A holistic wellness prescription for Parkinson’s disease 

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We sat down with the Chair of the Task Force and first author on the paper, Dr. Indu Subramanian, to discuss her journey, the meaning of wellness, and how clinicians might begin to implement this model in everyday practice. 

Q: Before we dive into the paper, could you tell us a bit about your career journey and what drew you to the concept of wellness in Parkinson’s disease? 

I grew up in an Indian household in Canada. My mother is a family doctor, and from early on she exposed us to “out-of-the-box” practices such as Ayurvedic approaches to nutrition and healing when we were sick. So, I was always thinking about medicine beyond the traditional Western box. I went to medical school in Toronto and moved to Los Angeles for residency, where I was drawn to neurology because, like many of us, I thought the brain was fascinating. I was especially drawn to Parkinson’s disease because I have a real passion for the people living with it and the people who care for them. It’s a very complex and interesting disease, and I saw it as a space where we could bring some of these less conventional ideas into clinical care. I trained as a fellow at UCLA, stayed on, and have worked part-time at UCLA and part-time at the VA. At the VA, we have a Parkinson’s Center of Excellence, which I’ve directed for the last 10 years. That experience, plus my training and interest in integrative medicine — things like yoga, mindfulness, traditional Chinese medicine, Ayurveda, and my fascination with the mental health and psychological aspects of this disease, all brought me here.  

I’ve also become very interested in who is not being served: People who don’t have many resources. How can we help them live better with this disease? Wellness, for me, is something we can offer to anyone with Parkinson’s, regardless of where they live or what they own. 

Wellness, for me, is something we can offer to anyone with Parkinson’s, regardless of where they live or what they own." — Indu Subramanian, Chair of the MDS Task Force on Wellness

Q: For readers who are new to the concept, how do you define “wellness” in Parkinson’s disease, and how does it differ from traditional models of care? 

One definition of wellness I really like is the idea of proactive lifestyle choices that a person living with a disease can make every day to live better. There’s a strong sense of agency there where the person is not just a passive recipient of medication but an active participant in their health. 

When we talk about wellness in Parkinson’s, we’re thinking about everyday choices around exercise, diet, sleep, social connection, something the pandemic has really underlined, and mind–body approaches that are integral to many traditional systems of medicine. 

Crucially, we emphasise self-management. This sits outside the classic Western model of disease management, where patients come to see us, complain of a symptom, we respond with a pill or a procedure, and we see them again in six months when something else has gone wrong. That model is very reactive. In between visits, patients are often confused and passive, unsure what they can do for themselves. 

So, they go searching for guidance from the internet, from ChatGPT, from all kinds of sources. What we’re saying in Parkinson’s, as neurologists, is that these lifestyle choices are not “soft extras;” they are potentially disease-modifying processes. We’re finally building evidence that things like exercise can make a huge difference to how people live with PD. 

Q: In your introduction, you point out that wellness frameworks are already embedded in cardiology, oncology, and diabetes care but less so in neurology. Why has neurology lagged behind, and what prompted the MDS to create a dedicated Wellness Task Force now? 

Neurology has historically been a “diagnose and adios” specialty. When I was in medical school, the joke was that neurologists made beautifully precise diagnoses but had very little to offer in terms of treatment. Patients would go home and just live with these bad diagnoses. In Parkinson’s, we’ve made enormous progress. We now have a host of excellent motor treatments that significantly improve disability. But when it comes to non-motor and mental health issues, we still have relatively little to offer, and yet these are often what most affect quality of life. 

Meanwhile, other fields have moved strongly into prevention and lifestyle. Think of campaigns around heart attack prevention, lung cancer, smoking, cholesterol, diet. Neurology is only now catching up to the idea that we can prevent or modify brain disease. We see this emerging in dementia and stroke, and we’re realising we have a responsibility to talk about prevention and proactive health in PD as well. 

We’re diagnosing Parkinson’s earlier and earlier. We have people with prodromal features such as REM sleep behaviour disorder, genetic predispositions, abnormal imaging, or even skin biopsy results. When we tell someone, “You are at high risk of Parkinson’s,” we should also be able to say, “And here are things you can do to live better and potentially influence progression.” Patients are hungry for this. That’s really the space the Wellness Task Force is trying to fill. 

When we tell someone, ‘You are at high risk of Parkinson’s,’ we should also be able to say, ‘And here are things you can do to live better and potentially influence progression.’ Patients are hungry for this.” — Indu Subramanian, Chair of the MDS Task Force on Wellness

Q: Your paper is titled “A Holistic Wellness Prescription for Parkinson’s Disease: Evidence-Based Perspectives and Unmet Needs.” What were the main aims of the paper, and what should a “wellness prescription” look like in day-to-day practice? 

When we assembled the Task Force, we were asked to make it truly global and multidisciplinary and not just physicians or movement disorder specialists. So, we brought together a very diverse group: A sex therapist from Israel, an occupational therapist from Australia, a physical therapist from Portugal, a psychiatrist, a psychologist, and others. It was intentionally broad. 

Our mission aligned with that of the Movement Disorder Society: To provide care and support to every person living with Parkinson’s on the planet. That meant wellness could not be something you “buy” — a niche, elite add-on for people with resources. We focused on what people can do for themselves, not just what they can purchase. 

We also wanted to elevate mental health as a core pillar. So the prescription emphasises: 

• The psychology of getting this diagnosis and ongoing mental health, 
• Key lifestyle choices: Diet, exercise, sleep, mind-body approaches, social connection, 
• And a deep respect for cultural context, which I think is quite novel. 

What wellness looks like for a man in his 30s with PD living in a stigmatizing community in Kenya will be very different from someone in an affluent part of Sydney or Los Angeles with easy access to care. We wanted this framework to be relevant and accessible to people in the most under-resourced places as well. 

Practically, we lay out categories with basic starting points. We stress not overwhelming patients. Instead, we advocate for a personalised, collaborative approach: Understanding who the person is, what they have access to, and helping them pick one domain to start with. It’s about co-creating a realistic, meaningful wellness prescription for that individual. 

Q: Could you walk us through the key domains or pillars of the wellness prescription and some of the evidence behind them? Was there anything that surprised you as you reviewed the literature? 

It’s a very exciting time. For example, Bas Bloem’s group has published important papers on lifestyle and PD that delve into mechanisms and physiology. Our approach in this paper was to look at the broader evidence base for categories, rather than narrow, highly protocolised interventions. 

Starting with exercise, there is growing evidence that it benefits both motor and non-motor symptoms. Exercise also influences sleep and mental health. Bas Bloem has written about the idea that these interventions are synergistic: One activity, say, a yoga class in a group, outdoors in the sunlight, can touch multiple domains at once: Movement, mood, sleep, social connection, perhaps even inflammation and autonomic regulation. 

It’s hard to isolate one pathway, but we can still give broad, evidence-based guidelines: For example, getting your heart rate up for about 30 minutes a day, five days a week, in whatever way is feasible. 

For diet, we highlight plant-based patterns such as the Mediterranean or MIND diets. Hydration is also important, and we suggest thinking of hydration as part of the “medicine,” tailored to comorbidities in consultation with a physician. 

Social connection is another major pillar. The evidence suggests that being socially disconnected increases the risk of developing Parkinson’s, and once you have PD, loneliness is associated with worse motor and non-motor symptoms, faster progression, and higher rates of depression and anxiety. Some of my own data supports this. 

In mind-body approaches, there are specific studies: 

• Tai Chi for motor outcomes, 
• Yoga and mindfulness for anxiety and depression. 

We expand this domain further, thinking about accessibility and cultural context. That includes dance therapy, art-based therapies, drum circles — things that might be locally available and culturally meaningful. For someone in Kenya, that might be community dancing or drumming rather than a formal studio yoga class. 

We also emphasise very “basic” things that we sometimes forget such as getting outside into nature, morning sunlight to support sleep, simple daily movement. It may sound simple, but we’ve never really had a document that formally legitimizes these as real, discussable options in neurology. That’s what we hope this paper provides. 

One activity, say, a yoga class in a group, outdoors in the sunlight, can touch multiple domains at once: Movement, mood, sleep, social connection, perhaps even inflammation and autonomic regulation." — Indu Subramanian, Chair of the MDS Task Force on Wellness

Q: Many clinicians are time-poor. We might have half an hour with a patient every few months. Where do you suggest we start in implementing a wellness approach in PD? 

I actually think this framework can free us a bit. It reminds us that we, the doctors, are not the be-all and end-all. The clinic visit is important, but we can’t, and don’t need to, deliver every element of wellness ourselves. 

In the paper we use a “flower” graphic, with petals representing the different people who might be “part of the medicine,” such as physical therapists, nutritionists or dietitians, support group leaders, social workers, spiritual leaders, mental health professionals, community exercise or arts groups. 

This gives clinicians permission to think in terms of team-based care and community resources. Our role may be to introduce the wellness concept, validate its importance, and then refer or connect patients to the right “petals” on that flower. 

I’ve been giving talks on this since the paper came out, and one exciting development is that the “PD Avengers,” a global advocacy group, took our prescription and created a one-page version by patients, for patients. At a support group meeting, the leader printed it out for everyone, and we literally sat together and said: “Pick one thing on this page to start with next week. Put it in your calendar.” 

Often we prescribe complex programs that require a particular treadmill or facility three times a week for months. And when the program ends, patients have no way to sustain it. Instead, we should aim for small, sustainable wins, with the patient choosing what feels meaningful and achievable, and much of the action happening in their own community. That’s where I’d start. 

Q: Your article also speaks very directly about global inequity — many people worldwide lack access even to levodopa, let alone multidisciplinary wellness services. What are the biggest challenges to implementing a wellness-based model across different health systems, and how might we overcome them? 

The challenges are huge, and it can feel overwhelming. But I hope this paper and the one-page visual makes it easier, not harder, to begin. 

Clinicians can use the flower or one-pager as a quick reference: Pick one domain, one person or resource from the petals, and give the patient something concrete to try: “Talk to your rabbi about this,” or “Let’s see if we can find an art class,” or “Join this local walking group.” It’s a starting point. 

My hope is that, because the article is freely available, colleagues around the world will adapt it to their local context, then feed back to us: What worked? What didn’t? What did we miss? This was a global project that I co-led, but it’s meant to be iterative and responsive to local realities. 

We’re at a tipping point. Our main journals are publishing on wellness. The MDS is signalling that this is important. We now need to take this into our own backyards — Sydney, LA, Nairobi, São Paulo — and ask, “How do we operationalise this here?” 

One of our goals is to transition from a Task Force to an ongoing Study Group, open to anyone interested. We want to create bespoke resources for each lifestyle domain, host them on accessible platforms, and even translate the visual metaphor into culturally resonant images, a different flower, (maybe a koala or kangaroo for Australia) so that local communities feel seen in the materials. 

Q: Where does the field of wellness in PD need to go from here? What are the next research priorities? 

This is a hard area to study if we insist on traditional, highly rigid models: Large randomised controlled trials over 10 years for every single lifestyle element. If we stay too “in the box,” we risk paralysis. 

Instead, I think we need a mix of approaches including  

1. Smaller, quality improvement projects in real-world settings,  
2. Pragmatic trials, and  
3. Observational studies that track outcomes as we roll out wellness interventions. 

There are huge gaps in the evidence. Sleep is a good example. We all see that when patients sleep better, they do better. But there’s surprisingly little robust evidence to quantify that or guide interventions. 

So we need to partner as a global community, identify low-hanging fruit, and design research that both evaluates and simultaneously implements wellness practices. The ideal is to move the needle scientifically and, at the same time, help people live better today. 

Q: Any final messages for our readers? 

Mostly gratitude. Thank you and to Moving Along, for highlighting this topic. Thanks to your fellow Australian and Immediate Past President of the MDS Professor Victor Fung, who has been a huge cheerleader for this space, and to the MDS for recognising wellness as a serious, important area. I’m grateful to my co-authors and the entire Task Force. It’s been a very cool project to help cheerlead.  

I hope colleagues will read the paper, adapt it, challenge it, and build on it. Wellness is not a luxury add-on — it’s central to how people live with Parkinson’s. 

Read the paper

 

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