“It’s often more than what we can see”
When you hear Parkinson’s disease, what is the first thing that comes to mind? For most people, it’s shaking or tremors.
While tremors are one of the more recognisable signs, Parkinson’s is much more complex than just that. April is Parkinson’s Awareness Month in Australia, a month where we have the opportunity to create more awareness regarding the disease and increase understanding of the condition that is often misunderstood.
In Australia, over 150,000 people are currently living with Parkinson’s disease. With approximately 50 new diagnoses every day, it is the second most common neurological condition after dementia, and these numbers continue to rise.
This is why awareness is so important — not just recognising Parkinson’s once it becomes obvious, but understanding the earlier signs and what they might mean.
“When the message from the brain starts to change”
Parkinson’s disease is a neurological condition, meaning it affects the brain and how it communicates with the body. The substantia nigra is a small but important area of the brain that helps control movement. It produces dopamine, a chemical that we have come to know as the “feel good” neurotransmitter, but it also allows the brain to send smooth, coordinated signals to the body so we can move without having to think about every step.
In Parkinson’s disease, the cells in this area gradually stop functioning and are lost over time, making dopamine levels begin to drop.
Why this happens isn’t linked to one single cause. Instead, it’s thought to be a combination of factors such as ageing, genetics, and changes within the cells themselves. Because dopamine-producing cells are particularly sensitive, they are more affected than others.
As dopamine levels decrease, the signal from the brain to the body becomes less smooth and less efficient. It’s not that the muscles stop working — it’s that the message they receive is no longer as clear as it once used to be. Movements that used to happen automatically, like walking, turning, or adjusting posture, begin to require more effort and more attention. Over time, this can make movement feel slower, smaller, and less coordinated.
A common follow-up question is: why can’t we just increase dopamine to fix the problem?
While treatments can help increase or replace dopamine in the brain, they don’t stop the underlying process. The challenge isn’t just the level of dopamine — it’s that the cells responsible for producing and regulating it are gradually being lost. So even if we temporarily boost dopamine through medication, the system that manages it is still affected and the cells are still being lost one by one.
“Why the shakes?”
Under normal conditions, dopamine helps regulate two important pathways in the movement control system of the brain — one that helps initiate movement, and one that helps control or inhibit movement. When these pathways are working in balance, movement feels steady, automatic, and controlled.
In Parkinson’s disease, as dopamine levels decrease, this balance begins to shift.
The signals that help initiate movement become weaker, while the signals that inhibit movement become relatively more dominant. At the same time, the communication within these circuits becomes less stable, as the systems that work together to start, stop, and fine-tune movement are disrupted. Instead of producing a smooth and consistent signal, the brain can begin to generate more rhythmic and repetitive patterns of activity.
This is what contributes to tremors.
Groups of neurons start firing in a looping, oscillating pattern, and this rhythmic activity is then carried through the nervous system to the muscles, and the result is the characteristic back-and-forth movement we see as a tremor.
“The changes often start quietly”
Tremors are often what lead to a diagnosis, but they are not usually the first symptom people experience. For many, the early signs are subtle, gradual, and easy to overlook — which is why they are so often missed.
People might first notice that they are moving a little slower than usual, or that everyday movements feel slightly more effortful. There may be a sense of stiffness, particularly in the neck, shoulders, or hips, that doesn’t seem to ease with movement. As a result walking begins to change in small ways, such as taking shorter steps, reduced arm swing on one side, or a feeling that the body isn’t moving as freely as it used to, because the signals are slowly decreasing.
Some people notice changes in their posture, becoming slightly more stooped, or feeling less stable when turning or changing direction, as the initiation and coordination of moving limbs becomes more difficult. Others may find that tasks requiring multitasking become more difficult, like walking while talking, turning quickly, or managing more than one thing at a time, as the need to focus on moving limbs takes more effort.
Fine motor changes are also common early on. This can include things like handwriting becoming smaller, buttons or zips feeling more difficult to manage, or a general sense that movements are less precise than before.
There can also be changes that are less obvious and not always immediately linked to movement. Reduced facial expression, a softer or quieter voice, insomnia, or feeling slower in thinking or responding are also early signs of Parkinson’s disease. Some people describe a general sense that things just feel “a bit off,” even if they can’t quite explain why.
Because these changes often develop gradually, they are frequently attributed to normal ageing, stress, or fatigue. But when multiple small changes start to appear together, it can be an early sign that something more is going on.
“When something feels harder, we naturally adapt”
As movement begins to feel more effortful and less automatic, it’s very natural for people to start adjusting how they move day to day. This doesn’t happen all at once, and it’s often not something people consciously decide.
It might look like slowing down, avoiding certain movements, or choosing what feels easier and more predictable. Tasks that used to be simple now require more thought, and over time, doing less can feel like the safer and more manageable option.
This isn’t a lack of motivation — it’s a normal human response to something becoming more difficult.
Over time, this tends to create a cycle where reduced movement leads to further difficulty, which then makes it even harder to stay active. What started as a small adjustment can gradually impact overall function and independence.
“Movement is one of the ways we support the system”
If you visit Parkinson’s Australia’s website, one of the key recommendations for managing the disease is exercise. In fact, exercise is often described as second only to medication in terms of effectiveness in slowing the progression of Parkinson’s disease.
At the same time, it can be one of the hardest things to do. When movement feels slower, more effortful, and less predictable, the natural response is often to do less. But this is also where exercise becomes most important.
As we’ve explored, Parkinson’s affects how the brain sends and regulates movement. When that system becomes less efficient, it doesn’t mean it should be used less — it means it needs more input, more practice, and more challenge to keep it working as well as possible. Exercise becomes one of the main ways we actively engage this system, encouraging the brain to continue sending signals and the body to continue responding.
Because of this, general recommendations for Parkinson’s disease don’t just focus on staying active, but on moving regularly, consistently, and with enough challenge to stimulate the system. This often includes a combination of strength-based movements, tasks that require coordination and control, and activities that challenge balance and timing. The key idea is not just to move, but to move in a conscious way that requires the brain to stay involved.
This is where the role of exercise physiology becomes particularly valuable. While general activity is important, the way exercise is prescribed can make a significant difference. As exercise physiologists, we have the opportunity to undertake further training and professional development specific to Parkinson’s disease, allowing us to refine how we use exercise to target the changes happening within the brain and body, and which exercises are most beneficial.
With this additional knowledge, exercise can be tailored more precisely — not just to keep someone active, but to challenge movement in a way that supports coordination, timing, and overall function. This allows exercise to become more than just staying active — it becomes a structured and intentional approach to supporting the system, maintaining function, and working towards meaningful outcomes over time.
“Understanding Parkinson’s changes how we respond to it”
Parkinson’s disease is complex, and it looks different for everyone. But it’s not just about tremors, and it’s not just about what we can see. It’s about how the brain and body communicate, and how that communication changes over time.
The more we understand this, the more we can shift the focus from what is becoming difficult to what can still be supported. While we may not be able to change the diagnosis itself, there is a lot we can do to influence how someone continues to move, function, and live with Parkinson’s.
And often, that starts with something simple — continuing to move, staying engaged, and gently challenging the body, even when times can feel hard.
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