Swimming Safety Checklist: For People with Parkinson’s & their care partners

1. Pre-Swim Preparation

• [ ] Physician Clearance: Has the swimmer discussed aquatic exercise with their neurologist?

• [ ] DBS Review: If the swimmer has Deep Brain Stimulation, have they been warned that "land success" does not always equal "water safety"?

• [ ] The "Buddy" Rule: Is there a dedicated person in the water or on the deck specifically watching this swimmer? (Never swim alone).

2. Entry & Environment

• [ ] Safe Access: Use a ramp or stairs with a handrail. Avoid ladders or diving.

• [ ] Depth Check: Ensure the swimmer stays in "chest-deep" water or remains close to the pool edge.

• [ ] Lifeguard Brief: Has the on-duty lifeguard been notified about the swimmer’s condition?

3. Mobility & Coordination Assessment

• [ ] Horizontal Stability: Can the swimmer maintain a flat position without their legs sinking?

• [ ] Stroke Sync: Are the arms and legs moving in a coordinated rhythm?

• [ ] Treading Water: Can the swimmer keep their head above water for 30 seconds without assistance?

• [ ] Breathing: Is the swimmer able to time their breaths without gasping or swallowing water?

4. Warning Signs (Stop Immediately if:)

• [ ] Swimmer is struggling to stay horizontal.

• [ ] Movements become excessively "small" or "frozen."

• [ ] Sudden loss of coordination (common with DBS settings).

• [ ] Increased tremors or visible fatigue.

💡 Why This Matters

• The Benefit: Water reduces fall risk and builds strength/posture.

• The Risk: Nearly 50% of Parkinson’s swimmers in a major study reported near-drowning experiences due to sudden coordination loss.

• The DBS Factor: Deep Brain Stimulation can improve walking but may "short-circuit" the complex coordination needed for swimming. Always re-test skills after a DBS adjustment.

Ensuring home safety is crucial for people with Parkinson’s disease (PD) due to mobility challenges, balance issues, and increased risk of falls. Home improvements focus on reducing fall hazards, improving accessibility, and enhancing lighting and communication. Key modifications include installing grab bars and railings, removing clutter and rugs, securing cords, improving lighting, using stable furniture with armrests, and adding assistive devices like bed rails or shower chairs. Consulting an occupational therapist for a personalized home safety assessment is highly recommended.

https://www.parkinson.org/living-with-parkinsons/management/activities-daily-living/home-safety

https://www.michaeljfox.org/news/7-home-safety-tips-people-parkinsons-disease

Choosing between carpet and wood flooring for a home with Parkinson’s disease (PD) involves balancing safety, comfort, and mobility needs. Carpets, especially low-pile, provide cushioning that reduces injury severity from falls and improves traction, which may help prevent slipping. However, thick or loose rugs can be tripping hazards. Wood floors are easier to clean and accommodate mobility aids like walkers and wheelchairs better, but can be slippery and hard, increasing fall risk and injury severity. Many experts recommend low-pile carpet with secure backing or smooth wood floors treated with non-slip finishes. Personal preference, gait characteristics, and specific mobility challenges guide the best choice.

Carpet Flooring

• Advantages:

  • Low-pile carpets provide cushioning, which can reduce injury severity if a fall occurs.

  • Carpets with contrasting colors or patterns can provide visual cues to help improve gait and reduce freezing.

• Disadvantages:

  • Thick, uneven, or high-pile carpets increase the risk of tripping or difficulty using mobility aids (walkers, wheelchairs).

  • Carpets can sometimes “stick” to the feet, which may precipitate freezing of gait.

• Recommendations:

  • Use low-pile, well-secured carpets or rugs with non-slip backing.

  • Avoid clutter and tripping hazards near carpets.

  • Use visual cues such as contrasting grout or lines near transitions between flooring types to aid gait.

Wood Flooring

• Advantages:

  • Smooth, flat surface facilitates easier movement with canes, walkers, or wheelchairs.

  • Easier to clean and maintain than carpet.

• Disadvantages:

  • Can be slippery, increasing fall risk if untreated.

  • Hard surface may increase injury severity during falls.

  • Visual pattern changes between tile and wood may trigger freezing of gait in some people.

• Recommendations:

  • Choose hardwood or laminate floors with non-slip finishes.

  • Avoid highly polished or waxed floors unless treated with anti-slip coatings.

  • Consider installing flooring with visual cues or subtle texture changes to help step initiation.

Visual Cues and Floor Transitions

Freezing of gait can be triggered by changes in flooring texture or color. Research shows that flooring with horizontal lines or color contrasts can help people with PD step over obstacles and improve gait initiation].

A physical or occupational therapist familiar with Parkinson’s disease can evaluate the home environment and recommend the best flooring based on personal gait characteristics, freezing episodes, and balance status. They can also suggest additional modifications like grab bars, proper lighting, and removal of tripping hazards

https://youtu.be/dzfQi5sfrjU?si=0apNiSAijkq3ndHF

Speaker Bio:   Greg Pontone, MD, MHS is Division Chief and Professor Of Aging, Behavioral, and Cognitive Neurology at the University of Florida and Co-Director of Neuropsychiatry Program at The Norman Fixel institute for Neurological Diseases. Dr. Pontone earned his medical degree from the University of South Florida in Tampa. After medical school he completed a medical internship at Johns Hopkins Bayview followed by a residency in psychiatry and a fellowship in geriatric psychiatry and movement disorders research at The Johns Hopkins Hospital in Baltimore, Maryland.  Time Stamps: 

3:54 – Mental wellness challenges in Parkinson’s: anxiety, depression, apathy, and anger defined and discussed. 

4:42 – Breakdown of anxiety symptoms—how it feels mentally and physically, and how it relates to medication cycles.

7:27 – What depression looks like in Parkinson’s and why it’s the single most impactful non-motor symptom. 

9:36 – Apathy vs. depression: key differences and why apathy often goes unnoticed or unreported. 

11:18 – Why these symptoms happen: neurochemical changes and how Parkinson’s affects mood regulation. 

14:57 – Introduction to the “wellness pyramid”: exercise, diet, sleep, and social connection as proactive tools. 

22:54 – Strategies for better sleep: sleep hygiene tips, melatonin, and setting a consistent “sleep opportunity.” 

25:50 – Socialization’s impact on brain health, mood, and longevity—why isolation is a major risk factor. 

33:46 – Medications for depression, anxiety, and apathy: what works, what doesn’t, and why patience is key. 

45:25 – How caregivers can help build structure and routine to reduce apathy and support long-term engagement. 

54:39 – Dr. Pontone shares what gives him hope: promising research on disease-modifying therapies for Parkinson’s.

=====

Anxiety in Parkinson’s Disease

• Anxiety affects about 40% of people with PD and can manifest as persistent worry, restlessness, panic attacks, physical symptoms (racing heartbeat, sweating, nausea), and avoidance of social situations due to fear or embarrassment.

• It can precede motor symptoms or develop during the disease course.

• Causes include dopamine loss and changes in other brain chemicals, “off” periods when medication effects wear off, sleep disturbances, social isolation, and uncertainty about the future [2], [4], [2].

Depression in Parkinson’s Disease

• Depression affects approximately 30-50% of people with PD.

• It is often a direct symptom of PD caused by neurochemical imbalances involving dopamine, serotonin, and norepinephrine, not just a psychological reaction.

• Symptoms include persistent sadness, loss of interest, fatigue, feelings of guilt or worthlessness, sleep disturbances, and in severe cases, thoughts of death or suicide.

• Depression can worsen motor symptoms and overall functioning but is treatable with medication, therapy, exercise, and social support [1], [3].

Anger and Irritability in Parkinson’s Disease

• Anger outbursts and increased irritability are common mood changes in PD, sometimes surprising to families due to personality shifts.

• Causes include emotional stress from coping with PD, direct brain changes, medication side effects, cognitive changes, or psychosis.

• These behavioral changes often coexist with depression, anxiety, or cognitive decline.

• Managing anger involves identifying triggers, medication review, counseling, stress reduction techniques, and caregiver support [5], [2].

Important Considerations

• Mental health symptoms may fluctuate with “on/off” medication periods.

• Sudden changes in mood or behavior require medical evaluation for infections, medication side effects, or other illnesses.

• Non-drug approaches should be tried first when possible.

• Safety is paramount if anger or psychosis leads to aggression.

• Collaboration among neurologists, psychiatrists, psychologists, and social workers is often needed [3], [2].

1. Depression and Mood - Parkinson’s Foundation

2. Anxiety and Depression in Parkinson’s - Parkinson’s UK Progress Summer

3. Treatment Approaches To Anxiety and Depression in Parkinson’s Disease

4. Managing Anxiety in Parkinson's - Parkinson’s Foundation

5. Mood and Cognition Webinar Notes - Stanford Parkinson’s Community

If you have not gone swimming for some time, and you want to add swimming to your exercise routine, start with a short s[[ession in shallow water. Even if you are (or were) a strong swimmer, PD-related motor impairments—such as bradykinesia, rigidity, and impaired coordination—can make swimming challenging and even pose safety risks like near-drowning.

I know, it happened to me. After more than 10 year as a life guard, water safety instructor and waterfront director, and able to handle myself in any water conditions, I lost my sence of "up" after swimming for about 20 minutes. I was able to stop and find the top of the water, but I have found other types of exercise that don't cause that knd of worry.

Swimming is a beneficial form of aerobic and resistance exercise for people with Parkinson’s Disease. It offers support to joints due to buoyancy, improves cardiovascular health, and can aid in muscle strengthening and flexibility. However,  Dopaminergic medications, compensation strategies (like using swim fins or internal cueing), and supervision significantly improve safety and swimming ability. Consulting a healthcare provider and incorporating swimming thoughtfully into an exercise regimen can enhance physical and emotional wellbeing in PD

Benefits of Swimming in Parkinson's Disease

Swimming is an excellent low-impact aerobic exercise, which is especially valuable for individuals with PD who may suffer from joint pain or muscle stiffness. The water's buoyancy reduces stress on weight-bearing joints, providing a supportive environment for exercise. Swimming can:

• Increase cardiovascular and respiratory fitness.

• Improve muscular strength and flexibility.

• Aid balance and coordination through resistance from water.

• Enhance mood and reduce fatigue through physical activity.

This can lead to improvements in stamina, mobility, and quality of life.

Challenges and Risks Specific to PD

Despite its benefits, swimming poses unique challenges to people with PD due to:

• Bradykinesia (slowness of movement): This can impair limb coordination and reduce swimming speed.

• Muscle rigidity and stiffness: May cause difficulty in stroke fluidity.

• Impaired interlimb coordination: Increases the risk of difficulty maintaining balance and propulsion in the water.

• Postural instability: May cause difficulty floating or maintaining horizontal position.

• Fear of falling or drowning: Real concerns as near-drowning events are reported.

A survey of 309 people with PD showed that nearly 88% noticed swimming capacity decline, and about half experienced near-drowning events, highlighting safety concerns [ https://pmc.ncbi.nlm.nih.gov/articles/PMC7328419/ ].

Medication and Compensation Strategies

Dopaminergic therapy (like levodopa) improves bradykinesia, which can enhance swimming ability but usually does not fully restore coordination. Nonpharmacological compensation strategies are valuable:

• Using swim fins to increase leg propulsion and water displacement.

• Internal cueing techniques, such as counting strokes to improve rhythm.

• Using a floatation aid or focusing on leg-only strokes to bypass impaired arm-leg coordination.

• Having supervision or swimming with a buddy for safety.

Practical Considerations for Swimming with PD

• Consult healthcare professionals before starting swimming; physiotherapists can provide personalized advice.

• Warm-up and stretching before swimming reduce stiffness and aid posture.

• Swimming aids: Floats, noodles, or fins can help maintain safety and improve movement.

• Swimming environment: Pools with ramps, non-slip tiles, less crowded times, and warm water are preferable.

• Start slowly and increase duration from 10-15 minutes to longer as tolerated.

• Adapt to outdoor swimming cautiously, with safety measures such as swimming with others and using wetsuits if needed.

If you are considering swimming as part of your PD management plan, discussing with your healthcare team is essential.

Explore Parkinson’s Europe collection of Parkinson’s-friendly recipes here. 

https://parkinsonseurope.org/parkinsonslife/category/recipes/

Exercise is an important part of managing Parkinson's disease. It can help improve balance, coordination, mobility, and reduce symptoms. 

Types of Exercise:

Aerobic exercise: Walking, biking, swimming, dancing

Strength training: Exercises with weights, resistance bands, or body weight

Balance and coordination exercises: Tai chi, yoga, Pilates, boxing

Cognitive exercises: Marching, tapping, counting, cross-body movements

In the last decade, research studies and clinical experience have upgraded the importance of exercise for people with Parkinson’s from a “nice to have” activity to an essential way to help manage symptoms and maintain quality of life. Exercise helps or even improves everything from your mood to your fatigue to muscle stiffness to tremor and constipation.

You can find local PD specific classes here: https://www.cdparkinsons.org/classes

What does LSVT BIG do?

• Improves balance, gait, and overall mobility

• Enhances coordination and agility

• Reduces freezing of gait (sudden involuntary stops while walking)

• Increases the amplitude (size) of movements

How does LSVT BIG work?

LSVT BIG involves intensive, individualized sessions with a certified therapist. The therapist guides the patient through a series of exercises that progressively challenge their movements, forcing them to make bigger, more exaggerated motions. This helps the brain rewire itself and adapt to the new movement patterns.

Who is LSVT BIG for?

LSVT BIG is primarily intended for individuals with Parkinson's disease who are experiencing movement difficulties. It may also be beneficial for other conditions that affect motor control, such as multiple sclerosis or stroke.

Benefits of LSVT BIG

• Studies have shown that LSVT BIG can significantly improve movement and quality of life for people with Parkinson's disease.

• It is a safe and well-tolerated therapy.

• LSVT BIG can provide long-lasting benefits, even after the therapy sessions are completed.

Where to find LSVT BIG

LSVT BIG is typically offered by physical or occupational therapists who are certified in the program. To find a certified therapist, you can contact your healthcare provider or search online.

Additional Information

• LSVT BIG is also known as "Lee Silverman Voice Treatment for Parkinson's Disease Big".

• There is also an LSVT LOUD (Lee Silverman Voice Treatment Loud) program, which focuses on improving speech and communication in people with Parkinson's disease.

• For more information, visit the LSVT Global website: https://www.lsvtglobal.com/

Come play with us at the Guilderland, Glenville, Clifton Park or Bethlehem Y and at the Parkinson's Center YMCA.

Local Ping Pong

https://www.cdparkinsons.org/exercise

Navin P. Kumar - Table Tennis Champion with Parkinson's

https://youtu.be/XLZO5kRHsL4?si=m_m3Zyd5Nb0E21H1

Ping Pong serves up therapy for mind and body among people with Parkinson's disease [CBS Mornings Health Watch]

https://youtu.be/JivSzx88f3g?si=wZOZRo2R5VPToJ9k

Can Ping Pong Help Parkinson’s? | Inside Penn Medicine’s Community Program

https://www.youtube.com/watch?v=T1xVW1Bog8g

Nenod Bach starts PPP

https://youtu.be/MvdK90m9dZQ?si=o7xRLX1AgE6OSgT5

https://www.brainandlife.org/articles/benefits-of-ping-pong-for-parkinsons-disease

A $1.9 million U.S. Department of Defense–funded Phase 2 clinical trial will test SwallowFIT, a targeted exercise program designed to retrain the brain’s ability to control the muscles involved in swallowing — a function often compromised in Parkinson’s disease — in active-duty service members, veterans, or their relatives who have been diagnosed with the disease.

SwallowFIT applies the principles of neuroplasticity (the brain’s ability to adapt and form new connections) to help reorganize the signals sent to the muscles involved in swallowing. Through repeated practice, it strengthens the muscles of the mouth, tongue, and throat while retraining the brain to send clearer signals.

In earlier pilot testing, SwallowFIT helped patients improve their ability to swallow. If the clinical trial succeeds, researchers believe it could pave the way for proactive swallowing therapy to become part of early care for dysphagia. Click here to learn more.

We usually try to communicate a few things when meeting with newly diagnosed folks:

1. People with Parkinson’s have the same life expectancies as people who don’t have PD.  People don’t die from Parkinson’s. We live with it, hopefully well and fully.

2. Everyone’s PD is different.  You will not get every possible symptom. Also, every symptom you might experience has been experienced and dealt with by some others.  There are ways to deal with it.

3. Exercise is an important part of healthy living for everyone. For those with Parkinson’s disease (PD), exercise is more than healthy — it is a vital component to maintaining balance, mobility and activities of daily living. Research shows that exercise and physical activity can not only maintain and improve mobility, flexibility and balance but also ease non-motor PD symptoms such as depression.

4. PD is a slowly progressing disease.  You have time to learn, process and make decisions over time.  If you have sudden changes to your health, check with your physician- it’s probably not from Parkinson’s.

We recommend ordering the printed book, Every Victory Counts, from the Davis Phinney Foundation.

https://www.davisphinneyfoundation.org/