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Exercise
By Bob Barnett

Online Exercise Classes Can Help People with Neurologic Disorders Improve Symptoms

Woman following an online exercise class at home
Illustration by Wesley Bedrosian

Cynthia Braver, 72, was teaching art to children in New Haven, CT, in 2017 when she noticed a tremor in her left hand. She was eventually diagnosed with Parkinson's disease and, with the encouragement of her neurologist, began working out several times a week at gyms with Parkinson's-specific programs that combined boxing and interval training to address movement problems and increase fitness. When the pandemic shut down those programs, Braver discovered the Rebel Fit Club, a gym in Portland, OR, that offered Zoom classes for people with neurologic conditions.

She now takes a one-hour Rebel Fit class six times a week. On her own, she practices yoga, uses a stationary rowing machine, walks outdoors, and dances with her husband at home. Since upping her exercise, she's been able to take a lower dose of her Parkinson's medication and has noticed fewer symptoms. “I can do more things now than I could three years ago,” she says.

Rebel Fit caters to people with Parkinson's disease, multiple sclerosis (MS), muscular dystrophy, cerebral palsy, Lewy body dementia, stroke, and more. “You will get fit, but these classes aren't technically about fitness,” says Rebel Fit Club founder Kimberly Berg, a clinical exercise physiologist who's worked with people with neurologic conditions since 2006. Instead the live online classes plus recorded videos address common concerns such as stiffness, balance, coordination, and cognitive difficulties.

Both exercise (a structured activity that uses repetitive movement to maintain or improve function, wellness, and fitness) and physical therapy (which targets specific symptoms related to neurologic disorders) have well-established benefits. For people with neurologic conditions, the risk of being sedentary is generally worse than the risk of exercise, says Cameron Mang, PhD, assistant professor of kinesiology at the University of Regina in Saskatchewan, Canada. “High-intensity exercise can reduce levels of alpha-synuclein, a toxic protein that accumulates in the brains of people with Parkinson's,” says Joseph Jankovic, MD, FAAN, director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston. Dr. Jankovic cites a 2022 observational study in Neurology that found an association between regular exercise and a slower deterioration of postural and gait stability and the ability to understand and process information in people with Parkinson's disease.

But transportation and mobility problems can make getting to a physical therapist or a gym difficult. That's where online classes come in. Tele-exercise, including streamed programs for people with Parkinson's disease, aphasia, stroke, and MS, “can be as effective as conventional exercise training without the burden of additional travel,” concludes a literature review in Frontiers in Rehabilitation Sciences in 2022.

Mariska Breland, 48, was diagnosed with MS in 2002. Not long after that, she discovered Pilates and became an instructor. In 2013, she developed an exercise protocol called Pilates for Neurological Conditions. She has little disability now, more than 20 years later. “I have lesions in my spinal cord. Years of exercise have built a reserve and minimized the effects of the damage.” She is co-founder of the Neuro Studio, which since 2018 has offered pre-recorded videos tailored to specific neurologic disorders.

For stroke survivors, rehabilitation exercises are most effective when started soon after a stroke, conducted frequently, and sustained, says Steven C. Cramer, MD, FAAN, professor of neurology at UCLA and medical director of research at the California Rehabilitation Institute. But getting to a clinic every day isn't easy, and there's a scarcity of trained occupational therapists and physical therapists. So Dr. Cramer and colleagues designed a six-week, six-days-a-week “telerehabilitation” program that uses a gamelike system (players use two handheld controllers to play rehab-oriented games on a smart television). “Telerehab was just as good as anything you could do in a clinic,” says Dr. Cramer, who published results of his program in JAMA Neurology in 2019. The program alternated live therapist-directed Zoom sessions with self-administered sessions. “Having your rehabilitation therapist appear in person on Zoom was key,” he says.

Live-streamed classes may be more engaging but offer less scheduling flexibility, and they tend to cost more. For example, Dr. Cramer's program, which is now commercially available, costs $299 a month and is not covered by Medicare or insurance.

Before you start any new exercise program, get evaluated by your neurologist, who may refer you to a physical therapist or exercise physiologist. “Many of my patients are highly motivated to exercise but are worried that it can increase their risk of falls and injuries,” says Dr. Jankovic. “So I usually recommend that they first see a physical therapist, who can develop an appropriate home exercise program.” If you have trouble with balance, he suggests, have a family member nearby when you exercise.

For people with autonomic conditions such as postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, multiple system atrophy, and syncope (fainting), and with many cases of long COVID, which include symptoms such as dizziness, imbalance, difficulty standing or walking, and exercise intolerance, even a single exercise session may lead to worsening symptoms. This may be a barrier to exercise, in person or virtual, says Svetlana Blitshteyn, MD, director of the Dysautonomia Clinic and clinical associate professor of neurology at the Jacobs School of Medicine and Biomedical Sciences at Buffalo.

Dr. Blitshteyn recommends working with a physician and a physical therapist trained in autonomic disorders, who can set up an at-home online regimen. Once you know how to exercise safely, she says, you may be able to do it without supervision using dysautonomia-friendly online exercise programs.

Not everyone with a neurologic condition needs specialized programs to exercise safely. You may be able to take advantage of a range of low-cost or free online exercise opportunities from video workouts to fitness apps. “Everyone can benefit from aerobic exercise, strength training, and neuromotor exercises, which involve coordination, balance, and cognitive skills such as counting backward from 100 while boxing,” says Ryan Glatt, a certified health coach at the Pacific Neuroscience Institute in Santa Monica, CA.

Affordable Online Exercise

Insurance can cover physical therapy sessions, sometimes even online ones, but almost never covers exercise classes. But many options are relatively affordable, or even free.

Use a health spending account.
Check with your medical team, including your physical therapist, to see what online resources they recommend. If you work and have a Flexible Spending Account or Health Spending Account, ask for a medical necessity letter to get costs covered.

Scour nonprofit websites.
For people with Parkinson's disease, consider these:

For those with multiple sclerosis, check out these sites:

  • The MSing Link provides online exercise programs, weekly check-ins, and more for $117 a month.
  • The MS Gym has free exercise videos, plus people can pay $15 a month for the full library.
  • MS Workouts are available for $69 a month.
  • The National Multiple Sclerosis Society offers online yoga, exercise, and rehabilitation resources. Many are free.
  • The Neuro Studio charges $25 a month for video classes and monthly Q&As with the founders.
  • Rebel Fit Club provides dozens of live-streamed Zoom classes and other resources for $95 a month.

Try general exercise programs.
Silver Sneakers and Age Bold offer large libraries of online classes geared for an older population and may be covered by insurance. “You may be able to make modifications for yourself—exercise in a chair or use a wall for balance, for example—to keep it safe,” says Ryan Glatt, a certified health coach at the Pacific Neuroscience Institute in Santa Monica, CA.