Symptom Management in PD: Mindfulness Yoga vs Conventional Exercise

Mindfulness yoga appeared to be an effective and safe treatment option for stress and symptom management in patients with mild-to-moderate Parkinson disease.

A study found that a mindfulness yoga program was effective for improving motor dysfunction and mobility in patients with mild-to-moderate Parkinson disease (PD) to a similar degree as stretching and resistance training exercise (SRTE). Mindfulness yoga appears to have additional beneficial impacts on anxiety and depression, as well as an increase in health-related quality of life (HRQoL) in patients with PD. Findings from this study were published in JAMA Neurology.

In 4 community rehabilitation centers in Hong Kong, a total of 138 adults with a clinical idiopathic PD diagnosis (mean age, 63.7) were randomly assigned to either mindfulness yoga in 90-minute groups (n=71) or SRTE in 60-minute groups (n=67) for 8 weeks. Patients included in the analysis were able to stand without assistance and walk with or without an assistive device. Changes in anxiety and depressive symptoms, as assessed on the Hospital Anxiety and Depression Scale, were the primary outcomes. The changes in severity of motor symptoms (Movement Disorder Society Unified Parkinson’s Disease Rating Scale [MDS-UPDRS], Part III motor score), mobility, spiritual well-being (ie, perceived hardship and equanimity), and HRQoL were included as the secondary outcomes. End points −were assessed at baseline, 8 weeks, and 20 weeks.

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The mean MDS-UPDRS score at baseline was 33.3. According to generalized estimating equation analyses, mindfulness yoga was associated with significantly better improvements in anxiety at 8 weeks (β, −1.79; 95% CI, −2.85 to −0.69; P =.001) and 20 weeks (β, −2.05; 95% CI, −3.02 to −1.08; P <.001).

Significantly greater improvements were found in the yoga group vs the SRTE group in terms of depression (8 weeks: β, −2.75; 95% CI, −3.17 to −1.35; P <.001]; 20 weeks: β, −2.75; 95% CI, −3.71 to −1.79; P <.001), perceived hardship (8 weeks: β, −0.92; 95% CI, −1.25 to −0.61; P <.001; 20 weeks: β, 0.76; 95% CI, −1.12 to −0.40; P <.001), perceived equanimity (8 weeks: β, 1.11; 95% CI, 0.79-1.42; P <.001; 20 weeks: β, 1.19; 95% CI, 0.82-1.56; P <.001), and disease-specific HRQoL (8 weeks: β, −7.77; 95% CI, −11.61 to −4.38; P <.001]; 20 weeks: β, −7.99; 95% CI, −11.61 to −4.38; P <.001).

Yoga was also associated with a greater improvement in MDS-UPDRS motor scores compared with SRTE (8 weeks: β, −5.19; 95% CI, −8.15 to −2.24; P =.001]; 20 weeks: β, −4.71; 95% CI, −7.70 to −1.72; P =.002).

Study limitations included the small sample size, the inclusion of only patients from China, and the fact that all patients were aware of their treatment allocation.

“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,” according to the researchers. “Future rehabilitation programs could consider integrating mindfulness skills into physical therapy to enhance the holistic well-being of people with neurodegenerative conditions.”


Kwok JYY, Kwan JCY, 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 [published online April 8, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.0534