La Mindfulness Yoga nel Parkinson è un opzione efficace di trattamento per gestire lo stress e i sintomi e dovrebbe integrare i programmi di riabilitazione, anche se servono studi sul suo effetto a lungo termine.

Lo yoga mindfulness migliora ansia e depressione nei pazienti con Parkinson

New research provides evidence that mindfulness yoga is an effective treatment option for patients with Parkinson disease. The study, published in JAMA Neurology, found that yoga practice improved motor dysfunction and mobility while also reducing anxiety and depressive symptoms.

• Un programma di 8 settimane di yoga mindfulness per il morbo di Parkinson PD (MY-PD) è superiore ai convenzionali esercizi di stretching e resistenza (SRTE) nel migliorare in modo statisticamente e clinicamente significativo l’ansia e la depressione nei pazienti con PD lieve o moderato.

• Entrambe le pratiche migliorano i sintomi motori e la mobilità, ma il MY-PD porta benefici al benessere spirituale in termini di difficoltà e calma percepite e alla qualità della vita correlata alla salute.

Descrizione dello studio

• Lo studio ha incluso pazienti con diagnosi clinica di PD idiopatico in grado di alzarsi senza aiuto e camminare con o senza un dispositivo di assistenza (4 centri di riabilitazione di Hong Kong, 2016-2017).

• I partecipanti, registrati tramite campionamento di convenienza, sono stati randomizzati a ricevere una volta a settimana per 8 settimane una sessione di MY-PD di 90 minuti (gruppo di intervento) o di SRTE di 60 minuti (gruppo controllo) .

• Outcome primario: sintomi di ansia e depressione misurati tramite il questionario Hospital Anxiety and Depression Scale.

• Outcome secondari: gravità dei sintomi motori misurati tramite il Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, mobilità, benessere spirituale (difficoltà e calma percepite), qualità della vita correlata alla salute.

• Valutazioni effettuate all’inizio dello studio, a 8 (T1) e a 20 settimane (T2).

• Applicato il principio intention-to-treat.

• Fonti di finanziamento: Professional Development Fund, Association of Hong Kong Nursing Staff.

Risultati principali

• Sono stati inclusi 138 pazienti (71 nel gruppo di intervento, 67 nel gruppo controllo): età media 63,7 (SD 8,7) anni, punteggio MDS-UPDRS 33,3 (SD 15,3).

• Rispetto al gruppo controllo, quello di intervento ha mostrato un miglioramento significativamente maggiore nei sintomi dell’ansia (interazione time-by-group, T1: β -1,79 [IC 95% -2,85 a -0,69; P=0,001]; T2: β -2.05 [IC 95% -3,02 a -1,08; P<0,001]) e della depressione (T1: β -2,75 [IC 95% -3,17 a -1.35; P<0,001]; T2: β -2,75 [IC 95% -3,71 a -1,79; P<0,001]).

• La riduzione dei sintomi motori e il miglioramento della mobilità si è avuta in entrambi i gruppi.

• Rispetto al gruppo controllo, il gruppo di intervento ha avuto un miglioramento significativo nella difficolta percepita (T1: β -0,92 [IC 95% -1,25 a -0,61; P<0,001]; T2: β -0,76 [IC 95% -1,12 a 0,40; P<0,001]), nella calma percepita (T1: β 1,11 [IC 95% 0,79 a 1,42; P<0,001]; T2: β 1,19 [IC 95% 0,82 a 1,56; P<0,001]) e nella qualità della vita correlata alla salute (T1: β -7,77 [IC 95% -11,61 a -4,38; P<0,001]; T2: β -7,99 [IC 95% -11,61 a -4,38; P<0,001]).

Limiti dello studio

• Probabile errore di selezione dei partecipanti, che inoltre conoscevano il gruppo di appartenenza.

• Esclusi i pazienti con PD grave.

• Abbandono precoce nel gruppo SRTE.

Perché è importante

• L’esercizio fisico gioca un ruolo nel migliorare la sofferenza psicologica, un problema che nonostante l’alta prevalenza (ansia 40%, depressione 50%) e le sostanziali conseguenze nei pazienti con PD, non è sempre riconosciuto.

• Il MY-PD è un opzione efficace di trattamento per gestire lo stress e i sintomi e dovrebbe integrare i programmi di riabilitazione, anche se servono studi sul suo effetto a lungo termine.

• Bibliografia e riferimenti

https://www.univadis.it/viewarticle/lo-yoga-mindfulness-migliora-ansia-e-depressione-nei-pazienti-con-parkinson-685326?u=g7Nnk16ewgvqgxN4IMNgF4LSzBkuqOtC2GYKHa2qgP6Fhm%2FBG0%2FEZc6ZaCYr6zn4&u=g7Nnk16ewgvqgxN4IMNgF4LSzBkuqOtC2GYKHa2qgP6Fhm%2FBG0%2FEZc6ZaCYr6zn4&utm_source=automated&utm_medium=email&utm_campaign=medical%20updates%20-%20daily%202.5%20gps%20sp%c3%a9&utm_content=3684609&utm_term=

New research provides evidence that mindfulness yoga is an effective treatment option for patients with Parkinson disease. The study, published in JAMA Neurology, found that yoga practice improved motor dysfunction and mobility while also reducing anxiety and depressive symptoms.

“Being a registered nurse, researcher in chronic illness care, as well as a yoga instructor, I was drawn to approaching yoga as a therapeutic mind-body practice for better health and well-being, in particular, among those living with neurodegenerative diseases,” said study author Jojo Yan Yan Kwok, a research assistant professor at The University of Hong Kong.

“I believe that providing the science behind the practice would help yoga to penetrate the mainstream of healthcare practice. Considering that chronic illness is not only a physically limiting condition, but also a psychologically distressing life event, healthcare professionals should adopt a holistic approach in rehabilitation.”

In their study, which included 138 patients with mild-to-moderate Parkinson disease, the researchers compared the effects of an 8-week mindfulness yoga program to stretching and resistance training exercise.

Participants who completed the yoga program had significantly better improvement in anxiety and depressive symptoms than those in the stretching and resistance training program. Those in the yoga program also reported greater improvement in psychospiritual outcomes, such as equanimity (or being able to accept the ups and downs in life as they come.)

When it came to improving motor dysfunction and mobility, both groups saw a similar level of improvements.

“Yoga is not only a physical training exercise, but also a dynamic mindfulness practice to cultivate one’s non-judgemental awareness of the present moment. By adopting a mind-body approach, patients are much better positioned to reframe their illness journey than through physical training alone,” Kwok told PsyPost.

“By learning to relate non-judgmentally to their physical symptoms and emotions, they develop new coping skills that cultivate openness, acceptance and resilience to these symptoms. The research findings suggest that when patients with Parkinson’s disease are in a grounded, relaxed state, they function better in general.”

The study used a randomized clinical design. But like all research, it includes some limitations. It is unclear, for instance, if the results extend to those with severe Parkinson disease.

“This is the first trial to indicate superior effects of mindfulness-based yoga compared to physical therapy alone on improving anxiety, depression, spiritual and quality-of-life outcomes. In order to demonstrate that yoga is a valuable complementary rehabilitation option in adjunction to allopathic medicine, more well-controlled experiments have to be conducted to show such effects across various settings,” Kwok said.

“The conventional healthcare system has very little in place that teaches our patients how to cope with negative emotions and stress as well as managing physical symptoms related to chronic illnesses. As a consequence, the chronic, unattended stress can lead to ineffective self-management, poor prognosis, increased care dependency and high healthcare burden among the patients and our society.”

“Evidence suggests that yoga improves one’s physical fitness as well as emotional stability and resilience while confronting health conditions. More research regarding its implementation has to be investigated to promote the adoption and integration of such evidence-based practice into routine healthcare settings,” Kwok added.

The study, “Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease“, was authored by Jojo Y. Y. Kwok, Jackie C. Y. Kwan,M. Auyeung, Vincent C. T. Mok, Claire K. Y. Lau, K. C. Choi, and Helen Y. L. Chan.

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

Jojo Y. Y. Kwok, PhD, MPH, BN, RN1; Jackie C. Y. Kwan, MSocSc, PDMH, BSW, RSW2; M. Auyeung, MBChB3; et al

Vincent C. T. Mok, MD, MBBS4; Claire K. Y. Lau, MSc, BN, APN5; K. C. Choi, BSc, PhD6; Helen Y. L. Chan, PhD, BSN, RN6

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

FullText

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

https://jamanetwork.com/journals/jamaneurology/article-abstract/2729691