Exercise and Parkinson's: what the evidence actually supports

If you have recently been diagnosed with Parkinson's, somebody will have told you that exercise is good for you. It is well meant and it is entirely true, and it is also close to useless as advice, because it does not tell you what sort, how hard, how often, or why it might matter more here than it does for the rest of the population.

This is our attempt at the more useful version. We treat Parkinson's every week, and it is the area our clinic is best known for locally.

Why exercise is treated as part of the management, not an extra

For most conditions, exercise is a sensible general health measure. In Parkinson's it is closer to being part of the treatment.

The reason is that a good deal of what makes daily life harder in Parkinson's is not the tremor people picture. It is the slowing and shrinking of movement, the stiffness, the loss of automatic balance reactions, the shuffling gait, the difficulty getting out of a low chair or turning over in bed. Those are things that respond to specific, repeated, deliberate practice. Medication helps enormously with some of them and rather less with others, particularly balance, and that gap is where physiotherapy does its work.

NICE guidance on Parkinson's disease recommends considering referral to physiotherapy for people who have balance or motor function problems, rather than waiting until things have deteriorated. Parkinson's UK makes the same point in plainer terms, which is that starting earlier gives you more to work with.

What the research points to

Two themes come out of the research consistently enough to be worth acting on.

The first is that intensity appears to matter. Trials of higher intensity aerobic exercise, typically on a treadmill or a stationary bike at a genuinely demanding effort level, have found it to be safe and tolerable for people in the earlier stages, and have reported less worsening of motor symptoms over the study period than in the comparison groups. That is a more interesting result than simply feeling fitter, and it is why we push harder in these sessions than people generally expect. It has to be said honestly that this is an area of active research rather than a settled question, and nobody should tell you that exercise halts Parkinson's.

The second is that specificity matters. Practising the actual thing you are struggling with beats general activity. Big, deliberate, amplified movements help counteract the shrinking of movement that the condition produces. Cueing, which means using a rhythm, a counted step, a line on the floor or a metronome, helps a great deal with a gait that has become short and shuffling and with the freezing that can happen in doorways. Balance work has to be genuinely challenging to be worth doing, which means it has to be done somewhere safe, with somebody who knows how to progress it.

Group activities with strong followings, such as boxing style classes and dance, are not a gimmick either. They combine intensity, big movements, rhythm and turning, which is a sensible combination, and they have the considerable advantage that people keep going to them.

What a programme with us looks like

The first appointment is long, because the picture is more complicated than a single sore joint. We look at how you walk and turn, how safely you get in and out of a chair and a bed, what your balance does when you are distracted, what your posture has started doing, and what has changed that you have not mentioned because you assumed it was age.

Then we set goals that are about your life rather than about a score. Getting up the stairs without holding on with both hands. Carrying a cup of tea across a room. Being confident enough to walk into Haslemere on a busy Saturday. Those are the things we build the programme around, and we adjust it as things change, because Parkinson's does not stand still and neither should the plan.

Our Parkinson's physiotherapy page sets out how that runs in practice. Where balance and the fear of falling are the dominant problem, balance and falls work often comes first, because confidence has to be rebuilt before anything else sticks.

The things people wish they had known sooner

Do not wait for a bad patch to start. The single most common regret we hear is having waited until something went wrong, because rebuilding lost function takes longer than maintaining it.

Bring somebody with you if you can. A great deal of the work happens between appointments, and the person helping at home needs to understand what they are doing and why. We would far rather answer their questions too.

Tell us about your medication timing. What you can do at your best and what you can do when a dose is wearing off can be quite different, and a programme built around only one of those states is not much use.

And if getting to the clinic is the hard part, we can come to you. Home visits are a normal part of how we work with neurological patients rather than an exception.

Where this fits alongside your NHS care

We work alongside NHS teams, not instead of them. If you have a Parkinson's nurse specialist, a consultant, a community physiotherapist or a speech and language therapist involved, we would like to know, and with your permission we will write to them so that everybody is aiming at the same things. If we think you need something we do not provide, we will say so.

Our neurological rehabilitation pages cover the rest of what we do in this area, including neurological physiotherapy more broadly.

If you want to talk it through

Ring us on 01428 642577 and describe where you are. If you are newly diagnosed and not sure whether it is too early to be doing any of this, the answer is almost certainly that it is not, and we will tell you honestly if we think otherwise.

This page is general information rather than advice for you personally. Please discuss any significant change in exercise with the clinician managing your Parkinson's.