Parkinson Disease — A Guide for Physical Therapists

Publication Date: December 28, 2021



Aerobic Exercise

Recommendation: Moderate- to high-intensity aerobic exercise improves oxygen consumption (VO2), reduces motor disease severity, and improves functional outcomes. (S)
Benefits: Start aerobic exercise on a treadmill or stationary bike early in disease for maximal benefit; perform 3×/wk for 30–40’.
Risks: Choose mode to ensure safety and gradually progress to reduce risk of musculoskeletal injury.
Exclusions: Screen to ensure no other conditions exist that preclude moderate–high intensity aerobic exercise.

Resistance Training

Recommendation: Strength, power, non-motor symptoms, motor disease severity, functional outcomes, and quality of life are all improved by resistance training. (S)
Benefits: Benefits observed when done alone or part of multi-modal program. May reduce fall rate. Optimal dosing has not been determined. Perform 1–2×/wk for 30–60’ at 80% repetition maximum (RM) for strength; 40% RM for endurance.
Risks: Muscle or joint pain.
Exclusions: Individuals with cognitive impairment or advanced.

Balance Training

Recommendation: Balance-training programs improve postural control, balance and gait outcomes, mobility, balance confidence, and quality of life. (S)
Benefits: Multi-system balance training 2–3×/wk may improve motor symptoms such as postural control and mobility as well as quality of life.
Risks: Falls.

External Cueing

Recommendation: External cueing reduces motor disease severity and freezing of gait and improves overall gait in individuals with Parkinson disease (PD). (S)
Benefits: Cueing included rhythmic auditory, visual, verbal, and attentional cues. No type of cue was superior. Cost of equipment should be considered.
Exclusions: None.

Flexibility Exercises

Recommendation: Flexibility exercises improve range of motion (ROM). (W)
Benefits: Addresses the impact of rigidity on ROM.

Community-Based Exercise

Recommendation: Community-based exercise reduces motor disease severity, and improves non-motor symptoms, functional outcomes, and quality of life in individuals with PD. (S)
Benefits: No one mode of community exercise program is superior to another. There may be improved adherence with community over individual exercise.
Exclusions: Most studies included individuals with mild to moderate PD with no cognitive impairment.

Integrated Care

Recommendation: For individuals with PD, integrating care with other health professionals can reduce motor disease severity and improve quality of life. (S)
Benefits: Receiving care from an integrated multi-disciplinary medical team (including physical therapists [PTs]) may improve motor and non-motor symptoms.
Exclusions: Studies limited to Hoehn and Yahr scale (H&Y) I–III without cognitive impairment.


Recommendation: Physical therapy services may be delivered via telerehabilitation to improve balance in individuals with PD. (W)
Benefits: Balance may improve with telerehabilitation. May remove patient barriers to therapy.
Risks: Some may need safety assistance from a caregiver for remote monitoring.
Exclusions: Studies limited to H&Y I–III without cognitive impairment who have access to technology.

Gait Training

Recommendation: To reduce motor disease severity and improve stride length, gait speed, mobility, gait training and balance should be included in any treatment plan for individuals with PD. (S)
Benefits: Appears to work best when provided 20–60 minutes, 3–5 days per week, for 4–12 weeks. Studies show a decline over time indicating gait training may need to be continued to prevent decline.
Exclusions: Studies did not include individuals in middle to late disease stages. A harness should be used for individuals at high risk of falls.

Task-Specific Training

Recommendation: Task-specific training improves task-specific impairment levels and functional outcomes. (S)
Benefits: Improves the task that was specifically trained and works in upper and lower extremity as well as bladder function.
Exclusions: Individuals in late middle and late stage and those with cognitive impairment were not included in any studies.

Behavior Change Approach

Recommendation: Behavior change approaches augment improvement in physical activity and quality of life. (M)
Benefits: Improved participation, activities, body structure, and function.
Exclusions: Additional training of physical therapists may be necessary to optimize behavior change approaches.

Recommendation Category — PD EDGE Suggested Measures to Assess Change

Having trouble viewing table?
Recommendation Category PD EDGE Suggested Measures to Assess Change
Aerobic Exercise Movement Disorders Society Unified Parkinson’s Disease Rating Scale (Part III; Motor Exam) (MDS-UPDRS III), Six Minute Walk Test (6MWT)
Resistance Training Montreal Cognitive Assessment, 10 Meter Walk Test (10MWT), Mini Balance Evaluation Systems Test (Mini-BESTest)
Balance Training Mini-BESTest, Functional Gait Assessment (FGA), Freezing of Gait Questionnaire (FOG-Q), Parkinson’s Disease Questionnaire-39 (PDQ-39), Activities-Specific Balance Confidence Scale (ABC)
External Cueing 10MWT, Dual Task Timed Up and Go (TUG), Mini-BESTest, 6MWT, FOG-Q
Community-Based Exercise MDS-UPDRS III, Montreal Cognitive Assessment, PDQ-39 and-8
Gait Training MDS-UPDRS III, 6MWT, ABC, FGA, Mini-BESTest
Task Specific Training 6MWT, ABC, Mini-BESTest, Dual Task TUG, FGA, 10MWT, 9 Hole peg test, FOG-Q, MDS-UPDRS III
Behavior-Change Approach MDS-UPDRS III, 6MWT, PDQ-39
Integrated Care MDS-UPDRS III, PDQ-39
Telerehabilitation 6MWT, PDQ-39