From the Journals

Mindfulness yoga reduced stress and motor symptoms in patients with Parkinson’s disease



Among patients with mild or moderate Parkinson’s disease, mindfulness yoga was as effective as stretching and resistance training in improving motor function and mobility, a randomized trial found.

In addition, mindfulness yoga reduced anxiety and depressive symptoms and increased spiritual well-being and health-related quality of life more than stretching and resistance training, researchers reported in JAMA Neurology.

Although guidelines support exercise for patients with Parkinson’s disease, investigators had not examined whether yoga is superior to conventional exercise for stress and symptom management in this patient population. Jojo Y. Y. Kwok, PhD, a research assistant professor of nursing at the University of Hong Kong, and her colleagues conducted an assessor-masked, randomized trial that included 138 adults with idiopathic Parkinson’s disease who were able to stand on their own and walk with or without an assistive device. The trial was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. Participants were randomized to 8 weeks of mindfulness yoga delivered weekly in 90-minute group sessions (71) or stretching and resistance training delivered in weekly 60-minute group sessions (67).

The primary outcomes was psychological distress in terms of anxiety and depressive symptoms assessed with the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included motor symptom severity, mobility, spiritual well-being in terms of perceived hardship and equanimity, and health-related quality of life. The researchers assessed patients at baseline, 8 weeks, and 20 weeks.

The average age of the participants was 63.7 years; 65 (47.1%) were men. Generalized estimating equation analyses found that patients in the yoga group had significantly better outcomes, including for anxiety (time-by-group interaction, beta, –1.79 at 8 weeks and –2.05 at 20 weeks), and depressive symptoms (beta, –2.75 at 8 weeks and –2.75 at 20 weeks). These improvements were considered “statistically and clinically significant, the authors wrote. There were no significant improvements in anxiety or depressive symptoms in the stretching and resistance training group at the different time points.

Outcomes in the yoga group were also better with regards to disease-specific health-related quality of life (beta, –7.77 at 8 weeks and –7.99 at 20 weeks). Those who were in the mindfulness yoga group also had greater improvements in measures of perceived hardship and equanimity, compared with the stretching and resistance training group.

Referring to the improved psychological outcomes in the yoga group, the authors wrote, “these benefits were remarkable because the participants who received the [mindfulness yoga] intervention attended a mean of only 6 sessions.”

There were significant reductions in motor symptoms in both groups, which were significantly higher among those undergoing stretching, but the differences in the mean scores between the two groups were “clinically insignificant,” they wrote.

Three participants in the yoga group and 2 in the control group reported temporary mild knee pain. No serious adverse events were reported.

Expectation bias, selection bias, and the dropout rates of 15.2% at 8 weeks and 18.8% at 20 weeks are limitations of the study, the authors noted.

“These findings suggest that mindfulness yoga is an effective treatment option for patients with PD [Parkinson’s disease] to manage stress and symptoms,” Dr. Kwok and her colleagues concluded. “Considering that PD is not only a physically limiting condition but also a psychologically distressing life event, health care professionals should adopt a holistic approach in PD rehabilitation. Future rehabilitation programs could consider integrating mindfulness skills into physical therapy to enhance the holistic well-being of people with neurodegenerative conditions.”

The trial was supported by the Professional Development Fund of the Association of Hong Kong Nursing Staff. The authors had no disclosures.

SOURCE: Kwok JYY et al. JAMA Neurol. 2019 Apr 8. doi: 10.1001/jamaneurol.2019.0534.

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