10 Ways to Get Moving

Follow this advice and you’ll be reaping the benefits of exercising in no time.

Beginning and maintaining an exercise program is challenging even for healthy people. For people with Parkinson's disease, the difficulties are only magnified. "Apathy is the number one obstacle," says Joseph Jankovic, MD, FAAN, of Baylor College of Medicine. "Another is fatigue." But don't give up before you start. "Once people find out how great exercise makes them feel, they come back," says Kimberly Berg, MS, CEP, of the Brian Grant Foundation. These steps can help you start and stick with exercise.

1. Check with your doctor. Make sure you’re healthy enough for exercise. Some people have Parkinson’s-related heart problems they need to be vigilant about, for example. Exercise does have risks, says Dr. Jancovic, but for most people the benefits outweigh the risks.
2. Find a program. Most towns have a local Parkinson’s disease organization that can refer you to exercise programs. You can also get leads from state organizations, neurologists with experience with Parkinson’s disease, physical therapists, other people with the disease, and major medical centers. Ask for physical therapists or trainers who specialize in neurologic therapy and have worked with people with Parkinson’s disease. Tell contacts about your functional level and ask for programs with others at that level, suggests Dr. Hirsch.
3. Start slow. Respect your current abilities and level of fitness, no matter how athletic you were pre-diagnosis. “If you’re doing a balance exercise where you stand on one foot, for example, hold on to a stable object and just lift your heel at first,” Berg says. Progress through raising your foot higher, then support yourself with two fingers before advancing to the full single-leg stance. When you introduce an aerobic activity, start at an easy pace and add intensity gradually from day to day. “You should feel invigorated and maybe a little sore the next day, but not physically exhausted,” Berg says. “As your abilities improve, you can push yourself more and challenge your limits.”
4. Don't be alarmed by increased tremors. It might seem like symptoms get worse right after exercise. That's because adrenaline released during a workout can increase tremors temporarily, says Dr. Jankovic. "It's a normal and transient response," he says. "It does not indicate Parkinson's is getting worse, and the long-term benefits of exercise outweigh the short-term effect."
5. Make exercise social. People tend to stick with exercise better when they work out with a group. “It builds community and holds you accountable to the team,” Berg says, adding that many participants form their own support group. Socializing can also help relieve depression.
6. Do a variety of exercises. Aerobic conditioning, strength training, tai chi, and yoga have all been found to help with Parkinson’s disease, but each may have distinct benefits, says Dr. Jankovic. “I encourage patients to combine exercises or do different things on different days,” he says. 
7. Aim for midmorning or early afternoon. In the morning, people with Parkinson’s disease are often stiff. In the evening, they’re often tired. Exercising around midday tends to be a sweet spot when the benefits of medication often peak.
8. Play music. People work harder and perceive exercise as less taxing when they listen to music, according to research published by the National Academy of Sciences. “Music is a motivator,” Berg says. “I find people especially respond to music from their high school days.” 
9. Drink plenty of water. People with Parkinson’s disease tend to be chronically dehydrated, in part because the disease affects brain cells that signal thirst. Medication for the disease can intensify the effect. “Carry a water bottle and sip from it the entire workout,” Berg says.
10. Exercise your mind. Animal studies suggest that mice in “enriched” environments full of other mice and lots of toys need less exercise to protect their brains than mice that do a limited number of activities by themselves, according to Michael Zigmond, PhD, of the University of Pittsburgh. “Instead of walking on a treadmill, I’d go outside where you need to pay more attention to where you’re going and where varying scenery stimulates your mind,” Zigmond says. When not exercising, play cards or chess, read, socialize, or do other activities that make you think, he suggests.

Read our interview with Brian Grant from the February/March 2016 issue.