Many people with Parkinson's wonder how and why to exercise for their disease. In a recent webinar on exercise for Parkinson's and an interview with Fox News, MJFF Patient Council Member and Team Fox athlete Jimmy Choi shared how exercise helps him manage Parkinson's disease (PD). Get inspired by Jimmy, and then get answers to your most commonly asked questions about exercise.

What's the Best Exercise for Parkinson's?
It's not a popular answer, but it's the truth: The best exercise is one that is safe, enjoyable and that pushes you. Research supports a variety of exercises for Parkinson's -- treadmill walking, boxing, dancing and many others -- but one is not necessarily better than another. Some people prefer swimming to biking; others like group fitness classes rather than exercising alone. Still others like to mix up their routine with a variety of workouts. Find what you enjoy and what motivates and challenges you. Then do it regularly, at least three times per week.

How Do I Find What Exercise Works for Me?
Experts recommend beginning physical therapy as soon as possible after diagnosis, but it's never too late to get started. A physical therapist can help guide you to the best exercise program for your needs, as well as help you improve your mobility. (More on finding a physical therapist below.)

Who Should Exercise?
Everyone with Parkinson's should exercise. It's important for general health and well-being and can ease motor and non-motor symptoms such as constipation and sleep problems. Regardless of your age, fitness level or stage of Parkinson's, there is something you can do to get and stay active.

What Is the Best Time of Day to Exercise?
The best time of day to exercise varies based on sleep and work schedules, personality (some love working out before the sun comes up while others prefer nighttime routines) and medication effect. Find a time when your medication typically works best to control symptoms so you have the best mobility and can exercise to your full potential.

Are There Specific Exercises for Motor Symptoms?
Certain exercises may be helpful for specific motor symptoms of Parkinson's:

• For balance, consider tai chi and yoga.
• To improve coordination and agility, look into dancing or boxing. 
• For significant balance problems or limited mobility, seated aerobic exercises can give a challenging workout that raise the heart rate. 
• To target freezing of gait (sudden, temporary inability to move) or falls, find a Parkinson's-specific physical therapy program that emphasizes bigger movements with walking and activities and can help with fall prevention strategies. Talk to your neurologist about finding a therapist who specializes in Parkinson's.
• For dystonia -- muscle cramping that often affects the calves, feet or toes -- try lower impact exercises (water aerobics or walking, for example) that don't bring on symptoms. Stretching overactive muscles and strengthening the opposing muscles also may help. (A physical therapist can show you proper exercises.) 

Do Certain Exercises Target Non-motor Symptoms?
You can tailor most exercises to work on memory and thinking. For example, while exercising, you can do math problems or name as many items as you can think of in a category (such as animals or automobiles) in one minute. Your physical therapist can provide other suggestions.

Most exercises also can help fatigue, a common Parkinson's symptom. It sounds counterintuitive to exercise when you feel tired, but this is one of the best treatments for fatigue. You may feel a little worse before you feel better (most people with or without Parkinson's feel tired when starting an exercise program). Rate your fatigue before and after working out and keep a log to see how much you can do and how fatigue improves over time.

Can Exercise Worsen Parkinson's?
Pushing yourself too hard (lifting too much weight or with improper form, for example) can result in injury. People with Parkinson's may notice that some symptoms such as tremor increase during exercise, but this doesn't mean tremor will worsen over the long run. If you're new to exercise, a physical therapist can help you start slowly and gently increase your intensity.

How Hard Should You Push Yourself?
Everybody has a different limit with exercise. With time, you'll learn your boundaries and how to push them. Keep a log of when and how much you exercise, when you take your medications, and how you feel to help you determine the best type and amount of exercise for you.

Remember that symptoms can fluctuate, so some days may be better than others. If you're just beginning, a physical therapist can prescribe an exercise routine that you can gradually add to until you find your limit.

Can Exercise Prevent Parkinson's?
No therapy, including exercise, has yet been proven to prevent Parkinson's. But studies of large populations have shown that people who exercise are less likely to develop Parkinson's. (This means that exercise is associated with less risk of Parkinson's, but is not necessarily the cause of the decreased risk.)

Does Exercise Slow Disease Progression?
Pre-clinical work demonstrates that exercise has protective effects on brain cells. It boosts trophic factors, which are like "fertilizer" for brain cells and increases the number and activity of mitochondria, the cells' energy sources. It also helps you use the dopamine your brain already has, more efficiently. (Dopamine is the brain chemical responsible for normal movement that decreases in Parkinson's.) Clinical studies also suggest that symptoms may progress more slowly in people who exercise.

Can Exercise Replace Parkinson's Medication?
Exercise is just as important as the medication you take for Parkinson's but it's not a replacement. Some people are able to decrease their medications because they can manage symptoms with exercise, but others need more medication in order to exercise. (Marathon runners, for example, may need more medication to run for longer distances.) To get the most benefit, work with your doctor to make sure you're on the best combination of medications to control your symptoms so you can exercise regularly. 

How Do I Find a Physical Therapist?
First, talk to your doctor. You'll likely need a prescription, and your physician may recommend a qualified therapist. If possible, work with a physical therapist who has experience in Parkinson's.

The American Physical Therapy Association maintains a list of therapists. You can search for a provider with neurological or, if you're older, geriatric expertise.

Alternatively, you can search online for physical and occupational therapists with Parkinson's-specific training such as those certified in LSVT BIG or PWR! or graduates of the Parkinson's Foundation's Allied Team Training program.

Learn more in a webinar on exercise for Parkinson's. Then, watch the Fox News piece on Jimmy Choi's journey from diagnosis to competing on NBC's obstacle course competition "American Ninja Warrior."

Reviewed by Heather J. Cianci, PT, MS, GCS, Neurologic Team Leader, The Dan Aaron Parkinson's Rehab, Penn Therapy & Fitness Pennsylvania Hospital, GSPP