Are Pilates Good for Parkinson's Disease?

Last Editorial Review: 7/14/2017

Ask the experts

Which Pilates exercises are good for someone with Parkinson's disease?

Doctor's response

Parkinson's disease occurs when neurons (nerve cells) in the brain die or become impaired and stop producing dopamine. Dopamine is a chemical messenger, known as a neurotransmitter, that helps control muscles and movement, and when dopamine levels are low, movement will be slow and unsteady (loss of balance and posture), muscles will be tense and rigid, and there will be shaking or tremors. Parkinson's disease is progressive, and so its symptoms vary depending on how long the individual has had the disease. The primary symptoms of Parkinson's that may be helped by exercise are slowness of movement, stiffness, and loss of balance and posture, and so exercises that improve these should be done.

I am not aware of any research on Pilates and Parkinson's that specifically addresses these symptoms, but that doesn't mean it can't help. For improvement of balance, I suggest that you do standing exercises as part of your Pilates workout, whether you are working on a mat or the equipment. Standing exercises challenge your muscles and your brain to maintain balance, and so over time you should notice some improvement. Improvements in people with Parkinson's are typically slow, but they can occur if you work hard and consistently.

As for slowness, flexibility and strength are part of the solution. Many Pilates exercises work through a full range of motion, and so stiffness and flexibility should improve. Make sure your instructor focuses some of the attention on a full range of movements and holding those positions to improve flexibility. For instance, using the leg springs on the Cadillac would be helpful.

As for strength, it typically improves quickly for beginners. This is because strength is not only a function of the mass of the muscle, but also because of improvements in nervous-system patterning (impulses from the brain, through the central nervous system, to the muscles). When you pattern the transmission of impulses from the brain to the muscles by repeating exercises over and over, the brain gets better at recruiting more muscles and you get stronger (improvements in patterning is why you get stronger with each workout at the beginning of a training program without any noticeable increase in mass). Patterning is important for people with Parkinson's because patterning may diminish with a loss of dopamine, so repetition of the exercises should help.

Pure strength is also important, not only for activities of daily living, but also for well-being. It's fair to say that under most conditions feeling strong feels better than feeling weak, and since most of the Pilates exercises build strength (whether on the mat or the equipment), there is certainly benefit to be gained. Some research with Pilates even shows an enhanced quality of life and well-being in people with Parkinson's as the result of strength building. With that said, however, it is still important to do some of your strength training standing up, whether it's with Pilates or traditional lifting. After all, you don't spend all day sitting or lying down, so some of your exercises should be specific to activities of daily living. One of the limitations I have observed with Parkinson's patients who do Pilates is the lack of motor training for the activities you do during your normal day, like opening doors, getting in and out of cars, and walking, so make sure your instructor helps you with that.

On a slightly different note, there is important research in animals to show that regular aerobic exercise has a positive effect on Parkinsonian symptoms. In one study, scientists gave rats a medication that induces Parkinson's disease by destroying brain cells that make dopamine. After administration of the medication to all the rats, the researchers then had half the rats exercise for seven days while the other half remained sedentary. After the study, they found that the exercising rats lost only 6 percent of their dopamine-containing neurons whereas the sedentary rats lost 87 percent. That's a substantial difference with the potential for important clinical improvements in symptoms. Research into the effects of exercise on the biochemistry of the brain has shown improvements not only in Parkinson's, but in dementia, Alzheimer's disease, and depression, as well. It is encouraging work and points to the benefits of an active lifestyle.

Based on results from the animal studies, I encourage aerobic exercise in addition to strengthening, balance, and flexibility work. If you have trouble walking because of balance problems, then I recommend holding on to the side rails of the treadmill (research proves that activities of daily living, motor performance, and ambulation improve even if you hold on), and I also recommend the use of walking sticks (or poles), but I recommend two, and not one. Two sticks help maintain better posture and gait than walking with one cane. I recommend the high-tech, low-weight type of walking sticks that you can purchase in sporting goods or outdoor stores. They are sold in pairs, and some are telescopic, so that they shorten for ease in carrying them around.

To summarize, any Pilates exercise that builds strength (as many of them do) and balance will be beneficial, but you need to incorporate standing exercises as part of your regime. If you don't do that with Pilates, then I recommend traditional standing weight-lifting exercises as a complement to your Pilates work. I also encourage aerobic exercise like walking or biking to help with some of the changes in the brain that have been observed in animals. Good luck with your workouts.

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Medically reviewed by Robert Bargar, MD; Board Certification in Public Health & General Preventive Medicine


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