Do you or a loved one have Parkinson’s syndrome or Parkinson’s disease, and are you wondering about the benefits of physiotherapy?
Are you wondering about the potential benefits of rehabilitation with a physiotherapist?
This is what we know to date about the effects of rehabilitation on Parkinson’s disease.
In writing this article, I drew on both my own experience as a physiotherapist and my extensive research into the international scientific literature. All study references are at the end of the article.
Last updated: September 1., 2025
👩⚖️ Declaration of interests: none directly related to this article. My complete declaration of links of interest is in legal mentions. Written by Nelly Darbois, physiotherapist and scientific editor
Summary
A reminder of Parkinson’s disease and Parkinson’s syndrome
Some people, especially after the age of 65, may have what is known as Parkinson’s syndrome, also known as pyramidal syndrome. This is the case when they have at least one of these three problems:
- resting limb tremors that stop when the person moves;
- stiffness in certain parts of the body, which bend and stretch less easily;
- a general slowing of gestures andwalking.
Parkinson’s disease is the most common form of parkinsonian syndrome.
People with Alzheimer’s disease can also have Parkinson’s syndrome, without having Parkinson’s disease.
Parkinson’s disease is diagnosed by a neurologist.
This article deals with physiotherapy and rehabilitation in Parkinson’s disease. Rehabilitation management of Parkinson’s syndrome is similar.
Parkinson’s disease and physiotherapy treatment
Exercise is beneficial for Parkinson’s disease, as we shall see.
In France, this practice can be supervised by physiotherapists in order to motivate people, propose personalized exercises adapted to their difficulties and environment, and monitor their progress by re-adapting physiotherapy treatment as necessary.
Physiotherapists can also manage possible complications of the disease at advanced stages (swallowing disorders, ventilatory problems).
Physiotherapists can determine and prescribe the most suitable walking aid, which in the case of Parkinson’s disease is often a 4-wheel walker.
The effect of physiotherapy on Parkinson’s disease
Dozens of trials have compared the effect of physical therapy versus no physical therapy on Parkinson’s disease, or the effect of certain types of physical therapy versus others.
Parkinson’s sufferers who have physiotherapy sessions, compared with those who do not (Tomlinson et al., 2013):
- have a higher walking speed;
- have greater walking endurance;
- have fewer blockages when they walk;
- have a better balance;
- have better functional capabilities.
The greatest improvement was seen in walking speed, balance and functional ability.
On the other hand, physiotherapy does not a priori improve :
- the number of falls that occur (whereas the risk of falling is reduced when physiotherapy sessions are given regularly to people over 65);
- quality of life.
Physiotherapy can also help people who are afraid of falling.
Physiotherapy improves walking speed, balance and functional abilities in Parkinson’s disease.
Does physiotherapy also improve cognitive functions in Parkinson’s sufferers, such as memory or concentration?
Other researchers have answered this question and find that this is likely to be the case in people at an intermediate or advanced stage of the disease (around 6 years after diagnosis). (da Silvia et al., 2018)
What type of physiotherapy sessions should I choose?
There are slightly fewer studies comparing the effect of different types of physiotherapy sessions on each other. When this is done, we find (Tomlinson, 2014):
- that physiotherapists offer very different things and techniques, grouped into these categories: general rehabilitation, exercise, treadmill training, indiçage technique, dance or martial arts ;
- at present, it is not possible to say that certain techniques work better than others, for those that have been the subject of randomized controlled trials.
There is one thing in common, however: the physiotherapy sessions on offer actively involve the patient. The patient does not lie on a table to be massaged, stretched or mobilized, or only for a short time during the session.
Even in heart failure, physical exercise and physiotherapy are possible.
Focus on active physiotherapy sessions, where the person with Parkinson’s moves on his or her own.
How often?
In France, physiotherapy sessions often take place 1 to 3 times a week, often on a chronic basis for Parkinson’s disease, i.e. all year round.
Sessions last around 30 minutes, either in the office or at the patient’s home.
In studies, multi-weekly physiotherapy sessions performed for 4 to 8 weeks have positive effects that seem to persist 3 to 12 months after the sessions are stopped. (Mak et al., 2017)
At least 4 to 8 weeks of 2 to 3 sessions a week of physiotherapy are needed to see an improvement in Parkinson’s disease.
When it comes to improving cognitive functions, sessions held 3 times a week for 60 minutes and lasting at least 24 weeks have a greater effect.
Physiotherapists can also intervene in the rehabilitation of post-fall syndrome (which occurs in Parkinson’s sufferers as in the general population, usually after the age of 65).
In this case, sessions can be scheduled more frequently to allow the person to return to their previous functional state.
Parkinson’s disease and breathing difficulties
Parkinson’s disease can affect respiratory function:
- their ribcage is more rigid;
- their strength and coordination of the inspiratory and expiratory muscles is less important.
They may become clogged more often and have difficulty evacuating their secretions.
Physiotherapy exercises can be used to prevent or treat breathing difficulties. Their effectiveness, however, is less well studied than that of physical exercise.
We can see that :
- breathing exercises can improve certain respiratory parameters in Parkinson’s disease (Reyes, 2013);
- exercises involving exhalation and coughing seem to be more effective in Parkison’s disease (Reyes, 2018).
Respiratory physiotherapy could improve certain ventilatory parameters in Parkinson’s disease, but there are few studies on the subject.
Physiotherapists can also provide respiratory physiotherapy in cases of bronchitis or interstitial lung disease.
Parkinson’s disease and foods to avoid
Both physiotherapists and speech therapists can give advice on how to prevent swallowing disorders, which can occur in the advanced stages of Parkinson’s disease.
However, ortophonic rehabilitation has yet to prove its effectiveness, whether practiced by physiotherapists or ortophonists (Herd, 2012).
On the other hand, physiotherapists, speech therapists and, more generally, healthcare professionals accustomed to dealing with people suffering from Parkinson’s disease can tell you what foods to avoid.
The aim is to prevent false routes.
Avoid the following foods (for swallowing disorders only):
- hard, round, crunchy foods: peanuts, candy, many raw fruits and vegetables such as apples and carrots, French fries, etc;
- foods with seeds or pits: olives, cherries, grapes, cherry tomatoes, rice, semolina, wheat;
- fibrous foods: certain vegetables such as salsify or certain meats
- enveloped foods: pulses ;
- foods that break down into small, crunchy pieces: rusks, dry cookies, etc.
Examples of physiotherapy treatment for people with Parkinson’s disease
Here are a few examples of physiotherapy treatments I’ve carried out in recent years with people suffering from Parkinson’s syndrome or Parkinson’s disease. Some elements have been modified to scrupulously respect people’s anonymity.
We have deliberately included examples of people at different stages of Parkinson’s disease . This section is updated regularly.
Mrs J, 67, diagnosed with Parkinson’s disease 7 years ago
Mrs J’s neurologist insists that she attend sessions to prevent her camptocormia (“hunchback”) from increasing.
Mrs J does not describe any particular discomfort in her daily activities due to her Parkinson’s disease, but is concerned about the aesthetic and functional repercussions of a more pronounced camptocormia.
The physiotherapy assessment identifies the following problems:
- pronounced camptocormia (lying on her back, Mrs J is unable to rest her head on the floor due to her camber, missing about 20 cm);
- lumbar spine pain.
In agreement with the patient, the following objectives are set:
- reduce the frequency and intensity of back pain;
- avoid increased camptocormia.
To this end, two exercises are proposed to Mrs J. I deliberately recommend few but very relevant exercises, as it’s easier to set up a routine of 1 or 2 exercises than of a dozen or so.
Only 2 sessions were necessary: the first to assess the situation, identify and note the relevant exercises, and the second at a distance to assess compliance (how well Mrs. J was doing with her exercises) and, if necessary, modify the exercises in the light of any difficulties encountered.
Each year, 2 sessions of this type may again be relevant.
Mrs J has managed to apply both exercises, daily for one, 2-3 times a week for the other. She describes a clear reduction in lower-back pain and greater ease in lying on her back (the space is now around 10 cm and the head can rest on the floor after 10 min of posture).
On the other hand, camptocormia was not reduced, as initially expected.
Mr. T, 81, diagnosed with Parkinson’s disease 10 years ago
Mr. T has been treated for several years by a home physiotherapist who massages him for his lower back pain. I take over his care.
After a physiotherapy assessment and an interview with Mr and his family, the following motor and functional problems were identified:
- inability to get out of bed or out of a chair on one’s own;
- frequent falls on the move (around 1 per month);
- possible to walk only 10 m with a crutch, increasingly frequent use of a wheelchair in the apartment;
- back pain.
Despite his difficulties, Mr T remains highly motivated to maintain his functional abilities as much as possible. The following objectives were therefore set:
- get out of bed and out of the chair on your own;
- improve static and dynamic balance to prevent falls and increase walking perimeter;
- encourage regular active mobilization to reduce back pain.
Sessions were held 2-3 times a week. After 2 weeks, Mr. T was able to carry out his transfers without assistance from a third party. His walking perimeter, still fluctuating, improved overall over the weeks (50m at best).
During the first year of care, only one fall occurred, compared with the usual one per month.
However, Mr. T is dependent on at least 2 weekly sessions to maintain his skills. Trials to space out the sessions have been inconclusive, as each time there is a significant loss of function.
Parkinson’s: is there a natural treatment?
What do we mean by natural treatment? Isn’t physical exercise (and therefore physiotherapy) a natural treatment, because it doesn’t require the consumption of certain substances, or the use of equipment invented by human beings (physiotherapy can be done without equipment for many pathologies)?
Often, when people talk about a natural treatment, they tend to include things that can be classified as “alternative and complementary medicine”.
In the case of Parkinson’s disease, we can distinguish as “natural treatment” :
- alternative physical exercises such as yoga or tai chi;
- acupuncture (TENS electrotherapy is more likely to be effective);
- herbs, medicinal plants and food supplements.
Alternative and complementary medicines used by people with Parkinson’s disease
Between 25% and 76% of people with Parkinson’s use alternative medicines, depending on the study and the type of practice involved.
The most commonly used practices are :
- acupuncture;
- massage ;
- medicinal herbs ;
- vitamins and food supplements.
People turn to these practices in the hope of improving their motor symptoms of the disease. (Wang, 2013)
Yoga, tai chi and other alternative practices in Parkinson’s disease
Tai chi and yoga are among the alternative and complementary therapies proposed and used by people with Parkinson’s disease, by healthcare professionals or not (Kim et al., 2016).
It’s reasonable to think that these practices can indeed improve certain health parameters in Parkinson’s disease, as is the case with physical exercises performed by physiotherapists.
Because these activities get you moving, improve balance and muscular strength, as well as cardiovascular function.
Yoga and tai chi can improve some Parkinson’s symptoms, simply because they get you moving.
On the other hand, it is not necessary to appeal to the concepts of vital energy, life flow, spirituality, etc. to explain the effect of these practices.
What’s more, the practice of yoga or tai chi, especially when supervised by non-health professionals, can expose you to the risk of injury.
Practitioners of yoga or tai chi with no medical or para-medical training may, for example, find it difficult to adapt sessions to the particularities of people with Parkinson’s disease, or fail to detect a progression of the disease that should lead to a different treatment.
Acupuncture and Parkinson’s disease
Although unscientific in its foundations, acupuncture has been tested to see if it has any effect on Parkinson’s disease. When these studies are well conducted, acupuncture is no more effective than a placebo. So acupuncture:
- alone cannot improve the motor symptoms of Parkinson’s disease, or prevent their worsening;
- does not improve or prevent these symptoms either when combined with levodopa therapy.
(Kim et al., 2016)
Acupuncture is not effective against Parkinson’s disease and its symptoms.
Phytotherapy, Chinese medicine, aromatherapy and dietary supplements in Parkinson’s disease
There is no evidence of the efficacy of aromatherapy on Parkinson’s disease; moreover aromatherapy can cause several adverse events such as pulmonary edema, dermatitis or allergic reactions (Kim et al., 2016).
Phytotherapy (or the use of medicinal plants, such as those recommended in Chinese medicine) was also tested. Many plants (over 60) have been used by Parkinson’s sufferers. Again, when we look at well-conducted, placebo-controlled studies, we find that herbal medicine is not effective in preventing or improving Parkinson’s symptoms(Kim et al., 2016).
The consumption of certain dietary supplements may, in theory, be relevant for some people with Parkinson’s disease, as well as for those in the general population. Numerous studies have been carried out, however:
- thatvitamin D supplementation does not improve the symptoms of Parkinson’s disease or prevent its onset (Zhou et al., 2019) ;
- same forubiquinone or co-enzyme Q10 (Zhu et al., 2017);
- the effect of creatine on improving motor function, activities of daily living or quality of life after one or two years of treatment for Parkinson’s disease has not been demonstrated (Cochrane, 2014) ;
- etc.
You need to take a close look at the literature for each dietary supplement. A trained health professional can do this for you if you have questions about the efficacy of certain supplements.
What we can see, however, is thatno single supplement stands out for treating the symptoms of Parkinson‘s disease, unlike, for example, medication, surgery or physiotherapy.
Any questions or comments? See you in comments!
📚 You may also be interested in these articles:
📕 Sources 📕
Effect of physical exercise therapy
On the effect of physiotherapy in general on Parkinson’s disease: Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KHO, Wheatley K, Ives N. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database of Systematic Reviews 2013, Issue 9. art. no.: CD002817. DOI: 10.1002/14651858.CD002817.pub4
On the effect on Parkinson’s of certain types of physiotherapy sessions versus others: Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, Deane KHO, Shah L, Sackley CM, Wheatley K, Ives N. Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2014, Issue 6. art. no.: CD002815. DOI: 10.1002/14651858.CD002815.pub2
On the effect of treadmill walking in Parkinson’s disease: Mehrholz J, Kugler J, Storch A, Pohl M, Hirsch K, Elsner B. Treadmill training for patients with Parkinson’s disease. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007830. DOI: 10.1002/14651858.CD007830.pub4
On the effect of physical exercise on cognitive function in Parkinson’s patients: da Silva FC, Iop RDR, de Oliveira LC, et al. Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS One. 2018;13(2):e0193113. Published 2018 Feb 27. doi:10.1371/journal.pone.0193113
On the long-term effect of exercise in Parkinson’s disease: Mak et al. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2017 Nov;13(11):689-703.
Effect of respiratory physiotherapy
On the effect of ventilatory exercises on neurodegenerative diseases, including Parkinson’s disease: Reyes et al. Respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review. Chest. 2013
On the type of respiratory physiotherapy techniques that are possible and relevant to use in Parkinson’s disease: Reyes et al. The effects of respiratory muscle training on peak cough flow in patients with Parkinson’s disease: a randomized controlled study. Clinical Rehab 2018
Swallowing rehabilitation
On swallowing and aphasia rehabilitation, and ortophonia management in Parkinson’s disease: Herd CP, Tomlinson CL, Deane KHO, Brady MC, Smith CH, Sackley CM, Clarke CE. Comparison of speech and language therapy techniques for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD002814. DOI: 10.1002/14651858.CD002814.pub2
Parkinson’s disease and alternative and complementary therapies
On the use of complementary and alternative medicine in people with Parkinson’s disease: Wang et al. Epidemiology of complementary and alternative medicine use in patients with Parkinson’s disease. J Clinical Neuroscience 2013
On the effectiveness of different alternative and complementary medicines on Parkinson’s disease: Kim et al., Professional ethics in complementary and alternative medicines in management of Parkinson’s disease. J Parkinson Disease, 2016
On the efficacy of dietary supplements (vitamins, minerals) on Parkinson’s disease: Zhou et al. 2019, The Association Between Vitamin D Status, Vitamin D Supplementation, Sunlight Exposure, and Parkinson’s Disease: A Systematic Review and Meta-Analysis
These publications were found and selected from searches of the Cochrane Collaboration and Medline databases, using the following keywords: Parkinson and (rehabilitation or physiotherapy or physical therapy or training), then Complementary and Alternative Medicine and Parkinson. Last update: January 2020.
Images: Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease | Wang CM, Shieh WY, Ho CS, Hu YW, Wu YR. Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study. Front Neurol. 2018;9:624. Published 2018 Jul 30. doi:10.3389/fneur.2018.00624
Written by Nelly Darbois
I enjoy writing articles that answer your questions, drawing on my experience as a physiotherapist and scientific writer, as well as extensive research in international scientific literature.
I live in the French Alps☀️🏔️, where I enjoy the simple pleasures of life (+ I’m a Wikipedia consultant and the founder of Wikiconsult).