Effect of an Eight-Week Adaptive Yoga Program on Mobility ...
Transcript of Effect of an Eight-Week Adaptive Yoga Program on Mobility ...
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