If you haven’t yet read Part 1 of our PD series, you can find it here.

Although there is currently no way to correct the brain changes that cause Parkinson’s disease, we know that exercise can help fight the disease and that staying healthy can help reduce setbacks that make living with PD more challenging. Moreover, in addition to regular medication adjustments and physical/occupational therapy, exercise is a core aspect of Parkinson’s treatment and symptom management.ⁱ

“People with Parkinson’s who engaged in at least 2.5 hours of exercise a week had a better quality of life than those who didn’t exercise at all or started exercising later.”

—Parkinson’s Outcomes Project, the largest-ever clinical study of Parkinson’s disease

How to get started teaching people with Parkinson’s disease

As a Pilates instructor and movement educator, how do you get started creating a one-on-one or group program for people with PD? First and foremost, it’s advisable to remember that there is no exercise prescription that is right for every person with PD. The exercises and movements you choose, therefore, should take into consideration the symptoms and challenges facing your client(s). In addition, for those who may be more sedentary, starting with low intensity exercise is beneficial. This can be increased to regular, more vigorous activity as tolerated.ⁱⁱ

“I like to encourage people to realize that any action is a good action if it’s proactive and there is positive intent behind it.”

—Michael J. Fox, actor, activist and founder of the Michael J. Fox Foundation for Parkinson’s Research

Body Harmonics Founder, Margot McKinnon, M.Ed., recently delivered a presentation called “Make Life With Parkinson’s Manageable Through Movement” at this year’s Active Aging Conference put on by the International Conference on Active Aging. The following recommendations were inspired by her presentation, the experience she and her colleagues have gained teaching people with PD, and the growing body of research on the topic of exercise as a critical component in the treatment of Parkinson’s disease.

How to select movements and exercises for people with PD

The following list offers a practical way to think through the kinds of movements, exercises and activities that will help you to meet the needs of clients as their PD progresses—all with a view to helping them enjoy as high a quality of life as is possible every stage. As such, recommendations are listed in priority order—from more foundational to more challenging exercises and movements—as “idea-generators” rather than a pre-set or finite list.

All exercises/movements should be modified to meet the needs of individual clients. For instance, lunges, multifidi rocking and other weight-bearing exercises can be done standing using a chair for support or seated, and spinal flexion should be avoided for individuals with “stooped” posture ⁱⁱⁱ or those with osteoporosis.

1) GOAL/FOCUS: POSTURAL STABILITY

Primary benefits

Improves: Spinal alignment, core strength, walking/movement, general function, bone density
Encourages: Neuroplasticity, independence, mental wellbeing
Alleviates or delays: Pain, motor and non-motor symptoms

Recommended Pilates exercises and movements

– Multifidi alternating forward/back standing rocks
– Quadruped arm/leg reach (or simply hovering one hand off then the other; can be done leaning against a chair or wall)
– Psoas alternating hand-to-knee press (sitting or supine)
– Tongue and mouth/neck exercises (for improved swallowing and postural control to assist with balance and gait mechanics)—the muscles of the tongue and neck and the deep frontal fascial line are implicated in forward head posture ^{iv, v, vi}

2) GOAL/FOCUS: SENSORY, MIND-BODY AND BREATHWORK FOR NEUROMUSCULAR CONNECTION

Primary benefits

Improves: Sense of calm and control, exercise effectiveness, coordination, cognition
Encourages: Neuroplasticity, relaxation response, independence
Alleviates or delays: Pain, motor symptoms (especially dyskinesias and dystonia) and non-motor symptoms (especially depression, anxiety) 

Recommended Pilates exercises and movements

– Sensory rich experiences using tactile props (e.g. spiky balance pods under hands)
– Breathing cues (as long as it is relaxing for clients—don’t obsess about patterned breathing, as it can be stressful for some)
– Focused breathing exercises for self-regulation of stress and anxiety
– Use of props like exercise balls, foam rollers, etc. to add neuro/sensory stimulation and exercise variation

3) GOAL/FOCUS: BALANCE, AGILITY AND BIG, RECIPROCAL MOVEMENTS

Reciprocal movements involve alternating the arms and/or legs—e.g. front crawl in swimming.

Primary benefits

Improves: Balance, ease of movement, coordination, proprioception, function in daily life, bone density when weight-bearing
Encourages: Neuroplasticity, independence, mental wellbeing
Alleviates or delays: Falling and some PD motor and non-motor symptoms

Recommended Pilates exercises and movements

– Dance-like movements (easiest if clients follow and mimic rather than perform freeform)
– Incorporating a scarf to encourage flowing movements
– Alternating sagittal arm raises, bow and arrow torso twist (reciprocal movement)
– Continuous/sustained movements—e.g. legs in straps on the reformer (open chain if they are agile, use footbar for pedaling – closed chain if they are compromised)
– Directional, repetitive movements— e.g. any combination of squats, lunges and lateral moves, with coordinated arms
– Large, dance-like, progressive movements (e.g. starting with feet stomping in/out while counting before adding arm work, then repeating the choreographed routine several times)
– Directional, rocking motions—e.g. multifidi forward/backwards rocks; tick tock weight-shifts side-to-side
- Functional moves—e.g. sit to stand
– Incorporation of rhythmic music to assist with coordinated movements (if cognitive decline is an issue, refrain from using music—to aid with focus)

4) GOAL/FOCUS: DUAL TASKING

“Dual tasking” in a movement and exercise context involves mixing motor with cognitive exercises and/or vocalizations.

Primary benefits

Improves: Movement coordination, function in daily life, proprioception, bone density
Encourages: Neuroplasticity, independence, mental wellbeing
Alleviates or delays: Loss of vocal strength/projection, cognitive decline

Recommended Pilates exercises and movements

– Counting while exercising
– Singing while dancing
– Shouting while exercising
– Clapping while moving
– Talking while walking

5) GOAL/FOCUS: FLEXIBILITY AND MOBILITY

Primary benefits

Improves: Range of joint motion, muscle function/elasticity
Encourages: Neuroplasticity, relaxation response, independence, mental wellbeing
Alleviates or delays: Motor and non-motor symptoms

Recommended Pilates exercises and movements

– Mat foundation exercises
– Pilates saw exercise
– Pilates swan exercise
– Hip hinges
– Wrist circles and stretches
– Ankle circles and Achilles stretches

6) GOAL/FOCUS: MUSCULAR STRENGTH AND ENDURANCE

Primary benefits

Improves: Muscle function, capacity, strength (including deep “core” muscles) and endurance; function in daily life, bone density
Encourages: Neuroplasticity, independence, mental wellbeing, resilience
Alleviates or delays: PD motor and non-motor symptoms

Recommended Pilates exercises and movements

– Body weight resistance exercises (e.g. squats, hip hinges, push-ups, bridge—modify as required)
– Exercises with resistance bands, light hand weights, Magic Circle, etc.
– Exercises with resistance bands, hand weights, Magic Circle, etc.
– Exercises on Pilates resistance equipment (e.g. reformer, chair, cadillac, spring board)
– System-based complex exercises for integrated, functional strength (e.g. lunge with javelin arms)

7) GOAL/FOCUS: VOICE PROJECTION

Primary benefits

Improves: Clarity of speech and voice projection, movement coordination, function in daily life, ability to be understood by others
Encourages: Neuroplasticity, independence, mental wellbeing
Alleviates or delays: Loss of vocal strength/projection, cognitive decline

Recommended Pilates exercises and movements

Clients should feel they are speaking “too loud” (with PD there can be a neurological disconnect between motor perception and reality).

– Voice “stretch and strength” exercises
– Sounding (with varied volumes and duration)—aids breathing too
– Have client(s) count or cue themselves along with (to engage their voice and connect it to their movements)

8) GOAL/FOCUS: CARDIOVASCULAR FITNESS

Primary benefits

Improves: Cardio-respiratory health, energy/endurance, gait
Encourages: Dopamine and endorphin production, dopamine optimization, neuroplasticity, relaxation response, independence
Alleviates or delays: Motor symptoms, especially bradykinesia (slowed movement) and dyskinesias (involuntary movements)
Non-motor PD symptoms (e.g. depression, anxiety, digestion, etc.)

Recommended Pilates exercises and movements

– Low impact “cardio Pilates”
– Pilates-based circuit training or HIIT classes
– Reformer jumpboard classes

You’re in good company!

The Parkinson’s Foundation recommends Pilates as an appropriate exercise methodology for people with PD. To download a copy of their Parkinson’s Exercise Guidelines, please click here.

Read Part 3 of our PD series: Pilates-inspired class plans and tips for teaching people with Parkinson’s disease, by Nancy McKinnon, BASc, NeuroFit Program Director, Body Harmonics.