When Parkinson’s disease is mentioned, many half-true ideas are passed around: “Walking and talking at the same time makes a fall likely, so never try it”, “a few dry needling sessions will relax the muscles”, “a focused ultrasound procedure will cure it”, and “working hard at exercise will reverse the disease”. Such claims are often half true, and some are quite contrary to the facts. Worst of all, they distort patients’ expectations, so that patients either become too pessimistic and give up training, or become blindly optimistic and stop medication in search of a cure.
This page examines these questions from one core position: Parkinson’s disease is a progressive neurodegenerative disease, and medicine still has no recognised treatment that cures it or clearly reverses its course. Whether medicines, surgery or exercise, the effect is to control symptoms and maintain function, and not to cure. Only by accepting this can expectations be managed honestly. The sections below go through four common myths one by one, and each claim is accompanied by its source in the research.
When reading this page, it helps to understand one important idea first: controlling symptoms is not the same as stopping degeneration. Even if a treatment lets the patient walk more steadily or shake less for the time being, this does not mean that the degeneration of the brain has stopped. Keeping the two apart makes it less easy to be misled by words such as cure.
Myth 1: Is walking while talking always dangerous for a person with Parkinson’s disease?
Dual tasking means handling two things at the same time, such as walking while talking, walking while counting, or walking while carrying a glass of water. When a person with Parkinson’s disease carries out a dual task, gait does become worse and the risk of falling rises at once, so many caregivers instinctively think the patient should be banned from doing two things at once.
But a higher risk at the time does not mean training can never be done. A randomised controlled trial of 121 patients at Hoehn and Yahr stages II to III (the DUALITY trial) showed that after 6 weeks of dual task training at home, walking speed under dual task conditions improved significantly, and the overall risk of falls did not increase significantly (P=.84) (Strouwen et al., 2017). A meta-analysis of 7 RCTs with 406 people also confirmed that dual task training helps to improve walking speed, Timed Up and Go performance and balance (Du et al., 2023). In other words, dual task training carried out in a planned way under professional guidance does have evidence of benefit.
Rather than asking whether dual tasking should be avoided, ask whether it should be treated as a trainable skill within rehabilitation. The answer is yes, but in stages and according to the stage of the disease, and not by banning it across the board.
The academic community has also discussed whether such risky behaviour should be trained. Strouwen and colleagues (2015) argued clearly against the traditional view of avoiding dual tasking altogether and proposed bringing it into the rehabilitation plan, on the condition that it is done in stages and adjusted flexibly to the stage of the disease. A meta-analysis of 14 RCTs with 548 people also found that dual task training improved walking speed better than single task training (an effect of about +0.48 SD, though with low certainty of evidence), but cautioned that the dual task situation itself increases the risk of falling, so training must be supervised by a therapist (Sarasso et al., 2024).
The right approach is therefore to never try it alone in an environment with a real danger of falling (such as the street or stairs), but there is no need for a total ban either. The safe arrangement is for a registered physiotherapist to assess the patient according to the Hoehn and Yahr stage, have the two actions practised separately first (single task), and combine them step by step (dual task) only once performance is steady, with the whole process in a controlled, supported and safe environment.
| Wrong approach | If a ban on walking and talking or doing anything else at the same time is imposed out of fear of falls, the patient is more likely to lose balance in daily life when distraction cannot be avoided, such as crossing the road or listening to someone speak. |
| Evidence-based approach | The therapist assesses the stage of the disease, the patient practises single tasks until steady and then adds the second task step by step, in a safe and supported environment. DUALITY showed that this improves walking speed without increasing fall risk (Strouwen et al., 2017). |
| Why home visits have an advantage | The therapist can arrange for the patient to practise on the spot in places at home where it is easy to be distracted (such as the kitchen, a corner of the corridor or the front door) and can improve the safety of the home at the same time, so the benefit of training carries over more easily to daily life. |
Myth 2: What dry needling does for muscle stiffness in Parkinson’s disease
First, a definition: the dry needling discussed here is a trigger point technique used by physiotherapists or doctors, in which a fine needle is inserted into a tight skeletal muscle to reduce muscle tension and pain for a time. Its theoretical basis comes from muscle trigger points, and it is quite different from Chinese medicine acupuncture, which is based on meridian theory. This page discusses only the former.
For Parkinson’s disease, the clinical evidence supporting dry needling is rather thin. A small randomised controlled trial found that patients with Parkinson’s disease who had a single session of dry needling had no measurable extra benefit in lower limb stiffness or gait compared with the sham group, and the authors themselves said that the evidence is currently limited and needs to be verified by more research (Brandín-de la Cruz et al., 2022).
An honest label: at most, dry needling can be used for short-term relief of muscle stiffness or discomfort. It cannot treat the cause, will not slow the progress of the disease, and cannot replace exercise training and the medicines prescribed by the doctor. If muscle stiffness is already affecting daily life, the approach with more research support is still to keep up regular exercise, do more stretching and have physiotherapy.
If a patient wishes to try dry needling, the right position is to treat it as an optional extra in the overall rehabilitation plan and not the main treatment, and it should never be used in place of regular exercise or stopping follow-up visits. Whether a patient is suited to dry needling and which group of muscles should be treated must be assessed by a registered physiotherapist with the relevant training.
Myth 3: What DBS and MRgFUS do for Parkinson’s disease
Deep brain stimulation (DBS) and MRgFUS (magnetic resonance-guided focused ultrasound) are both medical interventions aimed at motor symptoms. Both really help with symptoms such as tremor that is hard to control with medication. Taking MRgFUS as an example, a systematic review found that 12 months after surgery, the MDS-UPDRS part III (motor symptoms) score improved by about 20 to 22 points (Tian et al., 2023).
However, improving symptoms is by no means the same as a cure. The same study also states clearly that MRgFUS is symptomatic treatment only and cannot stop neurodegeneration. Its effect gradually weakens as the disease progresses, and more than a quarter of patients have adverse effects related to the ultrasound (such as temporary problems with speech, balance or sensation) (Tian et al., 2023). In other words, even after surgery the process of degeneration in Parkinson’s disease continues, and patients still need regular exercise and rehabilitation training after surgery to maintain balance, gait and self-care.
- Improves motor symptoms such as tremor (MDS-UPDRS III improved by about 20 to 22 points at 12 months)
- Especially helpful for tremor that is hard to control with medication
- May reduce the dose of some medicines and improve quality of life
- Does not stop neurodegeneration and is not a cure
- The effect gradually weakens as the disease progresses
- More than a quarter have ultrasound-related adverse effects (temporary speech, balance or sensory problems)
- Exercise and rehabilitation must continue after surgery
The details of surgery and whether the patient is suited to it must be assessed professionally by a neurologist or neurosurgeon (this is outside the scope of home physiotherapy, and this page is for managing expectations only and does not go into surgical technique). The core principle for patients and families to remember is that whether or not surgery is done, regular rehabilitation remains the foundation of long-term management of the condition.
Myth 4: What exercise does for Parkinson’s disease
This is the most widespread myth and the one most likely to disappoint patients. The objective fact is that Parkinson’s disease still has no treatment recognised to cure it or clearly reverse its course. Even medicines and surgery are limited to controlling symptoms. If the effect of exercise is exaggerated into a cure, patients will not only hold wrong expectations but may also think that exercise alone can replace medication and stop it on their own, which in the end does more harm than good.
But the other side must also be stated honestly: exercise is by no means without effect, and it is the non-drug intervention with the most evidence at present. A large Cochrane network meta-analysis (156 RCTs, 7,939 people) found that many kinds of exercise, including dance, aquatic exercise, tai chi, strength training and physiotherapy, improve the severity of motor symptoms and quality of life, although the certainty of evidence for the different kinds of exercise ranges from high to very low (Ernst et al., 2023). Another meta-analysis on physiotherapy also showed that dance, Nordic walking, treadmill and strategy training have medium to large effects on motor symptoms and gait, and are ways of managing symptoms that complement medicines and surgery (Radder et al., 2020).
Some studies further suggest that exercise may help to slow the worsening of motor symptoms. The SPARX phase 2 trial (Schenkman et al., 2018) had early-stage patients who were not on medication do 6 months of high-intensity treadmill exercise. The intervention was found “nonfutile”, and the worsening of motor symptoms was smaller. Another double-blind RCT, Park-in-Shape (van der Kolk et al., 2019), also found that patients who did home aerobic exercise (cycling) for 6 months had a smaller worsening of motor symptoms than the control group. It must be stressed, however, that these results are all improvements at the level of symptoms or function, not a cure, and have not been shown to reverse the course of the disease.
The right expectation of exercise is not to cure Parkinson’s disease but to maintain function, delay disability, reduce falls and keep self-care. Saying plainly what is useful helps patients more than empty talk of a cure.
Key data from the research
Numbers of patients in Hong Kong and the view of local medicine
According to local research estimates, there are about 12,000 people with Parkinson’s disease in Hong Kong (quoted from a press release of the Faculty of Medicine, The Chinese University of Hong Kong). Local authoritative medical bodies likewise stress that the disease “cannot be cured and symptoms can only be controlled”. The relevant research centre at the Chinese University of Hong Kong has stated that there is currently no treatment that effectively delays the course of Parkinson’s disease, and the goal of medical research is still to slow the course. This is exactly what dispels the community myth of a cure or reversal.
At the community level, Hong Kong has in the past had a Parkinson’s disease care programme offering community physiotherapy, occupational therapy, speech therapy and exercise classes, which shows that the need for continuing rehabilitation is not yet fully met. Home physiotherapy fills this gap, so that patients can bring in training safely and in stages, including dual tasking, in the familiar home environment. The therapist first assesses the stage of the disease and the risk of falls, then designs a suitable and safe home rehabilitation plan for the individual.
When to ask a registered physiotherapist for help
If the patient or family notices any of the following, it is advisable to seek an individual assessment early from a registered physiotherapist with clinical experience in Parkinson’s disease, through home physiotherapy: gait is beginning to get worse, starting to walk is difficult or there is freezing of gait; the patient has fallen or nearly fallen; the family wants to bring in dual tasking or exercise training safely but does not know where to start; the patient is considering dry needling or surgery and wants to clarify reasonable expectations first; or the patient simply wants to build a safe and sustainable exercise habit at home. The type of exercise may matter less, and consistency, enough intensity and safety are the key. All of this is best designed by the therapist for the individual according to the patient’s stage of the disease, balance ability and the timing of the medication effect.