Building Competence in Exercise Professionals for Parkinson’s Disease: A Call to Action

"I recommend exercise to my patients all the time. They understand—it's part of their treatment plan for living well with Parkinson's. Then they ask: How do I find an exercise professional who understands Parkinson's?"

And that's where the conversation often stops.

This scenario is all too common. Not because exercise isn't valued—but because it remains difficult to identify exercise professionals who are truly competent in working with people with Parkinson's (PwP). While exercise is increasingly recognized as a disease-modifying intervention, delivering it effectively requires more than general fitness knowledge. It requires precision—appropriate dosing, intensity, modality, and accessibility—tailored to a complex and evolving condition.

Parkinson's is Complex. Exercise Shouldn't Be.

Exercise has been increasingly recognized as an essential component of the treatment plan for Parkinson's disease (PD).¹ Research has demonstrated that a variety of exercise modalities, including progressive resistance exercise,^2,3 treadmill training,⁴ Tai Chi,⁵ and Tango,⁶ are associated with slower declines in functional mobility and improved health-related quality of life in individuals with PD.⁷

In addition to slowing disease progression, high-intensity aerobic exercise improves overall cardiorespiratory fitness.¹ Three studies have been conducted, all of which suggest that high-intensity (approximately 80–85% of peak heart rate) aerobic exercise has the potential to slow disease progression and reduce the signs and symptoms of PD.¹

The literature also highlights improvements in balance, gait biomechanics, and functional reach, along with reductions in fall risk, among those who regularly participate in Parkinson's-specific exercise programs.^7–10

At the neurological level, studies have demonstrated increases in dopamine transporter availability and neuromelanin concentration in the substantia nigra,¹¹ improved functional connectivity between the anterior putamen and sensorimotor cortex,¹² elevated serum brain-derived neurotrophic factor,¹³ and reductions in global brain atrophy.¹²

The Gap Between Evidence and Access

Despite this strong and growing body of evidence, access to appropriately trained exercise professionals remains limited. Physical therapy is one common pathway for engaging in prescribed physical activity, yet referral rates early after PD diagnosis are low.¹⁴

As a result, community-based exercise programs have become increasingly important for people living with Parkinson's.¹⁴ These programs—delivered in fitness centers, community centers, and other accessible settings—offer opportunities for ongoing engagement, social interaction, and long-term adherence to exercise.

Exercise professionals leading these programs include group fitness instructors, personal trainers, clinical exercise physiologists, athletic trainers, and health and wellness coaches. Many hold certifications from recognized organizations such as ACE, ACSM, NASM, and others and are required to maintain continuing education.

However, until recently, there were no unified guidelines to define competence for working specifically with PwP. This led to significant variability in knowledge and skills—and uncertainty among both healthcare providers and patients when evaluating the safety and effectiveness of community-based exercise programs.

As a leader in driving better health outcomes and quality of life for people with Parkinson's, the Parkinson's Foundation along with the American College of Sports Medicine (ACSM) recently updated Exercise Guidelines for people with Parkinson's.

The Parkinson's Exercise Guidelines provide direction to help people with Parkinson's maintain or improve their health through physical activity.

• 2025 Parkinson's Exercise Guidelines for Professionals
• 2026 Parkinson's Exercise Recommendations Infographic

Establishing Competency and Confidence

In response to this gap, the Parkinson's Foundation convened a group of experts in 2020 to develop curriculum criteria and a competency framework for exercise professionals.¹⁵ The goal: reduce variability and elevate the standard of care in community-based exercise programming for PwP.

In 2022, the Parkinson's Foundation launched an accreditation process to recognize exercise education programs that align with this competency framework. These accredited programs provide a clear pathway for exercise professionals to develop the specialized knowledge and skills required to safely and effectively serve individuals with Parkinson's.

Since the publication of this framework, education providers now have a structured foundation to build curricula that produce competent, confident professionals—professionals that healthcare providers can trust when referring their patients.

Connecting Competence to Care

This is where alignment with the United States Registry of Exercise Professionals becomes critical.

As a national registry dedicated to advancing the credibility and recognition of exercise professionals, USREPs provides a centralized system for verifying qualifications and supporting professional standards. Through this partnership, the Parkinson's Foundation's accredited education pathways can be more effectively connected to a broader professional ecosystem.

The registry also supports the National Exercise Referral Framework, helping clinicians identify exercise professionals whose qualifications align with the specific needs and health status of their patients.

Moving Forward

The evidence is clear: exercise is not optional in Parkinson's care—it is foundational. But evidence alone is not enough.

We must ensure that exercise professionals are not only present in the community, but prepared. Competence must be defined, developed, and recognized. Only then can healthcare providers confidently refer, and individuals with Parkinson's confidently participate.

This is the opportunity—and responsibility—before us.

References

1. Corcos DM, Lamotte G, Luthra NS, Mckee KE. Advice to People with Parkinson's in My Clinic: Exercise. Journal of Parkinson's Disease. 2024;14:609–617. DOI 10.3233/JPD-230277
2. Corcos DM, Robichaud JA, David FJ, et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Movement Disorders. 2013;28(9):1230–1240. doi:10.1002/mds.25380
3. Prodoehl J, Rafferty MR, David FJ, et al. Two-year exercise program improves physical function in Parkinson's disease. Neurorehabilitation and Neural Repair. 2015;29(2):112–122. doi:10.1177/1545968314539732
4. Harro CC, Shoemaker MJ, Frey O, et al. The effects of speed-dependent treadmill training and rhythmic auditory-cued overground walking on balance function, fall incidence, and quality of life in individuals with idiopathic Parkinson's disease: A randomized controlled trial. Neurorehabilitation. 2014;34(3):541–556. doi:10.3233/nre-141048
5. Li F, Harmer P, Liu Y, et al. A randomized controlled trial of patient-reported outcomes with Tai Chi exercise in Parkinson's disease. Movement Disorders. 2014;29(4):539–545. doi:10.1002/mds.25787
6. Hackney ME, Earhart GM. Health-related quality of life and alternative forms of exercise in Parkinson disease. Parkinsonism & Related Disorders. 2009;15(9):644–648. doi:10.1016/j.parkreldis.2009.03.003
7. Rafferty MR, Schmidt PN, Luo ST, et al. Regular exercise, quality of life, and mobility in Parkinson's disease: A longitudinal analysis of National Parkinson Foundation Quality Improvement Initiative data. Journal of Parkinson's Disease. 2016;7(1):193–202. doi:10.3233/jpd-160912
8. Gao Q, Leung A, Yang Y, et al. Effects of Tai Chi on balance and fall prevention in Parkinson's disease: A randomized controlled trial. Clinical Rehabilitation. 2014;28(8):748–753. doi:10.1177/0269215514521044
9. Gandolfi M, Tinazzi M, Magrinelli F, et al. Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial. Parkinsonism & Related Disorders. 2019;64:268–274. doi:10.1016/j.parkreldis.2019.05.006
10. Gobbi LTB, Oliveira-Ferreira MDT, Caetano MJ, et al. Exercise programs improve mobility and balance in people with Parkinson's disease. Parkinsonism & Related Disorders. 2009;15. doi:10.1016/s1353-8020(09)70780-1
11. de Laat B, Hoye J, Stanley G, et al. Intense exercise increases dopamine transporter and neuromelanin concentrations in the substantia nigra in Parkinson's disease. npj Parkinson's Disease. 2024;10. doi:10.1038/s41531-024-00641-1
12. Johansson ME, Cameron IG, Van der Kolk NM, et al. Aerobic exercise alters brain function and structure in Parkinson's disease: A randomized controlled trial. Annals of Neurology. 2022;91:203–216. doi:10.1002/ana.26291
13. Marusiak J, Żeligowska E, Mencel J, et al. Interval training-induced alleviation of rigidity and hypertonia in patients with Parkinson's disease is accompanied by increased basal serum brain-derived neurotrophic factor. Journal of Rehabilitation Medicine. 2015;47:372–375. doi:10.2340/16501977-1931
14. Slater LV, Gebska A, McCartney K, Rafferty MR. Designing a screening battery for exercisers with Parkinson's disease. Disability and Rehabilitation. 2021;44(15):4111–4117. doi:10.1080/09638288.2021.1883748
15. Rafferty MR, Hoffman L, Feeney M, et al. Parallel development of Parkinson's-specific competencies for exercise professionals and criteria for exercise education programs. Parkinsonism & Related Disorders. 2023;112:105407. doi:10.1016/j.parkreldis.2023.105407
16. Moor JL, Potter K, et al. A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation; Clinical Practice Guidelines. Journal of Neurologic Physical Therapy. 2018;42. Wolters Kluwer Health, Inc. / Academy of Neurologic Physical Therapy, APTA.