The Powerful Prescription: How Targeted Exercise Can Transform Life with Parkinson’s Disease

Parkinson’s Disease (PD) is a chronic, progressive condition that affects millions globally. It impacts not just movement—causing tremors, stiffness, and slowness (bradykinesia)—but also non-motor functions like sleep, mood, and cognition. While pharmacological therapies remain vital, research consistently proves that one of the most effective, non-invasive tools we have for symptom management and quality of life is Exercise for Parkinson’s Disease.

At NK Fitness, we understand that simply telling someone to “go exercise” isn’t enough. People living with PD face unique barriers, daily fluctuations in symptoms, and a distinct lack of specific guidance.   Taken from a recent publication in the Journal of Strength & Conditioning, this article serves as a practical guide for maximizing the benefits of Exercise for Parkinson’s Disease, ensuring safety, effectiveness, and long-term adherence.

The Urgent Need: Why Exercise is Non-Negotiable

PD is fundamentally defined by the loss of dopamine-producing neurons in the brain, leading to impaired motor control. Motor symptoms typically only appear after a significant percentage of these neurons are already lost. Therefore, starting Exercise for Parkinson’s Disease early is critical.

The benefits of regular physical activity are manifold:

• Neuroprotection: Exercise stimulates the release of factors like Brain-Derived Neurotrophic Factor (BDNF). BDNF acts like “Miracle-Gro” for the brain, promoting neuronal repair, survival, and plasticity in the dopaminergic pathways.
• Symptom Management: Aerobic exercise demonstrably improves walking cadence, distance, and gait. Resistance exercise helps counteract age-related muscle decline (sarcopenia), which PD often accelerates.
• Non-Motor Benefits: Exercise significantly improves mood, cognition, and helps manage related risk factors like diabetes and depression.

While deep brain stimulation or medication like Levodopa offer powerful treatment, they can come with side effects like dizziness, speech issues, or nausea. Exercise for Parkinson’s Disease offers an ancillary treatment that complements these therapies while minimizing adverse effects.

Prescreening and Assessing Severity: Starting Safely

Before starting any formal exercise program, safety is paramount. The right program for you depends heavily on your current disease stage.

1. Medical Clearance

If you have symptoms of cardiovascular, metabolic, or renal disease, you must obtain medical clearance from your neurologist or primary physician before beginning any new regimen. This ensures your safety and prevents unnecessary risk.

2. Assessing Disease Stage

Exercise professionals often use standardized clinical scales to tailor interventions:

• Hoehn and Yahr Scale: This simple 0–5 scale assesses PD progression.
  • Mild Symptoms (Stage 1 or 2): You can often follow general guidelines for age-matched non-PD cohorts, focusing on strength and aerobic work. You might need vigorous-intensity exercise to see significant benefits.
  • Moderate to Severe Symptoms (Stage 3+): You require more tailored programs that prioritize balance, coordination, and fall prevention. Intensity should start lower (moderate) and supervision is crucial.
• Orthostatic Hypotension Check: PD patients are at a higher risk of falling (approximately 60% report at least one fall). A major risk factor is orthostatic hypotension (low blood pressure upon standing), causing dizziness or lightheadedness. Always screen for recent falls, dizziness upon standing, or vision/breathing disturbances before a session.

Practical Application Point: Regularly assessing symptoms and disease severity using these tools allows us to guarantee that the Exercise for Parkinson’s Disease programs we design are safe, appropriate, and effective for your current functional capacity.

Aerobic Exercise: Fueling the Brain

Aerobic activity is the primary tool for neuroprotection. The goal is to accumulate 150 minutes of moderate-intensity (or 75 minutes of vigorous-intensity) aerobic activity per week, achievable in short bursts (e.g., 10-minute sessions) until longer durations are tolerated.

Intensity is Key—But Not Always Heart Rate

Due to cardiac autonomic dysfunction (which affects heart rate control) and the use of certain PD medications (like levodopa), relying solely on heart rate (HR) to measure intensity can be misleading.

The Solution: The Borg Rating of Perceived Exertion (RPE) Scale.

This simple self-reported scale, ranging from 6 (minimal exertion) to 20 (maximal), is highly reliable for PD patients.

Modalities for Effective Aerobic Exercise

Gait impairments can limit traditional treadmill use, but plenty of effective options exist for Exercise for Parkinson’s Disease:

• Stationary Cycling (Upright or Recumbent): Excellent for improving gait parameters and balance. Recumbent cycling offers greater stability.
• Rowing Ergometry: An excellent full-body option that combines aerobic and resistance benefits, engaging major muscle groups and demanding skilled coordination. It’s safe as the user can stop easily.
• Seated Arm Ergometry: A viable alternative for those with severely limited lower limb mobility.

Getting Creative for Aerobic Success

At NK Fitness we have experience of supporting clients with Parkinson’s Disease.  Based upon how they present on any given day we use running, rowing, cycling, skiing ergometers and even combinations of bodyweight exercises to provide a high intensity exercise stimulus.  This is easier with our client who also likes to run in their own time, and with those that don’t like running we have to be a little more creative!

High-Intensity Training: Driving Neuroplasticity

For patients who tolerate it, high-intensity exercise is particularly effective at elevating BDNF levels.

High-Intensity Interval Training (HIIT)

HIIT involves alternating intense effort (work phase) and recovery periods.

• Protocol: Aim for a 2:1 work-to-rest ratio (e.g., 2 minutes hard, 1 minute recovery).
• Intensity: Work phase target: Borg RPE 14–17. Recovery phase target: Borg RPE 11–13.
• Duration: Sessions are often shorter (around 30–45 minutes, 3 times per week).

Forced Intensity with Exercise for Parkinsons Disease

This involves using assistance (like a specialized motorized pedal system) to force the limbs to move faster than the client could voluntarily, typically 30–35% faster than their self-selected rate. This intense, forced cadence has been shown to stimulate neural activity in brain regions responsible for motor control.

Resistance Exercise: Building Strength and Stability

Aging already accelerates muscle loss (sarcopenia); PD compounds this. Resistance exercise is crucial for maintaining functional capacity and preventing injury.

The Goal: Maintain strength in major muscle groups to improve stability, gait, and the ability to perform daily tasks (like standing from a chair).

Varying Resistance Training Intensity

We have a PD client who came to us with an Early Onset diagnosis and was/is highly functional.  We employ a lot of resistance training at higher intensities (5-8 repetitions), using compound lifts such as deadlift, squat, bench press and rows.  Tasks of every day living do not yet pose a challenge for him but we are trying to offset any muscle and strength loss and almost ‘future proof’ him as much as we can.    For more information on how we approach our work with Parkinsons patients please feel free to contact leading ascot personal trainers here.

Daily Checks and Planning for Adherence in Exercise for Parkinsons Disease

Consistency is the ultimate determinant of success. Before every session, Exercise for Parkinson’s Disease requires a quick check-in:

In conclusion, Exercise for Parkinson’s Disease is not an option; it is a vital, neuroprotective component of managing the condition. By partnering with experts who understand the nuances of PD—from RPE monitoring to maximizing the neuroplastic benefits of strength and aerobic work—you take control of your functional capacity and quality of life.

Reference

Ingoglia, S. and Graves, B.S. (2025) Exercise Strategies for Parkinson Disease Management. Strength and Conditioning Journal, 47(4), pp. 433–440.