Research on the use of Yoga for Parkinson's disease

 


 In the United States around 1 million people live with Parkinson’s disease (1). Parkinson’s disease is the second most common neurodegenerative disease worldwide. Parkinson’s disease affects functional mobility, balance and gait. For this reason, people with Parkinson’s disease have an increased risk of falls. The clinical signs of Parkinson’s disease include bradykinesia, rigidity, resting tremors and postural instability. Depression, anxiety and cognitive impairment are common.

  There is no cure for this chronic condition. Therefore, the goals of the treatment for Parkinson’s disease are to ameliorate symptoms and to slow the progression of it with the combination of medications and routine rehabilitation training. The management offered can improve the patients’ quality of life. However, the long-term use of medications has potential complications.

  Research on the use of yoga to improve the quality of life of patients with yoga has been promising. In 2019 a randomized controlled study published by JAMA Neurology showed that offering yoga to patients with Parkinson’s disease was as effective as Stretching and Resistance Training exercises to improve motor symptoms and mobility, but yoga also had the added benefit of helping to manage anxiety and depression (2). Therefore, it had a more significant impact on quality of life.

 The study published by JAMA Neurology included a total of 138 participants diagnosed with mild or moderate Parkinson’s disease. Participants could give written consent to participate and were able to walk without an assistive device. They were excluded if they were receiving deep brain stimulation or medications for schizophrenia, psychotic disorders or major depressive disorder. Significant cognitive impairment was also a reason for exclusion. The pre-screening was done by telephone and in neurology clinics. Those who met the criteria were allocated to either an experimental group or a control group at a 1:1 ratio through computer-based permuted randomization.

  The experimental group received a ninety-minute session of Mindfulness Yoga for Parkinson’s disease; they were also encouraged to do a twenty-minute home based practice twice a week. This included a 12 basic Hatha yoga poses with sun salutations, breathing exercises and mindfulness meditation. The control group received a standard SRTE (Stretching and Resistance Training Exercises). In addition to the sixty-minute session of SRTE, they had to do a twenty-minute home-based practice twice a week. Fifty-two of the 138 participants had clinically significant anxiety symptoms; 44 participants had clinical depression.

 The intervention was done for eight weeks. The assessments included an interview and a clinical assessment at a rehabilitation clinic. These assessments were done at baseline (T0), at week 8 (T1) which was the time when the intervention was complete, and then three months later (T2).

The primary outcome evaluated the effects on psychological distress by using the Hospital Anxiety and Depression Subscale. The higher the score, the higher the psychological distress. The secondary outcome included the evaluation of motor symptoms, rigidity and postural instability, as well as spiritual well being and quality of life.  

The Yoga Mindfulness intervention had a statistically and clinically significant improvement in psychological distress compared to the SRTE group. The Yoga Mindfulness program helped to manage depressive and anxiety symptoms, whereas the SRTE had no effect on them. The added benefits were also shown in the quality of life. Both groups showed equal improvement in motor dysfunction and mobility.

 In 2021 a meta-analysis was published by Behavioral Neurology to assess the research on the benefits of using yoga for Parkinson’s disease to alleviate both motor and non-motor symptoms, and to understand whether yoga can help to improve the quality of life of patients with Parkinson’s disease (3). To accomplish this, the researchers analyzed the data of RCTs done for this purpose.

 To be included for this meta-analysis, the studies had to be RCT (randomized controlled trials) and the participants had to have a diagnosis of Parkinson’s disease. The studies had to include an experimental group that was offered yoga and a control group that received something else, such as resistance training, proprioceptive training, conventional balance exercise, routine care or non-exercise control).

 A total of 359 participants were included in this meta-analysis. Seven studies with 225 participants assessed motor symptoms and demonstrated the benefits of using yoga for Parkinson’s disease when compared to those in the control group (P less than 0.0002). Five studies involving 226 participants showed that yoga improved functional mobility. Four studies covering 198 patients showed that yoga helped to relieve anxiety when compared to control groups (P less than 0.00001). Similarly, four studies involving a total of 192 patients suggested that yoga improved clinical depression in patients with Parkinson’s disease (P less than 0.00001).

 Four studies covering 202 patients showed a significant improvement in the quality of life when compared to control groups.   The meta-analysis also found benefits of yoga on postural stability, which is necessary to support the patients in terms of fall prevention and balance. The adverse effect reported was mild transient knee pain.

 Yoga includes the use of asanas (postures) and movements combined with mindful breathing, and meditation.  It is important to offer a safe practice for each individual patient under the supervision of qualified yoga instructors.

This field of research is growing and it appears to have a relevant role in supporting the quality of life of patients with Parkinson’s disease.

 

References:

1)     https://www.parkinson.org/about-us/news/incidence-2022

 

2)     Y. Y., Kwan J. C. Y., Auyeung M., et al. Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with Parkinson disease: a randomized clinical trial. JAMA Neurology. 2019;76(7):755–763. doi: 10.1001/jamaneurol.2019.0534. https://pubmed.ncbi.nlm.nih.gov/30958514/

 

3)     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275425/

 

 

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