Strengthening Exercise in Parkinson's

The sun is out, flowers are blooming, and spring is just around the corner. For many of us the good weather is an inspiration to get moving and try something new. Maybe for you this is the time to focus on getting stronger.

Strength training, or resistance training as it is also called, is often an under recommended form of exercise for people with Parkinson’s. It can also be very intimidating to begin if you are inexperienced and fearful of risk of injury. But evidence shows the benefits outweigh the risks and it is safe when performed correctly.

So first let’s define resistance training. Quite simply it is the use of an opposing force to increase strength. That opposing force could be a dumbbell, resistance band, or even body weight against gravity. Within the strength training world there are different subtypes. These include focus on muscle hypertrophy, endurance, strength, and power. Depending on your goals there is benefits to each of these types of strengthening methods for people with Parkinson’s, but what does the evidence recommend?

There are significant benefits for strength training for everyone, especially as we age. Evidence shows resistance training can reduce your risk and even improve osteoporosis, cardiovascular disease, diabetes, and improve cognition. It has been shown to improve quality of sleep and mental health stability. As we age it has been shown that people who perform strength training maintain their independence with their daily activities longer as well as reduce their risk of falls. Much of these benefits are due to reduced age related muscle mass loss, which is known as Sarcopenia.

Sarcopenia and Osteoporosis are two of the most common predictors of falls and loss of function for people over 65 years of age. Sadly, sarcopenia starts as early as 40 years old, increases risk of mortality, and is more common in people with Parkinson’s. Osteoporosis, loss of bone density, increases risk of fractures with falls leading to increased risk of mortality. Caution ladies, as both of these disorders are more common for us, especially post menopause! The good news…both can be improved with strength training!

The below photo shows the quad muscle mass of three different individuals: a 40 year old triathlete, a 74 year old sedentary individual, and a 74 year old triathlete. The darker tissue is muscle and the whiter tissue is fat. I love this example because although it shows how detrimental a sedentary lifestyle can be to muscle mass (photo #2), it shows with continued exercise as we age we can maintain our muscle mass similar to much younger age groups(photo #3). In fact, evidence shows that people even over 100 years old were able to increase their muscle mass with strength training and it was safe. There is hope for all of us!

So I am sure some of you are wondering is this relevant to Parkinson’s specifically? Parkinson’s is not technically a disease of the muscle, but of the central nervous system. Despite this there is an increased occurrence of sarcopenia and strength loss compared to age related norms for people with Parkinson’s. Why??

Well, some of this is change in activity level and lifestyle with onset of Parkinson’s. Some of this is due to reduced ability to quickly and appropriately activate the muscles, which is controlled by your nervous system. If you can’t quickly contract and activate a strong muscle appropriately, is it truly strong? On top of these points, there has been newer data showing that there are proteins called alpha-syn nuclei found in muscle cells that are harmful to the muscles as well as neuro-inflammation which can also damage that system.

Primarily though, Parkinson’s is a movement disorder. I know most of you are familiar with the common symptoms like bradykinesia, rigidity, posture changes, imbalance, and even orthostatic hypotension. Many of these symptoms can lead to a perception of feeling weak due to reduced speed/timing of muscle activation, stiff muscles reducing agility of movement, more energy focused on maintaining balance, and feeling dizzy/lightheaded from low blood pressure. No wonder weakness is a common complaint in the disorder!

So how to we fight these symptoms and the increased risk of muscle loss?? You guessed it….Exercise! Now it’s time to look at the evidence out there for strength training with Parkinson’s. Although not as commonly mentioned, resistance training is one of the keys for disease modification. Evidence has shown strength training in Parkinson’s:

• Improves balance and reduces fall risk

• Prevents muscle atrophy 

• Improves walking ability 

• Improves cognition and executive function

• Reduces freezing of gait

• Improves Quality of Life Reported 

• Improves ability to complete daily functional activity (especially those requiring a lot of strength!)

• Improves sleep quality

Why does this help? Of course the reasons are multi-factorial:

• Neuroexcitation: 

  • Increased strength of signals from brain → muscles 

• Neuroplasticity: 

  • Changes to the brain, creating new pathways, especially areas that control movement and muscle use 

• Improved Muscle Strength → improved force generation capacity for demanding tasks

• Fight effects of reduced activity → muscle loss

  • If you don’t use it, you lose it

And as you have heard time and time again…INTENSITY MATTERS! The load and challenge must be large enough to promote change. Looking at at the evidence, increasing the weight challenge as you get stronger over the weeks leads to significantly greater improvements compared to staying at same level throughout. Lifting heavier loads has been shown to have more substantial benefit than lighter weight training for people with Parkinson’s. Strength itself can continue to improve even greater than 6 months after starting. Further benefit can be found by increasing the complexity of the task. This study looked at strengthening exercises with standard methods vs placing participants on unstable surfaces to challenge their balance as they did the exercise. Not only did the unstable group gain more strength, but also showed better improvements in cognition and their motor symptoms.

Looking back at the beginning of this newsletter, based on the information you know now, which method of strength training should you choose if you have Parkinson’s? Hypertrophy, Endurance, Strength, or Power??

Go with what gives you the most bang for you buck:

Strength!

• Beginners: Start higher reps and progress to lower

• 3-8 Repetitions for 3-5 Sets per muscle group 

• Focus on control but with a heavy load

AND

Power!

• Add speed with a load 

• Burst of energy for short periods 

• 1-5 reps for 3-6 sets 

• Usually more complex full body movements

Now you have to decide which muscles to work on. We do know that certain muscles tend to get weaker in people with Parkinson’s due to rigidity and posture changes while some muscles are overactive.

Focus on strengthening the extensor muscles that help with posture and power as well as muscles that are commonly used for daily functional activities. Getting up from the ground, out of bed, standing from a chair, walking up stairs all require a lot of the under-active muscles in Parkinson’s.

I am hoping now you feel inspired to get out there and start lifting heavy things, but where do you start? As strength/power parameters are recommended you will want to lift a heavy enough weight that you can only complete about 1 to 7 repetitions prior to fatigue. You can assist in figuring out where to start by using a percentage of the weight you can only lift one time, also known as your 1 Repetition Maximum (RM). If you are new to strength training it is normal to start with higher repetitions and lower weight and then progress to heavy loads for less repetitions once used to the exercise.

If you are feeling overwhelmed on where to start and would like some guidance on how to progress, then consider joining Ignite’s Progressive Strength Training program. This is a one time program that is 12 weeks long 2x/week focused on progressive strength training for people with Parkinson’s. This starts soon!! April 6th- June 25th at 11 am every Monday and Thursday. Spots for 6 participants available.  

Sign up below and reach out with any other questions:

Please be cautious of any injuries or uncontrolled cardiovascular issues before starting a new program and consult with your doctor or physical therapist if you have concerns. Once cleared then get out there and see what you are capable of. You are probably stronger than you think and there is always room for improvement.

As always if you think this newsletter would be beneficial for anyone you know please feel free to share. Reach out with any thoughts or questions you have.

The more your know, the stronger you will be

Laura

References:

SILVA-BATISTA, CARLA; CORCOS, DANIEL M.; ROSCHEL, HAMILTON; KANEGUSUKU, HÉLCIO; GOBBI, LILIAN TERESA BUCKEN; PIEMONTE, MARIA ELISA PIMENTEL; MATTOS, EUGENIA CASELLA TAVARES; DE MELLO, MARCO TUÚLIO; FORJAZ, CLÁUDIA L. M.; TRICOLI, VALMOR; UGRINOWITSCH, CARLOS. Resistance Training with Instability for Patients with Parkinson’s Disease. Medicine & Science in Sports & Exercise 48(9):p 1678-1687, September 2016. | DOI: 10.1249/MSS.0000000000000945

Xiaoxia Yang, Zhiyun Wang; Effectiveness of Progressive Resistance Training in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Eur Neurol 1 February 2023; 86 (1): 25–33. https://doi.org/10.1159/000527029

Nicholas P. Cherup, Andrew N.L. Buskard, Keri L. Strand, Kirk B. Roberson, Emma R. Michiels, Jessica E. Kuhn, Francisco A. Lopez, Joseph F. Signorile, Power vs strength training to improve muscular strength, power, balance and functional movement in individuals diagnosed with Parkinson's disease, Experimental Gerontology, Volume 128, 2019, 110740,ISSN 0531-5565,https://doi.org/10.1016/j.exger.2019.110740.

Meilin Gui, Lingling Lv, Shenglan Hu, Lixia Qin, Chunyu Wang,Sarcopenia in Parkinson's disease: from pathogenesis to interventions, Metabolism,Volume 169,2025, 156272, ISSN 00260495 https://doi.org/10.1016/j.metabol.2025.156272.

Kitsuda, Y., Wada, T., Noma, H. et al. Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis. J Bone Miner Metab 39, 787–803 (2021). https://doi.org/10.1007/s00774-021-01218-1

Talar K, Hernández-Belmonte A, Vetrovsky T, Steffl M, Kałamacka E, Courel-Ibáñez J. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of Clinical Medicine. 2021; 10(8):1630. https://doi.org/10.3390/jcm10081630