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Original Investigation
April 8, 2019

Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease: A Randomized Clinical Trial

Author Affiliations
  • 1School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
  • 2The Hong Kong Society for Rehabilitation, Hong Kong Special Administrative Region
  • 3Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region
  • 4Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Center for Prevention of Dementia, Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
  • 5Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administration Region
  • 6The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
JAMA Neurol. 2019;76(7):755-763. doi:10.1001/jamaneurol.2019.0534
Key Points

Question  Is yoga—a mindfulness-based exercise intervention—a safe and favorable coping strategy compared with conventional stretching and resistance training exercise for management of stress and symptoms in people with mild-to-moderate Parkinson disease?

Findings  In this randomized clinical trial that included 138 patients with Parkinson disease, the mindfulness yoga program appeared to be a safe and favorable coping strategy for patients with Parkinson disease to address their physical and emotional needs. Compared with conventional stretching and resistance training exercise, mindfulness yoga showed additional benefits on psychological distress, spiritual well-being, and health-related quality of life, with comparable benefits related to motor symptoms and mobility.

Meaning  Mindfulness yoga appeared to be an effective and safe treatment option for patients with mild-to-moderate Parkinson disease for stress and symptom management; further investigation is warranted to establish its long-term effect and compliance.

Abstract

Importance  Clinical practice guidelines support exercise for patients with Parkinson disease (PD), but to our knowledge, no randomized clinical trials have tested whether yoga is superior to conventional physical exercises for stress and symptom management.

Objective  To compare the effects of a mindfulness yoga program vs stretching and resistance training exercise (SRTE) on psychological distress, physical health, spiritual well-being, and health-related quality of life (HRQOL) in patients with mild-to-moderate PD.

Design, Setting, and Participants  An assessor-masked, randomized clinical trial using the intention-to-treat principle was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. A total of 187 adults (aged ≥18 years) with a clinical diagnosis of idiopathic PD who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Eligible participants were randomized 1:1 to mindfulness yoga or SRTE.

Interventions  Mindfulness yoga was delivered in 90-minute groups and SRTE were delivered in 60-minute groups for 8 weeks.

Main Outcomes and Measures  Primary outcomes included anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included severity of motor symptoms (Movement Disorder Society Unified Parkinson’s Disease Rating Scale [MDS-UPDRS], Part III motor score), mobility, spiritual well-being in terms of perceived hardship and equanimity, and HRQOL. Assessments were done at baseline, 8 weeks (T1), and 20 weeks (T2).

Results  The 138 participants included 65 men (47.1%) with a mean (SD) age of 63.7 (8.7) years and a mean (SD) MDS-UPDRS score of 33.3 (15.3). Generalized estimating equation analyses revealed that the yoga group had significantly better improvement in outcomes than the SRTE group, particularly for anxiety (time-by-group interaction, T1: β, −1.79 [95% CI, −2.85 to −0.69; P = .001]; T2: β, −2.05 [95% CI, −3.02 to −1.08; P < .001]), depression (T1: β, −2.75 [95% CI, −3.17 to −1.35; P < .001]); T2: β, −2.75 [95% CI, −3.71 to −1.79; P < .001]), perceived hardship (T1: β, −0.92 [95% CI, −1.25 to −0.61; P < .001]; T2: β, −0.76 [95% CI, −1.12 to −0.40; P < .001]), perceived equanimity (T1: β, 1.11 [95% CI, 0.79-1.42; P < .001]; T2: β, 1.19 [95% CI, 0.82-1.56; P < .001]), and disease-specific HRQOL (T1: β, −7.77 [95% CI, −11.61 to −4.38; P < .001]; T2: β, −7.99 [95% CI, −11.61 to −4.38; P < .001]).

Conclusions and Relevance  Among patients with mild-to-moderate PD, the mindfulness yoga program was found to be as effective as SRTE in improving motor dysfunction and mobility, with the additional benefits of a reduction in anxiety and depressive symptoms and an increase in spiritual well-being and HRQOL.

Trial Registration  Centre for Clinical Research and Biostatistics identifier: CUHK_CCRB00522

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