I am 82. I have had a minor stroke and have Parkinson’s dis­ease. The main prob­lem seems to be my bal­ance. When I walk it is dif­fi­cult to put my heels down first. And I find it hard to straighten my legs after sit­ting for a while. Could you sug­gest any way to improve my mobil­ity and bal­ance?

Parkinson’s dis­ease and stroke both upset the links between brain and body, cre­at­ing a wide and some­times dis­tress­ing range of phys­ical prob­lems in doing every­day tasks – includ­ing things that are nor­mally com­pletely auto­matic.

Stroke usu­ally affects one side of the body, immob­il­ising or weak­en­ing it. This causes you to make many changes in the way you move, so that you become gradu­ally lop-​sided, favour­ing your good or stronger side. This alone will cause bal­ance prob­lems.

Parkinson’s dis­ease also increas­ingly affects bal­ance, and cru­cially, your abil­ity to react quickly and instinct­ively to some­thing like a trip or stumble. This will leave you at greater risk of a nasty fall.

The most dis­abling aspect of Parkinson’s dis­ease is how it “freezes up” your muscles, mak­ing all move­ment slower and some­times mak­ing it impossible to get star­ted on mov­ing at all.

Without know­ing much more about you, I can­not give you spe­cific exer­cises, because the phys­ical effects of your com­bined con­di­tions will be unique to you. An advanced fit­ness instructor should be able to set you a suit­able exer­cise pro­gramme: ask your GP sur­gery or coun­cil leis­ure depart­ment for names of qual­i­fied local train­ers. Here are some gen­eral exer­cise pri­or­it­ies for you:

Stay upright: it is vital that you work hard on keep­ing good pos­ture, whether sit­ting, stand­ing or walk­ing. If you stoop for­wards and walk without put­ting your heels down prop­erly, your centre of grav­ity and stead­i­ness will be under­mined. It is pos­sible to teach your­self to walk bet­ter, so try to make the effort (see below).

Do stretch­ing: to com­bat the stiff­en­ing effects of tight muscles, you should stretch every day. Even doing some in bed first thing will help to ease your mobil­ity once you get up. To help with your heels, do calf stretches sit­ting on a kit­chen chair: sit near the front and put one leg out straight in front with the heel rest­ing on the ground. Then hook at towel round the foot, and hold­ing the ends of the towel in both hands, gently pull your foot towards you, hold­ing the stretch for 20 seconds or more, once you feel the calf tens­ing up. Remember to keep breath­ing through­out. Other stretches that are par­tic­u­larly import­ant are chest, front and back of your thighs, neck and shoulders.

Keep mov­ing: des­pite the dif­fi­culties, it is very import­ant to keep your body mov­ing, and reg­u­lar exer­cise will help. The Parkinson’s Disease Society has an excel­lent home exer­cise book­let, “Keeping Moving”, with clear instruc­tions and pho­tos. It cov­ers mobil­ity and bal­ance, as well as advice on how to improve your walk­ing. Click here to find out more, down­load the book or order an accom­pa­ny­ing exer­cise DVD.