Exercise is Medicine: Strengthening Body, Mind, and Voice in Parkinson’s

The Concept of "Exercise is Medicine" in Parkinson's

Have you heard the phrase exercise is medicine? When it comes to managing Parkinson’s disease, many of us immediately think of medications as the primary treatment. While medication is vital in controlling symptoms, there’s another powerful tool that often doesn’t get the spotlight it deserves: exercise. In fact, the concept of exercise is medicine—is not just for your body, but for your voice and mind as well. Exercising all three can be game-changers in slowing the progression of Parkinson’s symptoms, and improving quality of life.

The Power of Movement: Why Your Body Needs Exercise

The benefits of exercise for your body are well-documented, especially for people living with Parkinson’s disease. Studies show that regular and intense physical activity can improve balance, flexibility, and overall motor skills. More importantly, research suggests that exercise can slow the progression of the disease itself.

Parkinson's disease causes a gradual decline in dopamine levels in the brain, which leads to motor symptoms like tremors, stiffness, and slowness of movement. While medications like levodopa help to replace dopamine, exercise can boost the brain’s ability to use dopamine more efficiently. This means that you might not just be maintaining your abilities when you exercise—you could also be helping your brain work better in the long run.

What kinds of exercises are best for people with Parkinson’s? Here are a few ideas:

Aerobic Exercise: Activities like walking, swimming, or cycling help improve heart health and oxygen flow to the brain, boosting both physical and cognitive function.
Strength Training: Building muscle helps with balance and mobility, making daily activities easier and reducing the risk of falls.
Stretching and Flexibility: Yoga and tai chi can improve flexibility and balance, while also reducing stiffness and joint pain.

Parkinson Specific Organizations

Both Ping Pong and Boxing are excellent activities that can help improve Parkinson’s symptoms. PingPongParkinson is an organization that promotes Ping Pong as a way to enhance motor control and coordination, while Rock Steady Boxing uses non-contact boxing to improve balance, strength, and reaction time, helping people with Parkinson’s maintain physical and cognitive function.

Remember when it comes to exercise, it’s about consistency. Even small amounts of daily movement can have a big impact over time.

Your Voice is a Muscle Too: The Importance of Vocal Exercise

Exercise is medicine also applies to maintaining communication function. For many people with Parkinson’s, changes in speech are a significant challenge. Your voice might get softer, your words may slur, or it might take more effort to speak clearly. That’s because Parkinson’s can weaken the muscles involved in speech, including those in the throat and mouth. These muscles are also involved in swallowing function, which when weakened can result in swallowing issues, referred to as dysphagia.

But just like your leg or arm muscles, your vocal muscles can be strengthened through exercise. Vocal exercises, often guided by a speech-language pathologist, are designed to increase the volume and clarity of your speech. This is crucial because effective communication is a major part of maintaining your independence and quality of life.

Research shows that vocal exercises like the Lee Silverman Voice Treatment (LSVT LOUD) can lead to improvements in both voice volume and speech clarity for people with Parkinson’s. LSVT LOUD involves exaggerated, loud vocal practice that helps rewire the brain’s motor pathways, improving communication and even swallowing.

Here are a few ways you can incorporate vocal exercises into your daily routine:

Speak Loudly: Even if it feels exaggerated, practicing with a louder voice helps activate the muscles used in speech.
Sing: Singing engages different parts of your brain and vocal cords. Plus, it’s fun!
Breathing Exercises: Controlled, deep breathing helps with voice projection and reduces breathlessness during speech.
Join a PD specific voice/speech maintenance program: Online programs such as Get LOUD! Stay LOUD! offer an easy, convenient way to ensure you are doing the correct vocal exercises to optimize voice, speech and swallowing function.

Just like with physical exercise, consistency is key. Regular vocal workouts can help you maintain clearer speech for longer. For tips on how to stay motivated and diligent with Parkinson specific voice exercise click here.

Exercise for the Mind: Keep Your Brain Active

Parkinson’s isn’t just about physical symptoms. Many people with the disease also experience cognitive changes, such as memory loss, slowed thinking, and trouble with focus. But just as you can exercise your body and voice, you can also exercise your mind to stay sharp.

Cognitive exercises stimulate the brain and help build "brain reserves"—alternative neural pathways that compensate for damaged ones. Studies show that mentally engaging activities can help delay or even prevent cognitive decline in Parkinson’s patients.

So, what can you do to exercise your mind? Here are some ideas:

Puzzles and Games: Crosswords, Sudoku, and brain-training apps can help improve memory, problem-solving skills, and attention.
Learning a New Skill: Whether it’s a new language, a musical instrument, or a hobby like knitting, learning something new stimulates brain activity and promotes neuroplasticity—the brain’s ability to reorganize itself.
Mindfulness Practice: Mindfulness, including meditation and breathing exercises, can improve your focus and reduce anxiety. Research shows that practicing mindfulness can help slow cognitive decline by promoting relaxation and reducing stress, which are known to negatively affect brain function. Regular mindfulness practice also boosts emotional well-being, helping to manage symptoms like depression and anxiety, which are common in Parkinson's.
Social Interaction: Engaging in conversations, participating in group activities, or even volunteering can keep your brain sharp and improve mood.

Research supports the idea that mental exercise, including mindfulness, can help with cognitive symptoms, making it an essential part of your Parkinson’s management plan.

The Science Behind “Exercise is Medicine”

The phrase "exercise is medicine" isn’t just a catchy slogan—it’s backed by science. Numerous studies have demonstrated that regular exercise, in all its forms, helps people with Parkinson's manage their symptoms more effectively.

For example, a study published in the journal Neurology found that people with Parkinson's who engaged in regular physical activity had slower disease progression compared to those who were less active. Another study in Movement Disorders showed that vocal exercises like LSVT LOUD not only improved speech but also had positive effects on swallowing and overall communication.

Additionally, brain research supports the idea that cognitive exercises can promote neuroplasticity. This is particularly important for people with Parkinson’s, as the brain’s ability to adapt can slow cognitive decline and help maintain higher levels of functioning for longer periods of time.

Final Thoughts: You Are in Control

Exercise, whether for your body, voice, or mind, is one of the most empowering tools you have in your fight against Parkinson’s disease. While medications play an important role, integrating physical activity, vocal training, and cognitive exercises into your daily routine can help you slow symptom progression and maintain a higher quality of life.

So, start small, be consistent, and remember: exercise is medicine—and you hold the prescription.

#1 Tips to Prepare for Parkinson's Voice Exercises

Get Ready Get Set... Preparing for Parkinson's Voice Exercises

POSITIONING & POSTURE: Ensure you have proper posture when doing your daily Parkinson's voice exercises. Whether you're following along to our live or on demand speech therapist led sessions, you'll want to make sure that you are set up correctly. Cranio-cervical positional changes can greatly influence voice production!

Top Speech Therapist Tips

✅ Use a supportive chair with good back support

✅ Situate yourself squarely in front of your screen

✅ Both feet should be planted steadily on the ground. Ensure knees are not locked together.

✅ Chin should be parallel to the floor and slightly tucked in.

✅ Chest should be lifted (to achieve this, lift both arms straight up above your head, then gently let them fall back down without letting your chest drop).

✅ Shoulders should be relaxed and back, and spine should be straight.

BREATHING: Keep your stomach both firm and expandable at the same time. You will need to practice controlling these muscles while learning how to breathe using your diaphragm.

HYDRATE: Always have a full glass of water within reach during voice exercise sessions. Staying hydrated helps your body produce thin, watery mucus. Your vocal cords vibrate more than 100 times per second when you speak, and they need that mucus to help them move!

STAY RELAXED: Tension in the shoulders, neck and throat can result in poor voice quality and potentially strain those tender vocal fold tissues.

Try doing a few deep diaphragmatic breaths prior to starting. Breathe in deeply through the noise, imagining that you are inflating the belly like a balloon and slowly blow out through gently pursed lips. You can even make a gentle "ooh" sound as you breathe out. Feel the ZEN!

Now you're ready to safely do your daily Parkinson's voice exercises!

Difficulty Swallowing: Dysphagia in Parkinson's Disease

Difficulty swallowing, referred to medically as dysphagia is a common symptom of Parkinson's disease, particularly in the later stages of the disease. Swallowing is one of those bodily processes that we often don't give a second thought to... until it becomes a problem.

The Role of the SLP in Managing Difficulty Swallowing

A speech language pathologist (SLP) is trained to evaluate and manage both difficulty swallowing and all manners of communication impairment in a variety of conditions, including Parkinson's disease. Dysphagia became under the purview of SLPs because the process of swallowing involves much of the same anatomy and physiology involved in speaking.

Speech pathologists have specialized training in head and neck anatomy and physiology. They also study voice, articulation, respiration, resonance and motor speech. Most SLPs who work with adults have extensive training in dysphagia and complete clinical practicums to manage all manners of swallowing disorders.

Why does swallowing difficulty occur in Parkinson's?

Along with the hallmark feature of difficulty initiating movement, Parkinson's is known for making movements smaller. It's often referred to as the disease of low amplitude. We often think of these smaller movements as they refer to gross motor movements such as having a smaller shuffling gait pattern or reduced arm swing when walking.

With respect to swallowing function: jaw, lip, tongue and throat movements can become reduced in range resulting in difficulty chewing food, controlling liquid in the mouth and triggering a strong, timely swallow.

Impact on Communication

Now think of it in terms of communication. Vocal projection becomes reduced resulting in a soft, difficult to hear voice. Articulation and facial movements become reduced resulting in less precise speech and masked facial expression. Even intonation and prosody in the voice can be affected, resulting in flat, monotone sounding speech.

Disuse Atrophy: You Don't Use It, You Lose It

But it's not simply an issue of direct muscle weakness, for example like what may occur in a stroke. There is a two-fold effect happening. The dopamine deficiency in Parkinson's disease results in a perceptual impairment, a "faulty feedback loop" if you will. Your brain gives you incorrect information about the SIZE of the movements you are making.

You may think that you are speaking loudly or smiling widely because your brain tells you that you have put sufficient effort into these movements. But this is often false information! Your voice may in fact be too quiet and your smile minimal. Because of this perceptual issue, you don't adjust the movement to make it bigger.

And as the old saying goes... if you don't use it, you lose it. Over time, reduced movement and range results in further weakening of those muscles and systems.

The Three Phases of the Swallow

It's also important to know that there are three distinct phases of the swallow. Any or all of these swallowing phases can be impacted in Parkinson's disease.

The Mouth Phase

During the mouth or oral phase of the swallow, food or liquid must be prepared, controlled and transferred to the back of the mouth. This part of the swallow is completely under your volitional control. For example you can choose to hold a sip of water in your mouth for several seconds or chew a tough piece of steak extensively before swallowing, if needed. Many people with Parkinson's find thin liquids and mixed texture foods particularly challenging due to the increased challenge of controlling these textures in the mouth.

The Throat Phase

The second phase of the swallow is the throat or pharyngeal phase of the swallow. This is where the brain takes over and completes a complex set of movements to safely transport the food or liquid into the food tube. An important part of the pharyngeal phase is ensuring that the airway is sufficiently closed to prevent food or liquid from "going down the wrong pipe". When something goes down the wrong way it's called aspiration. Aspiration events can lead to aspiration pneumonia which can be deadly if left untreated.

The Food Tube Phase

The third phase of the swallow is the food tube or esophageal phase where the food is transported to the stomach. Speech pathologists primarily manage difficulty swallowing only in the first two phases of the swallow as this last phase is largely treated and managed with medication and/or surgical intervention.

Common Swallowing Difficulties in Parkinson's Disease

So what are some of the typical swallowing difficulties that can occur with Parkinson's disease?

Spillage of food/liquid from the lips or prematurely into the throat due to difficulty with mouth control
Trouble initiating the transfer of food from the front to the back of the mouth
Trouble triggering a timely throat (pharyngeal) phase of the swallow
Reduced range of movement of the throat's laryngeal structure resulting in reduced closure of the airway during the swallow
Food residue in the throat after the swallow (especially with dense food like bread or a thick pudding)
Reduced sensation of food/liquid entering the airway (aspiration!) resulting in an absent or ineffective cough response to clear
Difficulty swallowing pills

Increased Risk of Aspiration Pneumonia

People with Parkinson's disease have a higher risk of silent aspiration (not sensing/responding to things going down the wrong way) which puts them at a significantly higher risk of developing aspiration type pneumonia. There are ways to significantly reduce your risk of developing aspiration pneumonia in Parkinson's disease, including ensuring that you have a thorough oral care routine.

If you have Parkinson's disease and have started to experiencing difficulty swallowing, it's essential to seek out a clinical swallowing assessment with a trained speech language pathologist near you.