Parkinson's Drugs Physiotherapy Implications

Introduction[edit | edit source]

Exercise (increasingly considered to be a complementary strategy to Parkinson’s (PD) medications) is a major component of physiotherapy for Parkinson’s management.[1] This less than 5 minute video outlines the importance of exercise in PD>


Pre Exercise Assessment[edit | edit source]

A pre-exercise subjective assessment should be undertaken to find if common side effects from the drugs may impact on treatment. The therapist needs to be be aware of possible side effects and monitor accordingly or/or adjust treatment. Adverse effects of each of these drug classes will require monitoring. A clear understanding of the general yellow flags to improper dosing is vital. These adverse effects result from the poly-pharmaceutical approach to PD management.  Being aware of them allows us to alter our plan of care and not compromise the patient’s safety. If left unaddressed, these adverse effects could substantially decrease our overall quality of care that we administer.

Timing[edit | edit source]

Exercise is a critical part of treatment for Parkinson's and should be in done in the time slot that suits the clients "on" times. It may be appropriate for the client to keep a diary of symptoms. This may be helpful to track when symptoms occur so that your exercise sessions occur at the most effective timing.

Taking Parkinson’s medication can cause side effects, including:

  • Orthostatic hypotension (link provides physiotherapy strategies used to manage this condition).
  • Psychosis (report to specialist and curtail treatment).
  • Dyskinesias (monitor carefully as potential falls risk).
  • Confusion/memory loss (instruct at appropriate level so they understand and follow commands).
  • Psychological changes (report to a specialist)
  • Sleepiness, fainting or dizziness (monitor, don't compromise the patients safety).
  • Nausea
  • Involuntary movements
  • Behavioral problems, such as feeling an uncontrollable need to gamble, have sex or pursue hobbies.

Levodopa - On Off Times[edit | edit source]

Overtime as Parkinson’s progresses the levodopa dose will need to be adjusted. Many people will become more aware that symptoms sometimes return between doses of medication. This is called ‘wearing off’ and is a sign your dose needs to be adjusted.

Wearing Off: Physical therapy treatment should be administered during the peak effective time of each individual medication; or ideal treatment effects may be compromised due to a negative event known as End of Dose Dyskinesia. ie check the timing of physiotherapy sessions with the client so they will benefit maximally from there exercises.

The 2 minute video below outlines this phenomena


Conclusion[edit | edit source]

Exercise older person.jpg

Exercise is essential in the management of Parkinsons. However, clients with Parkinsons are most likely taking medications that can possibly have an effect on their physical response and tolerance to exercise. Therefore physiotherapists need to be aware of potential side effects and then time, dose and monitor exercise accordingly. The above gives you guidance on the best way to monitor and administer your exercise sessions

Reference[edit | edit source]

  1. Bouça‐Machado R, Rosário A, Caldeira D, Castro Caldas A, Guerreiro D, Venturelli M, Tinazzi M, Schena F, J. Ferreira J. Physical activity, exercise, and physiotherapy in parkinson's disease: defining the concepts. Movement disorders clinical practice. 2020 Jan;7(1):7-15. Available: (accessed 15.4.2022)
  2. LivingHealthyChicago Exercise and Parkinsons disease Available from: (last accessed 7.11.2019)
  3. BG Causes and symptoms of wearing off in PD patients Available from: (last accessed 7.11.2019)