Chapter 19

Chapter 19: The Final Chapter

Here we are, friends – at the final chapter. We have covered a lot of ground, all in the interest of helping the person with PD to live an improved quality of life. And – while we have covered a lot so far, there is so much more we can talk about.

It has been my intention to deliver effective concepts, techniques, and strategies that are not mainstream, common knowledge. And these techniques can be added to your current exercise program to boost the benefits. After all, we want what we do during training to transfer to activities of daily living.

I am an avid reader and there is something that frustrates me about many of the books of this type I have read; the author gives droves of important and relevant  information, but leaves you hanging with a lack of practical application techniques.

When I read a book of this type, I want to know WHAT to do and WHY I am doing it. That is what I hope you have gotten from this book.

And, rather than writing additional chapters about all kinds of things that can easily be found elsewhere, I will use this chapter to briefly cover additional concepts and modalities that are important and beneficial but are generally much more common knowledge.

Balance / Stability

Training to improve balance and stability is important for all of us, and especially those living with PD:

  • Static balance (balancing while in a stationary position),
  • Dynamic balance (balancing while moving)
  • Reactive balance training (avoiding a fall when balance is disturbed)
  • Perturbation training (intentionally disrupting balance)

Resources to consider:


We addressed strength already but remember – in addition to our functional strength training, a more traditional approach can be highly beneficial:

  • Free weights
  • Machines
  • Bodyweight training
  • Suspension training

Resources to consider:


Rigidity and postural issues are common in the PD population. Flexibility exercises can be very helpful. Flexibility modalities and techniques may include:

  • Stretching
    • BIG movements (over exaggerated stretching and postural movements)
    • Yoga (generally involves some stretching)
  • Manual therapy (out of the scope of practice for personal trainers)
  • Physical therapy
    • Chiropractic care
    • Massage

Resources to consider:


We learned that breathing issues are common in the PD population. Aerobic exercises will help to improve breathing capacity and cardio-vascular conditioning, and this is particularly important.

Mindful 3D breathing is also highly beneficial and should be practiced daily. 

Resources to consider:


People with PD often experience diminished voice projection. Some experience great difficulties articulating words. We are expanding our education in these areas, but there are other great resources available.

Resources to consider:


The addition of music to exercise can be almost magical. In fact, in countless situations, we have seen people go from uncontrollable involuntary movements to well controlled movement with the addition of music during their exercise, movement, and gait training sessions.

Looking at research around music and Parkinson’s, we can learn more about why we see improvements in movement.

Research suggests that music-based movement (MbM) therapy may be an effective intervention to improve gait and gait-related activities in Parkinson’s disease patients. This is because it naturally combines cognitive movement strategies, cueing techniques, balance exercises and physical activity while focusing on the enjoyment of moving on music instead of the current mobility limitations of the patient. (M.J. de Dreua, 2011)

We also know that the brain functions through dopaminergic neurotransmission, and music may be effective for rectification of symptoms in various diseases that involve dopaminergic dysfunction such as PD. (Den’etsu Sutoo, 2004)

Music acts as a specific stimulus to obtain motor and emotional responses by combining movement and stimulation of different sensory pathways. This particular study explored the efficacy of active music therapy (MT) on motor and emotional functions in patients with PD. (Pacchetti, et al., 2000)

In this study, MT had a significant positive effect on motor improvement, activities of daily living, quality of life, rigidity, and especially bradykinesia. Over time, changes on the Happiness Measure confirmed a benefit on emotional functions. The study proposes active MT as a new method for inclusion in PD rehabilitation programs. (Pacchetti, et al., Active Music Therapy in Parkinson’s Disease: An Integrative Method for Motor and Emotional Rehabilitation, 2000)

Special note: As with exercise choices, choosing music you like is paramount. As mentioned in part two, use of a metronome or playing music while walking to the beat can help to create a more symmetrical and rhythmical stride. The music-brain connection is powerful and can help with learning and memory. Additionally, give your brain a workout by listening to new music rather than what you always tend to listen to.

Trainers: Consider bringing a portable speaker with you for your client workouts. This can completely change the dynamics of the sessions in addition to benefitting the brain and movement.


Dancing is movement. Movement lights up the brain and as we discussed in part two, several factors come into play when dancing such as cross body patterns, rotations, cognitive skills (knowing the next move and where to step next) and moving to the rhythm of the song. Plus, it gets the heartrate elevated which we know causes the brain to create BDNF.

Resources to consider:

Stress and Anxiety / Meditation and Mindfulness

Anxiety is near the top of the scale as a non-motor symptom in the PD population. High anxiety can have adverse effects on symptoms and movement, leading to an increased risk of falling. Meditation can be immensely helpful in reducing anxiety. Guided mindfulness or meditation can also be helpful.

A resource to consider:

Nature vs. Built

We talked about this previously, but it bears repeating. Exercise outdoors as often as possible. The benefits to your brain, body, and immune system are significant over exercising on a built environment. Add barefoot training and working out with a partner, and you’ll be firing up all kinds of brain cells.

Parkinson’s Group Exercise

Group exercise can be beneficial for a multitude of reasons:

  • You’re moving
  • You’re exercising
  • You’re meeting people who have something in common with you: Parkinson’s
  • You’re socializing (something that many with PD start to do less and less as the disease progresses)
  • You’re interacting with others
  • You make new friends

We know that exercise helps to delay disease progression. If you don’t like exercising alone,  exercising with a group can be a great experience that yields tremendous advantages. Group exercise will help to improve flexibility, balance, strength, stability, cognition, and cardio-vascular conditioning. Group X further enhances your workout as you interact with others while moving. Throw some barefoot movement and music into the mix (and try doing the group class outdoors), and you’ll have the optimal components for reducing depression and anxiety while realizing the benefits of exercise.

Movement specialists: Group exercise for Parkinson’s is a fun and gratifying experience. I highly recommend the following for group PD classes:

  • Decide if you want to do classes with a mixture of high, medium, and low function clients or if you would rather do classes for more specific levels of function. This is up to you and your level of skill and confidence in this area
  • No matter which type class you decide to run, make sure your trainer to attendee ratio is sufficient. This is important because:
    • Every person with PD is uniquely affected differently and many with PD may need someone close to them in the interest of safety and to help avoid a fall.
    • We often times have caregivers volunteer to spot their person with PD in the interest of safety.
    • This gives caregivers the experience of learning the exercises. They can take this knowledge home and help the person with PD to do the exercises at home.

Emotional Support for People with PD and Caregivers

Emotional support for people with Parkinson’s and caregivers is important. In many situations, the person with PD will choose to socialize less as their symptoms advance and movement becomes more compromised. For those who like to socialize, the lack of interaction with others can be very depressing. Depression affects the person with PD, the caregivers, and others around them.

Consider the following: when a person with PD starts exercising and realizes improved movement (which happens often), their depression is likely to diminish. When they begin to feel inspired and hopeful, this will carry over to the caregiver and offer some relief there, as well.

Caregivers are under-recognized for their work and often suffer from depression. I’ve seen it happen countless times where a person with PD starts to move better and feel better. This radiates to the caregiver and helps them to feel better, too.

Additionally, when a person with PD moves better, this may offer a break to the caregiver, allowing them to get out on their own for a little while. A little bit can go a long way in this area.

Parkinson’s associations can offer wonderful support for people with PD. Many associations have caregiver support groups, as well.

Again, group exercise for PD is another area where people with PD and caregivers can receive support in the way of socializing.

Look for Parkinson’s support groups and PD group fitness classes near you. Give them a try. You might be glad you did.

Wheelchair Users

When I was first asked to work with a client who uses a wheelchair, I was afraid to do it. I didn’t know what to do, so I spent a few days reading publications and searching YouTube. I learned enough to get started and then found an expert to mentor me.

If you’re a person with PD and using a wheelchair, don’t let that wheelchair stop you. Even in advanced stages, there is so much you can do to help you feel better.

Nutrition and Gut Health

While nutrition was my major in college, I do not claim to be an expert in this area. While I can recommend a few things to improve gut health and nutrition, I will refer you to an expert in this area. Before I do that – research and experts tell us that Parkinson’s can live in the nerves of the bowel and gut for 10-20 years before making its way to the brain. Then it will take a few years for visible symptoms to develop.

I highly recommend reading Dr. Dale Bredesen’s book, The End of Alzheimer’s. In this book, he thoroughly explains the gut brain connection.

For nutrition and gut health advice, visit the website of Dr. Laura Mischley:

This is an amazing resource that will help you to improve your gut health and dietary lifestyle.

Patient Compliancy and Responsibility

Getting started with a workout program is a big deal. To realize benefits, it is imperative to stick with the program once you’ve gotten started. But, for many (myself included), sticking to it can be a real challenge. This requires discipline and taking responsibility for your health. It means you must be compliant and stay with the program, especially if you want to have any chance of slowing disease progression and reduce your risk of falling.

Lack of dopamine can exacerbate the lack of motivation to stick to it, but now you’ve learned about a couple things that can help with this dilemma:

  • Do exercises you like to do, and you’ll be more likely to get started
  • JUST GET STARTED and you’ll get the energy to keep going
  • Find an accountability workout buddy to help you stay on track
  • Think of how you’ll feel when you finish working out
    • Physically, emotionally, and mentally, you’ll feel better
    • Feeling a sense of accomplishment
    • Realizing improvements in your movement over time

All of these things are a big deal, folks. Just get started and stick with it. Your brain and body will thank you for it.

In Closing

I am honored that you have purchased this book. If you made this far, I am guessing you read the book and BRAVO to you for doing so!

I hope you have learned some things that will help to manage disease symptoms, reduce falls, and improve quality of life for the person living with Parkinson’s.

A special message to people with PD: I have been so deeply moved while writing this book. We have stories from PD fighters, many who I know personally, and they are all amazing people. If you read this book, YOU are a fighter! All over the world I see people with PD doing amazing things to fight back against PD. So, keep fighting. You know that Parkinson’s does not define you. Keep fighting and keep being a great example for humanity. You have inspired me so much that I have devoted my entire career to learning as much as I can to help you and I will never stop trying. You have taught me so much about what it means to fight back in the face of adversity. For this, I thank you. You all have helped to make me a better person. I owe you everything I can possibly do to help you.


  • Just get started with your exercise program and you will get the energy to keep going
  • Just get started and feel the satisfaction and gratification when you finish your workout
  • Just get started with movement every single day. This is your ticket to feeling better
  • Just get started and reap the benefits of moving better and reducing falls and fall risk
  • Just get started and be the example who inspires others to do the same
  • Just get started and do it for your family and loved ones

A special message for fitness professionals, PT’s, OT’s, and movement specialists:

  • Be a nerd. Be a geek like me
  • Be open minded and think outside the box. If you stick solely within the parameters of what you learned in your certifications or education, you will only know that. Strive to think outside the box
  • Always be learning and growing. Always
  • Seek out professionals who know a lot more than you
  • Seek out experts in areas you wish to learn about
  • Seek out professionals who are always learning and growing
  • Seek out professionals who will mentor you and help you grow. My primary mentors have taught me (and still teach me) so much:
    • Dr. Brent Brookbush: my number one mentor, ever. No one has taught me more than Brent
    • Ali Prettyman: a gentleman who is always learning 100% of the time. A man who believes education should be shared, not hoarded. A man who has passionately taught me so much
    • Dr. Emily Splichal: an amazing lady whose knowledge is unparalleled. Dr. Emily also launched my career as an educator, for which I am eternally grateful
    • Dr. Perry Nickelston: there is only one Dr. Perry and he is the best! He changed my life the first time we met, and continues to do so to this day
    • Dr. Alfonso Fasano: a globally known and highly respected neurologist who has generously spent many hours with me, sharing and teaching
    • Dr. John Ratey: I have learned more about the brain from Dr. Ratey than anyone else
    • Dr. Nick Sterling: my son who I look up to and who has taught me so much, it is mind boggling
    • And there are countless others. Visit and you’ll see well over 120 interviews I’ve done with countless experts. I am forever grateful to all of them for teaching me.
  • Be passionate about your work. It you do not like what you are currently doing, start exploring other options. I used to work with athletes. Hated it and they could tell. That was not fair to them. Now I work with people with movement disorders and love it so much – and they feel it.
  • Find a niche. Study everything there is to study within that niche and be the BEST at it