There is increasing evidence that exercise may have a neuroprotective effect, meaning that it can slow the progression of your condition. Researchers think that exercise can delay the onset of Parkinson’s as well as slow progression if introduced early on.

There are also psychological benefits to exercise. It won’t take Parkinson’s away but it can give you a sense of control over it and make you feel better about living with the condition. This, together with a good medication regime, can really enhance quality of life and help you maintain independence. You can tailor your regime to suit your own individual abilities and requirements, whether you want to maintain the strength and fitness you already have or get yourself fitter and healthier. Remember, it’s never too late to start and the benefits can be enormous.

Some of the benefits of regular exercise include:

• improved balance and fewer falls
• improved posture and flexibility
• greater energy and stamina leading to reduced fatigue
• a better connection between mind and body when moving
• improved mood and a reduced risk of depression
• an increased feeling of control and a sense of accomplishment
• enjoyable social contact
• improved brain function and health
• fewer muscle and joint injuries
• preventing/reducing gait, sleep, speech and swallowing problems
• preventing/reducing bone wasting (osteoporosis).

The Nintendo Wii, which combines video games with exercise, is increasingly popular among people with Parkinson’s. The Wii fit board that is used for many of the games can really help with balance and posture. A Wii is a very flexible tool which can be used alone or in a group by all ages. It can fit in with your routine as it is convenient and easy to use for as long or little as you want, whenever you want! The term 'Wiihab' is now being used to reflect its growing use as a rehabilitation tool.

Using a Wii requires hand-eye coordination, visual perception, timing and sequenced movement. This may sound quite a challenge but data from a study which involved using the Wii for one hour, three times a week over a four week period, suggests that there can be significant improvements in mobility, fine motor skills and energy levels. Results also suggested improved mood and emotional wellbeing. Researchers believe that this may be due to increased levels of the neurotransmitter dopamine as a result of using the Wii to exercise. 

You should tell your physiotherapist or occupational therapist if you plan to use a Wii to exercise. Ask your doctor for advice if you have any concerns about using this tool.

Virtual reality (VR). Ongoing rehabilitation training is needed for Parkinson’s to maintain the benefits. It has, however, high requirements for specialized therapists, financial challenges, and transportation to training centers, among others. As a result, it is challenging for people with Parkinson's to obtain and maintain long-term regular rehabilitation training. There is a growing interest in using virtual reality (VR) for rehabilitation as a tool to complement therapy. VR is an immersive experience using a training device (e.g., Nintendo Wii or Xbox 360) that recreates real-life settings and simulates exercise and game-based activities or challenges. This can result in more effective training compliance and motivation^2,3.

Home-based virtual reality (VR) training can be used in the clinic or home setting. It can provide high-intensity and multi-sensory training in an immersion or non-immersion virtual low-stress environment, stimulating the person’s visual, auditory, and tactile systems. It can include interventions, for example, balance training, sports games, visual feedback training, and gait training. In people with Parkinson's, VR interventions have been shown to improve the quality of life and postural balance^4,5. It also has been shown to improve gait in Parkinson's, namely step and stride length⁶. It has similar effects as conventional rehabilitation in global motor function, daily life activities, and cognitive function.

Some concerns exist, such as the development of dizziness, vomiting, and risk of falls during the interventions. A best practice for virtual training delivery has been studied to limit sessions to no more than 30-60 minutes in length. For more extended adjustment needs, the person can consider splitting these into shorter periods or spreading them across multiple weeks.

Importantly, VR can provide easy access to home-based activities and promote independent and active participation of people with Parkinson's, with increased adherence and tolerance to repetitions of movements necessary for daily physical well-being.

You can watch videos of a person living with Parkinson's using VR here.

Cycling has also been found to be very beneficial. Dutch researchers found that testing the ability of a person to ride a bike can determine whether or not they have atypical or standard 'idiopathic' Parkinson's¹ . This was discovered when they noticed that a man with freezing problems was still able to ride his bike, often riding up to 25 km each day, but once he got off the bike his gait difficulties immediately returned. It is thought that the highly coordinated skill needed to ride a bike is sensitive to the subtle problems that Parkinson's can cause in balance and coordination.

Cycling can help you keep your heart and lungs healthy and the pedalling action can improve the strength of leg muscles and general coordination as well as reduce stiffness. A word of caution though; you should begin with a stationary bike or exercise bike and take it slowly if you have not been regularly exercising. If you have experienced freezing or gait problems since you last tried cycling then check with your doctor before getting on a bike.

Dance, for example Irish set dancing, tango, waltz and foxtrot, has also been shown to improve symptoms. For more information on dance and its benefits in Parkinson's see Dance therapy.

References:

1. Cycling for Freezing of Gait - Snijders AH, Bloem B. N Engl J Med 2010 April 01; 362:e46 - view abstract
2. Benito PAM, Ana RG, Angel G, Alberto BS, Beatriz PA, Ana Isabel PAG. Application of virtual reality in the motor aspects of neurorehabilitation. Rev Neurologia. 2010; 8: 481–488.
3. Gallagher R, Damodaran H, Werner WG, Powell W, Deutsch JE. Auditory and visual cueing modulate cycling speed of older adults and persons with Parkinson’s disease in a Virtual Cycling (V-Cycle) system. J Neuroeng Rehabil. 2016; 1: 77.
4. Gandolfi M, Geroin C, Dimitrova E, Boldrini P, Waldner A, Bonadiman S, Picelli A, Regazzo S, Stirbu E, Primon D, Bosello C, Gravina AR, Peron L, Trevisan M, Garcia AC, Menel A, Bloccari L, Valè N, Saltuari L, Tinazzi M, Smania N. Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial. Biomed Res Int. 2017;2017:7962826. doi: 10.1155/2017/7962826. Epub 2017 Nov 26. PMID: 29333454; PMCID: PMC5733154.
5. Truijen S, Abdullahi A, Bijsterbosch D, van Zoest E, Conijn M, Wang Y, Struyf N, Saeys W. Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson’s disease, multiple sclerosis, and stroke: a systematic review and meta-analysis. Neurol Sci. 2022 May;43(5):2995-3006. doi: 10.1007/s10072-021-05855-2. Epub 2022 Feb 17. PMID: 35175439; PMCID: PMC9023738.
6. Lei C, Sunzi K, Dai F, Liu X, Wang Y, Zhang B, He L, Ju M. Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review. PLoS One. 2019 Nov 7;14(11):e0224819. Doi: 10.1371/journal.pone.0224819. PMID: 31697777; PMCID: PMC6837756.

Recent research suggests that exercise may be neuroprotective, that is it may help prevent or slow the loss of brain cells (neurodegeneration). The exact mechanism is unclear but many believe that intensive, vigorous aerobic exercise produces protective brain chemicals called neurotrophic factors.

There is increasing evidence supporting the positive effects of exercise on Parkinson’s symptoms. Studies have shown that different sorts of exercise - aerobic, strength, balance, resistance, gait and dance - all have beneficial effects.^1,2,3  For information on the benefits of dance see Dance therapy.

Many believe that a regular exercise programme should begin as soon as possible after diagnosis in order to achieve maximum benefits.

References:

1. Fisher BE. Et al. Treadmill exercise elevates dopamine D2 receptor binding potential in patients with early Parkinson’s disease. Neuroreport. 2013;24:509-514 - view abstract
2. Cycling for Freezing of Gait - Snijders AH, Bloem B. N Engl J Med 2010 April 01; 362:e46 - view abstract
3. Bloem B.et al. Nonpharmacological treatments for patients with Parkinson’s disease. Movement Disorders 2015; 30:11:1504-1520 - view abstract

It is important to choose activities suited to your general fitness and mobility. If you choose something that’s too strenuous or uncomfortable you are unlikely to keep it up for long and you may do more harm than good. Some exercises will keep you fitter than others but the important thing is to find activities or routines that are fun and will keep you motivated! Exercising consistently and regularly is more important than the choice of activity. Even a daily walk is a useful form of exercise as it makes the heart, lungs and muscles work harder, improves flexibility and relieves stiffness.

Work out how exercise will best fit into your routine so that it does not become stressful or difficult to maintain. Scheduling in time for exercise within your daily routine means you are far more likely to do it, particularly if you time it wisely for when you are most mobile and energetic! Think of exercise as a form of medication so don’t miss a dose!

If you can find an exercise partner then the social side of your routine will be an added bonus! Many people find dancing is good for this and the benefits of dancing are now widely recognised (see also, Dance).

It is a good idea to ask for advice on exercise as soon as you are diagnosed to find out what is suitable and safe for you. Discuss options with your doctor or ask for a referral to a physiotherapist who can tailor an individual exercise programme for you. Many exercise programmes can be followed at home and some can be adapted so that you can exercise lying down (using an exercise mat and supportive pillow), sitting on a supportive chair or standing.

Before choosing any exercise, think about what you want to achieve, for example do you want to reduce stiffness, do you want an aerobic exercise which makes your muscles, heart and lungs work hard, or do you want something gentler to keep you flexible?

Your exercise programme should include:

• stretching exercises to maintain joint flexibility, reduce stiffness and slow movement. Stretches will also help with good posture to reduce gait and balance problems, neck and back pain, and difficulties breathing and swallowing. Performing these in front of a mirror can be helpful to ensure you are doing them correctly

• strengthening exercises to develop and maintain strength and prevent muscles from weakening. Focus particularly on the arms, legs and trunk, using appropriate weights, resistance bands (large strips of elastic you work against) or the weight of the limb itself against gravity. Improved strength will also help with stamina and fatigue. Ask for guidance before using any equipment

• weight bearing exercise such as running, brisk walking and jumping that can improve bone health and reduce the risk of osteoporosis. Remember that walking or running machines can be dangerous if you ‘freeze’, as the treadmill may continue moving. Never use such machines alone

• exercises that focus on balance and fine movement control, particularly of the hands. Some people find boxing – either gentle or non-contact – very helpful for balance and coordination

• aerobic exercise, for example brisk walking, jogging or cycling, to increase your heart rate and improve circulation and the delivery of oxygen around your body). This may not be suitable for everyone though so always ask your doctor first

If you already do sports think about adaptations that will enable you to continue - for example try nine holes of golf rather than 18 or if you like tennis play doubles rather than singles. Think too about learning new activities such as yoga, Tai Chi, Pilates or the Alexander technique. For further information on these and other complementary therapies see Complementary therapies.

Here are some exercise suggestions from other people with Parkinson’s:

• Margot discovered juggling as a good way of reducing stiffness, especially when she feels her medication is wearing off - watch our video
• Tom created his own exercise programme to manage stiffness at work with the help of his physiotherapist - watch our video
• Birger enjoys running and this helps him reduce stiffness and stay fit - watch our video

Parkinson’s UK's 'Keeping Moving booklet' has many ideas: download booklet.

• Begin exercising slowly and don’t overdo it if your muscles are cold (don’t forget to warm up first).
• Gradually build up the duration of any exercise session – don’t try to do too much too fast.
• It may be helpful initially to have someone with you in case you feel unsteady or need them to read instructions to you or remind you how to perform each exercise.
• If you cannot get out much then try to walk indoors, if necessary with a frame or with your carer.
• An exercise ‘buddy’ or group sessions can add a welcome social dimension and motivation, so look for organised or group classes at your local gym or other public venues.
• Select an exercise programme that suits your daily routine but be flexible because energy levels and mobility are likely to vary from one day to another.
• Choose a time when movement is easiest for you, when medication is working well and you are feeling rested. But it can also be useful to exercise when you are ‘off’ as this can help you to cope with any stiffness or reduced mobility you experience.
• Try to include one stretching routine each day, perhaps early in the morning, with strengthening and postural exercises later in the day.
• Use stairs instead of lifts if you can, or get off the bus one stop early – you can even do leg exercises watching television!
• Stop if anything hurts or feels uncomfortable. Listen to your body and learn to recognise when to stop.
• Start each step with your heel and avoid walking on your toes.
• Concentrate when turning and exaggerate your steps if you experience freezing of gait.
• Think about your posture when you are exercising.
• If you want to have an exercise machine at home make sure it is effective and suits your needs. It is wise to consult a physiotherapist before buying one.
• Don’t rule anything out simply because you haven’t done it before – this might be the ideal opportunity to try something new.
• Try exercise that lets your mind wander, such swimming, walking and gardening.
• Allow time for your mind and body to relax after exercise.
• Remember to eat well – see Eating well.
• Ask a physiotherapist or occupational therapist for advice on the best type of sole when buying shoes. Some can may trips and falls more likely.
• Wear loose fitting clothes.
• Don’t give up easily – as with all things practice is the key to success.
• It may take time for you to feel the benefits so be patient.
• Make exercise a habit. It is better to exercise two or three times a week for shorter periods than just a long session at weekends.
• And most of all, have fun! 

Nordic walking can best be described as cross country skiing without skis. It is a form of fitness walking which uses two specially designed, hand-held walking poles and a particular technique which exercises the arms, torso and legs. Nordic walking can be carried out on a variety of surfaces and terrains by anyone who can walk, irrespective of age or level of fitness. 

Unlike normal hiking sticks which you stab ahead of you as you walk, you push back on Nordic walking poles, rotating your shoulders and hips, propelling your body forward. The poles act as levers to give a springy, lengthened stride. It takes a little getting used to but, almost imperceptibly, stride lengthens into a long and easy one and the whole body seems to loosen up. 

How can it help in Parkinson's?

Nordic walking can improve fitness in the same way that running does, but it is much kinder to the ankles, knees and hips as it has a much lower impact on the joints. This can be particularly attractive if you experience joint pain. 

Perhaps the most important advantage of Nordic walking if you have Parkinson’s is that is allows you to maintain and develop your ability to walk well by:

• enhancing balance and coordination
• reducing slowness of movement (bradykinesia) 
• reducing freezingand gait problems
• improving mobility and creating more fluid movements
• correcting posture, particularly the stooped position associated with Parkinson’s
• reinforcing the alternating movements of the arms and legs which can be lost in Parkinson’s and so improving stability
• boosting independence and quality of life.

Various studies ^1,2 have shown that people with Parkinson’s who participate in Nordic walking programmes have improved functional independence and quality of life. It seems that mood also improves.

Once the basic steps have been learnt you can tailor your programme to suit how you feel at any particular time. Walking in a group also has social and psychological benefits. 

Carers and family members who walk with you may find that they too feel fitter and have fewer aches and pains.

References

1. Effect of exercise on perceived quality of life of individuals with Parkinson´s disease - Baatile J, Langbein W, Weaver F, Maloney C, Jost M. - J of Rehabilitiation Research and Development 37(5), September/October 2000 - view abstract
2. Nordic walking improves mobility in Parkinson's disease - van Eijkeren FJ, Reijmers RS, Kleinveld MJ, Minten A, Bruggen JP, Bloem BR. Mov Disord. 2008 Nov 15;23(15):2239-43 - view abstract.

Once you have checked with your doctor that Nordic walking is safe and suitable for you, you will need to buy a pair of walking poles. There are various makes to try, so ask others who walk for recommendations and check with specialist companies for advice on choosing suitable poles.

As Nordic walking poles spend a considerable amount of time behind you, they have a strap which goes around your wrist so that the poles can be released behind you and then quickly held again when in front of you. When choosing poles make sure the grip is comfortable and the strap large enough for you to easily slip your hand in and out. The ‘swing-weight’ is also an important factor, so don’t get anything too heavy or too light – you should be able to maintain the natural arm swing without too much vibration. Poles are generally quite slim and have an adjustable length. They usually have two different types of end – spikes for gripping grass, mud or ice, or a ‘paw’ to cover the spike when walking on tarmac or asphalt.

The only other equipment you need is loose, comfortable clothing and a comfortable pair of shoes with good support under the heel and across the front of the foot. Sports shoes or boots designed for low level walking are usually well suited. You must be able to push off at the toes, so shoes should bend at the front and not on the arch of the foot.

It is a good idea to get some tuition from a qualified Nordic walking instructor so you learn good technique from the start. An instructor will give you tips on how to coordinate the poles and your body effectively. Some shops that sell poles may also offer some initial training or you can look on the internet for classes or qualified instructors in your area. After an hour or two, you should find you can walk comfortably with your poles, although further sessions will be helpful to perfect technique and maximise the benefits Nordic walking can bring.

• The benefits of exercise with...Parkinson’s
• VIDEO – CNS Academy: Physical Exercises in Parkinson's Disease
  
• Parkinson's Europe ExerciseCast – online video exercise programme by Josefa Domingos and John M. Dean
• Exercise tips on Keep it ON web platform
• VIDEO: Physiotherapy exercise presentation by Josefa Domingos
• Staying Active Versus Exercise

Articles from Parkinson's Life online magazine

• From Nordic walking to boxing: six sports for Parkinson’s disease
• How much exercise should people with Parkinson’s disease do each week? 
• Championing sport in the Parkinson’s community
• Watch: 13 people with Parkinson’s on the impact of exercise
• 5 Parkinson’s exercise classes for keeping fit in lockdown
• Could playing table tennis help reduce Parkinson’s symptoms?
• 6 tips to stay active while living with Parkinson’s
• Watch: “Gotta Keep Moving”
• Alison Anderson: the “cyclopath”
• “Life can still be fun if you have Parkinson’s”
• Former NBA star launches free Parkinson’s exercise programme
• Exercise as part of your treatment plan
• Watch: Michael J Fox Foundation pays tribute to Parkinson’s campaigner
• Sign up for the World Parkinson Boot Camp this April
• Tonya’s trainers: the long road back to running
• Cutting down grass (and my Parkinson’s symptoms) – one scythe at a time
• How tailored exercise programmes can help people with Parkinson’s
• Meet the 70-year-old who uses boxing to help fight Parkinson’s

Other articles and resources

• Brochure provided by World Parkinson's Program with information in 14 languages about exercise and Parkinson's
• Rana exercise diary for Parkinson's
• PD Warrior: 10-week Challenge programme