This paper investigates the challenges and strategies for expanding Dancing with Parkinson’s (DWP)—a Toronto-based dance intervention for Parkinson’s disease—into Indigenous communities in Northern Ontario. Using implementation science frameworks and a case study approach, and informed by a realist evaluation lens, the study defines spread as the replication of core program components in new settings through contextual adaptation. Key challenges in replicating interventions across diverse environments include: Specific barriers to the spread of Dancing with Parkinson’s discussed include unreliable internet access, cultural misalignment with Western-centric dance practices, and historical distrust of externally imposed healthcare initiatives. The analysis argues that successful spread requires prioritizing cultural adaptiveness and developing a “choice infrastructure” (e.g., broadband access, Indigenous-led partnerships). The chapter critiques linear replication models, advocating instead for dynamic, systems-oriented approaches that emphasize: community agency, iterative learning processes, and realist evaluation principles to guide adaptation.