empowerment.
“Exercise and staying mentally active have helped me the most. I was diagnosed in 2018. Don’t give up. Sometimes I have to force myself to exercise, but I always feel better when I do.” - Val
“I was diagnosed at age 75 and I plan on being here for a long time. I exercise every day, walk a couple of miles, take my medication and listen to my doctor.”- Frank
“A dance class called Dance Health Alliance has helped me a lot. You can even do it sitting in a chair if you have balance issues. It’s definitely helped improve my walking.” - Christine
Keeping the brain active can be just as important as keeping the body moving. Engaging in hobbies, learning new skills and staying mentally stimulated may support cognitive health and overall well-being.
For many, creative expression and intellectual engagement provide both joy and a sense of purpose.
“Learning new tunes and staying musically active has been a real benefit. I’ve been a professional musician for over 50 years and staying active in my music career — even at age 71 — has helped keep my Parkinson’s under control.” - Joe
“I write short stories, read, belong to a book club and take part in quizzes.” - Val
Mindset, Hope and Perspective
A positive outlook doesn’t erase the challenges of Parkinson’s — but many people shared that mindset plays a powerful role in how they navigate them.
“I was diagnosed 25 years ago, in my 40s and I’m now in my 70s. Focus on what you still have. If you have love, learning and laughter — even a friendly phone call or a good book — you are lucky.” - Fillis
“What truly helped me was hope with purpose. When I stopped seeing Parkinson’s as an ending and started seeing it as a teacher, everything changed. Healing isn’t just about the body — it’s about the mind, heart and spirit working together.” - Ellen
“After my diagnosis, I started learning about Parkinson’s and its treatments. I’ve learned to accept it, appreciate the small blessings, exercise, take my medication as prescribed and live with a positive attitude.” - Daisy
These reflections remind us that resilience can take many forms, including acceptance, gratitude, determination or simply continuing forward one day at a time.
Community and Support
Connecting with others who understand Parkinson’s can reduce isolation and provide encouragement. A strong online or in-person support network often makes a meaningful difference.
“As a woman in my 30s with young-onset Parkinson’s, community has helped me the most. Exercise is second and reading The Parkinson’s Plan has also been incredibly helpful.” - Erin
“Joining the Facebook group Life With Parkinson’s and accessing resources like yours has been extremely helpful. I also participated in an eight-week class for the newly diagnosed through my local hospital.” -Lin
Many people living with Parkinson’s find that sharing experiences, learning together and supporting one another strengthens both confidence and quality of life.
Explore our Community Network groups that empower key groups within the PD community — including people who are newly diagnosed, women with PD, those with early-onset PD and more! Find your community.
Learning about PD
Learning more about Parkinson’s can bring clarity, reassurance and empowerment. Understanding movement and non-movement symptoms can help people feel more in control of their care.
“Education has helped me so much. I didn’t realize many of my symptoms were part of Parkinson’s. Learning about the disease helped me understand that I’m not crazy. Physical therapy has also made a huge difference.” - Sharon
When people understand what is happening in their brain and bodies, it can ease uncertainty and make it easier to advocate for the care they need.
Living well with Parkinson’s does not mean symptoms disappear — it means finding tools, support and perspective that help you move forward.
As these shared experiences show, there is no single path. What works for one person may look different for another, and that’s okay.
If you’re looking for support, resources or ways to connect, we are here to help. Explore resources and information at Parkinson.org or contact our Helpline at 1-800-4PD-INFO (1-800-473-4636).
My name is Kim Lundgreen. I just turned 68. I was diagnosed with Parkinson’s disease (PD) in 2017 at the University of Utah’s Movement Disorder Clinic, a Parkinson’s Foundation Center of Excellence, in Salt Lake City. I remember thinking, “What a strange name for a place.”
My wife, Mindy, was 50 at the time. She cried when we heard the diagnosis. I was stunned. Shocked.
Prior to my diagnosis, running was more than exercise. It was my therapy, my prayer time, personal solitude time, my way of solving the world’s problems. I was an ultramarathon runner with nearly 50 marathons and ultramarathons under my belt. I ran the St. George Marathon 25 years in a row. I once beat ultramarathon legend Dean Karnazes at the finish line there during his famous 50/50/50 tour. That moment qualified me to run Boston two years later.
When I received the diagnosis, my first reaction was dramatic but honest: “If I can’t run anymore, I’ll go to Yosemite and base jump off El Capitan without a parachute.” That’s how much running meant to me.
Parkinson’s had forced me to stop running altogether. Symptoms like rigidity (stifffness), cramping and neuropathy made training nearly impossible.
Then, last June (after Cassie Webster, my Rock Steady Boxing coach kept encouraging me for years to try) I completed the Logan Peak Trail Run with a right sprained ankle, an ultra-distance race of 28 miles with over 7,000 feet of elevation gain with virtually no training. It was my first race in five years.
I fought my way back.
A news article in the Herald Journal highlighted the run. KSL News out of Salt Lake City, after getting wind of my seemingly impossible feat, covered my successful summit of the Middle Teton via the Southwest Couloir, which I achieved just a couple weeks prior. We climbed at night with headlamps, ice axes and micro-spikes. My “soul brother” David Toone saved my life more than once on that descent as my symptoms kicked in. Exhaustion, vertigo and total fatigue set in hard.
Throughout everything, I needed information about Parkinson’s and I found on Parkinson.org — I love the website and it has been very helpful for me.
Two years after my diagnosis, in the fall of 2018, Mindy received devastating news of her own: serious ovarian cancer. We had no warning, and the shock was overwhelming. Suddenly, we were both facing life-threatening diseases, and the reality of our situation hit hard. We both wept when Mindy’s doctor gave us the grim news while we were shopping together.
In that moment, I felt a heavy burden of responsibility. I had to be strong for Mindy, and I also had to manage my own Parkinson’s. We were both in for the fight of our lives.
Mindy was only 52, and I had just turned 62. Our dreams for our golden years felt shattered. I remember lying awake that night, overwhelmed by a sense of doom. I prayed to God, “Why now? Isn’t Parkinson’s enough for us?”
I lost Mindy, my beautiful wife of 23 years, in 2024 to ovarian cancer after a brutal five-year fight. She was only 57. We were both strong, active and healthy. We mountain biked, ran trails, paddle-boarded, lifted weights, practiced yoga and stayed committed to our physical and spiritual health.
Experiencing loss with Parkinson’s is horrible, however movement and exercise — especially weight-lifting, trail running combined with my Rock Steady Boxing now — are so vital for me in providing hope and light each new day!
A few months ago I spoke to the Salt Lake City support group alongside the doctors from University of Utah neurology, a Parkinson’s Foundation Center of Excellence, and that was very powerful for me and for the audience. It was a win-win.
Parkinson’s disease is relentless. The only real weapon against Parkinson’s is movement. Exercise, especially strength training and cardio, has been shown to slow the progression of the disease.
I’ve made intense exercise a daily part of my routine, seven days a week. It’s the “silver bullet” that keeps me fighting, and I’m convinced it’s the key to maintaining a good quality of life while living with PD. Also, it is so helpful to me in coping with Mindy’s death.
Now, I carry her with me through every climb, every run, and every battle with Parkinson’s.
Tremor, Shakes & Everything in Between: Tackling Parkinson's Motor Symptoms
🧠 What will you learn in this article?
Movement (motor) symptoms can affect nearly all aspects of daily life for people with Parkinson’s.
Discover how exercise, medications and therapies can help people with PD move easier at every stage.
Symptoms — including tremor, rigidity (stiffness), bradykinesia, dystonia, gait and balance issues and speech changes — stem from the progressive loss of dopamine‑producing neurons.
Exercise and medications (especially levodopa) are the most effective treatments.
Parkinson’s disease (PD) can make it difficult to move when you want to, in the way that you want to and equally hard to stay still. From shaking and stiffness to muscle cramping and difficulty walking, challenges with movement (motor) symptoms can affect all aspects of daily life when it comes to Parkinson’s. Discover how exercise, medications and other strategies can help you move easier.
The following article is based on aParkinson’s Foundation Expert Briefingexploring motor symptoms in PD, hosted by movement disorders specialist Pablo Coss, MD, Neurology Residency and Movement Disorders Fellowship at University of Texas Health Science Center at San Antonio, part of the Parkinson’s Foundation Global Care Network.
Key Parkinson’s Traits
Parkinson’s is called a movement disorder because it impacts how a person moves. While symptoms usually develop slowly over time, Parkinson’s is progressive — needs can change as PD advances through stages. A person’s history, symptoms and a physical exam are used to make a diagnosis.
To consider a diagnosis of Parkinson’s, slowness of movement (bradykinesia) must be present along with either:
Resting tremor, rhythmic, involuntary movement that tends to happen when the affected part of the body is at rest. This tends to affect one side of the body in early PD.
Stiffness (rigidity) resistance to movement caused by involuntary muscle activation at rest.
Balance issues (postural instability) that lead to stumbles and falls.
Dopamine and Movement
Although scientists are still working to understand the causes of Parkinson’s, we know that the disease is a progressive brain disorder that damages dopamine-producing neurons. Dopamine is a chemical messenger that regulates mood and helps the body move smoothly.
Movement Changes in PD
Dopamine loss in an area of the brain called substantia nigra and other chemical changes in Parkinson’s interfere with brain signals, causing many non-movement symptoms — including emotional changes, gut issues and fatigue — and impact movement in different ways, including:
Bradykinesia— a slowness of movement thatcan affect the whole body, causing fatigue and difficulty walking or completing everyday tasks. It can also cause:
Facial masking, stiffness in the face muscles that makes it difficult to express emotions.
Challenges with hand movements, making it harder to do things like ripping a bag open, unscrewing a cap or writing. Micrographia — small, cramped handwriting seen frequently in early PD — is strongly connected to slowness of movement.
Difficulty rising to stand while sitting.
Tremor. People with Parkinson’s often have a resting tremor in one hand or arm, but it can also affect the legs, jaw or face. Tremor in the hand is often described as “pill-rolling” — the thumb moves with other fingers as if it were rolling a pill between them.
About 70% of people with Parkinson's experience tremors. For some tremors are mild, but for others they can cause discomfort, self-consciousness, and interfere with sleep or daily tasks.
Action tremor, another PD symptom, happens when the affected area of the body is moving or trying to do a task like writing or drinking from a cup. Many people with Parkinson's experience a combination of resting and action tremor.
Rigidity, stiffness that is sometimes described as “lead-pipe” rigidity — the body’s resistance to movement during a physical exam (when relaxed) can be so strong that it can feel as if the examiner is trying to bend a heavy metal pipe. Rigidity can lead to:
painful aches and difficulty sleeping
reduced arm swing when walking
facial stiffness
Dystonia, painful, repetitive muscle cramping and twisting common in Parkinson’s, can:
make the fingers clench up or hold an abnormal position
cause the ankle to turn in and the toes to curl
impact the face and eyes, making it difficult for some people to open their eyes voluntarily
be accompanied by a jerky tremor that can overlap with other forms of PD tremor
Hypophonia and speech problems can include soft or slurred speech, difficulty with articulation, reduced speaking volume or monotone voice, which — coupled with facial stiffness — can make emotional expression challenging. Hypophonia can also cause shallow breaths, stuttering or rushed speech.
Parkinsonian gait — PD changes the way a person walks, causing small, shuffling steps, stooped shoulders, reduced arm swing or difficulty lifting the feet.
These balance and gait challenges — along with short, rapid steps that tend to speed up (festination), backward leaning and imbalance — increase the risk for falls and injuries, as does freezing of gait: a temporary but dangerous feeling of the feet being stuck to the floor. Crowded areas, doorways and thresholds can trigger freezing.
Increasing Dopamine: Exercise & Medications
Because dopamine loss drives Parkinson’s movement symptoms, increasing dopamine is the most effective way to manage them — and exercise is one of the simplest ways to help boost dopamine and slow PD progression.
Exercise can ease PD movement symptoms and improve strength and balance. Finding an exercise you enjoy can give you the motivation to keep moving. Our PD Health @ Home Fitness Fridays workouts, a collection of Parkinson’s-tailored fitness videos, can help you get active at home.
Levodopa is the most effective treatment for Parkinson’s. Brain cells metabolize levodopa to dopamine. It is most often combined with carbidopa — this allows more levodopa to enter the brain without being metabolized first by the gut (where it can cause nausea.)
To maintain the necessary dopamine levels to help the body function optimally, it is vital to take medications exactly as prescribed. It is common for your doctor to adjust dosing as Parkinson’s progresses, to manage changing symptoms.
There are many levodopa formulations, including:
Immediate release (Sinemet IR), often prescribed in three or more doses per day.
Controlled release (Sinemet CR), also prescribed in three or more doses per day.
Newer, extended-release formulations (Rytary or Crexont) may offer quicker and longer-lasting effects. These might be prescribed two to four times per day.
Pump therapies deliver a steady supply of medication:
Vyalev delivers foscarbidopa/foslevodopa through a wearable pump and a needle inserted under the skin.
Duopa provides continuous carbidopa/levodopa gel through a surgically inserted tube.
Inhaled levodopa (Inbrija) is used as needed to treat the return of symptoms between regular carbidopa/levodopa doses, from four to five times a day
Levodopa side effects can include nausea, constipation, dizziness, low blood pressure, drowsiness, hallucinations, or behavior changes, such as hypersexuality (impulse control disorder.)
Over time, some Parkinson’s medications can also cause erratic movements (dyskinesia) — including writhing, rocking, wriggling and dancing. This can often happen after taking a dose when levodopa reaches its maximum effectiveness in the body.
Parkinson’s Progression, Motor Fluctuations & Advanced Treatments
Though Parkinson’s impacts everyone differently, as Parkinson’s advances, for many people, the return or worsening of symptoms (motor fluctuations or “off” time) between doses of medications can occur more frequently. This may lead to increased dyskinesia, imbalance, or falls or the need for assistive devices — tools designed to improve daily living.
Talk to your doctor about any concerns. He or she can work with you to adjust your medication or explore advanced treatments.
Medications used to improve the effect and duration of levodopa include:
These medications can cause various side effects, including nausea, dyskinesia, headache, low blood pressure, dizziness, urine retention or discoloration, sleep problems or insomnia.
Surgery can be an optionfor movement symptoms in advanced Parkinson’s. Options can include:
Deep brain stimulation (DBS), surgery that helps control Parkinson’s movement symptoms, motor fluctuations and reduce medication doses.
Focused ultrasound, a newer, incisionless procedure guided by magnetic resonance imaging (MRI) that uses energy to shut down abnormal signaling an area of the brain connected to tremor.
Learn More
To learn more about managing movement symptoms in Parkinson’s, explore our resources below, or call our free Helpline at 1-800-4PD-INFO (1-800-473-4636):
