Abstract
This article introduces a new framework for therapists to develop an exercise program to delay mobility
disability in people with Parkinson disease (PD). Mobility, or the ability to efficiently navigate and
function in a variety of environments, requires balance, agility, and flexibility, all of which are affected by
PD. This article summarizes recent research identifying how constraints on mobility specific to PD,
such as rigidity, bradykinesia, freezing, poor sensory integration, inflexible program selection, and
impaired cognitive processing, limit mobility in people with PD. Based on these constraints, a
conceptual framework for exercises to maintain and improve mobility is presented. An example of a
constraint-focused agility exercise program, incorporating movement principles from tai chi, kayaking,
boxing, lunges, agility training, and Pilates exercises, is presented. This new constraint-focused agility
exercise program is based on a strong scientific framework and includes progressive levels of
sensorimotor, resistance, and coordination challenges that can be customized for each patient while
maintaining fidelity. Principles for improving mobility presented here can be incorporated into an
ongoing or long-term exercise program for people with PD.
