Dual-Task Training for Parkinson’s: Improve Balance, Walking & Reduce Falls with Exercise

Struggling with balance when walking and talking at the same time? You’re not alone—and you’re not broken.

In this episode of Live Parkinson’s – Live an Exceptional Life, we explore dual-task training for Parkinson’s, a research-backed exercise approach that helps improve balance, gait, walking confidence, and fall prevention.

Dual-tasking—doing a physical movement and a mental task at the same time—can be especially challenging with Parkinson’s. But the good news is this skill is trainable. Backed by neuroscience and real-world experience, this episode breaks down why dual-tasking is harder with Parkinson’s and how targeted exercise can retrain the brain through neuroplasticity.

In this episode, you’ll learn:

• What dual-task training is and why it matters for Parkinson’s
• How Parkinson’s affects balance, walking, and attention
• What clinical research says about dual-task exercise
• Simple, safe dual-task exercises you can start today
• How to reduce fall risk and improve confidence while moving
• How just 5–10 minutes a day can make a difference

Whether you’re newly diagnosed or have been living with Parkinson’s for years, this episode provides practical, actionable strategies to help you move with more confidence and live a better quality of life.

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Chapters

• 0:00 Welcome And Mission
• 0:26 What Dual Tasking Really Means
• 2:09 Why Parkinson’s Makes It Harder
• 3:36 Research On Gait And Attention
• 6:32 Executive Function And Walking
• 8:44 Safety Rules Before Training
• 9:46 Basic Dual Task Exercises
• 12:05 Intermediate Walking Challenges
• 13:12 Using Music To Train Rhythm
• 13:27 Functional Daily-Life Drills
• 16:37 Consistency, Neuroplasticity, Progress
• 18:03 Your One-Exercise Challenge
• 18:24 Resources, Support, And Closing

Transcript

SPEAKER_00: 0:10

Hello, and welcome to Live Parkinson's Live an Exceptional Life. I'm your host, Chris Custom Butter, and I've been living in 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. Okay, here's a quick question for you. Have you ever been walking along just fine? And then someone asks you a question and suddenly your feet feel like they forgot how to work? Or maybe this sounds familiar. You're walking, carrying something, trying to think about what you're going to do next, and suddenly your balance feels off. If that sounds familiar, or you're saying yes to those questions, well, that's me. Let's just say this right up front. No, you're not crazy, you're not failing, and believe me, you're not alone. Today I want to discuss something that affects almost everyone with Parkinson's, and that's dual tasking, which don't panic, I'll define it in a minute or so, so please bear with me. Now, dual tasking is something most of us do every day, but the nice thing is that we can train our brain to get better at it. This is one of those areas where exercise can literally change how our brains work. Okay, I've kept you in the dark long enough. So what is dual tasking? Well, dual tasking simply means doing two things at the same time. A physical task and a mental task. Now, these would be things like walking and talking, turning while thinking, carrying something while planning your next move. Sounds simple enough, right? Well, this is what we do every day. But ask yourself this question Was it easier to do before I had Parkinson's or after? Now I'm gonna be honest, I'll say it sure was easier before, because Parkinson's for most of us when we did it before we had Parkinson's, it was automatic. You really didn't have to think about walking, your brain just handled it. Ah, but with Parkinson's, movement often becomes less automatic, which means our brain has to work harder just to move, leaving less mental bandwidth for anything else. That's why your balance can feel shaky when your intention is divided and you're asked to do two things at one time. Now let me give you a real life example. I teach boxing to people with Parkinson's, and one of the activities I give them is a series of punch combinations. So for example, I might say jab, jab, cross, hook, hook, and I'll write that up on the mirror so they can see it. But we use number sequences for these combinations. So one for jab, two for cross, three for hook, and then four for hook. So in this case we would do one, one, two, three, four. Now I use sparing gloves to have the participants take turns going through the routine. Now we often have to stop and restart because one of us gets confused with trying to remember the number of the sequence we were on, or we start to lose our balance or get a little off. So dual tasking becomes harder for us. So that's why dual tasking is harder in Parkinson's. No, it's not because we're slow learners or we have some type of deficiency. The important thing to remember is it's neurological, not personal. Parkinson's affects the basal ganglia, the part of the brain responsible for automatic movement, coordination, and smooth transitions. So movements that used to run in the background on autopilot now require conscious effort on our part. So this means our walking slows down, our balance becomes less stable, freezing can increase, and our risk of falls goes up. But don't hit the panic button yet. So please take your fingers off that red panic button now, because the thing is our brains are adaptable. Which brings us to the really good news. See, every dark cloud does have a silver lining. Multiple studies show that dual task training improves balance in walking and Parkinson's. Now let's look at what some of the research says and why dual task training can help us in our daily lives. In a study titled A Review of Dual Task Walking Deficits in People with Parkinson's Disease that was published on the Wiley Online Library in 2012. In this study, the authors highlighted a simple but powerful truth. Walking is not automatic for people with Parkinson's. When a second task is added, gait quality drops sharply when people are given dual task conditions. People with Parkinson's show slower walking speed, shorter stride length, more variable steps, which is a major fault risk factor, reduced coordination, and higher likelihood of freezing. Now this study also showed that dual task exercises can reduce gate speed by up to 17 to 32 percent, depending on disease severity and the task type. Now the authors describe dual task walking as a competition for limited neural resources. Now in my case, my neural resources are always limited. Now in Parkinson's, gate becomes attention dependent. So adding a second task is going to overwhelm the system. So this explains why so many people with Parkinson say things like, I have to concentrate just to keep going and to keep an even pace. Now, this review also notes that effective interventions were limited at the time. Now remember, this is 13 years ago, but early evidence suggested that task-specific dual task training, cueing strategies, both auditory and visual, and cognitive training to improve attention and executive function. So the good news from this review is that dual task ability can improve. With targeted training, which we'll be sharing in just a few minutes, cueing, and strategies to reduce cognitive load, people with Parkinson's can regain confidence and safety in your everyday mobility. Now, one more study to reinforce this, and then we'll move into the actionable segments, which is probably what you're most concerned with, but I'd just like to provide a strong background into why dual-task exercises are so important. Now, in a review titled The Role of Executive Function and Attention and Gate that was published in Movement Disorders in 2008, they showed that walking isn't just a motor skill, it's also a cognitive skill. Believe it or not, your brain's executive function and attention are deeply involved in every step you take. And if I recall correctly, I think that was a sting song, every step you take. Now you may be asking yourself, what is executive function? Well, executive function helps you plan movements, adjust the obstacles, switch directions, and stay rhythmic because you have to have the rhythm, right? Now, just to give you a personal example, I was doing some personal training, and when I'm given a series of tasks to do where I have to do two or three things at the same time, I actually have to stop and actually walk through the process once so I can my brain picks it up. And then even then, I I get a little bit confused. So executive function in Parkinson's can be disrupted, and that's an example where if I have to step and do do a couple other things at the same time, I really have to think about it. Now, on attention, on the other hand, keeps your gait steady and coordinated. Now, in Parkinson's, these systems work harder because the automatic part of walking, that's the part most of us never think about, become less reliable. That's why distractions like talking, carrying a bag, or navigating a busy room can suddenly slow your steps and maybe even trigger a freezing episode. No, it's not a lack of strength or effort. It's your brain is juggling too many demands at once. But again, here's the positive part, which I'm all about. I'm always about the positive. Cognition is trainable. It's just like juggling. You know, most people have to practice so that they can juggle. Most people just don't pick up three balls and automatically start juggling. Now, dual-tast practice, cueing strategies, and cognitive motor training can strengthen your brain's ability to support walking. So, no, you're not stuck with the gate that you have today. With the right tools, your brain can adapt and your walking can improve. All right, now let's switch gears and begin to look at the exercises that you can do at home to help with your balance in your walking. But before we jump right into the exercises, let's talk safety first, because confidence comes from safety. Now I want to give you a few simple rules to follow, and these will be on the quiz at the end of the podcast. No, just kidding, there's no quiz because I don't want to have to grade all those papers. First, always start near a counter, wall, or sturdy chair for support. Next, begin with simple movements. And then, this is important, if your balance feels compromised, stop. This is not about pushing through the fear. So if you feel like your balance is off, then stop. And finally, and most important, before starting any new exercise program, always consult your healthcare professional first to ensure the program is suitable for your specific health needs. Now remember when doing these exercises, quality beats quantity every time. Alright, so let's dive into the exercises. And we'll start off with the basic level exercises. And exercise one is standing and thinking. And what you want to do is stand with your feet hip width apart. Now add a mental task. So for instance, count backwards from 50. Name animals. And for a real challenge with this one, try to name an animal for each letter of the alphabet. Or you can also name cities you visited. Now, if you feel steady with this, you can narrow your stance to make it a little bit more difficult. Now, once you try these, I want you to notice how your balance feels. Exercise number two is weight shifting and words. So shift your weight side to side, and while you do that, say the months of the year forward and backward. Or say every other letter of the alphabet. I know that can be really challenging. Now, if you notice it gets challenging, doesn't it? Now, if you do these, I want you to try to remember what you notice about your balance and your movement with this exercise. And while you're doing these, you want to be slow, controlled, and intentional in your movements. Alright, exercise number three is marching in place and focus. So what you want to do with this one is march in place, moving your arms and your legs, and you can start out slow and then gradually pick up the speed as you feel comfortable. And while you're doing that, name foods in a category like fruits and vegetables. And if you want to make this challenging, pick a color of fruits and vegetables like yellow, orange, or green, or name the different types of breads. And then you can also do simple math by counting by to 30 by twos or to 60 by 3s. And to make this challenging, you can also count backwards if you'd like. Now, once you try this, try to remember were you able to keep your feet moving while you were doing these mental exercises? And then how does that make your balance feel? So with these three exercises, you're training movement and attention. Now try to do these three to four times per week, and you'll you should definitely notice improvement over time. Okay, once you feel comfortable doing these exercises, you can progress to this next set. And I would recommend doing these with a friend to help spot you and give you support. And as always, use a wall for support if needed. Now these next couple are considered intermediate dual task training. And first up is walk while carrying a light object, maybe light weights in each hand or you know a light grocery bag. This forces your brain to think and move at the same time. Alright, next is walk and answer simple questions. Like what's your address, your phone number, your favorite color, your favorite food. And then finally, practice turning while you're counting out loud. Now, once you do these, what you want to remember how did your balance feel while doing these exercises? Now, another great tool that I like to use is to include music while I'm doing these dual task exercises. I walk to the beat while naming words and objects. I'll spell words forward and backward, and I even try to identify the band or the singer, maybe what year it was released, and maybe the even the album that it comes from. By using music, you're challenging your rhythm, your attention, and your movement at the same time. Now, since I love listening to music, these are my personal favorite dual task type of exercises. Okay, these exercises are a great way to help with our balance and our walking, but how can we make dual task training a part of our daily lives so that we can work on our balance and walking while doing our daily activities? Well, the nice thing about dual training exercises is that you don't need special equipment and you don't have to spend hours on training exercises every day. So let me give you some real life examples that you can include in your daily activities. Now, this is what we call functional training, and it's going to strengthen both your motor and your cognitive systems at the same time. So we'll start out with number one, which is walk and talk grocery list. And the motor tap items that you would buy at the grocery store, then switch categories, go from fruits to maybe cleaning supplies to maybe vegetables and snacks. What this does is it's going to mimic walking while planning or talking, and that's one of the biggest fall risk situations we have. So if you can work on that, it's going to help with our fall risk as well. Number two is carry and sort laundry. Carry a small laundry basket and sort the items mentally by category: socks, shirts, towels as you walk. This exercise trains divided attention during your household chores. Number three, step and count change. Now, what you want to do here is march in place or step side to side. Then count coins in your head. So for example, I have 35 cents and if I add 20 cents, how much do I have now? This builds your ability to maintain rhythm while doing mental math. It's similar to paying for something at the store. Number four, kitchen navigation and recipe recall. So walk between the counter, the fridge, and the sink while reciting a simple recipe. And what this is going to do, it's going to mimic real cooking where multitasking is essential. Number five, sit to stand and word generation. So what you want to do is perform sit to stands from a chair while naming words in a category like animals, cities, or foods. This is going to strengthen your functional mobility while challenging your executive function. Number six, folding towels and conversation. Fold towels are closed while holding a conversation or answering questions. Now, what's this for? Well, many people freeze or slow down when talking during tasks, so this helps to build your resilience. And then number seven, jacket on off and recall. Because we most of us put a jacket on and off all the time. So with this one, put on and take off your jacket while describing your day. You may be thinking, Chris, why would I do this one? Well, dressing is a common dual task challenge that requires sequencing and coordination. Now remember with all these exercises, consistency is what's going to change the brain. Now you've heard me say this term a lot of different times, and that's neuroplasticity. Your brain's ability to build new neural pathways. So we're trying to build that muscle memory. Now, I personally try to do dual training exercises as much as possible because it definitely helps me with my balance and my mobility. So when we do our warm-up exercises for boxing, we always do dual task training exercises. So we have the participants count out loud by threes, by sevens, or we have them spell words forward and backwards. And I've noticed a big improvement in their movements when we do this. Now, when you first start doing these exercises, if you struggle at first, it doesn't mean you're a failure and they're not for you. That's the farthest thing from the truth. It means you're challenging your brain and you're learning. Realize that some days are easier than others. That's the way Parkinson's is. One day you say to yourself, man, I feel great. And the next day you might think, what bus number just hit me? But here's the key. Every time you practice, even imperfectly, you're sending your brain a message. Now, I'm still learning and adapting, and that matters. Now, if I don't practice playing guitar or if I don't tie flash for a while, I get really rusty and I need to spend time getting back up to speed. The same is true here. Consistent practice is going to help you get better and develop your skills. So here's your challenge for today or tomorrow. Try one dual task exercise, just one, and notice. How do you feel? How was your balance? And then as you do these, slowly add one more of the ones that we talked about, and over time, track your balance in your walking and note the changes. Now remember, it's all about consistency. Now, if you want to learn more, visit LiveParkinsons.com and you can subscribe to the free monthly newsletter and get other valuable free resources and articles. And if you want to support my mission of helping people live a great quality of life with Parkinsons, click on the support to show link or visit my Kofi.com slash Live Parkinsons page to make a contribution. Every little bit helps to keep providing free resources and content. And then also check out my 30-day Parkinson's chip tip challenge on my Liv Parkinson's Live an Exceptional Life YouTube channel. And as always, thanks for listening. I really appreciate it. And until next time, stay healthy, stay strong, and live your best life with Parkinson's.