From body, mind, to the integration: A mixed-method, randomized controlled trial of mindfulness yoga on physio-psycho-spiritual well-being of people living with Parkinson’s disease

Abstract

Background: Clinical practice guidelines support exercise as rehabilitation for Parkinson’s disease (PD), but no randomized trials have tested whether yoga – a mindfulness-based exercise intervention – is superior to conventional physical exercises for stress and symptoms management for people living with PD. Methods: An assessor-blind randomized controlled trial was conducted at four community rehabilitation centers in Hong Kong, with embedded process evaluation. A total of 138 people with idiopathic Parkinson’s disease (H&Y stage I–III) were randomized into eight weekly sessions of mindfulness yoga (n=71) or stretching and resistance training exercise (n=67) groups between December 2016 and May 2017. Outcome measures: Primary outcomes included anxiety and depressive symptoms (Hospital Anxiety and Depression Scale). Secondary outcomes included severity of motor symptoms (Movement Disorder Society – Unified Parkinson’s disease Rating Scale motor score), mobility (Time-up-and-go test), spiritual wellbeing in terms of perceived affliction and equanimity (Holistic Wellbeing Scale), and health-related quality of life (Parkinson’s disease Questionnaire-8). Assessments were done at baseline, 8 weeks (T1) and 20 weeks (T2). Results: Participants included 65 men (47.1%); mean (SD) age was 63.7 (8.7) years. The participation rate of 88.5% with an attendance rate of 80% demonstrated that the mindfulness yoga program was well received. Both groups appeared to reduce motor symptoms significantly. Generalized estimating equation analyses revealed that the mindfulness yoga group generally had significant better improvement on various outcomes than the stretching and resistance training exercise group; particularly, anxiety, depressive symptoms, perceived affliction, perceived equanimity and healthrelated quality of life (HRQOL). From participants’ narratives, the mindfulness practice of yoga helps redefine their illness experience through body-mind integration. Instead of struggling to get away from vulnerable health experiences, they practice being present with every sensation and thought non-judgmentally with a lovingkindness mind. Conclusion: Among people with mild-to-moderate PD, mindfulness yoga was concluded to be as effective as stretching and resistance training exercise in improving motor dysfunction and mobility, with additional benefits on anxiety, depressive symptoms, spiritual wellbeing and HRQOL. Results support the implementation of mindfulness-based exercise interventions in PD care worldwide, which is essential to help people cope and live better with fluctuating PD symptoms that cannot be addressed pharmaceutically.