Parkinson's Fall Prevention: Essential Balance Exercises & Safety Strategies

Are you living with Parkinson's and finding that poor balance is restricting your confidence and daily life? In this critical, actionable episode of the Live - Parkinson's - Live an Exceptional Life podcast, we focus entirely on fall prevention strategies using targeted exercise.

Improving your balance is the single most effective way to maintain independence and safety. We dive into the specific movements and mental approaches necessary to counter the gait and stability challenges brought on by Parkinson's disease. Whether you are newly diagnosed or managing symptoms for years, these are the essential strategies you need to hear.

Key Topic Areas Covered:

• Understanding the specific reasons Parkinson's affects dynamic and static balance.
• The role of core strength in stabilizing the body and preventing unexpected falls.
• Breaking down essential low-impact exercises that directly improve gait and stability.
• How to build a consistent, effective exercise routine that fits your energy levels.

Take Action and Live an Exceptional Life

Free Resource & Newsletter: Take the next crucial step in fall prevention and safety today! Visit LiveParkinsons.com to subscribe to the free monthly Newsletter and get a copy of our dedicated guide, 9 Balance Exercises for Improving Balance.

Learn More About My Journey: To learn more about my personal journey and gain a deeper understanding of the four essential strategies for thriving with Parkinson's, get your copy of my book: Spectacular Life, 4 Essential Strategies for Living with Parkinson's.

#ParkinsonsDisease #FallPrevention #BalanceExercises #ParkinsonsExercise

#MobilityMatters #PDStrong #NeuroFitness #LiveParkinsons #PhysicalTherapy

#ParkinsonsAwareness #StrengthAndBalance #HealthPodcast

#LiveAnExceptionalLife

Chapters

• 0:11 Mission And Today’s Focus
• 1:26 From Fear To Action
• 2:12 What Causes Postural Instability
• 5:15 The Fear Cycle And Activity Loss
• 6:45 Why Specialized Exercise Matters
• 8:16 Three Balance Systems Explained
• 10:23 Neuroplasticity And Strength Foundations
• 12:18 Three Types Of Balance Training
• 13:36 Tai Chi Evidence And Benefits
• 15:06 Dual Tasking For Real-Life Safety
• 16:40 Agility, Dance, And Boxing
• 18:18 Challenging Surfaces And Sensory Inputs
• 19:24 Safe Home Exercises That Work
• 22:03 Gait Stability Drills
• 23:18 Vertical Stability And Weight Shifts
• 24:44 Consistency, Progression, And Safety
• 26:00 Pro Help: LSVT BIG And PWR
• 27:20 Key Takeaways And Next Steps

Transcript

SPEAKER_00: 0:11

Hello everyone, welcome to Live Parkinson's Live an Exceptional Life. I'm your host, Chris Kustemboder, and I've been living an exceptional life with Parkinson's for the past 15 years. The mission of this podcast is to help as many people as possible living with Parkinson's to lead a great quality of life. Now, today I want to talk about a topic that really hits home to most of us, and it's one of the most pressing concerns in the Parkinson's community, and that's balance and fall prevention. Because you may know somebody with Parkinson's that has had a fall, and we want to be able to prevent all of you from having falls if we can. And let's be really real about it. Falling isn't just a physical event that's really going to send us to the floor, but it's also going to kill our confidence. When you have that moment of instability or even just that fear, that moment can take that you're you lose your balance, and that can make you want to stay in your chair, make you want to stay home, and you really stop living the life that you want to live. And we don't want to let that happen. So we want to make sure that you're active and doing the things that you love to do. So today we want to change the narrative. We want to move from fear to action because really that's what it's all about. You taking control and taking action to improve your balance and your stability. So today we're going to discuss the science behind why balance is such a challenge with Parkinson's. And then, and this is the more important part, we're going to dive into specific proven exercise strategies that can help your brain and your body work together to help keep you upright, keep you confident, and keep you moving freely to do the things that you want to do. Now, before we dive in, I just want to give you a quick reminder that always talk to your neurologist, your movement disorder specialist, and if you're using a physical therapist, let them know as well before starting any new exercise routine. They're your personal team of experts, and they're going to be able to tailor strategies that are based on your personal needs. All right, now let's get started and talk about how you can reclaim your balance and your confidence. All right, so why is balance such a big deal with Parkinson's? Well, it really boils down to something that they call postural instability or PI. Not Magnum PI, the TV show from back in the eight seventies or eighties, I believe it was. But postural instability is what we're going to be talking about. So I want you to think of it as a high-tech building. So when someone bumps and hits the wall or the foundation of the building, a lot of times buildings are built so that they can give and move so they can absorb some of the shock. Now, for those of us living with Parkinson's, when we get bumped or we get pushed or whatever happens, those automatic reflexes, so those tiny little instant muscle adjustments that we need to keep our center of gravity over our feet, well, they get slowed down or disrupted. So our brain's command center for balance is in the basal ganglia and it's struggling to send those rapid fire instructions. So if you get bumped or you have to turn too quickly, it doesn't send those signals as rapidly as it did before. And so a lot of times we have trouble making those necessary adjustments. So a lot of times this is why we see leaning or the tendency to pitch forward or backward, and oftentimes why small stumbles can turn into a big fall. Now I know personally I walking through the grocery store and I'll catch my toe or my sneaker on the the linoleum, and then I start to to stumble and trip. And luckily, most of the times I've been able to catch myself or grab something so that I don't fall. But that's those, it's those little stumbles that can lead to a big fall because our center of gravity gets displaced because we're leaning too far forward. And once we get our weight moving too far forward, there's not a great way to be able to catch yourself. So Parkinson's doesn't just affect our movement, but it also affects the automatic movements that go with it. So it's not just about posture and stability. We also got to deal with some things like freezing of gait. And if you've ever experienced that, it feels where your feet are glued to the floor. Or I've had this myself as well, where you get episodes of dizziness when you stand up too quickly. Maybe you bend over and tie your shoes, or you're sitting down and you stand up quickly, and all of a sudden you're you feel dizzy and lightheaded, and you're thinking, what's going on here? That's also known as orthostatic hypotension. But here's the kicker. Research consistently shows that fear of falling is a huge problem in the Parkinson's community. And it's that fear that's gonna make you move smaller. Here it's gonna make you hold yourself more stiffly, and it's gonna reduce your activity level. And we all know what happens when we reduce our activity level, that our muscles are gonna get weaker, we're gonna we're gonna be stiffer, and our balance reflexes are gonna get slower. So it becomes this vicious cycle. So we're afraid of falling, so we reduce our activity, we get stiff and weak, and then our balance reflexes get slower. So this is what we want to talk about today, and how we can break that fear cycle. And that's what we're going to do. So we know we take medication to help us with our motor symptoms, but when it comes to directly improving our balance and making those automatic reflexes fire better, there's really only one what I'll call non-negotiable solution, and that's really specialized exercises. Because medication alone can't replace the targeted training that our brain needs in order to relearn balance. So let's talk about some of the fundamental principles that go into balance training. So you might be walking on a treadmill every day, and that's great, great for cardio, but general fitness is not the same as balance fitness. So to improve our balance, we need specificity. So we need to do some exercises that are going to intentionally challenge the three sensory systems that our brain uses to keep us upright. And those three systems are, which you were probably asking yourself, the first one is vision. We need to be able to see where we're going. And I know a lot of times if it's I have a cabin in the mountains and if I'm out walking at night and there's not a lot of light, I tend to stop because I can't see where I'm going and I lose my sense of where I'm at. The second is what they call the vestibular system, and that's your inner ear sense of movement and position. Now, if you've ever had an inner ear infection, you know people that get vertigo, that can really mess you up because you tend to the room tends to spin, you're very dizzy. So we want to be able to work on the vestibular system where the inner ear sense is movement and position. And then the last piece is proprioception. And I've talked about this before, but it's your body's awareness of where your arms and legs are without looking. So we don't need to look at our feet to know where our feet are while we're walking, or we don't need, if we're reaching for something, we don't need to necessarily or if we're just reaching out, we don't always don't need to grab and stare at what we're looking at. So those are the effective balance training forces, the three of them that we need to recalibrate when we're working on our balance training. Now, and one of the other factors that comes into play is neuroplasticity. And I've talked about this on previous podcasts, and it's a magic word, but it's your brain's incredible ability to reorganize itself by forming new connections. So think of it this way: if you have a wire in your house that goes into a bad outlet or socket, the energy is not going through there. So we rewire, we can rewire around that outlet to regain the flow of electricity to where you want it to go. And that's what uh an example of neuroplasticity would be. So for years we thought that the adult brain was fixed. Once you became an adult, there was nothing else you could do. Well, boy, were we wrong about that. Modern research tells us that intensive, complex, and challenging movement can actually induce these positive neuroplastic changes and help your brain find these new alternative routes to help us control our movement and our balance. So that's great news. So we can always retrain our brain to help with our balance and our movements. Now, Dr. Giselle Pettinger's work at USC, and there were some other stuff, similar studies that suggest that exercise can improve your brain health by increasing the blood flow and releasing what they call trophic factors that help our neurons grow and connect. So essentially, your specialized balance training is going to be rewiring our brains for stability. Now, another key piece that I wanted to touch on too is the role of strength. A lot of times we think balance is just, oh, we're standing up or we're using our brain and our vision. But while balance is mostly a nervous system skill, it rests on a physical foundation of our skeletal system and our muscles. So you can't build a strong house on quicksand because it's gonna fall, you know, sink into the ground. And that's why you need to have core and leg strength, and they're right, they're gonna be vital for your balance. Core is your abdominal muscles and your back muscles, and then you want to have strong leg muscles as well. So your glutes, which are your butt muscles, the quads, the big muscles in your thighs and your core, or they're gonna act as your anchors for your whole body. So the stronger your legs are, the more power and stability that you're gonna have to execute the necessary steps and weight shifts that you need when you start to lose your balance. So balance training isn't just about standing on one foot, it's about training your entire system for quick, powerful, and adaptive responses. So you also want to make sure that you're doing some strength training to work on your leg strength and your core strength. Now, before we dive in too much further, I want to talk about the three types of balance exercises that we can do. And the first is vertical stability. And this focuses specifically on improving your ability to maintain an upright posture. Second, the second type is exercises, is posture. That these are exercises that help improve the alignment of the body and are going to help also reduce muscle stiffness. And then the third type that we're gonna be talking about as well is what they call stability with gait. And these are exercises that combine elements of stability and gait or walking exercises to improve your balance and walking function. So as we move forward, I want to come back and touch on these again, but I just want you to remember that those are the three types of balance exercises that we're going to be touching on vertical stability, posture, and then stability with gait. Now, let's look at some concrete examples to start. Uh Tai Chi, it's not just a beautiful martial art, it's really one of the most heavily researched and proven interventions for Parkinson's balance. There was a study that was published in the New England Journal of Medicine way back in 2012 by Fuz Hong, Li, and colleagues, and it was reinforced by numerous studies that showed that Tai Chi training was superior to resistance training and stretching and improving your balance and in reducing falls in patients with mild to moderate PD. Now, in fact, there's been some more recent systematic reviews that have confirmed that Tai Chi has the most significant positive impact on balance for people with Parkinson's. And that was reported in Frontiers and Aging Neuroscience in 2024. So, why does Tai Chi work? Well, Tai Chi emphasizes slow, deliberate weight shifts, and it really teaches you to rely on ankle strategies. So there are small, quick adjustments at the ankle rather than always stepping. So it's mindful movement that engages your proprioception, and that's where your body, your limbs are any in space, and it does a beautiful job at that. And now I've personally done Tai Chi and I I found it to be great for my balance. I've it was great for flexibility, and it's great to get your mind to slow down and you slow your breathing down. So it's really mindful movement. So it's a great exercise. So if you haven't tried it, it's a great way to improve your balance. Now, next up is one of my favorite components for real life safety, and that's dual tasking. So if you think about a fall in real life, you probably weren't just walking and all of a sudden you tripped and fell. A lot of times we're walking and talking, or we're walking and we're reaching into our pocket for our keys, or we're looking at our phone. For example, my wife and I were went on a nature hike this past weekend and with her with my brother and sister-in-law, and she was walking, looking down at her phone and tripped over root and and fell. So a lot of times it's we're doing not just walking, but we're doing something else at the same time. So why this is important is that in PD, combining a cognitive task with a motor task often leads to degraded performance. So if we're doing walking and talking or walking and looking at a phone, that increases our risk of falling because we're not paying attention to what we're doing. So we need to train our brain by doing dual tasking exercises that are going to deliberately challenge us to move our body while moving our brain or working on our brain at the same time. So examples might be you're walking down a hallway while at the same time you're spelling a word forward and backward, or you're practicing standing on one foot while you're throwing a small ball against the wall, or you're doing lunges across the floor while you're counting backwards from 100 by sevens. So those would be all examples of dual tasking exercises, taking a mental and a physical exercise and combining them. Those are great exercises to help us work on making sure that we can do two things at one time to help us prevent falls. And then the other piece is agility and dynamic movement. And if you think about it, balance is all about agility. How fast can you train change directions or recover from a trip? I'll give you an ex personal example. I have a boxer dog named Katie, and she always likes to be where I'm at. And if I'm out in the kitchen and I'm making something, a lot of times she'll walk up behind me. And if I don't hear or see her coming, I turn around quickly, and there she is. And I have to adjust my movement and my body to be able to make sure that I don't fall. And so I have to be able to adjust to those quick changes. And a lot of times, if you you're walking through the store and you catch your foot and you stumble, you need to be able to make those quick actions to be able to catch yourself. Or if you accidentally step off a curb or you miss a step, you know, that can be a big problem as well. So you need to be able to learn how to change direction quickly and recover if you do happen to trip. And this is where programs like dance come into play, especially tango is a good one because that requires you to make uh quick weight shifts. But or Parkinson's non-contact boxing. There's a lot of different boxing programs out there, but boxing is a great way to teach you to keep your center of gravity over your core and your feet and do that while you're moving. I really I take boxing and I work on that as being able to move diagonally forward and backwards while keeping my center of gravity over top of my legs. These exercises are going to train your body to reaction time. So if you trip on a rug or you need some lightning fast reaction to catch yourself, agility drills like weaving through cones or doing some rapid stepping, what they do is they teach your brain to initiate those types of protective steps in a quick manner. And then finally, we need to challenge the environment and we need to challenge our sensory inputs. So if you're one of the things you can do with this is stand on an unstable surface like a soft pad or a small pillow, because what it does is it removes that reliability of, oh, this is a hard, flat floor, and it forces your vestibular and your proprioceptive systems to work harder. So they have to understand where you are because you're not standing on a stable surface, you're standing on an unstable surface. So this is going to help prepare your body for those unexpected events like stepping on over an uneven pavement. Maybe you're stepping over one of those parking blocks. So anytime something happens or you're walking across a thick rug, so you need to be able to adjust to those, and work walking on unstable surfaces is going to help you to do that. All right. Now let's talk about some practical applications of balance exercises that you can do at home. Now remember, you don't need a full gym and all kinds of equipment to get started. So I want to just give you some examples of some safe exercises that you can do today at home. And there is one non-negotiable that I want to talk about, and that's always safety first. So make sure that when you first start, you're holding on to something stable, whether it be a counter, the wall, a spot or someone to help you. Safety is going to be your primary goal when you do these. As you get better, then maybe you can go one finger, two finger, three finger, those type of things, but always make sure that you practice safety first. All right, let's talk about some different types of exercises. And let's start with I talked about the three different types of balance exercises: stability with gait, postural, and vertical stability. And let's start with postural. Some of the one of the best ways to do postural exercises is to do chair squats or what they call sit-to-stand. So sit in the chair with your feet flat on the floor and then stand up. And you may need to hold onto a counter or something like that to help you up. But do those several times, going from a sitting to a standing position. That's going to help with your postural stability. Another one is lunges, where you can you don't have to move across the floor. You can do a forward lunge where you step forward and bending your front leg, bending your back leg, and then coming back to an upright position. And again, when you're doing these, make sure that you have something to hold on to for stability, whether it be a counter or someone to help you. And then another one would be for postural stability, would be single leg stance with reaching. So if you stand with both feet on the floor, if you reach with one hand and gently lift your foot off the ground, then you may have to hold on to something stable with your other hand. And then do the opposite side, do the same thing. So it's you're shifting your weight, reaching for something while gently lifting your foot off the floor. And at first, maybe you have trouble lifting your foot off the floor, and that's okay. You can just reach and hold, but you're practicing learning to shift your weight. And if you do, you want to make sure that you do both sides. So it's always what you do to one side, you always do to the other. All right, now let's talk about the second type of bounce exercise, and that's stability with gait. And one of the things you can do is what they call tandem walking or heel to toe. And again, you're going to want to hold onto the wall or onto a counter, but you're going to put one foot in front of the other so that the heel of your front foot is touching the toe of your back foot. And then you're going to want to bring just like you're walking on a painted line. So put one foot heel to toe, second foot, heel to toe, and practice that at walking across a surface. So you might need to hold on to the wall, have walking poles, or have someone there spotting you. Another would be backward walking. And again, you're definitely going to want to have help with this. And you want to, as you're walking backwards, you want somebody there to spot you. And if you need to hold on to something, the wall or whatever it needs to be, but remember safety first. And that's just practicing walking backwards so that you're training your brain to go both forward and backwards. All right, next up is vertical stability, and that's the third one. And a couple exercises you can do here are sidestepping, where you just practice stepping to the side. If you stand with your feet, shoulder width apart, step with your right foot to one side, bring it in, step with your left foot to the other side, bring it in. So practice sidestepping. And you can you can keep going if you eventually as you get better and wanted to do this with movement, you can hold on to uh you get some poles and have someone spot you and just sidestep to the right, sidestep back to the left. The next one is lateral weight shift, and you can do this essentially by learning to shift your weight. So if you reach up like you're putting something on a shelf that's to the left, and then do the same thing to the right, you're working on shifting your body from one side to the other so that if you do get bumped or knocked over, your your body is used to making those adjustments, like, oh, my weight just shifted, I need to make a correction. So those would be some examples of balance exercises that you can do in the three types of categories. So another one would be single leg stance, and that's where you stand on one leg and you start by holding it onto a stable surface. Then as you improve, maybe you go down to three fingers and then eventually two fingers and then one finger. And then one of the nice things too is that you can time these as well. Maybe the maybe when you first start, you can only do it for three seconds, and then but maybe a month or two months from now, you'll say, Wow, I can I can do this for almost a minute because I've been practicing it every single day. So those would be some examples of practical applications that you can do it at home. Now I want you to remember that consistency is key. So your brain is going to adapt through repetition. So aim to do these balance challenges. You can do them throughout the day, but you can also have a dedicated session. So I'm going to spend 15 minutes a day working on balance exercises. You can also do them while you're doing activities around the house. So, for instance, you can do stand on one leg while you're brushing your teeth, hold holding on to the counter. That's called the flamingo stance. Or while you're making some tea or coffee, stand on with your feet on the together, and then just practice lifting your heels and doing heel raises. That's another good way to practice your balance. Now, you always want to remember that the challenge should be at the edge of your capacity. You don't want to make it too easy because it's not gonna, you're not gonna see a benefit, but then you don't want to make it dangerously hard either. So you want to continually push yourself to the edge of your capacity because that's how you're gonna get better and that's what's gonna trigger the neuroplasticity. But again, always do it in a safe manner and always make sure that your doctor's aware of what you're doing. Now, if you're experiencing frequent falls or you just have a lot of anxiety about falling, there's a lot of specialists out there that can help you. So you can make talk to your movement disorder specialist or your neurologist about the falls, and they can connect you with a physical therapist who specializes in movement disorders, and they can help you with programs that are certified like the LSVT Big program or the Power PWR program. I've done both programs and I highly recommend them. They're great for balance, they're great for stability, they're great for improving your leg strength. You do a lot of lateral movements, you do a lot of forward and backward movements, twisting. So all the things that are necessary for balance, those are going to be included in there. And they can also provide a customized fall risk assessment and give you a personalized plan to help you train safely and effectively when you're not there. So seek professional help when you need it. And then if you have anxiety about falling, talk to a mental health professional. One of the things I did and I talked about in a previous podcast was cognitive behavioral therapy, and that really helps address anxiety issues because you're retraining your brain in the way you think about it. So please seek professional help when you can. All right, now we've covered a lot today, and I just want to touch on the big takeaways. And number one was that balance issues are a complex part of Parkinson's, but they're absolutely trainable. That's what I want you to walk away with. You know, you don't have to say, well, I have poor balance because that's something that you can train and it's something that you can work on. Number two is that specialized exercise, things like Tai Chi and doing those dual tasks that we talked about, they can literally rewire your brain through neuroplasticity to help improve your reflexes. And then those different types of exercises that we talked about, postural exercises, stability with gait exercises, and vertical stability exercises are all very important. And remember, you want to include things where you're shifting your weight, you're reaching, you're turning, because all those things are important in balance. And don't forget leg strength and core strength are key as well. And then finally, you want to always prioritize safety and consistency because that's going to be your superpower. Consistency and safety. All right. You have the power to reduce fall risk, but more importantly, to dramatically increase your confidence. So don't let the fear of falling dictate how you're going to live your life. You want to start small today, work on these balance exercises, you want to be consistent, but most of all, just keep moving because the more you move, the better you're going to get at it. If you want additional information on balance training, if you visit liveparkinsons.com, not only can you sign up for the free monthly newsletter, but uh there's also on there nine balance exercises to help with your balance. And I it includes the vertical stability, postural stability, and stability with gait. So if you're looking for something there. And then also go to the Parkinson's Foundation. They've got good information on balance as well as the Davis Finney Foundation and the Michael J. Fox Foundation. I want to thank you for listening today, and hopefully you walk away with some actionable things that you can do at home to help you improve your balance because really that's what it's all about. I want you to stay safe, but I want you to be able to go out and do the things that you want to do without the fear of falling. So until next time, stay healthy, stay strong, and keep living your best life because you have the ability to do it and you have the ability to train your your balance. Thanks again, and I will see you soon.