PD and Yoga: Unifying Body and Mind

Bruce RollinsPosting for Dr. Hackney this month is Bruce Rollins, a third year Physical Therapy student at Emory University. He is certified as a Community Exercise Trainer for People with Parkinson’s Disease (American Council on Exercise). He has a strong interest in incorporating “non-traditional” methods of therapy into his future PT practice, including Yoga, Pilates, and Tai Chi. After graduating from Emory’s DPT program next month, Bruce will be moving to Dallas, Texas to begin his career as a Physical Therapist.

The Numbers

According to the Parkinson’s Disease (PD) Foundation[1], as many as 1 million individuals in the US are currently diagnosed with PD, while it is estimated that 10Madeleine E. Hackney, PhD The Exercise Files blog million people worldwide are currently living with PD. Not only are the physical and psychological burdens amongst those with the disease significant, but the economic burden is daunting. It is estimated that the cost of PD to the US healthcare system is $25 billion annually![1] There has to be an effective way of combating this disease.

Yoga and PD? Are you crazy?!

When most Americans hear the word Yoga, they immediately conjure up images of ultra-flexible people in spandex stretching, sweating, and chanting. In fact, the word yoga actually means “to yoke, to unify, or to integrate.” Without getting too esoteric, this implies a quest for connecting the body, mind, and spirit into a whole. Yoga is more about looking inside ourselves to gain a richer understanding of our emotions and thoughts, and less about gathering together in a hot room to stretch to our heart’s desire.

Yoga is said to have originated around the fifth or sixth centuries BCE, but is most likely thousands of years old. [2] Most Americans are aware of Hatha Yoga, but this is actually just one of various types of yoga. It is said that assisting an elderly person across the road is yoga, and contemplating the effect of war on the world is yoga. Yoga is much more profound than many give it credit for, and is certainly much more than the physical aspect that most are familiar with.

So, it is important to remember and understand that Yoga can be practiced by anyone, whether it’s someone who suffered a spinal cord injury and is paralyzed from the neck down, or the stiff middle-aged guy you see lifting heavy weights at the gym.

This is an exciting time in that numerous clinical research studies are being completed investigating the effect of Yoga on PD symptoms. They are finding that Yoga can be beneficial in addressing the physical and psychosocial symptoms of the disease. [4-7]

Hatha Yoga

Although the quest for spiritual enlightenment is very real and important, it’s Hatha Yoga and its ability to alleviate some of the debilitating symptoms apparent to PD that is the topic of this entry.

The word Hatha means forceful or willful. [3] The asanas (postures) are physical movements designed to align the skin, muscles, and bones, as well as assist the internal organs in functioning more efficiently. Many of the asanas are designed to be restorative and opening, meaning they are designed to encourage the flow of blood to vital tissues in the body as well as assist in recovering from an injury or illness. This is much of the reason Yoga has gained popularity amongst those suffering from anxiety and depression, as it has a natural ability to ease physical and psychological stress, which are of primary concern to individuals with PD. [4,5]

The beauty of exercise, is that it can be modified to fit the individual. Yoga is no different. The movements (Asanas) can range from very relaxing and rejuvenating to extremely physically challenging. Obviously, depending on the severity/stage of disease process, modifications will likely need to be made.

How long should I do Yoga?

There is a principle in Yoga philosophy called ahimsa, which means “non-harming.” A true practitioner of Yoga is in perfect alignment with their body. They are able to listen to their bodies when movements are uncomfortable. Putting together the nature of Yoga as a practice encouraging unity of body and mind as well as of “non-harming,” the recommendation is that one practices Yoga at their own pace and on their own schedule. It should not be a source of stress to “squeeze in” a session at the expense of another important activity. Over time, through consistent practice you will most likely find that you are naturally drawn to practice Yoga more often. The key is to listen to yourself and never force anything that feels uncomfortable.

Sample Modified Sequence

Sequence: Warm-up (gentle movements/poses, breathing, vocal sounds)  standing poses →  seated poses →  lying poses →  meditation/relaxation

1. Tadasana (can use chair for balance if necessary)

a. Begin in basic standing position, with arms at sides and palms facing forward

b. Ujayyi breathing for relaxation (like you’re trying to fog up a mirror, but with your lips sealed), emphasis on filling the lungs fully with air and forceful, but controlled exhale

c. Slowly raise both arms up and toward ceiling, 5 times, synchronizing with inhale/exhale

d. On last arm raise, lift arms and hold for 3 breaths

e. Alternate heel lifting and attempt to rise off of both heels at the same time

f. Half-squat position, arching the back in opposite directions (cat/cow)

2. Chair pose (modified standing against wall if needed, or with chair underneath, but not touching)yoga blog1

a. Lift both arms up and overhead x 5

b. Trunk twist to left and right x 3 while in chair posture

3. Modified Vrksasana

yoga blog2a. balance on one leg, with opposite heel on ankle of stance limb (15 secs ea side)

b. hold onto chair if needed

4. Virabhadrasana 2 (Warrior 2)

a. One leg forward with chair underneath for support ifyoga blog3 needed

b. can stand against wall for added postural stability if needed

c. moving arms up and down into/out of position while counting aloud each time (10x)

5. Seated Spinal Stretch

a. Sitting in chair, turn to R side and bring R UE to chair and L UE across body to R knee, sitting up tall with a straight back and continuing to breathe deeply

6. Seated Hamstring Stretch

a. Keeping back straight, bring forehead down and forward toward toes

b. Can reach toward toes with arms if you would like

7. Bridge w/ block for support under sacrum (height adjusted according to preference)

yoga blog4a. Hold position for 2 minutes, focus on contracting glutes and hamstrings for isometric strengthening

8. Double knee to chest and rocking forward/backward

9. Savasana (Corpse Pose)

a. Meditate in supine position with eyes closed

b. 3-part breathing to encourage coordination and core activation (belly to lower chest to upper chest in sequence)

c. Bring intention of stability into the practice

i. Imagine all joints and regions of the body being inter-connected and imagine yourself as an object of great stability, such as a tree.

ii. Imagine yourself entering a large area of varying obstacles and being able to jump over and around those obstacles with ease and without the fear of falling

iii. Feel the ground underneath you and how stable you are at this moment, take this moment with you as you go about your day into the world

iv. When you are ready, open your eyes and come to sitting. Take your time in coming to standing, asking for assistance if necessary or using a stable object such as a chair to assist you in standing.

 10. Namaste

References: CLICK HERE to view complete references to published research cited above.

Dr. Madeleine E. Hackney, Ph.D, is a Research Health Scientist at the Atlanta VA Center for Visual and Neurocognitive Rehabilitation and an Assistant professor of Medicine in the division of General Medicine and Geriatrics at the Emory School of Medicine. She holds a Ph.D. in Movement Science from Washington University and a BFA in Dance from NYU, Tisch School of the Arts and has also been an American Council on Exercise certified personal trainer since 2000. Dr. Hackney’s extensive research interests include inquiry into challenging exercise programs–traditional exercise, Tai Chi and partnered tango classes–designed to improve physical function and quality of life in people with PD, older adults and those with serious mental illness. In 2014, she co-founded MDT Education Solutions, which has trained dozens of fitness and allied health professionals how to develop and lead safe, evidence-based exercise programs for people with PD at all stages of the disease, including almost all instructors in the PD Gladiators Metro Atlanta Fitness Network (including the YMCA of Metro Atlanta).

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