Exercise for elderly with Parkinson’s disease

Exercise and Parkinson’s Disease – Start Early and Keep Moving

New recommendations about physical exercise for people living with Parkinson’s disease have just been released from the USA by the Parkinson’s Foundation and the American College of Sports Medicine (ACSM) to provide effective and safe guidelines about physical activity for people with Parkinson’s disease and certified exercise professionals.

“The recommendations followed a recent meeting convened in the USA by the Parkinson’s Foundation, which included experts in exercise programs and research, physical therapy, exercise certification, medicine, and Parkinson’s community-based exercise programs.

The exercise guidelines are built upon science-based standards for exercise testing and prescription by the ACSM, which is an organization dedicated to advancing and integrating research to improve practical applications of exercise science and sports medicine.

Research studies, including the Parkinson’s Outcomes Project — the largest clinical study of Parkinson’s including more than 13,000 participants in five countries — have revealed that those who exercise experience a better quality of life and decreased symptoms compared to those who do not. Such symptoms include balance and mobility difficulties, as well as depression, constipation, and thinking skills.

The guidelines recommend three days per week for at least 30 minutes per session of continuous or intermittent aerobic exercise at moderate-to-vigorous intensity. This includes rhythmic activities such as fast-walking, running, cycling, swimming, or aerobics class. Supervision may be required due to safety concerns such as the risk of freezing gait, blunted heart rate, or low blood pressure.

Two to three non-consecutive days per week for at least 30 minutes per session are recommended for strength training. Each session should include 10 to 15 repetitions focusing on major muscle groups, resistance, and speed and power. Using weight machines, resistance bands, handheld weights, or bodyweight to exercise the upper and lower extremities is suggested. Muscle stiffness and posture instability should be considered.

For balance, agility, and multitasking, the guidelines recommend two to three days per week of multi-directional stepping, weight-shifting, balance activities, large movements, and activities such as yoga, tai chi, dance, or boxing. Supervision may be required due to safety regarding cognitive and balance problems.

Finally, the recommendations include two to three days per week of sustained stretching with deep breathing or stretching before exercise. Adaptations for flexed posture, osteoporosis (bone loss), and pain needs to be considered. “STEVE BRYSON PHD – PARKINSONS NEWS

Exercising under the supervision of Allied health practitioners such as physiotherapists and exercise physiologists helps all Parkinson’s clients exercise safely and effectively. At Agility Health Centre our qualified exercise professionals use evidence-based guidelines to assist all our clients meet their goals. With our modern facilities and the recent addition of a gym we can offer

  • Consultation, planning and monitoring of a client specific exercise programme that will be meet these guidelines
  • Supervised gym sessions in our rehab gym in Ascot
  • Clinical Pilates sessions for strength and balance
  • Bones and balance classes
  • KLT classes specifically designed for Parkinson’s disease
  • Cardio programmes on bikes and treadmill
  • Group hydrotherapy classes at Ascot Aquatic centre conducted by our EPs
  • Big Moves dance classes
  • Aerobics and Stretching classes for Parkinson’s clients


Call us to make an appointment with one of our health professionals to discuss your needs and goals. Ph 3862 2322 We are conducting classes at our Ascot and Bulimba locations.

Ballet dancing shoes

Dance Physiotherapy

We have a great team of physios with many years of experience in dance to keep you on your toes.

While some dance injuries result from a single event like a poor jump landing many come about from mild technique and training errors that are repeated many times over.  Overloading intensity near exams and performances is a common factor in injury. We assess, treat, strengthen and evaluate the cause to get you back on your toes as soon as possible.

Dance Assessments

A detailed assessment at any age will identify strength and flexibility issues that could be contributing to poor performance or injury. After the assessment we design a home programme so you can strengthen specific weaknesses and elevate your performance. We can also design you a specific strengthening programme in our Clinical Pilates exercise studio on our Reformers, Trap tables and Wunda chairs where our instructors will help you focus on achieving your dance strength goals. If you are too busy to attend our studio we can develop a home programme of exercise.

Pre-pointe Assessments

Going en Pointé is a big step in a young dancer’s career. We assess young dancers proceeding to pointé to determine not only if their feet are strong enough for pointe but also if their bodies are strong and stable so the feet aren’t overloaded by weakness further up the chain, especially in the core and pelvis. A home programme will be prescribed so you can achieve the strength you need for the transition to pointe. We can provide a report both for you and your teacher so they assist with specific strengthening goals.

Dance Injury Treatment

Our experience gives us extra insight into dance injuries, their immediate treatment and the recovery pathway from injury back to full dance performance.

Dance Conditioning

Pilates has been the strengthening exercise of choice for dancers wanting to perform at their best for many years. The founder of Pilates was Joseph Pilates and he worked with the New York ballet dancers and famous choreographers of his time so dance technique was incorporated into his exercises. We have taken the principles of Pilates and merged it with the latest in sports physiotherapy and dance physiotherapy to bring you a client specific exercise system which we now call Clinical Pilates. We can design you an individualised programme for performance enhancement or to rehabilitate you fully from injury.


Our Dance Physiotherapy Team

Jenny Birckel – (APA Sports Physiotherapist) started working with QDSE in 1990 and has performed pre-entry assessments and treatments for over 30 years. She also had a clinic in the Australian Dance Performance Institute where assessments and treating dancers was a regular event. Jenny began her journey into Pilates in 1995 as she sought an exercise solution to dancers with weaknesses and injuries.

Jenny is the director of the Pilates Institute of Queensland and runs Pilates training courses for physiotherapists, exercise physiologists, dance teachers and Fitness professionals.  

Maria Yee specializes in dance & sports injuries and musculoskeletal conditions.

Maria trained in numerous dance styles herself, including classical ballet and Chinese dance. She presented her honours thesis on musculoskeletal profiles of pre-professional ballet dancers at the International Association for Dance Medicine & Science annual meeting in Switzerland in 2014, and at the World Congress of Physical Therapy the following year. 

Maria has since worked with established professional contemporary and ballet companies including Les Misérables (Australia), Singapore Dance Theatre, and T.H.E dance company, conducting functional assessments and dance specific screening on top of injury management. She works closely with a number of Brisbane’s dance schools, and regularly conducts pre-pointe assessments and dance screening for dance students. She also runs dance specific Pilates studio sessions at Agility to help dancers get the best from their bodies. 

Michael PostMichael graduated from the University of Queensland with a Masters in Physiotherapy. He was the recipient of multiple Dean’s commendations of academic excellence throughout his studies and place in the top three for highest clinical placement grades in his year group. He also has a Bachelor’s of Sport and Exercise Science and three years’ experience teaching Matwork and Reformer Pilates. Michael has a keen interest in sports physiotherapy, specifically dance injury prevention and management after having trained in classical ballet and contemporary dance himself. 

Andrea Maude is an APA Sports Physiotherapist  and part of our dance injury team.

Jo Kaighin has many years of experience treating and assessing sports and dance injuries. While she is a generalist musculoskeletal physiotherapist she has seen many dancers in our clinic and is spot on with finding a diagnosis, treatment and working them hard to rehabilitate and return to dance. 

Bones and Balance Article

Bones & Balance Classes at Agility

Aged Care Royal Commission identifies need for falls prevention programs for older people.

With the recent press surrounding aged care in Australia, and the Royal Commission into Aged Care Quality and Safety, Agility Physiotherapy is proud to be delivering Bones and Balance classes. Our Bones and Balance classes are run by our highly experienced Physiotherapists and are designed to improve strength, stability and balance, reduce falls risk and improve bone density.

If you would like more information about our classes, or would like to book in, please call or email either our Ascot or Bulimba practice.

The article below is from the Australian Physiotherapy Association and highlights the essential nature of promoting and maintaining strength and mobility as we age.

The Australian Physiotherapy Association (APA) has welcomed the Final Report of the Royal Commission into Aged Care Quality and Safety, which identified promoting and maintaining mobility to reduce the risk of life-threatening falls in older people. It has called on the federal government to roll out a comprehensive plan for implementation of its recommendations that has person centred care, not cost centred, as its basis.

The APA made a total of six submissions to the Royal Commission and presented expert evidence on falls prevention programs for both physical and mental wellbeing.

Promoting and maintaining mobility and reducing the risk of life-threatening falls in older people was noted as critical in the final report, which found that access to physiotherapists, who are highly trained and skilled in strength, balance and mobility training, was often lacking in aged care.

The report recognised that “mobility was closely linked with people’s health and their quality of life [and that] poor mobility increased the risk of falls and fall-related injuries due to deconditioning and reduced muscle strength.”

APA National President Scott Willis said, “Falls are the number one cause of preventable death in residential aged care. The lack of investment in falls prevention programs over a long period of time, particularly when there is such strong evidence for their value, is an oversight that has had tragic consequences for too many families.”

“The Royal Commission has rightly identified the critical role that physiotherapists play in aged care. These are highly skilled mobility experts who are literally helping to save and improve lives by ensuring residents are active, mobile and ultimately confident in their movement.”

“We know that mobility programs led by physiotherapists can reduce the number of falls in residential aged care by 55 per cent – the government simply has no excuse not to fund this critical care for older Australians.”

The report also found that those living with incontinence and dementia often received substandard care, which the APA has called out many times.

Mr. Willis said, “Appropriately qualified and experienced health professionals must be employed to provide the complex care and support that these extremely vulnerable people need. We have talked about team-based, holistic care in all health settings for a long time. There’s no more critical place for this to start than in aged care.”

Hypermobility and Physiotherapy

Hypermobility and Physiotherapy

While we often admire the extreme range that some people with hypermobility can achieve, many hypermobility conditions can cause joint pain, tiredness and even dislocating joints.

Maria Yee, one of our physiotherapists was a dancer and still keeps fit with dance. She personally understands the challenges of hypermobility.

Maria consults with many young dancers and children in general with hypermobility syndromes. Many of these children and adolescents are training hard under her supervision in our Pilates studio at Quay Street, Bulimba to develop strength and control. Many are dancing at high levels and performing well due to her great management of their conditions and their strengthening programmes. She also has a number of adult clients managing their hypermobility conditions with regular specific Clinical Pilates. Here is her research into this condition.

What is joint hypermobility?

Joint hypermobility is the capability of a joint to move (passively or actively) beyond normal limits. The term generalized joint hypermobility is used to describe someone with hypermobility in multiple joints. An easy test is via the Beighton scoring system, where a score above 5 is indicative of the presence of generalized hypermobility:

What are the causes of hypermobility?

There are different contributors to hypermobility, a few of which are listed below:

Training habits

Certain sports such as dance and gymnastics dedicate significant hours of training to increasing flexibility. Such flexibility training can stretch ligaments, joint capsules and other connective tissues and render a joint hypermobile. Traumatic injuries or recurrent sprains can also lead to a hypermobile, unstable joint. People with hypermobility often tend to choose dance and gymnastics as their sport as they can easily move into the flexible joint positions they require.

Genetics & Ethnicity

Genetic differences in collagen quality can render connective tissues such as skin, ligaments and joint capsules weaker and more elastic than normal. Africans, Asians and Middle Easterners also have a higher prevalence of hypermobility compared to other races.


Females are more likely to be more hypermobile than men.


Collagen fibres are more elastic in children which means they tend to have more predisposition for hypermobility. Connective tissue becomes less stretchy and hydrated with age.

Symptomatic generalized joint hypermobility

The presence of generalized joint hypermobility is in itself not a medical condition, and can be asymptomatic in some cases. However, it can also exist as part of a more complex connective tissue related conditions, such as Ehlers-Danlos syndrome, Marfan syndrome, Osteogenesis imperfecta, and Downs syndrome. Consult your healthcare professional if you also have:

  • Chronic multi-joint pain
  • Chronic muscle pain
  • Thin, stretchy skin
  • Recurrent joint dislocations
  • Fatigue
  • Anxiety-type disorders
  • Pelvic and bladder dysfunction
  • Gastrointestinal disorders

These can be symptoms of hypermobile-Ehlers Danlos (h-EDS) or Hypermobility Spectrum Disorder (HSD) and can impact seriously on quality of life. Prompt recognition and management by a team of health professionals is required.

A physiotherapist will be able to assist in prescribing suitable exercises for core, upper and lower limb strengthening. Pilates, swimming and a walking program are usually prescribed to strengthen muscles, build muscle tone and reduce recurrences of joint pain and dislocations.

Children and adolescents with hypermobility should be guided into sport and exercise pursuits that are smooth and don’t have sudden stopping and change of direction. Avoid contact sports , netball, martial arts.

Choose sports like swimming, walking and recreational jogging. Dance is usually fine if accompanied with strengthening exercises. Avoid doing lots of stretches if you know you are hypermobile.

Find a physiotherapist who understands your condition and can give you the individual advice you need to manage hypermobility.

We have a great team of sports and dance physiotherapists at our 130 Quay street, Bulimba practice and at our other practice at 188 Nudgee Road, Ascot who can help.


Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A., 2017, “A framework for the classification of joint hypermobility and related conditions.”, Am J Med Genet Part C Semin Med Genet, 175C:148–157.

Engelbert RH, Juul-Kristensen B, Pacey V et al., 2017, “The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome.” Am J Med Genet Part C Semin Med Genet 175C:158-67.

Malfait F, Francomano C, Byers P et al., 2017, “The 2017 international classification of the Ehlers-Danlos syndromes.”, Am J Med Genet C Semin Med Genet, 175(1): 8-26.

Knee Pain – Is It “Just Growing Pains”?

Knee Pain – Is It “Just Growing Pains”?

Does your teenager complain about pain in the front of their knees? Have you been told they have “growing pains” and it’ll just go away?  Have you been told you have arthritis in your knee and you should stop exercise?

This is just not true!!  Inaccurate advice like this can cost years of healthy activity and needlessly keep you or your loved ones from doing the things you love.

In a recent research update, world leaders in knee pain combed thousands of research articles to come up with updated clinical guidelines for Patello-femoral pain (aka runners knee, jumpers knee, netball knee etc).

Patello-femoral pain is felt at the front of the knee and hurts with sport, stairs, squatting and even sitting.


Some of the statistics are alarming:

  • It affects people of all ages and is extremely common
  • 29% of adolescents will get this condition
  • Half of them will struggle for 2 years to do the sport they love
  • Many will have niggling pain into their 20’s


The good news is that there are treatment options that are proven to help reduce pain, improve activity levels and get you back to sport. The ones with the most research evidence behind them are:

  • Hip and knee muscle strengthening exercises
  • Patellar taping
  • Inexpensive, off the shelf foot orthotics if you have flat feet
  • Patellar mobilisation and
  • Lower limb muscle stretching


The combination of these treatments should be tailored to you by a Physio skilled in treating Patello-Femoral pain. Treatments with no evidence to support them are passive choices like laser, electrical stimulation, needling, ultrasound and definitely not waiting for growth spurts to finish before going back to sport!

If you, or a family member has had enough of putting up with pain in your knee give us a call or book online to get started on the road to recovery and get back to doing what you love.  We are here to help!


10 Things Not To Do If You Have Lower Limb Tendon Pain

10 Things Not To Do If You Have Lower Limb Tendon Pain

  1. Rest completely

The old adage of use it or lose it applies to tendons, resting just decreases the ability of the tendon to take load. It also affects the muscle attached to the tendon and the rest of the leg, leaving the person with less ability to load the tendon. Conversely you cannot ignore the pain (point 4), you have to reduce loads to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to load.

  1. Have passive treatments

Treatments that do not address the need to increase the ability of the tendon to take load are not usually helpful in the long term, although they might give short term pain relief. Treatments like electrotherapy and ice will only temporarily ameliorate pain only for it to return when the tendon is loaded.

  1. Have injection therapies

Injections of substances into a tendon have not been shown to be effective in good clinical trials. In fact many of them are based on the false premise that tendons heal like other tissues and that there is a capacity to return a pathological tendon to normal. Do not have injection in a tendon unless the tendon has not responded to a good exercise based program.

  1. Ignore your pain

Manage the load on your tendon, pain is a way of telling you that the load is too much. Reduce the aspects of training that are overloading your tendon (point 10).

  1. Stretch your tendon

Aside from the load on your tendon when you play sport, there are compressive loads on your tendon when it is at  its longest length, adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon. Stretching while you are standing can be especially provocative to your tendon. If your muscles are tight use massage to loosen them.

  1. Massage your tendon

A tendon that is painful is one that is telling you that it is overloaded and irritated, therefore adding further insult by massaging it can actually increase your pain. Sometimes tendons will feel better immediately after a massage but can then be worse when you load them.  As mentioned in point 5, massage of the attached muscle can be helpful.

  1. Be worried about the images of your tendon

The pictures of your tendon with ultrasound and MRI can frighten you, and the words used by doctors such as degeneration and tears can make you wonder if your tendon should be loaded. There is good evidence that the pathological tendon can tolerate loads, especially when you gradually increase the loads on them.

  1. Be worried about rupture

Pain is protective of your tendon, it makes you unload it, in fact most people who rupture a tendon have never had pain before, despite the tendon having substantial pathology in it (see point 7).

  1. Take short cuts with rehabilitation

Taking short cuts with rehabilitation do not work, you need to take the time that the tendon needs to build its strength and capacity. Although this can be a substantial period (up to 3 months or occasionally even more), the long term outcomes are good if you do the correct rehabilitation. Things that are promised as cures (see point 3) often give short term improvement but the pain recurs when the loads are resumed on the tendon.

  1. Not have an understanding of what loads are high for your tendon

The highest load on your tendon is when you use it like a spring, such as jumping, changing direction and sprinting. Any loads that do not use these movements are low load for a tendon, so exercise using weights and exercise that is slow will not place a high load on the tendon, although they can certainly have a beneficial effect on the muscles.


The take home message is that exercise-based rehabilitation is the best treatment for tendon pain. A progressive program that starts with a strength program and then progresses through to more spring like exercises and including endurance aspects will give the right loads on the tendon and the best long term results. Make sure you see a qualified health professional with expertise in this area to guide your rehabilitation.


Jill Cook:  http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/