Yoga and Parkinson's Disease
My personal journey to yoga
Over the past 16 years since completing my movement disorders fellowship training, I have worn a number of hats. I have had three boys and have experienced all the joys and stressors of being a working mom. I have been a movement disorders neurologist at UCLA and more recently taken over as the Director of the South West PADRECC, which is the Parkinson disease (PD) center of excellence based at the West Los Angeles Veterans Administration Medical Center. After the birth of my second son, I had increasing issues with pain in my neck and spine. The new baby spent a lot of time in a baby carrier that I wore and before long I had shooting pains down my arm. I ended up seeking help and finally found my answer through yoga. With yoga I found that I was not only able to relieve my pain, but that I slept better, was more emotionally balanced and had more energy.
Bringing Yoga to My Practice
Since I practice in Los Angeles, I have met a number of people with Parkinson's disease (PwP) who had practiced yoga for years and wanted to know how to continue to do so after getting PD. I noticed that many of these yoga-performing PwP seemed to progress slower than their non-yogi counterparts, at least from an anecdotal perspective. We as PD docs had been recommending that patients exercise as a form of PD treatment for years, but I was intrigued at how PD and yoga interacted.
Richard Rosen
Photo credit: You and the Mat
Assembling the Yoga Dream Team
I ended up undergoing a yoga teacher training under the direction of Annie Carpenter who introduced me to Richard Rosen, a renowned yoga teacher in Berkeley, CA. He married all my passions together in one very cool person. He was a veteran, with PD for over 15 years, who was also a yoga teacher. He introduced me to pranayama ( yogic breathing techniques) which he said had helped his anxiety tremendously. Richard has been involved in teaching yoga to PwP in the Berkeley area for the last decade with classes that were wait-listed through the roof.
I also met Kaitlyn P. Roland, PhD, who is a brilliant neuroscientist with a research interest in PD, dementia and yoga. She has taught yoga to PwP in British Columbia. Richard, Kaitlyn and I are currently designing a program to teach yoga teachers about Parkinson's and how to work with PwP. We are designing a manual and videos and hope to do weekend-long teacher trainings to eager yoga teachers.
A brief intro to Yoga in PD written by Kaitlyn and me:
Yoga is an amazing therapy that can help with many aspects of Parkinson disease, both motor and non-motor. People are often fearful of getting started in a yoga class since there is false portrayal of yoga in the media as being only for flexible, skinny ballet dancers. Yoga, on the contrary, is a very adaptable practice, with both functional and psychosocial benefits, that can be suited to a wide variety of abilities.
Yoga has become synonymous with holding and moving between a series of static postures (called asanas); however, this physical practice (called hatha yoga) is only one part of the larger lifestyle of yoga framework that includes branches such as philosophy, chanting and selfless service. Hatha yoga combines physical postures to address strength, flexibility, balance and mind-body-breath connection. Breathing practices (pranayama) and meditation are included to develop greater self-awareness and can have tremendous benefit on the mental state.
What do we know about yoga in Parkinson disease?
The studies that do exist suggest modest benefits for:
Mobility. The issue of mobility has important implications for fall prevention in PD. Yoga participation can improve functional mobility and influences how a person with PD walks.
Balance. Balance training is an important component of PD therapy, as 40 percent of nursing home admissions are preceded by a fall. Research shows yoga-related improvements in balance (tandem, one-leg) and an associated decrease in a person’s fear of falling
Strength. Gains in lower-body strength occur for PD patients following yoga practice and are associated with improved postural stability.
Flexibility. Improvements in flexibility and range of motion (ROM) are important since rigidity is a common clinical manifestation in PD. Research shows improvements in flexibility/ROM of the shoulder, hip and spine. Stooped posture is common in PD and can be related to short spinal flexors and weak spinal extensors; improved shoulder and spinal flexibility from yoga supports a more upright posture.
Mood & Sleep. The calming effect of yoga (by enhancing parasympathetic output) may lessen perceived stress, enhance relaxation, and benefit sleep in PD. Many people with PD have apathy and fatigue which anecdotally are helped with yoga. Since the mind and the body are very connected in PD, any mental state benefits are tangibly translated into motor benefits. A yoga class can offer a support group, improved confidence, and self-efficacy. Caregivers can also participate and reap the rewards in the psychological realm as well.
Yoga can benefit people with Parkinson’s both physically and cognitively!
Yoga is both physically and cognitively engaging by focusing on body-awareness during complex body positions. Yoga postures improve physical strength, flexibility, and balance. Yoga postures are also considered skill-acquisition exercises and can benefit our brains thinking patterns and processes to make our movements more efficient and effective. Yoga helps to increase muscle mass that is useable in everyday life by focusing on functional movements.
Yoga is actually a form of cueing/attentional training.
The ability to move in PD is not lost; rather the brain mechanisms that initiate movement are defective. Attentional training/cueing may provide a non-automatic drive for movement, which may compensate for this faulty brain circuity and improve performance. Yoga breaks up complex sequences and/or postures into component parts, enabling a person to focus their attention on individual aspects of the posture and improve performance.
Use yoga as an opportunity to focus on posture
Stooped posture in PD is common. It is attributed to shortened contracted spine flexors and weak extensors of the spine. Asymmetry of stiffness can lead to misalignment and can lead to misuse and disuse of muscles that can further worsen posture.
What does yoga do?
Strengthens your core, especially your transverse abdominal muscles.
Lengthens your psoas muscle… a thick muscle that runs from under your armpits to your hips and connects your legs to your torso.
Encourages gentle backbends to open upper spine.
Creates self-awareness, and good habits, around how you hold your body in standing posture.
Yoga and the WPC
I had the great honor of presenting a talk on Yoga and PD in the Integrative Medicine Session at the WPC 2016 in Portland . It was an amazing experience and a really fun talk to give to the packed room full of supportive colleagues and patients thirsty for knowledge in the integrative medicine arena. Gearing up to the meeting, Richard and I taped some yoga videos for the Power through Project, which was launched by the Brian Grant Foundation in collaboration with the World Parkinson Coalition before the WPC 2016 to get people to virtually exercise their way to Portland. I had the pleasure to teach yoga to a group of PwP at a kick-off to the meeting. It was so amazing to teach yoga to Brian Grant himself! I feel blessed to have been able to combine my many passions for taking care of people with PD, veterans, yoga and integrative medicine together in my professional and personal life. I can’t wait to join my patients in the journey to Kyoto for the WPC 2019. Namaste and hope to see you all there!
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Indu Subramanian, MD presented at the Fourth World Parkinson Congress in Portland, Oregon. She is currently Associate Clinical Professor at UCLA. Dr. Subramanian is also Clinic Director at the Greater Los Angeles Veterans Administration Medical Center.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not reflect the opinions or positions of the World Parkinson Coalition®