Effect of an Eight-Week Adaptive Yoga

Program on Mobility, Function, and

Outlook in Individuals with Parkinson’s

Disease

Bryan Coleman Salgado, PT, DPT, MS, CWS

Lois Boulgarides, PT, DPT, MS

Edward Barakatt, PT, PhD

Janice Freeman-Bell, RYT

Danett Choo, SPT

Michelline El-Zahr, SPT

Kristi Williams, SPT

April Morales, SPT

SYTAR 2008 § Los Angeles

Introduction & BackgroundParkinson’s Disease

Progressive Neurological Disease

Second most common neurological disease (after Alzheimer’s)

Occurs frequently in older persons -7 million in US

1 in every 1000 for > 65 yrs of age

By 2020, > 40 million worldwide

Gradually progressive movement disorders

Can lead to paralysis and death (PNA is #1 cause of death)

Parkinson’s Disease

Signs/Symptoms

Bradykinesia

Tremor

Rigidity

Shuffling gait

Impaired balance

Impaired function

Vocal, facial and oral impairments

Decreased activity level due to impairments

Parkinson’s Disease and Exercise

Balance training, resistance training, gait

training, and Tai Chi programs caused

improvement in:

Muscle strength

Balance and coordination

Quality of Life (QOL)

Activities of Daily Living (ADL)

(Hirsch et al., 2003, Baatile et al., 2000, Caglar et al., 2005, Venglar, 2005)

Literature: Yoga’s Effect on

Parkinson’s Disease

No research was found

that specifically

addresses the effect

of Yoga on the

symptomology of

Parkinson’s Disease

Purpose of the Study

Determine improvement in strength, ROM, balance,

gait, depression and anxiety after 8 weeks of

participation in a Yoga course

Methodology

Inclusion criteria:

Follow simple instructions

Tolerate 1 hr of gentle activity

Independent sitting balance

Exclusion criteria:

Medical history that would place them at risk

Approved by the Committee for the Protection of Human Subjects, CSU Sacramento

Participants

Recruited from the

Parkinson’s

Association of

Northern

California

10 subjects dx’d

with PD

Hoehn and Yahr

stage 3 or less

Study Design –

One-way Repeated Measures

Assessment

1

Assessment

3

Assessment

2

No change

in activity

Adaptive

Yoga

8 weeks 8 weeks

Yoga Class Description

1 hour class

1 time/week

RYT led class

Warm up (10 min)

Poses (40 min)

Cool down (10 min)

Adaptive Yoga

Ayurvedic Principles

Asanas to calm vata excesses (etiology of Parkinsonism)

Ananda Yoga

Affirmations, relaxation, meditation

Restorative Yoga

Use of props to help people easily achieve and relax into

poses

Appropriate for older adults and special population

embarking on a yoga program

Adaptive Devices

Chair, blocks, strap, blankets(Jones et al, 2005)

Yoga Asanas - Standing

Tadasana

Baddha Hastasana

Hasta Chakrasana

Vrksasana

Trikonasana

Virabadrasana

Ardha Chandrasana

Adho Mukha Svnasana

Prasarita Paddotanasana

Yoga Asanas Sitting

Upavasta Konasana

Paschimotanasana

Marichiyasana

Lying:

Supta Padangusthasana

Apasana

Jathara parivartasana

Setu Bandasana

Savasana

Outcome

Measures Overall Status of Disease

(UPDRS)

Anxiety and Depression(Hospital Based Anxiety and Depression Scale [HADS])

Walking (Modified Dynamic Gait Index [DGI])

Balance (Berg Balance Scale [BBS])

Falls Risk (Functional Reach)

Flexibility (Sit and Reach LB; Apley’s UE)

Functional Strength (30 Second Chair Stand)

Results

Descriptive Statistics Sex

3 Females

7 Males

Age

mean: 65.7 years

Range 43-77 years

Average # of Yoga sessions attended

7.2

Hoehn & Yahr

Stage 2, 2.5, or 3

Inferential Statistical Analysis*

Change over time:

One-way ANOVA with repeated measures

(Normally distributed data)

Follow up T-test with Bonferroni correction

Friedman’s two-way ANOVA by ranks

(Non-normally distributed data)

Follow-up Wilcoxin Signed-Ranks test

*using SPSS software v. 13.0

TEST Distrib ANOVA p

value

p value for

Δ 2-3

HADS Nl. 0.14 .06

Anxiety

subscale

Nl 0.51 .41

Depression Nl 0.03 .002

Functional

Strength 30-

second stand

Not nl. 0.03 .03

Flexibility Sitting Reach

Nl. 0.03 .02

BalanceBBS

Not nl. 0.13 .24

TEST Distrib ANOVA p

value

p value for

Δ 2-3

Single-limb

stance

Not nl. 0.39 0.77

Functional

Reach

Not nl. 0.60 1.00

DGI Nl. 0.06 0.15

UPDRS Not nl. 0.97 0.97

Apley’s Nl. 0.35 0.45

Discussion & Conclusion

Statistically significant changes in lower body

flexibility, functional strength and depression

outcomes measures indicate a positive effect

of adapted yoga for persons with Parkinson’s

Disease

No adverse effects

Yoga program was well received overall:

Continued participation by over half of subjects

Further study is justified

Outcome measures to be considered: Timed

Up & Go; Gait velocity test

Further refinement of postures to address

underlying etiology; combined with other

Ayurvedic treatments

Discussion & Conclusion

Questions?

This research was assisted in part by grants from:

The Parkinson’s Association of Northern California

The California State University, Sacramento LIFE Center

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Acknowledgements

Janice Freeman-Bell

Our Yoga instructor who gave her time, her enthusiasm, and her compassion to help develop and implement the Yoga program

The ten participants of the Yoga program

Diligently attended classes, gave us their input, and helped to create an experience that was full of humor, courage, and optimism