This feature article was written by guest author, Susha Thomas, PT, DPT, C/NDT, and LSVT BIG Certified Clinician. Susha has published two books for the Parkinson’s community, “100 Exercises for Parkinson’s Disease” and “Parkinson’s Disease- Reclaim your Life”, which have been featured at the World Parkinson Congress.
Receiving a Parkinson’s diagnosis can feel overwhelming and life changing. For many patients, hearing that it is a progressive disorder brings fear, discouragement, and a sense of hopelessness. In my experience working with individuals living with Parkinson’s disease, I have seen how easy it is for people to believe there is nothing they can do to improve their quality of life. But I have also witnessed something incredibly powerful hope restored through action.
Understanding Parkinson’s
Deep within the brain are two important structures called the substantia nigra and the basal ganglia. The nerve cells in the substantia nigra produce a chemical messenger, or neurotransmitter, called dopamine. In people living with Parkinson’s disease, dopamine levels become significantly reduced over time.
Why is Dopamine so Important?
Dopamine plays a critical role in helping the body produce smooth, efficient, and coordinated movement. When dopamine levels decrease, movement becomes slower, smaller, and more difficult. For many people with Parkinson’s, it can feel as though their entire world has gradually become smaller.
This loss of dopamine can lead to many of the hallmark symptoms of Parkinson’s disease, including short shuffling steps, smaller handwriting, a softer voice, stiffness, rigidity, freezing episodes, and the sensation that the feet are “stuck” to the floor. These changes occur because the brain is no longer sending movement signals as effectively as it once did.
One of the challenges with Parkinson’s is that many individuals do not realize their movements have become smaller. The brain’s internal sense of movement, sometimes called internal calibration, becomes altered. As a result, movements that feel exaggerated or “too big” to someone with Parkinson’s are often actually normal-sized movements.
This is why specialized exercise programs, such as LSVT BIG®, can be so beneficial. These programs help retrain and rewire the brain to produce larger, more intentional movements. In Parkinson’s disease, bigger movements are often better movements.
Symptoms of Parkinson’s
The symptoms of Parkinson’s disease typically do not begin to appear until nearly 80% of the brain’s dopamine has been depleted. Imagine that, by the time noticeable symptoms develop, the disease process has often been progressing silently for years. In fact, many individuals may be living with the early stages of Parkinson’s for six to ten years before they even realize something is wrong.
The hallmark symptoms of Parkinson’s disease include smaller and slower movements, tremors, stiffness or rigidity, and difficulties with balance and coordination. Although Parkinson’s is a progressive disorder, there is still hope. There are many strategies, exercises, and treatment approaches that can help manage symptoms, maintain independence, and even slow the progression of the disease.
Top 5 Tips for Living Well with Parkinson’s
1. Exercise, Exercise, Exercise
Exercise is one of the most important tools for individuals living with Parkinson’s disease. Regular physical activity helps improve balance, mobility, strength, posture, and overall quality of life. More importantly, exercise has been shown to help slow the progression of the disease and play a critical role in managing symptoms.
In Parkinson’s disease, the brain cells that produce dopamine, the neurotransmitter responsible for smooth and efficient movement, become damaged over time. By the time symptoms begin to appear, nearly 80% of these dopamine-producing neurons have already been lost. Because of this, the brain must begin creating new pathways and connections to help support movement and function. Research has shown that exercise promotes neuroplasticity, the brain’s ability to form and strengthen these new connections.
One of the hallmark features of Parkinson’s is that the brain begins signaling the body to move smaller and slower. Steps become shorter, handwriting shrinks, posture becomes more stooped, and the voice may become softer. To help retrain the brain, individuals with Parkinson’s must intentionally practice moving bigger.
Practice taking BIG steps, forward, backward, and sideways. Practice speaking with a louder voice. Practice writing larger and moving with exaggerated effort. Often, movements that feel “too big” are actually normal-sized movements.
When freezing or difficulty with movement occurs, making the movement larger and more deliberate can often improve performance. Early intervention is essential. Starting exercise early allows us to maximize and protect the remaining dopamine reserves in the brain while encouraging healthier movement patterns. Exercise should be viewed like daily medication, something that becomes a consistent and non-negotiable part of treatment.
To create meaningful changes in the brain, exercise should be challenging, purposeful, and engaging. Specialized programs such as LSVT BIG are specifically designed to improve movement amplitude and help recalibrate the brain’s perception of movement. These programs have been shown to improve balance, posture, mobility, and overall quality of life for individuals living with Parkinson’s disease. Other forms of exercise, including boxing programs, dance, aerobic exercise, strength training, stretching, yoga, and cycling, have also demonstrated significant benefits. The key is consistency. Every movement matters, and every effort to stay active helps support both the brain and the body.
Tips for Freezing:
You may notice freezing or the feeling that your feet are stuck, especially in doorways, thresholds or transitioning from standing to walking. Never push through a freezing episode. Remember the 4 S’s instead to unfreeze and be able to move:
- STOP
- STAND TALL
- SHIFT WEIGHT
- STEP BIG
2. Medication Management
Timing of Parkinson’s medication is very important. Many Parkinson’s medications-especially Carbidopa/Levodopa work for a limited number of hours. If doses are late, missed or taken inconsistently, it can make the symptoms worse, more tremors, increased rigidity, loss of balance, confusion and difficulty communicating, and it may take a longer time to recover. Have your ever felt like you have times that you perform very well soon after you have taken your Parkinson’s medications, and then you can feel that drug wearing off and your performance is not so great anymore? Well, you are not alone. There is commonly a peak performance period and a wearing off period.
As Parkinson’s progresses, medication needs often change.
- Doses may need adjustment
- Side effects may emerge
- Medications may stop lasting as long
- New symptoms may appear
It is very important to keep your neurologist or movement disorder specialist informed of any medication side effects or changes. Well managed medication routines can help maintain mobility, independence, sleep and active participation in activities.
Tips for Medication Management:
- Pill organizers
- Medication reminder systems, like setting alarms or smartwatch reminders
- Timed pill dispensers
- Symptom diaries
- Regular follow up with neurologist or movement disorder specialist
- Medication apps
- Take medication 30-60 minutes before meals or 1-2 hours after meals to improve effectiveness
3. Diet and Hydration
Diet and hydration are very important in Parkinson’s disease and good dietary habits can improve daily functioning and quality of life. Diet and hydration can affect
- Constipation
- Medication absorption
- Energy levels
- Blood pressure
- Swallowing
- Overall mobility
Dehydration is very common in Parkinson’s disease and those affected may drink less because there is reduced thirst sensation, swallowing difficulty, bladder urgency concerns or mobility challenges. Dehydration can worsen the risk of developing urinary tract infections, can worsen dizziness, confusion, fatigue, constipation and can result in low blood pressure especially when changing positions from lying to sitting to standing (orthostatic hypotension).
People living with Parkinson’s disease should consider a protein shift diet where larger protein intakes are reserved for evening meals. The reason for this is that dietary protein present in eggs, milk, chicken, etc. can compete with levodopa absorption in the intestine and brain, So the less competition during the active parts of the day, the better. Try intaking less protein during breakfast and lunch so more Levodopa can be absorbed and shift protein consumption to dinner.
Tips for Diet and Hydration:
- Take Levodopa 30-60 minutes before meals or 1-2 hours after meals
- Shift protein intake towards evening
- Always eat sitting upright to prevent risk of aspiration pneumonia
- Encourage hydration throughout the day
- Use water bottles marked with hourly goals
- Use flavored water
- Drink more fluids during the day, restrict large fluid intake close to bedtime to avoid need for frequent urination
4. Fall Prevention and Home safety
Falls and balance problems are very common with Parkinson’s disease. Problem with balance and strength leading to the inability to remain upright causes a fall. Some people tighten their muscles when they feel they are about to fall. This stiffening can limit the range of motion and make a fall more likely.
Some contributing factors for a fall include:
- Problems with vision
- Loss of sense of touch in a person’s feet and ankles
- Dizziness due to medical conditions like orthostatic hypotension or diabetes
- Weak muscles, especially in the legs
- Foot problems and foot deformities
- Memory loss, confusion, or difficulty with problem solving
- Medication related falls
- Environmental risks: outside hazards like icy sidewalks, home hazards like loose throw rugs, risky footwear like flip flops or high heels
Tips to Prevent a Fall:
- Talk to your doctor:
- Inform your doctor of any falls or changes to your health.
- Some of the medications that you may be on can lead to side effects that lead to a fall. Common medications that can cause these side effects are blood pressure, pain medications, medications for sleep and antidepressants.
- See your eye doctor and make sure your eyewear prescriptions are up to date. Poor vision and conditions like glaucoma and cataract increase the chances of falling.
Remove Hazards:
- Remove loose rugs and cords and keep pathways clear.
- Install grab bars as needed in the bathroom near the toilet and in the shower.
- Purchase a shower chair or tub bench to be able to sit down for showers.
- Install a handheld shower.
- Add railings to stairs.
- Choose chairs with long arm rests.
- If your couch is too low making it hard to stand up, consider purchasing couch risers.
- Keep things within reach.
- Re-arrange furniture to open the area and remove unnecessary obstacles in your path.
- Add bed rails that can be installed under the mattress to help move easier in bed.
5. Community Support
Maintaining emotional health is just as important as maintaining your physical health. The entire process of Parkinson’s may be difficult from the onset of symptoms to the official diagnosis to seeking out treatment. You may be overwhelmed with emotions and feelings of despair, anger, grief, denial, and hope. You are not alone. There are support services and support groups available to every state. If you go to Parkinson.org and type in your zip code, you will be able to view all resources available in your area. You can also visit the American Parkinson Disease Association website for more information on Parkinson’s. Many support groups offer group exercise classes, boxing classes, speech classes, support groups and other resources free of charge to people living with Parkinson’s.
Reclaim your Life
When patients began applying the tips, strategies, and techniques I shared with them, they were often amazed by how much they were still able to accomplish. Small changes led to meaningful improvements, helping them regain confidence, independence, and motivation. Watching these transformations inspired me to author two books on Parkinson’s disease, both of which were selected and displayed at the World Parkinson Conference in 2026 and 2023. The link to my books can be found at the end of this blog.
If you are living with Parkinson’s, remember this: you are not powerless. Your mindset matters, and your actions matter. Focus on what you can do, one step at a time, and take pride in continuing to move forward despite the challenges. Life with Parkinson’s may look different, but it can still be meaningful, active, and fulfilling.
Exercise remains the only proven way to help slow the progression of the disease, making movement one of the most powerful tools you have. It may feel difficult at first, but consistency creates progress. Keep showing up for yourself, even on the hard days.
