Raise Awareness

Temblores, estremecimientos y todo lo demás: enfrentando los síntomas motores del Parkinson

🧠 ¿Qué aprenderá en este artículo?

  • Los síntomas motores (movimiento) pueden afectar casi todos los aspectos de la vida de las personas con Parkinson.

  • Descubra cómo el ejercicio, los medicamentos y las terapias pueden ayudar a las personas con la enfermedad de Parkinson a moverse con mayor facilidad en cada etapa.

  • Los síntomas —incluyendo el temblor, la rigidez (agarrotamiento), la bradicinesia, la distonía, los problemas de marcha y equilibrio, y los cambios en el habla— se deben a la pérdida progresiva de las neuronas que producen ‑dopamina.

  • El ejercicio y los medicamentos (especialmente la levodopa) son los tratamientos más eficaces.

Pareja de personas mayores estirando al aire libre

La enfermedad de Parkinson (EP) puede dificultar moverse cuando quiera, de la manera en que quiera y puede ser igual de difícil mantenerse quieto. Desde el temblor y la rigidez hasta los calambres musculares y la dificultad para caminar, los problemas motores pueden afectar todos los aspectos de la vida diaria en la enfermedad de Parkinson. Descubra cómo el ejercicio, los medicamentos y otras estrategias pueden ayudarle a moverse con mayor facilidad.

El siguiente artículo se basa en una de las Charlas con Expertos - Expert Briefings de la Parkinson's Foundation, que explora los síntomas motores en la EP, presentada por el especialista en trastornos del movimiento, el Dr. Pablo Coss, de la residencia de Neurología y la subespecialidad en trastornos del movimiento del University of Texas Health Science Center at San Antonio, parte de la Red Global de Atención de la Parkinson’s Foundation.

Puntos clave para el Parkinson

La enfermedad de Parkinson se denomina un trastorno del movimiento porque afecta la forma en que la persona se mueve. Aunque los síntomas suelen desarrollarse lentamente con el tiempo, el Parkinson es progresivo; las necesidades pueden cambiar a medida que la EP avanza a través de sus etapas. La historia de una persona, sus síntomas y el examen físico se utilizan para hacer el diagnóstico.

Para considerar un diagnóstico de la enfermedad de Parkinson, debe estar presente la lentitud de movimiento (bradicinesia) junto con alguno de los siguientes:

  • Temblor en reposo: movimiento rítmico e involuntario que tiende a ocurrir cuando la parte del cuerpo afectada está en reposo. Esto tiende a afectar un lado del cuerpo en las etapas tempranas de la EP.

  • Rigidez (agarrotamiento): resistencia al movimiento causada por la activación involuntaria de los músculos en reposo.

  • Problemas de equilibrio (inestabilidad postural) que provocan tropiezos y caídas. 

Dopamina y movimiento

Aunque los científicos aún trabajan para comprender las causas del Parkinson, sabemos que se trata de un trastorno cerebral progresivo que daña las neuronas productoras de dopamina. La dopamina es un mensajero químico que regula el estado de ánimo y ayuda al cuerpo a moverse con fluidez.

Cambios motores en la EP

La pérdida de dopamina en una zona del cerebro llamada sustancia negra y otros cambios químicos en la enfermedad de Parkinson interfieren con las señales cerebrales, lo que provoca muchos síntomas no motores —incluidos cambios emocionales, problemas gastrointestinales y fatiga— y afecta el movimiento de distintas maneras, entre ellas:

  • Bradicinesia: lentitud de movimiento que puede afectar a todo el cuerpo, causando fatiga y dificultad para caminar o realizar actividades cotidianas. También puede causar: 

    • Enmascaramiento facial: rigidez en los músculos del rostro que dificulta expresar emociones.

    • Desafíos con movimientos de las manos, lo que dificulta más hacer cosas como abrir una bolsa, abrir un envase o escribir. La micrografía, escritura pequeña y amontonada que se ve frecuentemente a principios de la EP, suele estar conectada con la lentitud de movimiento.

    • Dificultad para ponerse de pie después de estar sentado.

  • Temblor. Las personas con Parkinson suelen tener temblor en reposo en una mano, pero también puede afectar las piernas, la mandíbula o la cara. El temblor de la mano suele describirse como “pill-rolling”, como si la persona estuviera haciendo rodar una pastilla entre el pulgar y el índice.

Alrededor de un 70% de las personas con Parkinson experimentan temblores. Para algunos, los temblores son leves, pero para otros pueden causar inseguridad e interferir con el sueño y las tareas diarias.

El temblor de acción, otro síntoma de la EP, sucede cuando la parte del cuerpo afectada está moviéndose o tratando de hacer una tarea como escribir o tomar de un vaso. Muchas personas con Parkinson experimentan una combinación de temblor de acción y de reposo.

  • La rigidez, que a veces se describe como “rigidez en tubo de plomo”: la resistencia del cuerpo al movimiento durante un examen físico (cuando está relajado) puede ser tan fuerte que puede sentirse como si el examinador intentara doblar un tubo de metal pesado. La rigidez puede conducir a:

    • Molestias dolorosas y dificultad para dormir

    • Menor movimiento de brazos y piernas al caminar

    • Rigidez facial

  • Distonía; calambres y retorcimientos musculares dolorosos y repetitivos, frecuentes en Parkinson, pueden:

    • hacer que los dedos se engarroten o mantengan una posición anormal

    • provoquen que el tobillo se gire hacia adentro naturalmente y que los dedos se giren

    • impactar la cara y los ojos, dificultando para algunos abrir los ojos de manera voluntaria

    • ir acompañado de un movimiento que puede sobreponerse con otras formas de temblor de la EP

  • Hipofonía (problemas del habla) puede incluir un habla suave o arrastrada, dificultades con la articulación, menor volumen o monotonía al hablar lo que, — a la par de la rigidez facial—, puede ser que la expresión emocional sea un desafío. Hipofonía también puede provocar respiraciones poco profundas, vacilantes, acelerada.

  • Marcha parkinsoniana—Cambios en la forma en que camina una persona debido a la EP, provocando pasos pequeños arrastrados, hombros encorvados, menor balanceo de los brazos o dificultad para levantar los pies.

Estos problemas de equilibrio y de la marcha, —junto con pasos cortos y rápidos que tienden a acelerarse (festinación), inclinación hacia atrás y falta de equilibrio—, aumentan el riesgo de caídas y lesiones, al igual que la congelación de la marcha: una sensación temporal pero peligrosa de que los pies están pegados al suelo. Las áreas concurridas, las puertas y los umbrales pueden desencadenar el congelamiento de la marcha.

Aumentar la dopamina: ejercicio y medicamentos

Woman taking medication

Debido a que la pérdida de dopamina impulsa los síntomas motores del Parkinson, aumentar la dopamina es la forma más eficaz de manejarlos y el ejercicio es una de las maneras más simples de ayudar a incrementarla y ralentizar la progresión de la enfermedad.

El ejercicio puede aliviar los síntomas motores del Parkinson y mejorar la fuerza y el equilibrio. Encontrar un ejercicio que disfrute puede darle la motivación para mantenerse activo. Nuestros ejercicios Viernes de Ejercicio de EP Salud en Casa, una colección de videos de ejercicio adaptados para personas con Parkinson, pueden ayudar a mantenerlo activo en casa.

La levodopa es el tratamiento más eficaz para la enfermedad de Parkinson. Las células cerebrales metabolizan la levodopa para convertirla en dopamina. Se suele combinar con carbidopa; esto permite que una mayor cantidad de levodopa llegue al cerebro sin ser metabolizada primero en el intestino (donde puede causar náuseas).

Para mantener los niveles necesarios de dopamina que ayuden al cuerpo a funcionar de manera óptima, es fundamental tomar los medicamentos exactamente como se prescriben. Es común que el médico ajuste la dosis a medida que la enfermedad de Parkinson progresa, para manejar los cambios en los síntomas.

Existen muchas formulaciones de levodopa, entre ellas:

  • Liberación inmediata (Sinemet IR), a menudo recetada en tres o más dosis al día.

  • Liberación controlada (Sinemet CR), a menudo recetada en tres o más dosis al día. 

  • Las formulaciones más recientes de liberación prolongada (Rytary o Crexont) pueden ofrecer efectos más rápidos y de mayor duración. Estas pueden recetarse de dos a cuatro veces al día.

  • Las terapias con bomba administran un suministro continuo de medicamento:

    • Vyalev administra foscarbidopa/foslevodopa mediante una bomba portátil y una aguja insertada debajo de la piel.

    • Duopa proporciona un gel continuo de carbidopa/levodopa a través de una sonda colocada quirúrgicamente.

  • La levodopa inhalada (Inbrija) se utiliza según sea necesario para tratar la reaparición de los síntomas entre las dosis regulares de carbidopa/levodopa, de cuatro a cinco veces al día.

Los efectos secundarios de la levodopa pueden incluir: nausea, estreñimiento, mareo, baja presión arterial, somnolencia, alucinaciones, o cambios en el comportamiento, como la hipersexualidad (trastorno de control de impulsos.)

Con el tiempo, algunos medicamentos para el Parkinson también pueden causar movimientos irregulares (discinesia), incluidos retorcimiento, balanceo, contorsiones y movimientos tipo “baile”. Esto puede ocurrir con frecuencia después de tomar una dosis, cuando la levodopa alcanza su máxima eficacia en el cuerpo.

Progresión del Parkinson, fluctuaciones motoras y tratamientos avanzados

Aunque la enfermedad de Parkinson afecta a cada persona de manera diferente, a medida que avanza, en muchas personas la reaparición o el empeoramiento de los síntomas (fluctuaciones motoras o periodos en “off”) entre las dosis de los medicamentos puede ocurrir con mayor frecuencia. Esto puede provocar un aumento de la discinesia, el desequilibrio o las caídas, o la necesidad de dispositivos de asistencia — herramientas diseñadas para mejorar la vida diaria.

Hable con su médico acerca de sus inquietudes. Él o ella puede trabajar con usted para ajustar su medicación o explorar tratamientos avanzados.

Los medicamentos utilizados para mejorar el efecto y la duración de la levodopa incluyen:

Estos medicamentos pueden causar diversos efectos secundarios, incluyendo náuseas, discinesia, dolor de cabeza, presión arterial baja, mareo, retención urinaria o decoloración de la orina, problemas de sueño o insomnio.

La cirugía puede ser una opción para los síntomas motores en el Parkinson avanzado. Las opciones pueden incluir:

Aprenda más

Para aprender más acerca de cómo manejar los síntomas motores de la enfermedad de Parkinson, explore los recursos a continuación o llame a nuestra Línea de Ayuda gratuita al 1-800-4PD-INFO (1-800-473-4636), opción 3 para español:

My PD Story

Steve and Lisa Fischlin
People with PD

Steve and Lisa Fischlin

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.

Steve and Lisa with friends at the 2025 FISCH 4 Parkinson’s Golf Tournament
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.

Raise Awareness

People with Parkinson’s Share What’s Helped Them

🧠 What will you learn in this article?

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.

We asked out social media community what helps them live well with Parkinson's

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

Exercise at home with our PD Health@Home Fitness Friday videos. Sign up for our next live Fitness Friday or check out our On-Demand videos right now.

Mental Engagement and Hobbies

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.

Explore Parkinson’s resources that address your most concerning symptoms right now.

Living Well with Parkinson’s

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 PD Story

Kim on a ladder on a mountain
People with PD

Kim Lundgreen

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.

Kim with his wife Mindy

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.

Exercise is essential for people living with Parkinson’s. Find your nearest Parkinson’s Foundation Chapter to explore exercise and wellness PD exercise classes near you.

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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.

Seniors stretching outdoors

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 that can 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

Woman taking medication

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 option for 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):

My PD Story

Richard and his wife outside
People with PD

Richard Huckabee

Richard Huckabee is a passionate Parkinson’s advocate, global speaker and retired Executive Manager who lives by two powerful mottos: “Get Better Every Day” and “Every Day I Fight.” Diagnosed with Parkinson’s disease (PD) in 2013, he transformed adversity into action—turning his journey into a global mission of hope, movement and momentum.

A devoted husband to Angela and proud father, Richard blends his love for global travel, hiking and photography with relentless advocacy. From hot air balloon safaris in Africa to exploring the pyramids, he proves that for him, Parkinson’s does not limit possibility, but fuels purpose.

Richard holding his award

Honored with the 2023 and 2024 President’s Bronze Volunteer Service Award, signed by President Joe Biden, Richard serves as a Parkinson’s Foundation Ambassador and Research Advocate, an InMotion Ambassador, and a member of the Michael J. Fox Foundation (MJFF) Patient Council along with various other non-profit volunteer groups. He has led Ohio delegates on Capitol Hill advocating for increased federal funding for Parkinson’s research and has spoken to thousands, including at the World Parkinson Congress.

Richard is a powerful champion of inclusion in research. He was instrumental in encouraging the Black community to participate in PD GENEration: Powered by the Parkinson’s Foundation, helping ensure genetic research reflects the diversity of the PD community. His advocacy continues to open doors and build trust between underrepresented communities and leading research institutions.

“I want people with Parkinson’s to know that participating in PD GENEration is free, private, doesn’t involve any medications and is a way of contributing to a finding a cure someday. When you get your genetic testing results, you can review them and ask questions with a health professional.” – Richard

Exercise has been central to his journey from day one. In 2013, he participated in a dance drumming research study for people with Parkinson’s and their care partners. From this study, the members of the group formed into a source of invaluable support for Richard and his wife. They continue to meet for breakfast as the “Breakfast Club” and enjoy hikes together.

Additionally, Richard has participated in hundreds of research initiatives and groundbreaking clinical trials, including Cleveland Clinic’s Augmented Reality study, an experience that led to his appearance in the 2025 Cleveland Clinic Super Bowl commercial spotlighting Parkinson’s research.

Whether mentoring those newly diagnosed, collaborating with researchers, speaking internationally or lacing up his hiking boots, Richard inspires others to rise, move and believe in a bright future.

Explore ways to get involved with Parkinson’s research today. Visit our Join A Study page and learn more about PD GENEration, the Parkinson’s Foundation genetics study that offers genetic testing and counseling at no cost to participants.

My PD Story

Benjamin Friedman headshot
Health Professionals

Benjamin Friedman, MD

I have always been involved in caring for people with Parkinson’s Disease (PD). I was fortunate to grow up surrounded by elderly relatives, including my grandfather, who was diagnosed with PD at a relatively early age.

I witnessed how important mobility was for my grandfather’s well-being and how my grandmother was a force in his life. She was his strongest advocate. One memory I have of her support is when she would have me take him to the local pool to work on his strength and balance in the water.

Later, I was privileged to support one of my uncles who also had PD. I remember how my aunt assisted him and how music was instrumental in his movement. Memories of him dancing with my cousin in the hospital hallway will always stay with me.

Look for Dr. Friedman in our new PSA aiming to help people find real answers to their Parkinson’s questions. 

As I started to think about my own career, I did not initially plan to have a career in medicine. I originally studied health policy and was interested in gerontology (the study of aging). I was exposed to the policy side, but I found that the work — while important — did not allow me the human connections that I enjoyed while working in college at an adult day care center.

Once I decided to go to medical school, I was drawn to physical medicine and rehabilitation where the focus was on restoration and maximizing function.

When I joined Shirley Ryan AbilityLab in 2018, the director of the Parkinson’s Disease & Movement Disorders (PDMD) Program asked if I would be one of the clinicians in the program, and I have been a part of the PDMD clinic ever since. Today, I serve as the medical director of the program, and I am proud to work with the PD community each day.

Our work in the PDMD Program is built on an interdisciplinary approach. Our team of physicians; physical, occupational and speech therapists; psychologists; and exercise physiologists all work together to identify customized personal recommendations for our patients.

We have a unique system with multiple levels of care: inpatient rehabilitation, day rehabilitation and outpatient care, as well as functional fitness classes to help meet this diverse population’s functional needs. We recognize that not everyone has the same level of support at home, and we tailor our care accordingly.

In addition to our clinical practice, we also collaborate on PD research at Shirley Ryan AbilityLab. We have rehabilitation outcome measures based on our extensive patient data. Together with Northwestern University’s neurologists and scientists, who have collected genetic data on people with PD, we are hoping to determine which patients with PD may respond well to exercise therapies versus those who may need an alternative approach.

Being able to tailor therapy based on a patient’s genetics is exciting for the future of PD treatment.

Outside the clinic, members of our team are involved in various PD organizations on local, national and international levels. We will be sending a team to the World Parkinson’s Congress this May.

Additionally, we have a team of patients and clinicians, called the “Parkinson’s Peak Performers,” who participate in Shirley Ryan AbilityLab’s SkyRise Chicago each year and recently participated in the Parkinson’s Revolution ride to raise funds for the Parkinson’s Foundation.

What keeps me motivated in my work are the relationships my team has built with our patients over time. We meet many of our patients early in their disease, and we collaborate with them to help maintain and optimize their function over the course of their PD progression.

Every patient and their care partners are unique and bring something special to each visit. Whether it be suggestions about our current programs or ones they would like to see in the future, we are fortunate to have an advisory board of patients and care partners who provide us with ideas and feedback.

Once again, I always go back to my childhood and how my grandmother cared for my grandfather with PD. She often said, “It’s about the quality of life, not just quantity.” I remember her mantra daily. It serves as a reminder to me that members of the PD community are resilient and always looking for ways to improve their quality of life.

Find expert PD care near you. Explore centers in our Global Care Network or contact our Helpline at 1-800-4PD-INFO (1-800-473-4636) or Helpline@Parkinson.org to build your care team and find tailored PD specialists.

My PD Story

Aleksandra Gebska headshot
Health Professionals

Aleksandra Gebska

I’m inspired to work with individuals living with Parkinson’s disease (PD) because I see how profoundly exercise can change the trajectory of their lives.

In my role as manager of adaptive fitness programs at Shirley Ryan AbilityLab, I oversee, develop and continuously evolve exercise programs for people living with neurological and orthopedic conditions, including Parkinson’s.

When people learn to connect their mind and body and move with intention, exercise becomes a tool for independence, and that transformation in their mindset is what keeps me committed to this work.

My primary goals are to make sure that every person has access to safe, appropriately challenging exercise — and to help them create long-term, consistent exercise habits. I work with people across the entire spectrum of PD, from those in their 40s with early-onset PD to those in very advanced stages who require significant physical support.

For people with PD, exercise truly is medicine … and the benefits are numerous:

  • Regular, properly prescribed movement helps people with PD manage symptoms such as bradykinesia (slowness of movement), hypokinesia (reduced speed of muscle movement), rigidity (stiffness), postural instability, gait and balance changes.
  • Working with experienced exercise professionals enables individuals with PD to gain symptom awareness and learn practical exercise strategies to use at home.
  • Specialized fitness training, as well as group exercise, provides tremendous mental and emotional support to help people feel empowered.

Look for Aleksandra in our new PSA aiming to help people find real answers to their Parkinson’s questions. 

While many individuals with PD know exercise is essential, they may not know how to structure it or how often to exercise. Through our fitness center at Shirley Ryan AbilityLab, they don’t have to figure that out on their own. 

With 24 weekly classes, our participants can attend multiple sessions per week (or even multiple times per day) for a well-rounded exercise program that includes balance, endurance, strength, progressive resistance training, boxing, Tai Chi, flexibility and mobility training. In addition, I collaborate closely with our hospital’s Parkinson’s Disease & Movement Disorders program, and all of our classes integrate PD-specific movement strategies and symptom education.

Our fitness center also is equipped with specialized tools, including an anti-gravity treadmill for people with PD to work on improving their gait, speed and power, as well as overhead harness systems for those in later stages to work on standing balance, walking and postural control without fear of falling.

As a result of consistent exercise, the people I meet through my work at Shirley Ryan AbilityLab don’t just get stronger; they regain confidence.

I’ve watched people go from identifying themselves by their diagnosis to identifying themselves by what they can do: traveling again, dancing, getting up from the floor independently, participating in community events, navigating airports, walking long distances or going on challenging heights. They tell us what they were able to accomplish because they felt steadier and more prepared.

As people living with PD get started on an exercise program, my advice is to pause before defining your future based on what you read online.

I often see people come in overwhelmed and frightened by not knowing what to expect in the years ahead. Instead of focusing on what might be lost, I encourage people to focus on all that is possible. When people feel informed, supported and physically capable, they often regain a sense of control, hope and possibility.

At the end of the day, the PD community taught me the power of showing up for one another. There is something uniquely strong about this population — building lasting friendships, encouraging each other through hard days, celebrating small wins and advocating not just for themselves, but for the entire community. The PD community reminds me that progress is not just physical — it’s emotional as well.

Learn more about exercise and find a local PD-tailored exercise class through your nearest Parkinson’s Foundation Chapter. Find your Parkinson’s Foundation Chapter here.

My PD Story

Fidel Guzman headshot
People with PD

Fidel & Myrella Guzman

Fidel Guzman’s PD Story

I came to this country over 30 years ago from Mexico and have worked various jobs throughout my life to support my family. My true passion has always been music. I come from a family of musicians and have been blessed to be part of several bands here in the U.S., where I played the bajo sexto, or the Mexican 12-string guitar, and sang.

I have two daughters, a son, and two granddaughters who motivate me to face the challenges of my diagnosis. My oldest daughter noticed my early Parkinson's disease (PD) symptoms and helped me find a neurologist who gave me the official diagnosis five years ago. Since then, my daughter has made sure I stay active every day and enrolled me in Rock Steady Boxing, which has helped me feel my best.

I didn't think I was going to enjoy it, but movement has truly been like medicine for me. The Foundation says that the type of exercise you enjoy doing most, as long as it's safe, is the best exercise for you.

Look for Fidel and Myrella in our new PSA aiming to help people find real answers to their Parkinson’s questions. 

I also enjoy dancing with my daughters whenever I can. Music is a kind of therapy for me, and it transports me to a place of pure joy. Even my eldest daughter says that when we dance together, my balance is at its best and mobility seems to come to me easier.

I love spending time with my children and granddaughters, and I'm so grateful for their support.

Read Fidel’s story in Spanish

Myrella Guzman’s PD Story

Myrella Guzman headshot

When my father was diagnosed with Parkinson’s five years ago I knew I needed to find out every single thing about Parkinson’s. My father is the most hardworking and loving person I know, and I did everything in my power to help him navigate this disease.

I decided to pursue physical therapy as my career so I could give him the best care possible myself. After graduating and passing my boards I began working with Parkinson’s patients in various settings and came across the realization that movement is medicine.

During this time, I moved in with my significant other five hours away from my dad, which made it difficult to keep my dad motivated and moving. I signed him up for Rock Steady Boxing and he thrived in this class! I noticed such a positive change in his mood and physical state. It was thanks to the Parkinson’s Foundation that I was able to find these classes.

Since his diagnosis, I’ve become inspired, every day, to help people like my dad and their families. I’ve made it my mission to educate not only my patients about the importance of the Parkinson’s Foundation official exercise recommendations, but also my colleagues. Every day alongside other therapists, I try to create a space where the most up to date guidance, professional training and resources are available to everyone with PD who may come through the door.  

As a first-generation Mexican-American, I also know the challenges adult children may face navigating the healthcare system in both English and Spanish. Having resources available in both languages like those the Parkinson’s Foundation provides, has been a lifesaver.

There seems to be a stigma in the Hispanic community about sharing medical hardships, and oftentimes many people with PD — like my father — feel isolated. This is why building community has been such an important part of my father’s journey, and as advocate, part of mine as well. Educating our community about Parkinson's symptoms and treatments is a job I take very seriously.

I am thankful for my siblings who always check in on Dad and for technology which helps me keep in touch with my father daily. I make the most of my monthly trips to take him to his appointments and check in on his progress in person.

I love you, Dad. You are my best friend, and I would do anything to make sure you’re happy and healthy!

Read Myrella’s story in Spanish

Exercise is essential for people living with Parkinson’s. Find your nearest Parkinson’s Foundation Chapter or call our Helpline at 1-800-473-4636 to explore exercise and wellness PD exercise classes near you.

Raise Awareness

Mi Historia con EP – Fidel & Myrella Guzman

Fidel Guzman en foto de cabeza

Fidel Guzman

Llegué a este país hace más de 30 años desde México y trabajé en varios empleos a lo largo de mi vida para mantener a mi familia. Mi verdadera pasión siempre fue la música. Vengo de una familia de músicos y tuve la bendición de poder formar parte de varias bandas aquí en Estados Unidos, donde tocaba el bajo sexto y cantaba.

Tengo dos hijas, un hijo y dos nietas que me motivan a enfrentar las dificultades de mi diagnóstico. Mi hija mayor notó mis primeros síntomas de Parkinson y me ayudó a encontrar un neurólogo que me dio el diagnóstico oficial hace 5 años. Desde entonces, mi hija se ha asegurado de que me mantenga activo todos los días y me inscribió en Rock Steady Boxing, lo cual me ha ayudado a sentirme lo mejor posible.

No pensé que iba a disfrutarlo, pero el movimiento realmente ha sido como una medicina para mí. La Fundación dice que el tipo de ejercicio que te gusta hacer, mientras que sea seguro, es el mejor ejercicio para ti.

Busque a Fidel y Myrella en nuestro nuevo anuncio de servicio público, cuyo objetivo es ayudar a las personas a encontrar respuestas reales a sus preguntas acerca del Parkinson.

También disfruto bailar con mis hijas cada vez que puedo. La música es una especie de terapia para mí y me transporta a un lugar de pura alegría. Hasta mi hija mayor dice que, cuando bailamos juntos, mi equilibrio está en su mejor momento y la movilidad parece más fácil.]

Me encanta pasar tiempo con mis hijos y mis nietas, y estoy muy agradecido por tener su apoyo.   

Lea la historia de Fidel en inglés

Myrella Guzmán en foto de cabeza

Myrella Guzman

Cuando a mi padre le diagnosticaron la enfermedad de Parkinson (EP) hace cinco años, supe que tenía que averiguar todo lo posible sobre el Parkinson. Mi padre es la persona más trabajadora y cariñosa que conozco e hice todo lo que estuvo a mi alcance para ayudarle a navegar por esta enfermedad.

Decidí dedicarme a la fisioterapia como profesión para poder darle yo misma los mejores cuidados posibles. Después de graduarme y aprobar mis certificaciones, empecé a trabajar con pacientes de Parkinson en varios entornos y me di cuenta de que el movimiento es medicina.

Durante este tiempo, me mudé con mi pareja a cinco horas de distancia de mi padre, lo que dificultó mantenerlo motivado y en movimiento. ¡Lo inscribí en Rock Steady Boxing y la clase le sentó muy bien! Noté un cambio muy positivo en su estado de ánimo y físico. Fue gracias a la Parkinson's Foundation que pude encontrar estas clases.

Desde que lo diagnosticaron, cada día me he sentido más inspirada para ayudar a personas como mi padre y a sus familias. He adoptado la misión de educar no sólo a mis pacientes acerca de la importancia de las recomendaciones oficiales de ejercicio de la Parkinson’s Foundation, sino también a mis colegas. Cada día, junto con otros terapeutas, intento crear un espacio en el que la orientación, la formación profesional y los recursos más actualizados estén al alcance de todas las personas con la EP que entren por mi puerta.  

Como mexicana-estadounidense de primera generación, también conozco los desafíos a los que pueden enfrentarse los hijos adultos al navegar por el sistema de salud tanto en inglés como en español. Contar con recursos en ambos idiomas, como los que ofrece la Parkinson’s Foundation, ha sido un salvavidas.

Parece que en la comunidad hispana existe un estigma a la hora de compartir las dificultades médicas y a menudo muchas personas con la EP — como mi padre — se sienten aisladas. Por eso, crear comunidad ha sido una parte tan importante del recorrido de mi padre y, como defensora, también del mío. Educar a nuestra comunidad sobre los síntomas y tratamientos del Parkinson es un trabajo que me tomo muy en serio.

Estoy agradecida con mis hermanos, que siempre están pendientes de papá y con la tecnología, que me ayuda a mantenerme en contacto con mi padre a diario. Aprovecho al máximo mis viajes mensuales para llevarlo a sus citas y comprobar en persona sus progresos.

Te quiero, papá. Eres mi mejor amigo, ¡y haría cualquier cosa para asegurarme de que eres feliz y estás sano!

Lea la historia de Myrella en inglés

El ejercicio es esencial para las personas que viven con Parkinson. Encuentre su Chapter de la Parkinson’s Foundation más cercano o llame a nuestra Línea de Ayuda al 1-800-473-4636, opción 3 para español, para explorar las clases de ejercicio y bienestar para el Parkinson cerca de usted.

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