While Parkinson’s has no cure, we do know that regular aerobic exercise can slow its progression.
Oliver W. Phillips, MDAt 45, Tamara Barry noticed a slight tremor in her right hand. She brushed it off since it didn’t interfere with her nursing job or daily routine.
But over time, Barry developed new symptoms. She started shuffling her feet, moving more slowly, and her arm no longer swung naturally when she walked.
Fifteen years after she saw the first tremor, a scan at age 60 confirmed that Barry had Parkinson’s disease.
“I already suspected Parkinson’s, but I wanted to be sure,” Barry says.
About 1.1 million people in the United States have Parkinson’s disease, a progressive neurological disorder that causes involuntary movements, stiffness, and balance problems.
“Parkinson’s progresses slowly, and symptoms can be very different from person to person,” says neurologist Oliver W. Phillips, MD, of Dartmouth Hitchcock Medical Center.
How can you spot the early signs of Parkinson’s, and how do doctors diagnose it?
What are the early symptoms?
Before his Parkinson’s diagnosis in 2015, actor Alan Alda once dreamed he was defending himself from an attacker by throwing a sack of potatoes. In reality, he threw a pillow at his sleeping wife.
Alda had what’s known as REM Sleep Behavior Disorder (RBD), a neurological condition where people lose the normal muscle paralysis that happens during REM sleep.
Studies show that roughly half of people over age 50 with isolated RBD will develop a neurodegenerative disorder within ten years.
“Acting out dreams is one of the strongest predictors or the highest risk factors for Parkinson's disease,” Phillips says.
Other Parkinson’s symptoms can include loss of smell, mood changes, constipation, and smaller handwriting. These often show up long before tremors or movement problems start.
Early Parkinson’s symptoms include:
- Mood changes, including depression and anxiety
- Fatigue
- Constipation
- REM sleep behavior disorder
- Loss of sense of smell
- Changes in handwriting
Motor symptoms, required for diagnosis
- Slowness of motion (called bradykinesia)
- Rigidity or stiffness
- Resting tremor
- Lack of arm swing while walking
- Gait impairment, falls
What causes Parkinson’s?
Experts don’t know the exact cause of Parkinson’s disease. It develops when the brain cells that produce dopamine slowly die, leading to tremors, stiffness, and balance issues.
Researchers believe the disease results from a mix of genetic factors, environmental exposures, and the natural aging process.
Most people diagnosed with Parkinson’s are older adults, with the average age of diagnosis between 60 and 69.
Only 10 to 20% of Parkinson’s cases are considered early-onset with a diagnosis before age 50. Actor Michael J. Fox was diagnosed at 29, and boxing legend Muhammad Ali at 42.
How is Parkinson’s diagnosed and treated?
No single test can confirm Parkinson’s. Doctors use a mix of patient history, symptom patterns, and a clinical exam to make the diagnosis.
A new diagnostic tool, synuclein skin biopsy testing, can detect abnormal protein deposits associated with Parkinson’s and help clarify uncertain cases.
Barry’s diagnosis involved a DaTscan, a test that measures the health and density of the brain’s dopamine system.
There is no cure for Parkinson’s. But medications like levodopa can ease stiffness and tremors, and regular exercise, physical therapy, and speech therapy help.
Treating Parkinson’s disease is different for everyone.
“It depends on the person and is really about individualizing treatment,” Phillips says. “There’s not necessarily a standard course of treatment or an algorithm with a one-size-fits-all approach.”
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Is it hard to diagnose?
Research shows that about 15 to 25% of patients get an incorrect Parkinson’s diagnosis.
“A few things can paint a picture that looks like Parkinson’s disease but isn’t,” says Anas Hannoun, MD, a neurologist at Dartmouth Health Clinics Concord and Bedford.
Some medicines, like antipsychotics, anti-nausea drugs, and mood stabilizers, can cause symptoms that mimic Parkinson’s.
When diagnosing Parkinson’s, Hannoun says he reviews the patient's history, performs a physical exam, checks both motor and non-motor symptoms, and rules out other causes, such as medication side effects.
Does exercise help?
“While Parkinson’s has no cure, we do know that regular aerobic exercise can slow its progression, and that’s something I always stress to my patients,” Phillips says.
Research shows that regular, high-intensity aerobic exercise can slow Parkinson’s progression by supporting dopamine-producing brain cells.
Studies have also found that patients who exercise several times a week improve their movement, balance, and energy.
“Exercise has shown some slowing down, and in some cases, the reversal of the progression of the disease,” Hannoun says.
Exercise can improve balance, flexibility, energy, thinking, anxiety, sleep, and fatigue for people living with Parkinson’s. Stretching also prevents stiffness and keeps joints flexible, which can be lost if those joints aren’t used often, Hannoun says.
“We do see a big difference between patients who exercise and those who don’t,” he says.
Living with Parkinson’s
For Barry, being diagnosed with Parkinson’s didn’t slow her down.
“I really didn’t skip a beat,” says Barry, an avid hiker, rock climber, and boxer. “I believe that with crisis comes opportunity.”
After retiring in 2020, she began leading the Upper Valley Programs for Parkinson’s, working to expand support and exercise opportunities in the area.
“The key to slowing the progression of Parkinson’s is staying active and exercising,” she says. “After living with Parkinson’s for 23 years, I believe regular exercise has helped slow the progression.”
Awareness of Parkinson’s disease has grown in recent decades, reducing stigma and encouraging earlier diagnosis and treatment, she says.
Advocates like Fox and TV shows such as Shrinking with Harrison Ford have played an important role in bringing the disease into the spotlight. Barry says this visibility helps show that people living with Parkinson’s can still lead energetic, fulfilling lives.
“Having Parkinson’s isn’t the end of your life. You can still be engaged and strong,” says Barry.
She encourages anyone with Parkinson’s to keep living life to the fullest and to not lose hope.
“You can still push yourself, challenge yourself, and be active,” Barry says. “Remember to eat well, exercise, be social, and have a positive attitude.”
Resources + Related Stories
Parkinson's Disease and Movement Disorders Program at Dartmouth Health
Upper Valley Programs for Parkinson’s
