Parkinson's disease

Also called: Parkinsonism

Exercise is the main treatment Strength Balance Stretch

Slowness, stiffness and unsteadiness from loss of dopamine-producing cells. Exercise is the only intervention with evidence of a disease-modifying effect - and high-intensity exercise appears to slow progression rather than only managing symptoms.

How common: ~1% of adults over 60; 3% over 80

Open the Movement for Neurological Conditions routine All problems

What it is

Parkinson's disease results from progressive loss of dopamine-producing neurons, producing slowness of movement, rigidity, tremor and postural instability. Medication replaces the dopamine and manages symptoms effectively for years.

What is genuinely remarkable is the exercise evidence. Trials of high-intensity aerobic exercise have shown slowing of motor symptom progression - not just symptom management but an apparent effect on the disease itself. No medication has demonstrated that. Exercise in Parkinson's is therefore treatment rather than adjunct, and intensity appears to matter.

What it feels like

Slowness getting started and slowness of movement generally
Stiffness, and a tremor at rest in one hand
Small handwriting, a quieter voice and reduced facial expression
Shuffling steps, reduced arm swing and difficulty turning
Unsteadiness and freezing, particularly in doorways and when turning

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Loss of dopamine-producing neurons: Cells in the substantia nigra progressively die, reducing the dopamine that initiates and scales movement. Symptoms appear once a substantial proportion has been lost.
Bradykinesia - slowness and reduced amplitude: Movements become smaller and slower, and the brain miscalibrates how big a movement needs to be. This is why amplitude-based training - deliberately exaggerated big movements - is effective.
Rigidity: Increased muscle tone throughout the range makes movement effortful and contributes to the stiffness and the reduced arm swing.
Postural instability: The automatic reactions that recover balance are impaired, which is why falls become common as the disease progresses and why balance training is central.
Reduced automatic movement: Movements that should be automatic - arm swing, stride length, swallowing - require conscious attention. This is why cueing strategies, using rhythm or visual targets, work so well.
Deconditioning: Reduced activity from the motor symptoms costs strength, fitness and balance on top of the disease. A large share of the disability is this rather than the neurology.
Freezing of gait: A sudden inability to start or continue walking, most often in doorways and when turning. It is a specific and frightening symptom that responds to cueing techniques.
Non-motor symptoms: Constipation, sleep disorders, loss of smell, low mood and cognitive change are all part of the disease and often precede the motor symptoms by years.
Age and genetics: Age is the strongest risk factor and a minority of cases have identifiable genetic causes. Family history raises risk modestly.
Not exercising hard enough: The trial evidence for a disease-modifying effect comes from high-intensity exercise. Gentle activity helps symptoms; intensity appears to matter for progression.

Who tends to get it

Older adults, with risk rising steeply after sixty
Men, in whom it is around one and a half times more common
Anyone with a family history, which raises risk modestly
People with certain occupational exposures, notably some pesticides
Anyone already diagnosed, for whom the deconditioning risk is the modifiable part

What makes it worse, and what settles it

Makes it worse

Inactivity, which accelerates functional decline on top of the disease
Exercising only at low intensity, which may not produce the disease-modifying effect
Avoiding activity after a fall, which is understandable and costly
Untreated constipation, sleep problems and low mood, which all limit activity
Delaying starting exercise until symptoms are advanced

Settles it

High-intensity aerobic exercise, which is the only intervention showing an effect on progression
Amplitude-based training - deliberately large, exaggerated movements - which addresses the specific motor deficit
Balance and gait training, including cueing strategies for freezing
Resistance training, which improves strength, function and quality of life
Boxing, dance and tai chi programmes, all of which have evidence in Parkinson's

What actually helps

The short version: Dopaminergic loss producing bradykinesia, rigidity and postural instability; exercise appears neuroprotective

Strength work: Full Body; Legs: Quads; Glutes; high-intensity and large-amplitude movements

Stretching: Chest; Hips: Flexors; Spine - counter the flexed posture

Massage: Foam Roller Massage; Neck & Shoulders

Also worth doing: Balance and gait training; boxing and dance programs; cueing strategies

What the evidence says: High-intensity aerobic exercise slowed motor decline in the SPARX trial. Amplitude-based training (LSVT BIG) improves function. Exercise is disease-modifying here, not just symptomatic.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineMovement for Neurological Conditions

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Get it checked if…

Freezing of gait with falls needs specialist input; sudden change may be medication-related

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise improves motor symptoms, balance, gait and quality of life, with benefits appearing over eight to twelve weeks and needing to continue. The high-intensity trials suggesting slowed progression are the most important development in Parkinson's management in years, and they argue for starting early and training hard rather than waiting. Exercise works alongside medication and neurology care rather than replacing either, and a physiotherapist experienced in Parkinson's is worth seeking out.

Prevalence basis: Neurology epidemiology

Others the same routine covers

These share the Movement for Neurological Conditions routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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