What it is
A short, honest summary.
- —Parkinson's disease is a progressive condition of the brain's dopamine-producing cells.
- —Symptoms emerge gradually — tremor, stiffness, slowness, balance changes, voice softening.
- —Exercise has the strongest evidence base of any non-medication intervention.
What families notice
The signals worth taking seriously.
- 01Resting tremor in one hand
- 02Shuffling gait, freezing in doorways
- 03Stooped posture
- 04Soft, low-volume speech
- 05Sleep disturbance, low mood, or constipation (often early signs)
My approach
How the work is structured.
- —Tailored exercise — large-amplitude movement work (LSVT-style), gait training, balance and dual-task practice.
- —Coordination with the neurologist on medication-timing for therapy sessions.
- —Caregiver training for freezing episodes, fall prevention, and home modifications.
- —Quarterly reviews tracking standardised functional measures.
What recovery looks like
A plain-language picture.
“We don't reverse Parkinson's, but with the right work most people preserve function, confidence, and independence for years longer than they otherwise would.”
FAQ
Common questions, answered briefly.
- How often should someone with Parkinson's exercise?
- Most evidence supports moderate-to-vigorous exercise four to five times a week, with at least two sessions of strength or amplitude work.
- Can exercise really slow progression?
- It can preserve function and quality of life significantly, and there's evolving evidence it influences disease course.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Parkinson's disease is a progressive synucleinopathy with degeneration of nigrostriatal dopaminergic neurons; bradykinesia, rigidity, rest tremor and postural instability emerge once substantial cell loss has occurred. Exercise has the strongest non-pharmacological evidence base, with amplitude-focused and higher-intensity work showing the clearest functional — and possibly disease-modifying — signal. Therapy is most productive timed to the medication ON state.
Terminology
Terms worth being precise about.
- Bradykinesia
- Slowness and progressive decrement of movement; the core motor feature.
- Freezing of gait
- Sudden, brief inability to step, often at thresholds or on turning; a major falls driver.
- ON/OFF fluctuations
- Swings in mobility with the levodopa cycle; therapy is scheduled to the ON state.
- Hypophonia
- Reduced voice volume; flagged for speech-and-language referral.
Assessment & measures
What the first sessions measure.
- —MDS-UPDRS motor section as the shared severity and tracking measure.
- —Balance with the Berg Balance Scale and mini-BESTest; Timed Up and Go with a dual task.
- —Gait with the 10-metre walk test — amplitude and cadence; Freezing of Gait Questionnaire.
Red flags
Signs that need urgent escalation.
- Sudden marked deterioration — consider infection, a medication error, or an alternative diagnosis.
- Recurrent falls with injury.
- Rapid cognitive decline or early severe autonomic failure — consider an atypical parkinsonian syndrome.
Referral & MDT
When and to whom to refer.
Neurologist for medication optimisation and timing. Speech-and-language therapy for hypophonia and swallow; occupational therapy for ADL and home safety; discussion of the deep-brain-stimulation pathway in selected cases.
Evidence
References and guideline anchors.
- Exercise intensity and functional outcome in Parkinson's — PLACEHOLDER — verify against current guidelines before launch.