Types of exercise recommended for Parkinson’s

Recent studies underscore the importance of exercise as a cornerstone of Parkinson’s disease management, highlighting its capacity to significantly improve both motor and non-motor symptoms (1). Notably, exercise is the only intervention currently shown to slow disease progression (2). Beyond this, regular physical activity enhances balance, cardiovascular and respiratory health, memory, and mood, offering comprehensive benefits for individuals living with Parkinson’s.

1. Aerobic exercise

Aerobic activities improve gait, balance, and mobility, while also alleviating symptoms like tremors and stiffness, making daily tasks easier to manage.

Examples: Walking, cycling, swimming, rowing, and using an elliptical machine.

Tips:

• Start small and work your way up, i.e. break up your frequency into shorter duration more times a day if you don’t have the stamina built up yet.
• Find a group class to attend or a walking/cycling group in your area to help with maintaining social contacts and a commitment to regular exercising.
• Look for specialised gyms and exercise physiologists for tailored advice for your symptoms.

Guidelines (adapted from Oliveira de Carvalho et al., 2018):

• Frequency: 20 to 60 minutes per day, 3 to 5 days per week
• Intensity: Light (<40% HRR/VO2R), Moderate (40–60% HRR/VO2R), or Hard (>60% HRR/VO2R)
• Type: Activities like walking or cycling tailored to individual symptoms

2. Resistance exercises

Resistance training helps maintain and improve muscle strength, which is often compromised in Parkinson’s. This training reduces fall risk, enhances mobility, and supports bone health.

Examples:

• Resistance band exercises (e.g., bicep curls, shoulder raises, leg extensions)
• Dumbbell exercises (e.g., chest presses, rows, squats)
• Bodyweight exercises (e.g., push-ups, planks, lunges)
• Functional strength training (e.g., lifting objects, carrying groceries)
• Pilates or yoga incorporating resistance elements.

Tips

• Warm up with light activity before working out.
• Make sure to tell your instructor if you have any balance or dizziness issues.
• Get guidance from specially trained exercise physiologists with movement disorder experience.

Guidelines (adapted from Oliveira de Carvalho et al., 2018):

• Frequency: 2 to 3 times per week
• Intensity: Light (40–50% 1RM), Moderate (60–80% 1RM), Hard (>80% 1RM)
• Type: Progressive resistance (2 to 4 sets of 8 to 15 repetitions for large muscle groups).

3. Flexibility exercises

Flexibility exercises alleviate muscle rigidity, improve range of motion, and prevent a forward-stooped posture. These exercises are essential for reducing fall risk and maintaining physical independence.

Examples:

• Body Twist: Sit on a chair, twist your torso to one side, and hold for 20–60 seconds.
• Wall Hang: Lean forward gently with hands placed on a wall above your head.
• Doorway Bend: Stretch your shoulders by turning away from a doorway frame.
• Side Bend: Sit tall, lift one arm over your head, and lean to the side.

Tips:

• Warm up with light activity before stretching.
• Hold each stretch for 20 to 60 seconds without bouncing.
• Aim to stretch 3 to 4 times weekly, ideally daily.

Guidelines (adapted from Oliveira de Carvalho et al., 2018):

• Frequency: 2 to 3 times per week
• Intensity: To the point of mild discomfort, 10 to 30 seconds per stretch
• Type: Static, dynamic, or PNF stretches, with emphasis on spine and trunk.

4. Neuromotor exercise

Neuromotor exercises improve coordination, posture, balance, and agility, directly addressing motor control challenges in Parkinson’s. These exercises reduce fall risk and enhance overall physical function.

Examples:

• Tai Chi: Slow, deliberate movements and deep breathing
• Yoga: Combines physical postures, breathing exercises, and meditation
• Dance: Enhances rhythm, coordination, and fitness
• Balance training: Activities like standing on one leg or heel-to-toe walking
• Pilates: Focuses on core strength and flexibility
• Boxing: Improves agility and strength through footwork and punches.

Tips:

• Practice regularly to see benefits.
• Work with a physiotherapist or exercise physiologist specialising in Parkinson’s care.
• Ensure exercises are performed in a safe environment.
• Tailor routines to individual needs and abilities.

Guidelines (adapted from Oliveira de Carvalho et al., 2018):

• Frequency: 10 to 15 minutes, 2 to 3 times per week
• Intensity: No specific intensity guidelines
• Type: Exercises involving balance, agility, coordination, and proprioception.

1. Consult your GP before starting, especially if you have co-morbidities (e.g., diabetes, cardiac issues).
2. Exercise during “on” periods when medications are effective and stay hydrated.
3. Work out with a buddy or join a specialist gym for accountability and social engagement.
4. Inform your healthcare provider if you experience dystonia or orthostatic hypotension during exercise.
5. Schedule group classes or gym sessions for routine adherence.
6. Monitor for post-exercise tremor and consider cooling down or meditating if needed.
7. Create a safe space at home with appropriate equipment for convenience.
8. If you have deep brain stimulation (DBS), seek professional advice for suitable exercises.
9. Track activity levels and heart rate to monitor progress.
10. Personalised plans from exercise physiologists can optimise outcomes. Find an Accredited Exercise Physiologist (AEP) through Exercise & Sports Science Australia (ESSA).

How do I access an EP?

Accessing exercise physiology services can make a significant difference in managing the symptoms of Parkinson’s, improving quality of life and maintaining independence. Personalised plans from exercise physiologists can optimise outcomes.

It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:

• getting a GP referral to an EP with Parkinson‘s experience
• your state-based Parkinson’s organisation for advice on EPs to access
• private health to see what is covered in relation to EP consultations and expenses
• Find an Accredited Exercise Physiologist (AEP) through Exercise & Sports Science Australia (ESSA)
• NDIS or My Aged Care plan supports.

Infosheet kindly reviewed by Exercise & Sport Science Australia

Exercise & Sports Science Australia (ESSA) is the nation’s leading voice on exercise and sports science. To find an accredited exercise physiologist near you see here.

References:

(1) Langeskov-Christensen M, Franzén E, Grøndahl Hvid L, et al. (2024). Exercise as medicine in Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry; 95:1077-1088.

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

(3) Shen, X., Wong-Yu, I. S., & Mak, M. K. (2016). Effects of exercise on falls, balance, and gait ability in Parkinson’s disease: a meta-analysis. Neurorehabilitation and neural repair, 30(6), 512-527.

(4) Jiang, Y., Zhang, S., Chen, Y. et al. Physical activity and risk of Parkinson’s disease: an updated systematic review and meta-analysis. J Neurol 271, 7434–7459 (2024). https://doi.org/10.1007/s00415-024-12672-y