The Importance of Physical Therapy for Parkinson’s Disease

Without proper guidance, Parkinson’s disease management can seem overwhelming. While PD causes various complex symptoms, a properly selected, individualized exercise program is the first step toward muting the effects of the disease.

Parkinson’s Physical Therapy can encompass many treatment options that overlap or work together to help you meet your treatment goals. By carefully helping you select the right exercises, your physical therapist can be your guide and ally on your Parkinson’s journey.

What Are the Effects of Parkinson’s Disease?

Parkinson’s disease is a neurodegenerative condition that damages the cells in the brain responsible for creating dopamine.

With a loss of dopamine, nerves have a more difficult time communicating, which results in unwanted movement patterns like tremors or difficulty initiating movements, including speech. (1)

As Parkinson’s Disease progresses, you may experience symptoms such as slowed, smaller movements, stiffness, walking changes, and balance problems. Fortunately, physical therapy can hugely benefit those with Parkinson’s Disease.

How can Physical Therapy Help?

Physical therapists are trained medical professionals specializing in movement and movement disorders.

Physical therapy is based on your individual needs and abilities. Unlike group-based classes, a physical therapist will design a program specific to your needs while ensuring your exercise safety.

Physical therapy for Parkinson’s disease has been widely studied, creating clinical practice guidelines (CPGs) to help therapists make informed, research-based decisions regarding the best possible care practices. (2)

Research best supports moderate to high-intensity aerobic exercise, resistance training, balance training, gait training, and task-specific training. Community-based activity is also highly recommended.

As a unique attribute specific to Parkinson’s treatment, your physical therapist may also recommend cognitive challenges and specific exercises that focus on the amplitude—or size of movements. (2)

What To Expect From Your Physical Therapy Exercise Program

Aerobic Training

Aerobic exercise (cardio or cardiovascular exercise) is any exercise that increases your heart rate and helps your body use oxygen more efficiently.

Common examples include walking on a treadmill or biking. Still, the effects can also be accomplished with sustained aerobic exercises (such as step-ups).

Many studies have demonstrated reduced motor decline and improved walking performance following aerobic training in people with Parkinson’s Disease, while others have reported improved balance, ease of daily living tasks, cognition, sleep, and a lower prevalence of depression which can be common in some Parkinson’s patients.

The American Physical Therapy Association recommends moderate-to-high aerobic intensity levels defined as 60-75% of your maximum heart rate for moderate and 75-85% for high intensity. Your physical therapist can help you to determine the proper range for your body. (2)

Amplitude Training:

Amplitude training is a central focus point of physical therapy for Parkinson’s Disease.

LSVT-BIG (The Lee Silverman Voice Treatment) is a specialized program that explicitly addresses amplitude of motion using large body movements to improve speed and reduce hesitations in movement. This program requires specific training and is administered by a certified physical therapist.

After only four weeks of training, the program has improved motor performance and overall quality of life in patients. More significant improvements have been seen with more prolonged treatment periods. (3)

The LSVT-BIG program is designed to be an individualized approach that addresses motor symptoms and the emotional and cognitive challenges faced by people with PD. To find a certified provider near you, visit lsvtglobal.com. (4)

Resistance Training

Physical therapist-guided resistance exercises build muscle strength through body weight, bands, weights, or other devices.

High-quality resistance training is progressive, meaning each session gradually increases intensity so your body can continually adapt and grow. Focusing on functional movements like squatting, lifting, lunging, and pulling during training sessions improves strength for daily tasks.

Resistance training has been found to improve strength and power in people generally. However, it can be specifically beneficial for people with Parkinson’s.

Even more significant improvements have been documented when combining resistance training with instability, like standing on a foam pad during training.

Studies have also shown improvements in depression, anxiety, cognition, and quality of life following resistance training. (2) 

Balance Training

Balance training may include various activities, from static (standing still) to dynamic movements, like stepping over an obstacle.

Since Parkinson’s Disease affects your motor patterns and movement planning, you may be at higher risk of falls. For this reason, balance training is typically a crucial part of physical therapy.

Balance exercises will precisely simulate real-life challenges. For this reason, activities may include weight shifting in varied positions and, in some cases, perturbation training which involves being bumped or moved to test your response and stability. (2)

Balance training can help reduce your risk of falls, improve your confidence while moving, and improve your walking ability, regardless of a Parkinson’s disease diagnosis.

Task-Specific Training and Gait Training

Task Specific Training

Task-specific training refers to training the exact movement or activity you are trying to improve.

This type of training is all about being specific. For example, if you want to get better at standing from a chair without using your hands, you must practice standing from a chair without using your hands.

Just like an athlete, training in specific, repetitive ways helps to improve the carryover of the activity from the clinic to your daily life and activities. Repetition is a critical factor in the success of this type of training, ensuring that the motor pattern being taught or practiced becomes a habit.

Gait Training

Gait training is one form of task-specific training to improve walking ability. Gait training has been found to help reduce motor disease severity and improve speed, balance, and stride length. (2)

It is common for your physical therapist to include external cues during training to help build valuable skills. Guided gait training may consist of treadmill walking at certain speeds, walking to the beat of a metronome, walking on varied surfaces, and many other methods based on your specific difficulties.

This method can also be used at home to train and improve daily movement patterns. (5)

Cognitive Training

Cognitive challenges during exercise require increased mental focus and are typically associated with learning a new skill.

Dual-task training is a prevalent way to combine both task-specific training and cognitive challenges. This method typically requires the completion of one physical activity while simultaneously performing mental challenges.

This might look like walking while counting by threes or naming states. The goal of dual tasking is to try to maintain proper mechanics and balance while also focusing your attention on mental challenges. (2)

Skill-based activities are goal- and accuracy-oriented and have been shown to increase the number of synapses per neuron in the motor area of the brain, leading to more significant improvements in brain function in PD patients. (6)

Group-Based Exercises

Group-based exercises are highly supported in the research to stay active and incorporate the categories mentioned above.

Classes might range from sport specific, such as boxing, golf, and karate, to balanced-based classes, like yoga and tai chi. Talk with your PT about which resources and classes are available in your area and which may be most beneficial for you.

Summary

An adequately chosen exercise program is your first defense against Parkinson’s disease symptoms.

You can look to your physical therapist as your partner in minimizing the effects of Parkinson’s disease on your daily life. They will build a program with a wide array of treatment methods to ensure you get the best care to meet your needs.

Click this link if you’d like to try PWR Moves, a Parkinsons-based training method.

Resources:

1. MacCormick, Holly. Good Vibrations- Can Parkinson’s Symptoms be stopped? Stanford Medicine Magazine: Neurology and Neurosurgery. 2021 Oct 14. (2) https://stanmed.stanford.edu/vibrating-glove-reorganize-neurons-parkinsons/

2. Osborne, J. A., Botkin, R., Colon-Semenza, C., DeAngelis, T. R., Gallardo, O. G., Kosakowski, H., Martello, J., Pradhan, S., Rafferty, M., Readinger, J. L., Whitt, A. L., & Ellis, T. D. (2022). Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Physical therapy, 102(4), pzab302. https://doi.org/10.1093/ptj/pzab302

3. Peterka, M., Odorfer, T., Schwab, M., Volkmann, J., & Zeller, D. (2020). LSVT-BIG therapy in Parkinson’s disease: physiological evidence for proprioceptive recalibration. BMC neurology, 20(1), 276. https://doi.org/10.1186/s12883-020-01858-2

4. LSVT Global. Locate an LSVT Certified Clinician. https://www.lsvtglobal.com/LSVTFindClinicians

5. Morris, M. E., Martin, C. L., & Schenkman, M. L. (2010). Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Physical therapy, 90(2), 280–288. https://doi.org/10.2522/ptj.20090091

6. Jakowec, M. W., Wang, Z., Holschneider, D., Beeler, J., & Petzinger, G. M. (2016). Engaging cognitive circuits to promote motor recovery in degenerative disorders. exercise as a learning modality. Journal of human kinetics, 52, 35–51. https://doi.org/10.1515/hukin-2015-0192