• People living with Parkinson’s disease are twice as likely to fall compared to people without Parkinson’s.
• There are a variety of reasons people with Parkinson’s are at high risk of falling, including bradykinesia, vision changes, fatigue, and rigidity.
• Exercise, physical therapy, and medical interventions can help people with Parkinson’s find solutions to balance issues and falling.

As people age, their risk of falling increases. However, people with Parkinson’s disease experience twice the risk of falling as compared to their peers, with about 60 percent of people with the condition falling every year. There are different motor and nonmotor symptoms of Parkinson’s disease that contribute to a loss of balance and an increased risk of falling.

As one member of MyParkinsonsTeam wrote, “I have fallen at least a dozen times, and thankfully, have not broken anything.” Another member said, “A good day is one without falls.”

As Parkinson’s disease progresses, so does the possibility — and fear — of falling. However, not all people with Parkinson’s will experience falls. While individuals with Parkinson’s are at an increased risk of falling, there are many methods for preventing these accidents and their resulting injuries.

How Parkinson’s Causes Balance Issues and Falls

There are several reasons why people with Parkinson’s disease are more prone to balance issues and falling.

Motor Symptoms

Specific motor symptoms from Parkinson’s may contribute to a person’s loss of balance and risk of falling. Some of these symptoms include:

• Axial rigidity (stiffness and loss of flexibility in the neck and trunk)
• Freezing (a sudden, temporary inability to move)
• Bradykinesia (delayed reaction time and slow movements)
• Changes in posture (such as stooping) or postural instability
• Changes in center of gravity
• Impairment of reflexes that help with balance
• Vision changes, such as blurry or double vision

Balance issues and motor symptoms that lead to balance difficulties while standing up, walking, and turning are the main sources of falls in Parkinson’s. The progression of Parkinson’s disease and its symptoms varies from person to person, so people may experience differing levels of balance loss.

Members of MyParkinsonsTeam commonly discuss changes with balance. One member wrote, “My biggest challenge has been overall balance.” Another said, “I lose my balance very easily.”

Nonmotor Symptoms

Some nonmotor symptoms of Parkinson’s disease also present risk factors for balance loss and falling. These symptoms include:

• Low blood pressure, or hypotension, which can produce lightheadedness and dizziness when standing up and walking
• Constipation, which can lead to bathroom falls
• Fatigue
• Stress
• Declines in executive function and cognition, which can lead to an inability to organize information and distraction while standing up or walking

One MyParkinsonsTeam member commented, “I’m dizzy. Sometimes it lasts a few hours, and sometimes it lasts for days.” Another wrote, “It happens when I’m sitting or lying down — when I get up to stand, the dizzy spells happen. I have to stand still and hold on to something for a few minutes before they go away.”

Medications and Other Causes

Balance issues in Parkinson’s may occur due to medications or medication dosages. Some side effects of Parkinson’s medications may affect blood pressure, dizziness, and balance. Higher doses of levodopa/carbidopa, for instance, have been associated with increased falls. Drugs used to treat other conditions, like blood pressure, may also cause dizziness and balance issues.

“I am dizzy from the meds. Does anyone else have problems with the carbidopa/levodopa?” asked one MyParkinsonsTeam member.

People with Parkinson’s disease may also lose their balance and fall if there are items like furniture out of place, or if their home has not been adapted to meet their mobility needs. People get used to the arrangement of household items and grow comfortable moving around those spaces. If something gets moved out of place, it may pose a fall risk to someone with Parkinson’s.

How To Improve Balance and Prevent Falls With Parkinson’s

Fortunately, there are several ways to improve balance and prevent falls when living with Parkinson’s disease.

Talk to Your Doctor

Talk to your doctor about your experiences. People may feel embarrassed or ashamed about falls, but it is important to talk to your health care provider about any falls. Your medical team could find ways to prevent these issues and reduce your chance of injury.

Your doctor could assess your medications, as well as their dosages and side effects. They could also refer you to a physical therapist or exercise programs to improve balance. Your doctor will have your best interests in mind. It’s beneficial to tell them the full story of your Parkinson’s symptoms so they can help you.

Exercise

Exercise and physical activity programs have been found to improve balance and gait (the pattern of moving your arms and legs while walking) in people with Parkinson’s disease. One study found that people with Parkinson’s had improved walking posture and balance after 24 one-hour sessions of high-intensity exercise on a treadmill, as compared to people who did low-intensity exercise of balance and stretching techniques.

A meta-analysis that examined 25 randomized control trials found overall positive effects on balance, gait, and fall rate from different exercise interventions. The best exercise programs for people with Parkinson’s are those that combine cognitive focus and intentional movement to help improve balance and quality of life.

Some exercises that are suitable for people with Parkinson’s include:

• Dance
• Tai chi (an exercise that incorporates movement and meditation)
• Walking
• Qi gong (a practice that incorporates body postures and movements, breathing, and meditation)

“I have been doing tai chi for two-and-a-half years, since my diagnosis,” one MyParkinsonsTeam member wrote. “My balance is still excellent. In my opinion, tai chi is great for balance and meditative activity, and I wouldn’t give it up for anything.”

Always talk with your doctor or another health care provider before starting any new exercise regimen, including home exercises. Your medical team may also be able to guide you to a type of exercise best suited to your abilities.

Try Physical Therapy

Working with a physical or occupational therapist can be a great way to improve balance and gait in a supported environment. Physical therapists can assess your risk of falls and work to improve your walking, posture, and balance through various exercises. Physical therapy can help at any stage of Parkinson’s, whether you experience regular falls or want to prevent them.

One member of MyParkinsonsTeam said, “My balance has been helped by physical therapy.”

Practice Balance-Improving Techniques

Many techniques and exercises for improving balance can be done at home. Different exercises are more suitable for people with different levels of Parkinson’s, so you should talk to your doctor or physical therapist before trying any new balance techniques.

Some techniques recommended by a physical therapist with the Johns Hopkins Rehabilitation Network include:

• Sit-to-stand exercise — For this exercise, you repeatedly practice sitting down in a chair and standing up. Have a sturdy support like a countertop or table in front of you that you can reach for support.
• Balance exercise — For this exercise, practice stepping side to side next to a table. Have someone with you in case you lose your balance, and also have a sturdy support in front of you that you can use to steady yourself.

You can also make small changes while you move to prevent falls. Tips to help you overcome loss of balance and freezing while walking include:

• Practice swinging both arms while walking to maintain balance.
• Walk to a regular beat, like music or a metronome, to prevent freezing.
• Consciously lift your feet and imagine stepping over a laser while walking.
• When making turns, use a “U” technique. Imagine walking in a U shape instead of pivoting sharply.
• Focus on one task at a time.
• Move slowly when standing up, sitting down, or changing positions. Try counting to 15 seconds between each movement.

Other Methods

There are several other ways to improve balance and avoid falls with Parkinson’s disease. A walking aid, like a cane or walker, can help you to retain stability and balance while walking.

“I just gave in to using a walker. I am so excited at the difference it has made for me. My falls have decreased, and I can walk much longer distances,” said one MyParkinsonsTeam member.

Making modifications to the home may also help to prevent falls. Home adaptations include:

• Removing tripping hazards like throw rugs
• Adding grab bars in the bathroom
• Ensuring bright lighting throughout the house
• Adding bright tape to the edge of steps
• Clearing clutter from walking paths

Talk With Others Who Understand

A great tool for coping with stress caused by a loss of balance is connecting with others — especially those who may understand what you’re going through.

MyParkinsonsTeam is the social network for people with Parkinson’s and their loved ones. On MyParkinsonsTeam, more than 89,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.

Do you have Parkinson’s and experience issues with balance and falling? Share your experience in the comments below, or start a conversation by posting on your Activities page.