Practical strategies for exercising to cope with akathisia

Apr 3

While reducing or stopping the drug that caused akathisia is the gold standard treatment, many people—especially those tapering or experiencing tardive or chronic akathisia—look for non-drug ways to cope. Exercise isn’t a cure, but for some, it becomes essential, particularly walking. Benefits can feel small, and in some cases, exercise may even worsen symptoms. As a dance/movement therapist who has worked with people at all stages of akathisia, I’ve learned strategies that can help make movement safer and more manageable. Here are some ideas to make exercise more effective:

Recalibrating expectations

Your current capacity may differ greatly from before akathisia. Adjust expectations accordingly.

Accept fluctuations

Your ability to exercise may change during recovery. Some days it may help, other days not. That’s normal, it’s part of the process, not a failure.

Follow your “now body

The concept of the “now body” invites you to respond to your body based on current sensations. When we listen to our sensations, we can respond to them, listen more, and respond again, creating more ease in movement. “What do I notice about my body right now? And what can I do to bring myself more ease?” are questions that can help you attend to the now body. An example of this might be noticing a slight pain in your knee while walking and identifying that keeping a soft micro-bend in the knee brings relief.

Adjust in real time

If symptoms increase, reduce intensity, take a break, or stop. Your nervous system will relax a bit each time you respect the signals from your body and adjust.

Avoid overexertion

Pushing too hard can trigger flare-ups. If you feel worse after activity, scale back.

Start with walking

It’s accessible, adaptable, and reported as at least marginally helpful by almost all clients I’ve worked with. Some people find it incredibly helpful and notice symptoms are minimal during walking.

Embrace gentle movement

Low-intensity activities are often best tolerated, such as stretching, swimming, or gentle practices like tai chi. Exercise doesn’t need to be formal, it can be pacing at home or following a yoga video.

Experiment with intensity

While the majority of my clients prefer low-impact movement, some find higher-intensity exercise more relieving. There’s no single right approach: pay attention to your body, and stop of modify, if restlessness increases.

Lying down

Research on akathisia (Sachdev, page 168) suggests that most people find lying down to be their most comfortable position. If lying down is your most comfortable position and you still have restlessness, you might experiment—Pilates, yoga, weightlifting, and even dance can be adapted to this position.

Care for your feet

Whether it’s investing in a good pair of walking shoes, using anti-blister balm or socks, or rolling out sore feet on an acupressure ball, foot care can help you prevent injuries that interfere with using this strategy.

Strive for small improvements

Trying to make movement feel “good” can feel impossible. Instead, ask: “What would make this 1% more comfortable?” or “slightly less bad?” When practiced consistently, this can reduce stress (which exacerbates akathisia) and create a greater sense of control over your internal experience.

Create a rest routine

Balance activity with rest by using supports like soft lighting, calming sounds or music, a gentle guided meditation, or a nature video. Adjust to what feels right in the moment and be mindful of sensory sensitivities to light, sounds, or textures.

These strategies are meant to support coping and comfort. They are not a substitute for medical care. If you suspect that you have akathisia, consult a healthcare professional.

References:

Sachdev, Perminder. Akathisia and Restless Legs. Cambridge ; Cambridge University Press, 1995. Print.

*Now Body” is a concept I learned through my training and practice in the Nia Technique

colleen donaldson