Training for the Boston Marathon while managing Parkinson’s requires more than following a standard marathon plan. The mileage still matters, but so do medication timing, balance, fatigue, recovery, symptom patterns, hydration, and the support system surrounding each workout. A successful plan must train the athlete who shows up each day, rather than forcing every day to match a schedule written months earlier.

For an endurance athlete living with Parkinson’s, adaptation is not a sign that the goal has become smaller. It is part of pursuing an ambitious goal intelligently. Greg Schaefer’s experience as a longtime endurance athlete, business leader, father, and Parkinson’s advocate reflects a broader principle found throughout his personal story: forward motion is built through discipline, honest assessment, and the willingness to adjust without walking away.

Begin with an individualized readiness assessment

Parkinson’s can affect people in very different ways. One runner may primarily notice stiffness at the beginning of a workout. Another may experience changes in balance, stride rhythm, fatigue, blood pressure, sleep, or medication response. A generic marathon schedule cannot account for those differences.

Before beginning a Boston Marathon training cycle, discuss the goal with the healthcare professionals involved in your care. Depending on your circumstances, that team may include a movement-disorder specialist, primary care clinician, physical therapist, occupational therapist, registered dietitian, or experienced endurance coach. The Parkinson’s Foundation recommends a functional evaluation by a physical therapist with Parkinson’s expertise before beginning an exercise program.

The assessment should consider more than whether you can currently complete a certain distance. It should also examine gait, balance, mobility, strength, recent falls or near-falls, blood pressure concerns, medication patterns, previous injuries, heat tolerance, and recovery from harder sessions. These observations help establish a realistic starting point and identify areas that deserve attention before weekly mileage increases.

Train according to patterns, not just pace

Traditional marathon plans organize training around pace, distance, heart rate, and weekly volume. Those measures remain useful, but an athlete managing Parkinson’s may need another layer of information: how symptoms and movement quality change throughout the day.

Some people have predictable periods when medication is working well and movement feels more fluid. Others experience variable or sudden changes. The Parkinson’s Foundation notes that exercise may be easier during an individual’s more functional or “on” periods, but medication decisions and timing should always be discussed with the prescribing clinician.

For two to four weeks, record a few simple details after each session:

• Workout start time and duration
• Medication timing as directed by your clinician
• Energy and sleep quality
• Stiffness, tremor, balance, or gait changes
• Fuel and fluid intake
• Weather and temperature
• Perceived effort and recovery the following day

The goal is not to become consumed by data. It is to identify useful patterns. If longer runs consistently feel steadier at one time of day, that may be the best window for key sessions. If balance deteriorates late in a workout, the plan may need shorter loops, more frequent check-ins, or a training partner.

Build mileage gradually and preserve consistency

Boston’s reputation can tempt athletes to treat every training week as a test of toughness. That approach is risky for any marathoner. When Parkinson’s, medication effects, fatigue, or balance concerns are also present, aggressive mileage increases can make it harder to distinguish productive training stress from a developing problem.

A stronger approach is to establish repeatable weeks before chasing peak volume. Begin with mileage that feels sustainable alongside work, family responsibilities, medical appointments, sleep, and strength training. Increase the workload gradually, and use recovery weeks to absorb the training.

Long runs can also be adapted without losing their purpose. Depending on the athlete and guidance from the training team, options may include:

• Running a familiar loop that passes water, restrooms, and a support person
• Breaking a long aerobic session into planned run-walk segments
• Completing part of the session on a treadmill or controlled course
• Using a training partner for later miles when fatigue may affect gait
• Reducing distance when movement quality declines rather than forcing a predetermined number

Consistency over several months is more valuable than completing one heroic workout that disrupts the next two weeks.

Train strength, balance, mobility, and coordination

Marathon preparation is not only a cardiovascular project. The Parkinson’s Foundation and the American College of Sports Medicine organize Parkinson’s exercise guidance around aerobic activity, strength training, stretching, and balance, agility, and multitasking. A runner’s plan should account for all four domains.

Strength

Strength work can support posture, propulsion, joint control, and the ability to maintain form when fatigue builds. Exercises may include squats or sit-to-stands, step-ups, calf raises, hip-hinge movements, rows, presses, and loaded carries, provided they are appropriate for the individual. A physical therapist or qualified coach can modify exercises when balance, freezing, pain, or coordination is a concern.

Balance and agility

Balance training should be deliberate and safely supervised when necessary. It may include controlled changes of direction, stepping patterns, single-leg stability progressions, or exercises that challenge coordination without creating unnecessary fall risk.

Mobility

Regular mobility work can address stiffness in areas that influence running mechanics, including the ankles, hips, upper back, and shoulders. Dynamic movement before a run and calmer stretching afterward may be more practical than relying on one long mobility session each week.

Dual-task preparation

Race environments demand attention. Runners must watch the road, respond to crowds, manage fueling, adjust pace, and navigate around other participants. Carefully supervised dual-task exercises may help an athlete practice maintaining movement while processing simple external cues. These drills should remain controlled and should never introduce avoidable risk.

Prepare specifically for Boston’s demands

Boston rewards patience. The early portion of the course can encourage runners to move faster than planned, while later hills arrive after substantial fatigue has accumulated. Training should therefore develop restraint, downhill durability, climbing strength, and the ability to maintain sound mechanics late in a run.

Useful course-specific preparation may include gradual exposure to rolling terrain, controlled downhill running, steady uphill efforts, and long runs that place hills in the later miles. Downhill work should be introduced conservatively because it can create significant muscular soreness. An athlete with changes in balance, stride control, or joint stability may need a safer alternative designed with a physical therapist or coach.

Practice the pacing strategy during training rather than relying on race-day emotion. The goal should be to arrive at the later sections of the course with enough physical and mental control to respond to the terrain.

Take hydration, fueling, and blood pressure seriously

Hydration and fueling affect every marathoner, but they may require additional planning for someone living with Parkinson’s. Some people with Parkinson’s experience dizziness or low blood pressure, and dehydration or overheating can make symptoms harder to manage. Individual fluid and sodium needs vary, particularly for people with heart, kidney, blood pressure, or medication-related considerations.

Develop the fueling and hydration plan with appropriate professional guidance, then rehearse it repeatedly during long runs. Do not introduce an unfamiliar strategy on race morning. The plan should account for:

• What foods and fluids are tolerated during exercise
• How medication timing relates to meals, protein, and gastrointestinal comfort
• How much fluid can be carried or obtained along the route
• What to do if nausea, dizziness, swallowing difficulty, or loss of appetite appears
• How weather conditions may change fluid and cooling needs

Any concerns about medication absorption, food interactions, or dose timing should be directed to the prescribing clinician or pharmacist. A marathon plan should work around the medical plan, not quietly rewrite it.

Use recovery as part of the training load

Recovery is where training becomes usable fitness. Parkinson’s-related fatigue, sleep disruption, stiffness, or stress may change how much recovery an athlete needs after a demanding session. That does not automatically mean hard training must disappear. It means the response to hard training must be observed honestly.

Keep easy days genuinely easy. Schedule demanding sessions with enough space between them, and avoid stacking a long run, intense speed workout, and heavy strength session simply because the calendar looks open. Walking, gentle mobility, easy cycling, or full rest may all serve a purpose depending on the athlete.

Watch for changes that persist beyond normal post-workout fatigue, including a significant decline in balance, unusual weakness, repeated near-falls, worsening pain, sustained dizziness, chest symptoms, confusion, or a major change in movement. Stop the workout when necessary and seek appropriate medical guidance rather than treating every warning sign as a test of resolve.

Create a race-day operations plan

A well-organized race day reduces the number of decisions that must be made under stress. Write down the plan and share it with the people supporting you. It should cover transportation, pre-race meals, medication storage and timing as prescribed, warm-up, clothing, fueling, hydration, emergency contacts, post-race transportation, and a meeting point.

Carry identification and relevant medical information in a secure, accessible form. A support person should understand your normal symptom patterns and know what would represent a meaningful change. Discuss the Boston Marathon’s current medical, bag, transportation, and participant policies directly with the race organizer before race weekend, as operational rules can change.

Race-day goals can also be layered. A primary goal might be to execute the plan safely. A second might relate to pacing or finishing time. Another might simply be to stay present through a meaningful return to the course. Multiple goals keep the day from being judged by one number alone.

Frequently asked questions

Can someone with Parkinson’s train for a marathon?

Some people with Parkinson’s are able to participate in endurance events, but readiness varies widely. The decision should be individualized with guidance from qualified healthcare professionals who understand the person’s symptoms, medical history, medications, mobility, and training background.

Should marathon workouts be scheduled around medication?

Many athletes find it useful to understand when movement and energy are most predictable in relation to their prescribed schedule. Do not change a medication dose or timing independently. Discuss training logistics with the prescribing clinician, especially when long sessions or race-day transportation may disrupt the normal routine.

What if symptoms change during the training cycle?

Record the change and contact the appropriate healthcare professional when it is new, persistent, severe, or affects safety. The training plan may need to change while the cause is evaluated. A reduced workout is better than hiding a meaningful change from the people helping manage your care.

Is run-walk training acceptable for Boston preparation?

A planned run-walk strategy can be a useful endurance tool for some athletes. Its suitability depends on the runner’s experience, goals, qualification status, expected pace, symptoms, and the event’s official requirements. It should be practiced well before race day.

How important is a training partner?

A training partner can provide pacing support, observe movement changes, assist with route logistics, and respond if a safety concern develops. Not every session requires company, but support can be especially valuable during long runs, unfamiliar routes, difficult weather, or workouts performed when symptoms are less predictable.

Keep the mission larger than one workout

Preparing for Boston while living with Parkinson’s brings ambition and uncertainty into the same training cycle. Progress may include strong workouts, revised plans, difficult days, and moments when simply continuing carries more meaning than a pace on a watch.

The standard is not rigid perfection. It is responsible effort, honest communication, and another well-chosen step. That same perspective shapes Greg’s work as a speaker and advocate, where lessons from endurance, leadership, family, and adversity come together through a grounded message of forward motion.

This article is for educational purposes only and is not medical advice. For diagnosis, treatment, or personalized medical guidance, please speak with a qualified healthcare professional.

Sources & further reading

• Parkinson’s Foundation: Exercise
• Parkinson’s Foundation: Parkinson’s Disease Exercise Recommendations Updated by Parkinson’s Foundation and American College of Sports Medicine
• Parkinson’s Foundation: Diet & Nutrition
• Parkinson’s Foundation: Low Blood Pressure and PD
• American Parkinson Disease Association: Get the Most Out of Your Exercise Routine for PD