As a child growing up in the Bronx, Evan saw his grandfather Jack’s hand shake. “We knew he had Parkinson’s disease (PD), but we never really spoke about it,” Evan said. Many years later, Evan’s father — Jack’s son — Keith, would inspire Evan’s Parkinson’s Champions campaign: Push Ups 4 Parkinson’s. 

Fast forward to 2002, Evan and his wife Rachel were on speaker phone with his father, when Evan’s mom said, “Dad has Parkinson’s disease.” What are his symptoms? What happens next? And the family’s PD journey began.

Evan’s parents had a strong marriage. They were ready to take on this challenge together and push through with grace and a positive attitude. At first, symptoms were minimal — no shaking or tremors. Keith dragged his feet, shuffled and him arm stopped swinging when walking. Next, his handwriting changed.

Parkinson’s is a challenging disease because no two people have the same symptoms or progression. In Keith’s case, the family wouldn’t notice new PD symptoms for years. Keith began to experience depression, but he pushed through.

Evan’s parents became involved with Parkinson’s support groups. “Dad led their chapter and enjoyed bringing value to the community,” Evan said. “He was a stand-out leader in business and in his community, and he was becoming noticed.”

But as Keith’s PD worsened, he began to withdraw from his community. Years passed; he was no longer able to drive, and medicines increased as symptoms did. Keith’s mom became his primary caregiver and had to keep pushing, while Evan learned the term “sandwich generation” from experience — caring for multiple generations simultaneously.

Eventually, the family had to make the tough decision to move Keith to a home. “Mom was dealing with everything,” Evan said. “I don’t know how she held it together, but she did. However, she wasn’t taking care of herself. Caregivers get too little credit.”

Evan saw his parents’ ability to push through their situation. “Their strength, hope, and selfless attitude inspired me, and I felt the need to inspire them back somehow. But how?” Evan said. Eventually, Evan came up with the idea of challenging himself to 100 push-ups every day for the rest of his life. He posted his progress on social media daily. His friends and family supported his effort, and soon it caught on around the world.

Even also noticed that his daily commitment was helping him cope with the stress, stay focused, get stronger and channel this into something positive. As Evan’s parents kept on pushing, so did he.

Unfortunately, Keith’s Parkinson’s journey ended at the young age of 74, on June 23, 2017. Evan knew they needed to do more to help others in the PD community. With quick math from his son Jonah, they realized that if Evan continued this push-up movement every day until that same age of 74, the same age his father passed away, he would reach one million push-ups.

“If I can do one million push-ups, and I will, then we should be able to get the rest of the world to do 100 million! And while we’re at it, let’s raise 100 million dollars,” Evan said. This idea grew into the worldwide Pushups 4 Parkinson’s challenge, or 10.10.10, where anyone can get involved by doing 10 pushups, donating $10, and telling 10 friends!

“I wanted to create a catchy way to spread awareness, while challenging, engaging and inspiring people to improve their health and have some fun,” Evan said. He formed an executive board to manage the new 501(c)3 nonprofit that would launch the official 10.10.10 Pushups 4 Parkinson’s challenge and take part in the Parkinson’s Foundation Champions fundraising program.

“We must take action right now and start moving for good health,” Evan said. “Push-ups can help!” Right now, 10.10.10 is hosting a six-month challenge to raise money to end Parkinson’s. At the end of the challenge, Evan will donate the money raised in the campaign to the Parkinson’s Foundation and other organizations to speed up research for a cure, raise awareness, improve quality of life and ensure expert care.

Evan challenges everyone to make a difference and take part in the 10.10.10 challenge in four easy steps:

1. DO 10 push-ups and share on social media (use video or photo)
2. TAG 10 / Challenge 10 friends to do the same. Use hashtags: #My101010  #Move4PD
3. GIVE $10 today @ My101010.org
4. Include these instructions in your post

Once you complete the challenge, commit to daily push-ups and log them on www.PushUps4Parkinsons.org. Keep pushing-up!

Have your own fundraising idea? To start a Parkinson’s Champion fundraiser, visit Parkinson.org/Champions.

Parkinson’s disease (PD) can change the way a person walks. Movement Symptoms like stiff muscles, rigidity and slow movement make it harder to take normal steps. In fact, short, shuffling steps are a common sign of PD, as is freezing, the feeling that your feet are stuck to the floor, for people with mid-stage to advanced PD.

On their own, these changes are distressing enough. But add the fact that Parkinson’s affects balance and they also become dangerous, putting people with PD at risk of falling. The good news is that with exercise and physical therapy, people with PD can improve their balance. What can you do to minimize freezing and avoid falls? Read on to find out.

The following article is based on the latest research and a Parkinson’s Foundation Expert Briefings about Parkinson’s-related freezing, balance and falls hosted by Fay B. Horak, PhD, PT, Professor of Neurology at the Oregon Health & Science University, a Parkinson’s Foundation Center of Excellence.

Freezing of Gait

Freezing happens when your feet stop moving forward while you are walking, even though you try to keep going. It can be brief and happen erratically. Many people experience freezing as they approach a narrow space, like an elevator door. Usually the legs do not stop moving, instead they tremble or the knees move. This happens because during freezing a person rapidly shifts their weight from foot to foot to take a step.

Trouble With Turning

For people who experience freezing, turning in place is difficult. In fact, it is more likely to set off freezing than walking straight. Turning requires quick adjustments to balance and moving your head, upper body and lower body in sequence. If you have rigidity, this is especially difficult to do.

“In my laboratory we have used wearable sensors to measure freezing and turning in people with PD.” Dr. Horak said. “In one study, we put a camera on each participant’s belt and aimed it at their feet, so we could record and count how often they turned during the day. We were surprised to see that people turn more than 100 times an hour, or up to 1,000 times a day. In fact, we all turn more than walk straight.”

Dr. Horak and her team found that people with PD turn significantly more slowly than people without PD, and they take as many as four or five steps to make a turn. In addition, people with more advanced PD avoided making turns. When they did, they made them slower.

Ultimately, Dr. Horak’s team discovered that a person’s risk of falling can be predicted based on the way they made turns. People who made slower turns and took more steps were more likely to fall. Freezing, turning, shortened steps and falls all are related to balance.

Balance and the Brain

Difficulties with balance and walking are linked to the brain changes that take place with PD. For people who don’t have PD, balance is automatic, a reflex. But Parkinson’s affects the basal ganglia (a part of the brain essential to balance). To compensate, the brain assigns another brain area — an area used for thinking — to take over. The thinking part of the brain, mainly the frontal cortex, can’t control balance automatically. The result: for many people with PD, balance becomes less automatic.

This means that when people experience freezing and fall, they can’t adjust their balance automatically. Taking small steps to try and regain balance can make things worse, because it involves shifting weight with each step. The brain changes from PD inhibit their ability to take a big step to catch their balance and avoid a fall. For some, the drug levodopa (Sinemet) can help prevent freezing, but does not improve balance.

A person whose balance is less automatic must pay more attention while walking. For everyone, walking slows down when we’re talking and thinking slows down when we’re walking. This is called the “dual-task cost” and it’s higher in people with PD. That tells us that people with PD are using more attention and more cognitive control for balance and gait.

Dr. Horak has used brain-imaging techniques in her lab to show how balance signals are rewired in the brains of people with PD, compared to scans of people without PD. The ideal situation is for a person with PD to walk with no distractions. Additionally, people with PD can find that using a walker may require additional attention. To date, deep brain stimulation (DBS) has not been shown to help freezing.

The Route to Better Walking

The good news for people with PD is that with exercise and physical therapy it is possible to cope better with freezing, turn and walk more normally and improve balance. Through practice and sessions, a physical therapist can help people with PD avoid tripping by helping them learn to take larger steps. Additionally, joining an exercise class tailored to people with PD can help. If you take levodopa, be sure to exercise while it is working — the drug helps your body learn and remember motor skills.

Tricks that can help overcome freezing:

• Walk to a regular beat to help prevent freezing. Try a metronome.
• Take large, voluntary marching steps.
• Step over an imaginary line or laser pointer.
• Work with a therapist to find the solution that works best for you.

People respond differently to audio, visual or sensory cues. Dr. Horak and her team are testing a device that provides sensory feedback — vibration on the foot — to stimulate automatic stepping.

Another consideration for people who have freezing is anxiety, a common PD symptom. People who have anxiety experience freezing more often. It is a vicious circle — being anxious about freezing can trigger it. Treating anxiety may help freezing.

To Prevent Falls, Exercise

Exercise is the only intervention that significantly reduces a person’s risk of falling, among older people without PD as well as people with Parkinson’s. Research is beginning to show how exercise changes the brain for the better and can help people with PD gain back some of their automatic balance reflex.

In a study, Dr. Horak and her team asked participants with PD to stand on a quickly moving treadmill, until they began walking. Participants initially took too-small steps, but with one hour of practicing, they improved, taking bigger steps to stay balanced while walking.

Many kinds of exercise can improve a person’s balance. Consider trying:

• Tai Chi: a moving meditation where movements involve shifting the body’s center of mass back and forth over the feet. Studies found fewer falls among people with PD who practiced Tai Chi three times a week.
• Dance: to dance tango, a person has to walk backward and sideways, take big steps and both follow and lead — good ways for people with PD to practice balance control.
• Boxing: the rapid arm movements provide good balance training.
• Agility boot camp: completing different tasks in a series of stations can improve balance.

What is the best exercise? The one you actually do. Choose exercise that makes you sweat and do it three times a week. As you get better, make it more challenging. According to the Parkinson’s Foundation Parkinson’s Outcomes Project, increasing physical activity to at least 2.5 hours a week can slow decline in quality of life.

Conclusion

Changes in the brain that take place with PD affect a person’s balance. This, combined with difficulty walking because of stiffness, freezing or shortened steps, puts people with PD at risk of falling. No medications are effective for these issues. Only exercise has been proven to help. Find ways to exercise that you enjoy, get help if you need it and walk with more confidence.

Learn More

• Parkinson.org/Freezing 
• Parkinson’s: Substantial Matters podcast on freezing
• Call our Helpline at 1-800-4PD-INFO (1-800-473-4636) to find a Parkinson’s-tailored exercise class or physical therapist in your area. 

Who would have ever thought I would be writing about boxing? I'm that person who hides behind her coat in the movie theater during fight scenes! Luckily, boxing for Parkinson's disease (PD) is non-contact and a fight worth a good punch. In recent years, boxing programs for people with PD have been popping up all over the United States, many affiliated with Rock Steady Boxing in Indianapolis, IN. This onset of new exercise programs has brought with it many questions about the safety and effectiveness of boxing for PD.

We are just beginning to understand more about boxing for PD. What I can tell you to date is that participants in our studies have safely completed training and have been able to adhere to the program. And boxing training, like what is done at Rock Steady Boxing, does appear to be effective. Participation in intense boxing training over time is associated with better mobility and better perception of quality of life. This is all very promising, but we still have a lot of work to do to better understand the effects of boxing and how it compares to other types of exercise.

Let's consider some hard-hitting evidence from an ESPN poll (okay, maybe not so hard-hitting). A panel of experts including scientists, athletes and sports journalists decided that boxing is THE most demanding sport. They reported that collectively boxers need more endurance, strength, power, agility, flexibility and speed than athletes from any other sport. Does this mean that boxing is the best exercise for anyone, including those with Parkinson disease? There actually may not be a right answer to that question. The type of exercise one chooses needs to fit their unique interests and ability. So, why then are so many people with PD choosing to box? Boxing makes for a novel and intriguing exercise choice for many adults with PD. It's fun, dynamic and different. And let's face it, who doesn't want to punch Parkinson's right in the kisser from time to time?

Many boxers have told me that they enjoy the camaraderie with the others in the program and that motivates them to keep going, class after class. That might just be the most critical point here! It may not matter if you box, walk, cycle, dance, or do Tai Chi. What matters is that you find an exercise program that you enjoy and stick with it! And better yet, find others who want to exercise with you and motivate each other to keep going. Just like daily medications, a regular dose of exercise, no matter the type, may be a key ingredient to maintaining health and function over the long haul for those with PD.

It has been exciting to see so many communities develop boxing programs for people with PD. As a physical therapist, I am thankful that many people with PD now have an option for ongoing exercise in their communities. If you are considering boxing, it is important to remember to slowly build up your tolerance to the intensity of the training. Know your physical limits, seek guidance from the coaches and give it your best shot! But regardless of what type of exercise keeps you going back to the gym, by regularly exercising you are likely to give Parkinson's a good fight.

Stephanie Combs-Miller, PT, PhD, NCS, is a board-certified clinical specialist in neurologic physical therapy, educator and researcher at University of Indianapolis. Dr. Combs-Miller has collaborated with Rock Steady Boxing for the past 10 years to build the community-based partnership and to conduct research on the effects of boxing training for people with Parkinson disease.  

As winter melts into spring, you may be realizing that your exercise routine suffered through the cold season. You probably already know that exercise is a vital component to maintaining balance, mobility and daily living activities for people with Parkinson’s disease (PD). A Parkinson’s Outcomes Project study found that 2.5 hours of weekly exercise can improve your quality of life and help manage your Parkinson’s symptoms.

Now is a great time to kick back into gear, but make sure you do so safely. Below are some tips for easing into a new exercise routine:

Talk to Your Doctor

• Your physician knows your condition and can refer you to a physical therapist who can give you specific exercises based on your health and symptoms.
• Did you know that people with Parkinson’s are at a higher risk for osteoporosis (a medical condition that makes bones weak and brittle)? Research has found that people with PD have lower bone mineral density (BMD) than their peers. Vitamin D shortage increases your risk. Ask your doctor about a BMD test before you begin a new workout plan and get outside.

Start Slow

• Try returning to a previous routine, if you had one, at a lower intensity.
• If you’re just getting started, try working fitness into your daily schedule. For example, walk to the mailbox. Next, try parking far from the entrance when running errands. When that’s easy walk around your block. Increase your distance as you go, trying new walking trails or try joining a walking group.
• Work in an extended warm up and cool down time to protect yourself from injury.
• Each month, assess your progress and see if you’re ready to take it to the next level!

Safety First

• Wear comfortable clothing and shoes that provide good support.
• Make sure you have the proper safety equipment for your activity — like a helmet if you are cycling or walking sticks.
• Do NOT continue an exercise that causes pain. All movement should be done in a controlled manner to prevent injury.
• If you push too hard one day, take a break from your exercise routine the following day so you can heal and restore your energy.

Don’t Do It Alone

• Having someone there if you need an extra hand is always a good idea, but is vital if you’re just getting started again and learning your new starting point.
• While exercise is vital for people with PD, it’s important for everyone! Ask your caregiver if they would like to try a new class together. Ask a friend or neighbor to be your workout buddy. You’ll be more likely to stick to your plan if you have someone else working out with you.
• Connect with a local gym or a Parkinson’s-tailored exercise class, to double up on benefits by adding a social component to the physical one! Contact your local Parkinson's Foundation chapter or call our Helpline at 1-800-4PD-INFO (473-4636) to find a Parkinson’s exercise class near you.

Never been interested in fitness? Here are great activities that don’t feel like exercise:

• Join us at Moving Day, A Walk for Parkinson’s! Taking place in 39 cities nationwide, Moving Day celebrates the importance of exercise for people with Parkinson’s in a fun, family-friendly way.
• Hike with friends. With great spring weather, it may not even feel like a workout to the nature lover or socialite.
• Play with your children or grandchildren outdoors. Make memories and break a sweat! Trying to keep up with them on the playground or in the backyard should do the trick.
• Spruce up your yard. Since gardening combines stretching, lifting, pushing and pulling you get a functional exercise. Don’t have a yard? Join your local gardening club.
• Try a new dance, yoga, or Tai Chi class — all three benefit balance and mobility. You may even have a Parkinson’s-specific class near you. Want to try it at home? Try different videos on YouTube until you find one you enjoy.
• Play Nintendo Wii Sports with a friend or grandchild. The Wii gaming system gets you up and moving with games like golf, bowling and tennis. Your local senior center may even have a Wii available for members if you don’t have access to one.

Additional Exercise Resources:

• Fitness Counts: This book contains descriptions and explanations of specific exercises that can help you maintain flexibility, strength and aerobic conditioning. 
• Toll-free Helpline: Our 1-800-4PD-INFO (473-4636) Helpline is staffed by nurses and social workers who can answer your questions about Parkinson's and help you find local exercise and wellness classes.

After 41 years of marriage, four children, seven grandchildren and a Parkinson’s disease (PD) diagnosis, Hector and Mary Padilla still say they are in their honeymoon stage.

“Throughout my entire career, every time I traveled for work, Mary took care of everything,” said Hector. “I always appreciated that someone so beautiful, talented and smart, devoted all her efforts to make me happy.”

In 2015, Mary was diagnosed with Parkinson’s. Hector was familiar with the disease, as his uncle lived with it. “When Mary was diagnosed I was scared,” he said. “She went from being a life-long multi-tasker and a powerful woman, to doubting herself.”

Hector knew it was his chance to take care of Mary. “When she needs me I cannot say no,” he said.

Together, they began learning how to manage Parkinson’s. Their first step was to seek the best Parkinson’s care, so Mary began treatment at the University of Miami, a Parkinson’s Foundation Center of Excellence. In three years, Hector has never missed an appointment. “I ask questions, describe new symptoms and talk through everything, even though Mary doesn’t always want me to,” Hector said.

From day one, the couple complemented their care with Parkinson’s Foundation resources, such as Parkinson.org, to read about symptoms, research and the latest treatment approaches.

“We fight this together,” Hector said. “We started exercising hard, eating better, learning more about Parkinson’s and trying to deal with it objectively.”

Mary attends PD boxing classes at Memorial Regional Hospital, a Parkinson’s Foundation community grant recipient. Hector also attends, standing in the back of the room, mimicking Mary’s hook-uppercut boxing combinations. “I’m here for encouragement, which is important for anyone fighting a disease,” he said.

It’s through classes like boxing that Mary and Hector built their PD community. Together, they also attend Moving Day, A Walk for Parkinson’s, to raise Parkinson’s awareness.

“Hector’s unending love and source of strength in my life is what has allowed me to fight. My journey with Parkinson’s is manageable because of his constant support and encouragement to make me feel normal again.”

Hector’s caregiver advice is simple: “If you care or love someone, you’ll do whatever it takes to support them. I feel great doing things for my wife. She’s the love of my life. How can I walk away from that?”

Visit Parkinson.org/Caregivers for information

Our podcast, Substantial Matters: Life and Science of Parkinson’s, features more than 35 episodes about the latest PD treatments, research and therapies that help make life better for people with Parkinson’s. Catch up with our 10 most popular episodes:

1. How to Manage Parkinson’s “Off” Time

Parkinson’s symptoms can get better and worse throughout the day. These so-called “on-off” fluctuations (or motor fluctuations) and dyskinesias can be troubling, but a movement disorder specialist can help. Find out what causes these changes and how your doctor can help you manage them.
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2. The Benefits of Exercise for People with Parkinson’s

Regular exercise is essential for people with Parkinson's. This podcast describes what is known about exercise and PD and what is being researched, as well as tips on overcoming exercise barriers.
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3. Early Warning Signs of Parkinson’s

In the debut episode of Substantial Matters, Parkinson’s Foundation national medical director Michael S. Okun, MD, talks about the early signs of Parkinson's and gives advice on what to do following a diagnosis.
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4. The Importance of Good Nutrition for People with Parkinson’s

Nutrition plays an integral role when it comes to good Parkinson's care. Find out which PD symptoms are impacted by diet, how to optimize the effects of medication and how to get adequate nutrition.
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5. The Keys to Driving with Parkinson’s

Age, along with Parkinson’s, can affect critical driving skills. However, giving up the keys is an emotionally charged issue. This podcast examines DriveWise, a program that involves a multidisciplinary team of health professionals who assess the skills and mental abilities needed to drive safely.
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6. New Levodopa Delivery Methods for Parkinson’s

While levodopa is the most effective treatment for Parkinson’s, some people experience “off” periods or dyskinesias. Learn about the new delivery methods that promise to help. Learn about levodopa infusions, skin patches and long-release pills that are in development.
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7. Genetics as a Guide to Neuroprotection in Parkinson’s Disease

For decades medication has been used to control PD symptoms, but researchers have yet to find a way to protect neurons (brain cells) to slow down or stop disease progression. Learn how modern genetics can be a guide to developing new drugs.
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8. Young-Onset Parkinson’s 101

A diagnosis of young-onset Parkinson’s disease brings special challenges. For instance, deciding when to disclose the diagnosis at work and to children can be difficult while you are still coping with the news. Learn techniques for dealing with these challenges.
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9. Medical Marijuana: Going Green for PD?

More people are exploring medical marijuana, also called cannabis, to help treat various chronic health conditions, including Parkinson’s. However, much is still unknown about its use for medical purposes. Learn the latest developments in this podcast.
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10. Autonomic Problems

To avoid embarrassment, people with PD often avoid telling their physicians about PD-related urinary symptoms, sleep disturbances, sexual and intimacy matters and many other issues. This podcast focuses on these topics and how some can have easy solutions.
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Subscribe so you don’t miss an episode

Eating well can help you take control of your health. In fact, choosing to eat healthy foods can improve your Parkinson’s disease (PD) symptoms. And some research suggests that sound nutritional choices could have disease-modifying effects, meaning that they could potentially slow PD progression. Changing your eating habits can be a challenge, but there are many small adjustments you can make to your diet that will add up to big benefits. Learning about them is the first step.

The following article is based on the latest research and a Parkinson’s Foundation Expert Briefings about nutrition, hosted by John E. Duda, M.D., from Philadelphia VA Parkinson’s Disease Research, Education & Clinical Center (PADRECC).

Managing PD Symptoms with Diet

Research supports these strategies for managing the following PD symptoms and medication side effects:

Fluctuations. Some people who take levodopa (Sinemet) notice that their medication is less effective when taken with a high-protein meal (a meal including foods like meat, fish and eggs). To address this difficulty, your doctor may recommend taking levodopa 30 minutes before, or 60 minutes after, you eat. That’s because levodopa is absorbed into the digestive system by the same route as protein — when taken together, both compete to be absorbed into the body.

Even after adjusting medication timing, some people still have difficulty absorbing it. This can lead to fluctuations — the levodopa wears off too soon or you experience changes throughout the day between the medicine working well and not having any benefit at all.

A protein-redistribution diet is a popular solution for fluctuations. That means eating most of your daily protein at dinnertime — the last meal of the day — to minimize Sinemet interference during most of the rest of the day. In research studies, fluctuations improved in about 80 percent of people who made this dietary change. People who benefitted most were those who started the regimen early in the course of their PD, before fluctuations became severe.

Iron also can prevent your body from taking up levodopa medications. Do not take iron supplements or multivitamins with iron within two hours of Sinemet.

Daytime sleepiness. Studies show that taking caffeine in two to four cups of coffee a day can improve daytime sleepiness.

Orthostatic hypotension is sustained low blood pressure and dizziness on standing. There are several ways to reduce this symptom:

• Avoid large meals, as they divert blood to the digestive system.
• Increase the amount of salt in your diet.
• Reduce alcohol consumption.
• Drink one and a half to two quarts a day of fluids (six to eight 8-ounce glasses, including water, coffee and other beverages). You can also use a tall cup that has lines to mark your progress and help you keep track throughout the day.

Constipation. If you have less than one bowel movement per day, try to:

• Drink more fluids.
• Consume more fiber, from fruits, vegetables, beans, whole grains, nuts and seeds. Aim for 30-40 grams of fiber per day. Choose foods that have five or more grams of fiber per serving.

Cognitive changes. Many studies have shown that the Mediterranean diet can lower the risk of cognitive impairment for everyone. This diet is rich in whole grains and vegetables. It also includes fish, as well as small servings of low-fat dairy and lean meat, and uses olive oil instead of butter.

Bone health. People with PD often have low blood levels of vitamin D, which is essential for strong bones and may also play a role in warding off depression and cognitive change. Make sure your doctor tests your vitamin D. It can be difficult to get enough vitamin D through diet. Your doctor may recommend supplements.

Malnourishment and weight loss. If your food tastes bland, you’ve probably lost some of your sense of smell — a common PD symptom. To make food more appealing, so that you feel like eating more, try seasoning it with herbs, spices and other flavors. If you or your loved one with PD has experienced significant weight loss, ask your doctor for a referral to a nutritionist. This member of your health care team can offer different strategies for maintaining a healthy weight depending on your age and PD symptoms.

Your Diet and the Microbiome

One of the big stories in medicine is the role of the gut microbiome (the bacteria and other microorganisms that live in the digestive system) in health and disease.

Several studies have found that people with PD have much lower levels of Prevotella species of bacteria — a type thought to be good for maintaining gut health. They also have higher levels of bacteria associated with inflammation, which can be harmful.

How does that relate to your diet? What you eat affects which bacteria can thrive in your digestive system. Studies have shown that eating a Mediterranean, or whole-food plant-based diet, creates an environment where Prevotella and other healthy bacteria can flourish. Fiber and other components of whole plant foods and sometimes referred to as ‘prebiotics’ because they feed the “good” bacteria in the gut, which may be beneficial for people with PD.

Can eating well alter the course of PD?

Scientists know a lot about the molecular changes that underlie Parkinson’s. You may have heard of alpha-synuclein, the protein that forms clumps in brain cells, oxidative stress, mitochondrial dysfunction, and inflammation. The search is intense for therapies that can stop or reverse these processes. Can nutrition or dietary choices do anything to change them or alter the course of PD?

Some laboratory and animal research suggest that diet could have an effect, especially plant-based foods like fruits, vegetables, legumes, nuts and seeds. Every plant-based food contains hundreds of chemicals called phytochemicals. These are not nutrients, but substances that may, alone or in combination, affect many of the processes thought to be involved in PD including oxidation, chronic inflammation, protein aggregation and mitochondrial dysfunction.

Phytochemicals have not been proven to change disease progression in people with PD, but neither is there typically any harm in eating a diet that includes whole, unprocessed plants. This diet has proven benefits for preventing heart and vascular disease and can reduce PD symptoms, like constipation and risk of cognitive change. 

The best way to increase anti-oxidants and anti-inflammatory compounds in your blood and brain is by eating plants — all the different parts of them. Choose fresh, or frozen whole foods and avoid boxed or canned foods as much as possible. There is no one food that is best — aim for variety every day. And be sure to include nuts and seeds. Sprinkling a tablespoon of ground flax seeds on other foods is a simple way to improve your diet.

Healthy Eating with PD

Eating a whole food, plant-based diet, often called a Mediterranean diet, can help you live well with PD. Eat what you need to eat to be happy — but also eat more of the food that is good for your health.

If you have Parkinson’s, every healthy lifestyle change can help. Choosing to eat well also leads to a feeling of empowerment that helps you in your daily life with PD. While it can be challenging to eat better, most people make minor diet changes gradually that become major changes over time. Always consult your physician before making major changes.

To learn more about nutrition and Parkinson’s, visit Parkinson.org/Nutrition.

Learn more by tuning in to our podcast episodes “The Role of the Microbiome in PD: Part Two” and “Nutrition Advice - Part 2.”

Getting regular exercise is essential to managing Parkinson’s disease (PD). It is well established that exercise promotes aerobic conditioning, strength, balance, flexibility and mobility, which can substantially improve overall quality of life.

Multiple clinical trials have demonstrated that aerobic exercise in particular, can enhance cognitive functioning, such as learning, thinking, remembering and problem solving. Further, a 2019 PD clinical trial called Park-in-Shape, investigating the effectiveness of remotely supervised aerobic exercise (using a stationary bike) resulted in a reduction of PD movement symptoms.

We know brain heath and cardiovascular fitness are connected. What we don’t know is how and where in the brain aerobic exercise is enhancing cognitive functions and reducing motor symptoms for people with PD.

A study recently published in the Annals of Neurology, “Aerobic exercise alters brain function and structure in Parkinson’s disease: A randomized controlled trial” (Johansson et al., 2022) investigated how aerobic exercise may influence PD-related functional and structural changes in the brain. The study also explored the effects of aerobic exercise on the substantia nigra, which helps the brain produce with dopamine. Movement disorders specialist Bastiaan R. Bloem, MD, PhD, from Nijmegen Parkinson Center — a Parkinson’s Foundation Center of Excellence ­— is one of the study’s authors.

The study further drew upon the study authors’ previous Park-in-Shape research, which was a single-center, six-month trial of 130 sedentary people with PD, ages 30–75 years, who experienced mild symptoms, and were either unmedicated or on stable dopaminergic medication.

Half of the participants were randomly assigned to ride a stationary bike (equipped with gaming feature) at home for 30- to 40-minute sessions at 50 to 80 percent of their ideal target heart rate. The other half (the control group) were assigned to do 30 minutes of stretching, flexibility and relaxation exercises. Both groups exercised in their own homes three times per week for 30 to 45 minutes over six months. Both groups received a motivational app and remote supervision.

To assess potential progress, researchers used a rating scale that measures PD symptoms (called the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)). Participants were assessed at the beginning of the study and at the six-month follow-up to provide a snapshot of disease severity. Additionally, there was a subset from this trial (25 people from the bike group and 31 from the stretching group) who underwent:

1. Functional MRIs to measure which parts of the brain are more active by measuring blood flow changes in the brain
2. Resting state MRIs for anatomical structure comparisons
3. Oculomotor (eye) movement cognitive control tests

Results

At the six-month follow-up:

• The aerobic exercise group had a shift in balance of connectivity from the sensory motor region of the cortex (the outermost layer of the brain) to the putamen region of the brain. The balance in connectivity was shifted in favor of connections between sensory motor cortex to the front part of putamen instead to the back part of putamen.
• The brain atrophy (brain shrinkage) worsened with time in the stretching group.
• The aerobic exercise group had lower brain atrophy (less brain shrinkage) compared to the stretching group.
• No change in substantia nigra area was found in either the aerobic nor the stretching group.
• The aerobic exercise group experienced improved cognitive control compared to the stretching group.
• The aerobic exercise group had a significantly larger change in functional connectivity within the right frontoparietal network, a cognitive control network, located at the intersection of the frontal (the most front area) and parietal (the upper back area) section of the brain.

What does this mean?

For all people, physical inactivity is a leading modifiable risk factor for cognitive decline, diminished mobility, and reduced quality of life. For people with PD, this study additionally suggests that aerobic exercise, but not stretching, can impart measurable protections and improvements in PD progression, both physically and cognitively.

Specifically, the aerobic exercise group had a a relative posterior-to-anterior shift in sensorimotor cortex connectivity to putamen. What does this mean? The putamen is involved in learning and motor control/voluntary movement. Generally with PD, the posterior (back part of the) putamen is negatively affected by dopamine depletion, whereas the anterior (front part of the) putamen is relatively spared, allowing for more available dopamine. It has been reported that parts of cortex (the outermost layer of the brain), that normally communicate with the posterior putamen in healthy individuals rely more on the anterior putamen in people with PD. This study suggests that the aerobic exercise, unlike stretching, led to a functional and structural change in the balance of connectivity towards anterior putamen of the brain of people with PD.

That said, the number of PD participants in this study was relatively small. Further research, involving comparisons between people with PD and those without PD and new brain connectivity needs to be conducted.

Bottom line? Exercise is essential for people with Parkinson’s. According to the Parkinson’s Foundation Parkinson’s Outcomes Project, increasing physical activity to at least 2.5 hours a week can slow decline in quality of life. Research dedicated to better understanding the positive impact of exercise and Parkinson’s ultimately helps us guide potential new treatments and empower the Parkinson’s community.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and aerobic exercise by visitng the below Parkinson’s Foundation resources, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636).

• Podcast Episode 129: Using the New Parkinson’s Exercise Recommendations as Part of Your Treatment Plan
• New Exercise Recommendations for the Parkinson’s Community and Exercise Professionals (blog)
• Episode 3: The Benefits of Exercise for People with Parkinson's Parkinson’s Exercise Recommendations
• Professional Education: Exercise Professionals

Do you ever walk into a room and forget why? Next time, try closing your eyes to jog your memory.

Your brain is a mysterious organ that researchers are still trying to better understand. Brain Awareness Week is a global campaign that raises public awareness about the progress and benefits of brain research, including research into the causes of Parkinson's disease (PD) and how to treat it. This year we wanted to provide you with 12 ways you can enhance your cognitive function, starting right now:

1. Keep Learning

Choose activities that keep your brain working. Set out to complete a complex goal or learn something new. Start with watching a new video on our YouTube channel.

2. Eat a Healthy Diet

Following the Mediterranean Diet can help people with Parkinson's slow levadopa absorption into the brain. This diet not only helps the brain, but can reduce blood pressure and cardiovacular disease.

3. Take a Book with You

Reading is a complex task that requires multiple parts of the brain to work together. A complex book can improve memory and cause positive neurological changes that last even after you stopped reading.

4. Stay Social

Staying social has been proven to help retain cognitive sharpness. Surround yourself with people who make you laugh and smile, or make new friends at Parkinson’s support groups. Get to know us on Facebook, Twitter and Instagram.

5. Keep Calm

Stress of any kind can temporarily worsen PD symptoms. Meditating just 15 minutes a day can bring a sense of calm and the ability to see things more clearly.

6. Get Enough Sleep

Maintain a regular sleep schedule; get up and go to bed the same time every day. Not sure where to start? Try Sleep: A Mind Guide to Parkinson's Disease.

7. Keep Track of Medications

Establishing a daily routine helps keep you on track with medications and exercise regiments. It can also help with sleep and digestion issues. Watch this guided meditation video to get started now.

8. Increase Your Heart Rate

Intense exercise can improve efficiency of your brain cells using dopamine and lessen PD symptoms.

9. Give Your Brain a Workout

Creativity in everyday life provides excellent mental stimulation. Vary your activity to keep the mind strong and healthy. Draw, paint or write your My PD Story.

10. Groove to the Music

Listening to music can improve memory. Singing and dancing to a song helps cognitive and physical functions. Research shows that exercise, social stimulation and singing can help postpone PD symptoms.

11. Drink Caffeine

Several studies have shown that caffeine may reduce the risk of developing Parkinson’s. A cup a day may also help with motor symptoms, boosting memory and lowering the risk of depression.

12. Laugh Out Loud

Laughing stimulates different areas in the brain. Some studies show laughing can also improve short-term memory. Watching a funny movie or cat video is also a natural stress reducer.

Want more? Follow us on Facebook and Twitter for the latest in Parkinson's news.

This Parkinson’s Awareness Month, we want to hear your #KeyToPD.

Here are the Foundation’s top five keys to living a better life with Parkinson’s:

• ​Find a neurologist. Regular neurologist care can save the lives of thousands of people each year. Neurologist care saves about 4,600 lives each year in the U.S. alone.
• ​Get Answers. Call our 1-800-4PD-INFO (473-4636) Helpline or visit Parkinson.org to get your Parkinson's questions answered — at any stage of PD.
• Put together a care team. People living with PD who seek expert care have better outcomes — complication risks are lower, they enjoy better quality and longer lives.
• Establish an exercise routine. Increasing physical activity to at least 2.5 hours a week can slow decline in quality of life for people with PD.
• Get moving and socialize. Meet others with PD and families living in your area at your nearest Moving Day, A Walk for Parkinson's. Register at MovingDayWalk.org.