Opinion

Finding Stillness: Introducing Yoga for People with Parkinson’s Disease

David J Blacker^1,2,3* and Kirsten M Blacker⁴

¹Perron Institute for neurological and translational science. Western Australia

²The University of Western Australia, Department of Medicine and Pharmacology, Crawley, Western Australia

³Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia

⁴Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia

Submission:October 01, 2024;Published: October 21, 2024

*Corresponding author: David J Blacker, Perron Institute for neurological and translational science. Ground floor, Ralph and Patricia Neuroscience building, 8 Verdun St, Nedlands , Western Australia

How to cite this article: David J B, Kirsten M B. Finding Stillness: Introducing Yoga for People with Parkinson’s Disease. J Yoga & Physio. 2024; 11(5): 555824. DOI:10.19080/JYP.2024.11.555824

Abstract

Yoga is one of the many non-pharmacological therapies that are now being utilised in the treatment of Parkinson’s disease [1]. Several small clinical trials have demonstrated benefits including improved motor function [2-4], non-motor symptoms [3], quality of life and respiratory function. [4] The state of Mindfulness related to the meditative components of yoga seems particularly valuable, with benefits on anxiety and depression in PwP [3,5]. In this article we describe our personal experience of using yoga to help control PD symptoms. We explain how this lead to a program designed to introduce PwP to yoga. Initially, individual evaluations were undertaken to assess physical limitations and any specific risks to participation. This information was used to create specific modifications which enabled participants to safely undertake the program. The main objective was to prepare PwP to participate in yoga classes in the general community by providing the required knowledge, confidence and modifications. Six PwP commenced the 10 week program; we advised one to withdraw due to an exacerbation of previous neck pain. Subjective feedback was positive, and participants particularly commented on the benefits of socialising with peers. All reported feeling capable of attending yoga classes in the general community.

Keywords: Yoga; Parkinson’s Disease; Mindfulness; Depression

Introduction

Exercise is now regarded as a crucial component of any treatment plan for Parkinson’s disease (PD). The Parkinson’s Foundation recommends that exercise includes a mixture of: aerobic activity, strength training, balance, agility and multitasking [6]. Yoga practice covers all these and also features breath control and mediation.

Background and Our Personal Experience

We both undertook together two beginners yoga courses in 2014 and 2015. Neither of us had previous experience with yoga, although KB had ten years of Pilates both clinical and mat based. DB was diagnosed with PD in 2018, and as a result, increased the amount of exercise he was doing, with yoga becoming a regular component of this. We attended group classes once or twice a week until the COVID-19 era, when we changed to using a yoga App. As restrictions lifted, we began attending yoga retreats twice a year. DB began to realise how important regular yoga was to control PD symptoms [7], and KB was extremely supportive, assisting DB to improve yoga technique. This provided KB with ample opportunity to observe how specific PD deficits impacted on yoga practice, and how modifications could be made to enable DB to continue to participate. With a long background in clinical teaching as a nurse and midwife, KB decided to undertake yoga teaching training, with the specific goal of making yoga accessible to people with disease or disability.

Meanwhile, DB was leading a feasibility study of non-contact boxing training (FIGHT-PD) for PD [8]. As DB’s exercise intensity increased he found yoga, particularly yin yoga, to be particularly helpful to counteract post exercise muscle soreness. It also provided an excellent contrast to the boxing. In 2023, DB underwent a robotic assisted radical prostatectomy and lymph node clearance. In preparation for this, we met with a specialist physiotherapist and exercise physiologist to formulate a specific pre and post operative exercise plan, incorporating yoga. The surgery was complicated by an obturator neuropathy affecting DBs left leg, which is less affected by PD. This provided an additional challenge to the recovery, but with time and a regular program of walking and yoga, mobility was restored, close to preoperative state. Having experienced the effect of this on recovery, inspired us to assist other PwP obtain the benefits of PD.

It seems there are barriers, even for healthy individuals to commencing yoga. These might include a gender bias (more females participate in yoga), misperception of what yoga is, body image concerns, expense and access. PwP have additional challenges, such as the fact there are more males than females with the condition, balance problems and fear of falling. Our objective was to create a Yoga program that would overcome these barriers and provide participants with the confidence to use their new knowledge of yoga to participate in regular yoga classes for the general population, making modifications where necessary.

Building A Group Program

In collaboration with Parkinson’s WA, we developed a yoga program for PwP. We selected yoga poses that facilitate extensor posture and balance, to counter the tendency for PwP to stoop into forward flexion and to have poor balance. Parkinson’s nurse specialists selected PwP who were interested to learn yoga, and had the capacity to participate in the majority of sessions of a 10 week program. We recruited PwP who were independently mobile with Hoehn and Yahr scores of 1-2. [9] WhatsApp” was used to create a group messaging communication system for reminders and notifications. The structure of the program consisted of:
1. A pre-commencement questionnaire seeking information regarding past medical history and history of PD, exercise history and experience with yoga.
2. A pre-commencement 90 minute individual assessment, specifically checking for issues that could be problematic during yoga, such as postural hypotension, balance problems, spinal and other musculoskeletal problems, and glaucoma. KB assessed approximately 30 yoga postures at this session and determined if they could be done safely, required modification or needed to be avoided. Most people also had numerous general questions about PD. DB assisted by reviewing medical issues and answering questions about PD.
3. 8 one hourly sessions, once per week.
4. Morning tea and chat after each yoga session.
5. Post completion questionnaire.
6. Post completion written list of recommendations for modifications, that could be given to a yoga instructor. Additionally, we visited a number of private yoga studios, participated in a class and then discussed with the yoga teacher the suitability of their specific program for attendance by PwP who had completed our program. We were therefore able to guide participants towards suitable classes upon completion of our program.

Description of the Classes

The 60 minute sessions typically began with controlled breathing practice to allow time to focus and perform the session mindfully. KB provided oral instructions whilst demonstrating the poses. Where necessary KB provided “hands on” adjustments. DB also demonstrated the postures and observed participants for safety. KB provided a written instruction sheet for each participant for each class, utilising modifications that each participant required, based on the pre-commencement assessment. This included using a chair where necessary, and one class was almost exclusively performed in a chair. A “peak pose” was undertaken at about the 40-minute mark, before completing the session with floor based poses and then guided meditation during Shavasana. The classes were planned on a week-by-week basis based on the needs of the participants, and progress to new poses was only made when all participants were ready. This series of classes was developed as the weeks progressed, rather than preset at the beginning of the series

Results

This program was not undertaken as a research project; however the results of the pre-commencement and postcompletion questionnaires were used to optimise the second 8 week program. Six participants enrolled in the first series.one subject withdrew after just two sessions due to pain from a flare up of a pre-existing neck injury. Their general practitioner and physiotherapist advised it was safe to continue yoga, however we suggested deferring to a later time. Amongst the remaining five, most of them attended all available sessions, with approximately 5% of total sessions being missed. A second group of 5 was screened. One candidate was unsuitable because of residual deficits due to a stroke that occurred between the time of the initial visit by the PD nurse and the pre-commencement evaluation.

Selected feedback comments from the first cohort include:
1. Confidence to attend yoga classes in the future
All participants indicated they could now attend yoga classes
“ I feel as if I now understand what supports I need to use”
‘not confident but capable of joining a beginner’s class”
‘experiencing a new teaching with a different focus specifically for PD I have gained more confidence”
“participating has given me the confidence to seek out classes that will be suitable for my specific needs”

2. Difficulties with the course
“difficult to understand the terminology”

3. Suggestions for improvement
‘handout to be introduced earlier in the program’ – this has been addressed by sending a preview link to the flow before class,
and including a printed handout of the poses each week

4. Changes in PD
“I use some of your techniques at various times without realizing. Now that I have found PWA as a support mechanism, the fear of the unknown has been reduced”
“better balance”
“allowed me to gain confidence”

5. Changes in physical health
“my physical health as improves as I introduce the various exercises”
“not slouching so much, improving my posture”

6. Changes in mental health
“in a better frame of mind again now…being able to talk to others in the group really helped”
‘my mental health has improved as I no longer feel alone in my diagnosis”
“ since being diagnosed with I was overwhelmed with feelings of fear and being alone. Since joining the group that all turned around for me…I see my pathway in a more positive outlook”
“doing the exercises…did take me out of my negative thoughts”

7. Achievement of self-set goals
“flexibility has improved in some areas”
“slowing my breathing is helpful with anxiety”
“I had not set any goals other than setting up a coping mechanism. You achieved that and gave me more than I had been searching for”

8. Other comments
“realising that I can achieve things physically helps”
“I no longer feel alone”
“I could not recommend this yoga programme enough”
“ I wish the class could go on for a few more weeks”

Future Plans

Further 10 week introductory programs for groups of no more than six are planned for2025, and ongoing classes for those completing the introduction are being considered.

Conclusions

The objective of empowering PwP to feel able to attend yoga classes in the general community was achieved by all participants. There was useful and positive feedback, with particular note of the socialisation opportunity with other PwP.

Acknowledgements

Parkinson’s WA provided the funds for yoga equipment (mats, bolsters etc) and the venue. DB and KB provided their time pro bono.

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References

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