Yoga Therapy and Parkinson's Disease

Elasticity, Umberto Boccioni, 1912, Oil on Canvas, Milan, Italy 

by Ram Rao

Parkinson's disease (PD) is an age-associated, progressive neurological disorder that affects movement. It all starts with resting tremors progressing to a noticeable tremor to full blown tremors, joint stiffness, and slowing of movement.

As the condition progresses, the individual’s face may show little or no expression, the arms remain stiff while walking, and speech is often soft or slurred. Tremors, slowed movement, muscle rigidity, impaired posture and balance, speech changes, and loss of automatic movements aggravate as the individual ages. Although PD does not have a cure, medications might significantly improve or delay the symptoms.

Most of the symptoms are due to a loss of neurons that produce a neurochemical called dopamine. As the dopamine level decreases, it causes abnormal brain activity, leading to symptoms of PD. While the exact cause is unknown, risk factors for PD include: Age (PD begins in middle or late life, and the risk increases with age, young adults rarely experience PD), Heredity (having a close relative with PD increases the chances that you'll develop the disease), Gender (Men are more likely to develop PD compared to women), and environmental toxins (herbicides and pesticides increase the risk of PD). Since the cause of PD is unknown, doctors are unable to suggest suitable interventions to prevent the disease. However, research studies have shown that regular aerobic exercise might reduce the risk of Parkinson's disease.

There are also a few research studies that suggest that yoga may help counteract PD symptoms, thereby providing moderate improvement. Yoga together with meditation helps to cultivate greater body awareness, thereby allowing an individual to resort to suitable interventions when the symptoms aggravate. If a yoga student has PD, a competent yoga teacher needs to understand about the student’s condition, the duration, and the extent of the disease. A yoga teacher needs to consider four factors in order to suggest specific yoga poses to a student with PD including a) mobility, b) balance, c) strength and, d) flexibility. Based on the above factors, the teacher can also decide whether the student needs suitable support props like belt, chairs, and bolsters. In fact, I would recommend that students with PD not attend a regular public class, but seek out a therapeutic class as they definitely need extra attention.

Poses need to focus on improving the sit-to-stand ability, functional mobility, and lower-limb strength. Standing yoga poses including chair pose, warrior poses, and tree pose serve as mobility focused exercises because they simultaneously target three functionally important muscle groups: the hip extensor (e.g., hamstrings, gluteus maximus), the knee extensor (e.g., quadriceps), and the ankle plantar flexor (i.e., the muscles used when “curling” the toes). Balance training is an important component of therapeutic yoga as persons with PD fall more frequently than other older adults. Improvement in balance through suitable yoga poses also contributes to a reduced fear of falling. This is important as persons who have the fear of falling tend to keep away from physical activity, leading to further decreases in strength, flexibility, and balance putting them at a greater risk for additional falls.

Improved strength is important, as muscle weakness progresses in PD. Holding static postures for a longer time and controlled systematic movement from one pose to the next increases muscular strength. Similarly, incorporating several poses and holding each pose for a certain time improves muscle endurance. Flexibility is important since muscle rigidity is a common PD symptom. An improvement in upper-body flexibility (i.e., shoulder, spine) helps support a more upright posture and, thereby, overcome the stooped posture that often presents in people with PD.  Yoga poses that focus on hips, quads, and hamstrings are essential for regular stride length to improve balance and overcome the shuffling gait that may occur in people with PD. 

People with PD often suffer from anxiety and depression. Hence, each yoga session needs to end with 10-15 minutes of meditation and pranayama practice that helps to reduce fear and anxiety. Attention to the inhalation, retention of breath, and exhalation is very important. It usually gets easier over time for the student to stay focused. Yoga teachers need to keep the sessions fun and mobile and, at the same time, be careful to avoid injury in these sessions. There are several stages of PD and symptoms vary among students so it is important for teachers to speak confidently and clearly, and to maintain a positive attitude as this can keep students at ease. A teacher’s ability to change the postures or offer thoughtful modifications is an important part of yoga therapy for people with PD. 

Rammohan Rao (Ram) comes from a family of Ayurvedic practitioners and Vedic teachers in India tracing back to the illustrious Vedic-acharya Rishi Kaundinya (although Ram admits he cannot do the Eka pada or Dwi pada Kaundinyasana). With a doctorate in Neuroscience, Ram was a Research Associate Professor at the Buck Institute for Research on Aging. He focused on various aspects of age-associated neurodegenerative diseases with emphasis on Alzheimer’s disease. In addition, Ram completed the academic training at the California College of Ayurveda (CCA) and received his certification as Clinical Ayurvedic Specialist. He has been a faculty member of the California College of Ayurveda and teaches in their Nevada City location. Ram is also a dedicated Hatha yoga practitioner and is a Registered Yoga Teacher from Yoga Alliance USA. In his spare time he offers consultations in YAMP techniques (Yoga, Ayurveda, Meditation & Pranayama). Ram has published several articles in major Yoga/Ayurveda magazines and has been a featured speaker in several national and international meetings and symposia. He is a member of the National Ayurvedic Medical Association (NAMA) and is on the Research Board of the Association of Ayurvedic Professionals of North America (AAPNA).

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

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