No matter where you are in your Parkinson’s disease (PD) journey, regular movement is good medicine. While studies show incorporating an exercise routine is essential to PD symptom management, knowing where to start — or how to safely start back up after a break — can be a challenge. Working with a physical therapist to build a tailored exercise plan and finding the right support can provide motivation to get moving.

This article is based on a Parkinson’s Foundation Expert Briefing Use it or Lose it: The Impact of Physical Activity in Parkinson’s presented by Miriam Rafferty, PT, DPT, PhD, Shirley Ryan AbilityLab Research Scientist from Northwestern University, a Parkinson’s Foundation Center of Excellence. Dr. Rafferty is also a Foundation Parkinson’s Outcomes Project steering committee member.

Broad Exercise Benefits

It’s no secret that exercise is good for all of us. For people with PD, exercise is a powerful component of well-being. The Parkinson's Outcome Project, the largest-ever study of people with PD, shows those who exercise at least 2.5 hours per week soon after diagnosis experience improved quality of life.

A structured, rigorous exercise program can ease PD movement symptoms. Task-specific workouts benefit walking, balance, strength, mobility and more. Exercise can boost quality of life and minimize non-movement symptoms such as mood changes, depression and anxiety. It can improve cognition, as well as heart and lung function, too.

Dangers of Deconditioning

While many of us have the best of intentions regarding exercise, life’s unpredictability can easily derail progress. Increased pain or fatigue during exercise, an injury, a fall or, in recent times, COVID-19-related closures are all valid reasons an exercise routine can be disrupted.

Frustratingly, periods of inactivity decrease our ability to be active. Lack of exercise leads to “deconditioning,” a challenging cycle in which fatigue grows, movement becomes increasingly difficult and strength and endurance decrease.

Just a few days of inactivity can make a normal exercise routine feel more demanding. Longer movement breaks can cause feelings of fatigue even during everyday activities, such as walking or grocery shopping. Extended hospitalization or bed rest can result in severe deconditioning, where completing even the most minimal activity without fatigue is difficult.

Though it’s important to try to arrest deconditioning early, it’s never too late to reap the benefits of more movement and get back on your exercise routine.

Small Leaps Lead to Success

Research shows jumping into, or back into, an exercise program can be overwhelming. People often embrace healthy changes gradually, in stages. In terms of exercise, this can range somewhere in between these four stages:

1. Precontemplation stage: You have no intention of working out or are beginning to contemplate taking action.
2. Contemplation stage: You are aware exercise is beneficial but have not made the leap from knowing to doing.
3. Preparation stage: You started to exercise but are not doing it regularly. Or you are building up your exercise routine after a break.
4. Active and avid exerciser stage: You work out regularly to maintain good health.

To move from thinking about exercise to actively engaging in fitness, you’ll need to address each of the challenges standing in your way. A successful commitment to long-term exercise requires motivation, support, direction and occasional adjustments to your program, based on your specific needs.

Enlist Supports

Once you have made the decision to prioritize exercise and well-being, creating a system of support can help you maintain your commitment. A physical therapist can help you ease into activity safely and help you maintain movement throughout the course of PD — creating a movement baseline, designing an exercise program tailored to your needs and addressing movement challenges as they happen.

Look to friends, family, your social support network or your care partner for motivation and collaboration. A workout partner can keep you engaged, accountable and safe. A convenient location can ease barriers to exercise. Good symptom control is also important. Work with your PD doctor to optimize your medications.

Digital health technology can also help. Smartphones or watches often offer fitness-tracking features such as a pedometer (step-counter) and heart rate monitor and allow users to download exercise applications and monitor exercise progress. Setting a timer can nudge you into remembering your regular workout.

Adjust as Needed

Parkinson’s is progressive, meaning symptoms and needs can change as the disease advances. It’s important to discuss strategies to improve coordination, strength, balance and other challenges that interfere with daily living with your healthcare team annually.

Together with the American College of Sports Medicine the Parkinson's Foundation created Parkinson’s disease-specific exercise recommendations, advising people with Parkinson's to strive to participate in 150 minutes of aerobic activity, strength training, balance activities, stretching and more weekly. A physical therapist can tailor these key elements into an exercise program suited to your current needs.

Most importantly, find an exercise you enjoy. It can help you make a long-term commitment to healthy living.

Learn More

Call the Parkinson's Foundation Helpline 1-800-4PD-INFO (1-800-473-4636) for referrals to health professionals and Parkinson’s-specific exercise classes near you.

Our PD Health @ Home Fitness Fridays workouts — a collection of Parkinson’s-tailored fitness videos — can help you get moving from the comfort of home.

Tea is an ancient, centuries-old beverage that is consumed by virtually all of the world’s population. Tea is composed of polyphenols, methylxanthine, caffeine, fats, amino acids and other substances. Tea has been thought to reduce cancer risk, prevent heart disease and even aid in weight loss. The flavonoids, caffeine and theanine have been tested in animal models of Parkinson’s disease and have shown protection against cell loss in similar areas of the brain that are affected in the human Parkinson’s patient. In this month’s What’s Hot in PD?, we will examine what is known about tea and Parkinson’s disease.

A recent meta-analysis of all studies on tea and Parkinson’s risk revealed that across 1,418 cases and 4,250 control patients, there was a protective effect of tea drinking on Parkinson’s disease risk. Interestingly, whether you drink one or more cups a day did not impact the risk (1,2,3)

Louis Tan, one of the authors of the Singapore Chinese Health study, reported differential effects of black versus green tea. People in his study who drank at most one cup of black tea a day (but not green tea) decreased their risk of developing Parkinson’s disease. Caffeine also reduced the risk of Parkinson’s disease. This study lends support to the mounting evidence supporting a caffeine Parkinson’s-related benefit. Interestingly, most black teas have more caffeine than green teas (1,2,3).

What should patients understand about coffee and tea drinking and Parkinson’s disease? Consumption of coffee or tea seems to reduce the risk of developing Parkinson’s disease. Once you have been diagnosed with Parkinson’s disease, no matter how much time you spend in Starbucks, you can no longer alter your risk profile. The cat is out of the bag. Consumption of caffeine in moderate doses does however seem to benefit the motor symptoms of Parkinson’s disease. A nice cup of tea might just be what the Parkinson’s doctor ordered.

You can find out more about our National Medical Director, Dr. Michael S. Okun, by also visiting the Center of Excellence, University of Florida Health Center for Movement Disorders and Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life and 10 Breakthrough Therapies for Parkinson's Disease.

Exercise is vital for improving balance, mobility and overall health in persons diagnosed with Parkinson's Disease (PD). PD is the second most common neurological disease in the world(1). It is characterized by a deficit in dopamine resulting from a progressive loss of neurons in areas of the brain responsible for movement and coordination(2).

Recently, literature has demonstrated that participating in strength training regularly can improve symptoms, make dopamine use more efficient and possibly even slow the progression of PD! In this article, we will look at why strength training has benefits specific to PD, and discuss ways to make it safe and fun.

Why Exercise?

Exercise is amazing because it changes the way our brain functions. Studies have shown that in people who regularly exercise, brain cells use dopamine more efficiently. This occurs because areas of the brain responsible for receiving dopamine signals – the substantia nigra and basal ganglia, are modified. Exercise also increases the number of D2 receptors in the brain, meaning dopamine has more places to go. Additionally, researchers at the University of Pittsburgh were able to demonstrate that in animal models, exercise increased the amount of a neurotrophic factor called GDNF, which helps protect dopamine neurons from damage(3).

Choose Strength Training

The benefits of strength training include increasing muscular strength, endurance, dynamic balance and cognitive functioning. Recent studies have demonstrated that there are decreases in gross muscular strength in people diagnosed with PD, most notably in the back and hip extensors4. Researchers have speculated that this occurs secondary to postures developed throughout the course of the disease. As people begin to hunch their shoulders and lean forward instead of standing upright, postural muscles become weaker. When postural muscles become weaker, it is more difficult to balance, or recover from perturbations. This increases the likelihood of falling. Strength training is an excellent, safe way to increase strength, stability and confidence for those with PD.

Where to Start

Beginning a new exercise program can be intimidating at first. My suggestion is to find a fitness buddy – a friend or family member to start with, and help you stick to your program. Then, do your research. Build a strong program, and execute it with good form. A great resource for learning to perform exercises correctly is Exrx.net. You can also consult a local fitness expert, or ACSM guidelines for strength training. When exercising, be sure to focus on all 5 major muscle groups – chest, back, legs, arms and core (abdominals).

Tips for Exercising Safely

1. Check with your doctor before beginning any new exercise program, and continue to take all medications prescribed by doctors. Strength training is not an alternative to medication.
2. Make sure you hydrate! Drink water before, after and during your exercise to feel better and stay safe.
3. Bring a copy of your workout with you, so you don't forget any exercises!
4. Progress slowly. Make goals, and work towards them by perfecting your form and starting with light weights first. Remember, all good things take time. Have patience and enjoy the ride!

Danielle Leshinsky is a Certified Strength and Conditioning Specialist (CSCS) and a doctoral candidate at Emory University School of Medicine's DPT program. She is currently researching with Dr. Madeleine Hackney and the Atlanta VA Center for Visual and Neurocognitive Rehabilitation , looking at the effects of Tango on Parkinson's Disease. She is also working in the INSPIRE laboratory at the Emory Rehabilitation Hospital. Danielle chose to pursue a career in physical therapy because she finds it both challenging and rewarding. She plans to obtain a Specialist Certification in Neurology upon graduation in May 2016.

This blog is the fifth in a series detailing the roles of each member of a comprehensive care team, covering social work, occupational therapy, speech-language pathology and physical therapy. Learn more about the healthcare professionals that are part of a comprehensive care team and how you can put your care team together today.

What Is Dance/Movement Therapy?

Dance/movement therapy is a form of psychotherapy that uses movement, in all forms, as a means of observation, assessment and intervention in the therapeutic relationship. Unlike dance, dance/movement therapy does not focus on a stylized choreography, specific set of skills or technique. Instead, it allows individuals to move and find comfort in their bodies and to express what words might be too difficult to uncover.

Dance/movement therapy can help support people with Parkinson’s disease (PD) in the moment, even when it is hard to be present to physical sensation and symptoms.

What Do You Do During a Dance/Movement Therapy Session?

There is no one-size-fits-all session, though there are some common basic components. In an individual session, you will likely start with a warm-up where the therapist guides you through movements, from head to toe.

You will be encouraged to move each body part, no matter how small. This allows you to become more aware of your body and experience your capacity for movement. Next, the therapist will coach you to use your body to express behaviors and thoughts or to explore movement patterns and preferences.

Group sessions might incorporate elements from a support group, a social dance or mindful movement class. For example:

When asked how she felt at the beginning of the dance/movement therapy group, Sally reported feeling isolated, standoff-ish and unsure of her ability to participate because of her tremor and poor balance. The therapist invited Sally to show what that looked like using her body. Sally slumped over in her chair, crossed her arms and lowered her gaze. Sally then lifted her chest, looked up to the ceiling and threw her arms up in the air. With a smile on her face, Sally said, “A weight has been lifted. Now, I feel free!”

Who Is a Dance/Movement Therapist?

Dance/movement therapists are registered or board-certified individuals with a master’s degree in dance/movement therapy. Depending on where they practice, dance/movement therapists may be clinical counselors, social workers, creative arts therapists or psychologists. Most have a background in psychology and dance, with a focus on dance as an outlet for mental health and expression. Dance/movement therapists are required to fulfill clinical internships in such settings as hospitals, treatment facilities, day programs, nursing homes, day schools or even private practice.

A dance/movement therapist is an integral part of the care team because he/she can mesh clinical counseling or social work with movement observation and assessment. The therapist’s keen ability to observe the relationship between movement and mental health helps foster a more holistic, mind-body approach to medicine.

Dance/movement therapists receive referrals from other care team members and often co-treat, co-facilitate and collaborate with them. As part of the team, your dance/movement therapist should communicate with other care team members about treatment plans, symptom management and disease progression.

What Symptoms Can Dance/Movement Therapy Help Treat?

Dance/movement therapy addresses motor and non-motor symptoms of Parkinson’s. It focuses on balance, coordination, gait and mobility, but also uses movement to address depression, digestive complications, anxiety and fatigue.

Furthermore, dance/movement therapy encourages individuals to prioritize their mental health. Embracing the arts as a mode of psychotherapeutic intervention and expression seems to help reduce stigma around mental health issues.

Research specifically on dance/movement therapy with PD is taking off. For example, Northwestern University in Illinois recently conducted a study on the effects of dance/movement therapy on fatigue in people with PD. More researchers are becoming interested in this topic, so expect to hear more about the impact of dance/movement therapy in the future. In the meantime, try it for yourself.

How Do I Find a Therapist or Program?

Dance/movement therapists and programs are all over the country. To find one nearest you, go to The American Dance Therapy Association’s website at www.adta.org. You can find a list of resources and a directory of therapists in your area. The toll-free Parkinson’s Foundation Helpline can also help connect you to information and resources: 1-800-4PD-INFO (473-4636).

Dance/movement therapy is often a wonderful complementary or adjunct therapy for individuals affected by movement disorders. Some dance/movement therapy sessions may be covered by private health insurance, which can make it an affordable and accessible option for treatment of symptoms and maintenance of quality of life. 

Erica Hornthal, LCPC, BC-DMT, is CEO of Chicago Dance Therapy. She is a clinical counselor and board-certified dance therapist who specializes in working with individuals living with movement and cognitive disorders. Additionally, Erica works with people of all ages and abilities to connect the mind and body to promote self-awareness, self-expression, healthy attachments, compassion and improved quality of life. 

For more insights on this topic, listen to our podcast episode “A Western Perspective on PD: Understanding Complementary Medicine”.

All Science News articles summarize a research study and are not an official opinion, endorsement or position of the Parkinson’s Foundation’s.

JAMA Neurology, “Viewpoint”, 11/13/17

Authors: E. Ray Dorsey, MD, Department of Neurology, University of Rochester Medical Center, Rochester, NY; and Bastiaan R. Bloem, MD, PhD, Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands.

In June 2017, the Parkinson’s Foundation brought together the thought leaders in the Parkinson’s community to discuss the future of Parkinson’s research at an event called, “World Without Parkinson’s” in New York City. At this event, Drs. Dorsey and Bloem stressed the importance of caring for people with Parkinson’s today, and the increasing need for systems to extend the reach and expand the scale of care.  They asked the audience: How can we shift the paradigm within the health care system to be more patient-focused?

People are at the heart of the issue.  At the World Without Parkinson’s event, Drs. Dorsey and Bloem pointed out that if you look at how public health and healthcare are changing lifespans around the world, the resulting growth in the over 65 population will effectively result in a pandemic of Parkinson’s disease. They have now published in JAMA Neurology, a major scientific journal, an opinion piece issuing a clarion call to action to make the voices of the Parkinson’s community heard. They pose the question: if the worldwide number of people with Parkinson’s disease (PD) will double from 6.9 million in 2015 to 14.2 million in 2040, do our efforts reflect the urgency commensurate with the challenge?  What are we doing to treat these millions of individuals to lead healthy lives?  They write that increasing access to care and increasing funds for Parkinson’s research are the answer.

For decades, the Parkinson’s Foundation has been educating and empowering people living with Parkinson’s and their families. We are at the forefront of improving lives for people with Parkinson’s today.  Starting with our focus on today’s patients through the first Parkinson’s advisory council and people with PD research training program, we have extended this vision to include the Parkinson’s Outcomes Project, the largest clinical study of Parkinson’s ever conducted and the only major study with a singular focus on how to improve the lives of everyone living with Parkinson’s today. We ensure better care through our global network of 42 Centers of Excellence and we work to close the gaps in Parkinson’s care by training doctors, nurses, physical therapists, speech language therapists and social workers so they can provide better care to their Parkinson’s patients across the nation and around the world.

We will remain at the forefront of addressing disparities in Parkinson’s care and engaging patients to advocate for better care. As Parkinson’s reaches epidemic-like proportions, it’s clear that this work is more important than ever. We will continue to invest in research and improving lives until a world without Parkinson’s is in reach.

#WorldWithoutParkinsons