How we treat Parkinson's

Aerobic intensity is set from an exercise test and monitored, not estimated from how hard a session feels. The target is high — the range associated with slowed motor decline in trials — and it is reached progressively over the first week.

Cardiac and respiratory screening comes first. Where high intensity is not safe, the programme moves to the moderate range rather than being abandoned, and you are told which applies to you and why.

Movements are trained deliberately larger than they need to be: big steps, big reach, big turns, at high effort and high repetition. The aim is to recalibrate a system that has been under-scaling, so that normal-sized movement returns to feeling normal.

It feels theatrical at first and patients say so. It stops feeling that way with practice, which is itself a sign that the calibration is shifting.

Auditory, visual and tactile cues are trialled to find which works for you — a counted rhythm, a metronome in an earpiece, lines on the floor, a laser cue on a stick, a tap on the thigh. Then it is practised in the situations that actually cause freezing: doorways, turns, narrow spaces, being hurried.

The goal is a strategy you can use unaided at home rather than a device that stays here.

Sessions are placed in your best "on" periods, because training during an "off" period trains a different person. This requires knowing your actual timing rather than the prescription on paper, so the first days include mapping it.

What we observe about your response and timing goes into the discharge letter for your neurologist, who is the person who can act on it.