Two New Studies on Yoga and Parkinsons Disease

by Nina

Richard Rosen, Age 67, by Melina Meza

Just a quick post today to let you know about two recent studies on yoga for Parkinson’s Disease. Parkinson’s disease (PD) is a progressive neurodegenerative disorder, prevalent in 1% of all individuals over the age of 60 years. It is characterized by tremor, rigidity, slowness of movement, and postural instability. In addition, people with PD have neuropsychiatric symptoms affecting mood, sleep, psychosis, and impulse control. Because the medication currently used to treat symptoms (there is no cure for it) loses effectiveness over time and also has serious side effects, these researchers realized there is a compelling need for alternative therapies to improve function and quality of life in persons with PD.

The first study Effect of Yoga on Motor Function in People with Parkinson’s Disease: A Randomized, Controlled Pilot Study was a small pilot study designed to determine whether yoga could help improve motor function in people with PD. Remember, a pilot study is small because the intention is to find proof of concept before investing in a larger study. So for this study, only thirteen adults with PD who were unfamiliar with yoga were studied. The yoga program used was an 60-minute Iyengar sequence specifically designed for people with PD to help improve strength, flexibility, body alignment, and overall well-being. The sequence included physical postures, breathing, and meditation, and the participants practiced it twice a week for 12 weeks. Participants were assessed prior to starting the program, at 6 weeks of pratice, and immediately following 12 weeks of practice. The assessment included motor examination scores from the Unified Parkinson’s Disease Rating Scale, posture, measures of extremity range of motion, flexibility and strength, and biomechanical measures of balance and gait that occurred at 3 time points. The researchers concluded: 

"Findings suggest that yoga practice improves motor function which may be partially explained by improvements in balance, strength, posture and gait. Due to the progressive nature of PD yoga programs may offer a way to maintain wellness and perhaps quality of life."

The second study Applications of yoga in Parkinson's disease: a systematic literature review focused on the impact of yoga both on physical function and psychological well-being in people with PD. This study was a systematic literature review, which means rather than doing original research, the researchers performed a literature search for randomized controlled trials, pretest–post-test design, and case studies. The outcomes of the studies included functional mobility, flexibility, balance, strength, depression, sleep, and quality of life. According to the researchers:

"The preliminary data suggested that yoga resulted in modest improvements in functional mobility, balance, and lower-limb strength in persons with PD. This has implications for gait, postural stability, balance confidence, and functional declines related to inactivity. An improved upper- and lower-body flexibility following yoga in persons with PD is applicable to rigidity, shuffling gait, and flexed posture. The presented evidence also showed positive outcomes for mood and sleep, demonstrating yoga's benefit for self-efficacy and social support."

They concluded that yoga provides an alternative method for addressing some of the reversible factors that impact motor function as well as contributing to improved psychosocial well-being.

Although more research is necessary for full proof, these two studies are very promising. And we already know from anecdotal evidence that yoga is very beneficial for people with PD (see Yoga for Parkinson's Disease, Part 1 and Interview with Vickie Russell Bell). So if you are already practicing, by all means keep it up. And if you have not yet started to take yoga for PD, perhaps these studies will encourage you to find a suitable class or teacher in your community.

And thanks to all you teachers out there who are specializing in teaching for this group. You're doing such important work!

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Interview with Vickie Russell Bell, Continued: Teaching Yoga to Students with Parkinson's Disease (Rerun)

by Baxter

Baxter: Can you talk a bit about what sort of experience or training would be optimal for a teacher out there thinking about doing this sort of class for folks with Parkinson’s?

Vickie: Teachers interested in working with PWPD need to have a strong background in teaching asana and adapting classic poses. Assisting a teacher who works with disabilities or special populations (or even someone who is adept at working with seniors) would be very useful. If a teacher is interested in eventually working with a group, starting solo with a PD student who is mobile and only slightly limited might help her begin to understand this population.

There are often local PD organizations that offer classes or info sessions for those interested in furthering their knowledge. I am currently training a number of yoga teachers who want to take this work into the community and I hope to expand this educational opportunity further.

Baxter: And final advice to either students with Parkinson’s, or teachers interested in working with this population?

Vickie: The thing that drives my success in working with this population is this motto: Teach to their possibility, not their disability! Be willing to be light, to play ant, to constantly continue to learn. 

Vickie Russell Bell was born and raised in Ohio, and is a journalist by education. She teaches yoga because she loves to. Her intention is to help her students increase their level of daily awareness through their body, breath and experience. She is a graduate of the Piedmont Yoga Studio Advanced Training Program and is a certified “Relax and Renew Trainer” through Judith Lasater’s accredited program. See her website for more information about Vickie. See Parkinson's Disease Classes for her PD classes schedule.

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Interview with Vickie Russell Bell: Yoga for Parkinson's Disease (Rerun)

by Baxter

In October, we were fortunate to have long-time yoga teacher and yoga writer Richard Rosen contribute a post about his personal journey with Parkinson’s Disease and the recommendations he has for working with the condition (see Yoga and Parkinson's Disease, Part 1). This month, I am pleased to share with you an interview with another yoga teacher, Vickie Russell Bell, who has been involved in serving the Parkinson’s community for several years now. You can learn more about her teaching here. 

Baxter: Vickie, I know that you have been offering a Parkinson’s Yoga Class at Piedmont Yoga Studio in Oakland for some time now. How did that come about, and what’s the class like?

Vickie: I’ve been teaching a yoga class for people with Parkinson’s Disease (PWPD) for a little more than three years now. I started off assisting Richard Rosen, teaching about 8-10 students, and then took over leading the classes. I now offer two classes weekly through a local organization called PD Active! In a given week there are usually 12-18 participants per class. These students have varying physical abilities. I have two assistants helping in each class.

As Richard Rosen stated in a previous post about PD (see Yoga and Parkinson's Disease, Part 1): it is a progressive degenerative disorder of the central nervous system. Common physical symptoms are loss of muscular flexibility (PWPD become very stiff), loss of balance, loss of strength and often a noticeable resting tremor. Sometimes people who have been diagnosed with Parkinson’s are in denial, resentment or rejection of their condition. PD affects the body, mind and spirit and needs to be looked at holistically. Asana practice done regularly can help students to cultivate and refine their body awareness so as to work productively with some of these symptoms.

My students with Parkinson’s definitely need extra attention during classes. I attempt to adapt what I’m teaching in my public classes that week for the classes (for example, Downward Dog with hands on a chair seat, Warrior I with the front knee supported by a block and the wall, Bakasana (Crane pose) lying on the back). Often in class there is an extra emphasis on keeping the feet stretched, open and supple to increase awareness of the base, on balance, on opening the upper back/chest/lungs, and on restorative poses (PWPD are often taking various medications that can make them fatigued or affect sleep adversely).

Baxter: Can you share with our readers any observations of the benefits your students have discovered by regular attendance in your class?

Vickie: I can do even better! Here is some testimonial directly from one of mty PD Active yoga students:

“The yoga exercise class has helped me immensely and I feel it is due mostly to stretching of the muscles. Parkinson’s causes atrophy in our muscles and the yoga exercises are a direct hit against that atrophy. I walk straighter and breathe properly when I walk now. Learning to breathe properly in the yoga class has helped my freezing of feet problem as well. When my feet freeze now I stop, breathe, relax and off I go again. Before, I would go into panic mode, struggle and usually fall. I have had fewer falls since I started the yoga class. I used to fall about three times a week and now it is about twice a month and that’s usually due to my own inability to breathe properly and stay relaxed. Yoga has added to the quality of my life.”

Baxter: In Richard’s post, he mentioned the benefits of supported backbend over a bolster. Where do you see that pose fitting in, and what are two or three other essential poses you find helpful for your classes?

Vickie: I often incorporate the backbend over a bolster that Richard described in my classes. My students also love supported twists over a bolster as well as a Viparita Karani variation. Legs up the Wall is difficult for many Parkinson’s students due to tight hips and hamstrings, and rounded upper backs. So this is how I teach the Viparita Karani variation:

Fold two long, single fold blankets (Shoulderstand size in half long ways) and place them on the floor in front of a chair seat. Have the student sit with their tailbone right on the front edge of the blankets and lie back so that the blankets are perpendicular to the spine and support the lumbar curve and back of the pelvis. Some PD students may need help lying back safely, or may need help adjusting the blankets. The student then hooks the back of their knees on the front edge of the chair seat, resting the calves on the seat. If your student has a rounded upper back they might benefit from a lift under their head so that the chin and forehead are on the same level. Here's a photograph from one of my classes of a student in the pose:

Viparita Karani variation (also called Easy Inverted pose)

This pose allows the low back (lumbar spine) to have a neutral curve or for some a slight backbend and allows the shoulders and chest to gently open. This can be a delicious pose for someone who spends most of their day with the head and shoulders hunched forward! I also teach PWPD adaptations of many standing poses and other beneficial active poses.

Tune in tomorrow for the second half of Baxter's interview with Vickie Russell Bell, in which she will talk about how to teach students with Parkinson's Disease.

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In Praise of Chair Yoga

by Nina

Recently we’ve been featuring some yoga poses you can do while seated on a chair, such as a chair twist, backbend and forward bend. We’ve been offering up these poses as “office” or “travel” yoga, for those times when you don’t have the space or option of practicing on the floor. But it’s also true there are many people out there who cannot practice yoga standing up. They may have a chronic disease, such as Parkinson’s or Multiple Sclerosis, may have balance problems, or may be too weak to get up from the floor for any number of reasons. They may even be in a wheelchair.

To be honest, it’s only lately that I’ve come to realize what a godsend chair yoga can be for such people. As I’ve been learning more and more about the aging process, I’ve started to understand how important it is to keep moving your joints through their range of motion. If you don’t, you will continue to lose mobility, and very quickly (I watched my own father go through this when he stopped exercising). But if you do continue with your yoga, even while seated on a chair, you can help slow down your losses (and, maybe, depending on your condition, maintain or even regain some mobility). That was driven home to me this weekend when I took Shari Ser and Bonnie Maeda’s therapeutic workshop “Yoga for Neurological Disorders.” One of the students in the class shared her story with us. She is a middle-aged woman with an inherited form of Muscular Dystrophy who had been a yoga practitioner before she came down with the disease. As a participant in a study of people with the disease, she was told that keeping up with her practice during her illness was clearly helping her slow down the progression of her disease. She seemed both very committed to and very grateful for her practice. She was also an inspiration to others in the class, whether they were currently dealing with a neurological disorder themselves or were just, like me, interested in learning to help those who are.

Cat Pose in a Chair

And although I’ve read many books that talk about the benefits of chair yoga for people with chronic illnesses and even helped produce the photo shoot for one such book (Yoga As Medicine by Timothy McCall), Saturday was the first time I did a full practice of chair yoga myself. I have to say, I was eating a little humble pie during the practice, as some of the poses were more strenuous than I was expecting. One particular pose was a revelation to me. We did a version of Downward-Facing Dog where you sit on a chair facing a wall, far enough away from the wall so you can touch your fingertips to the wall when you bend forward. Start by sitting upright with your feet flat on the floor, hips-width apart. Then bending forward from your hip joints, bring your fingertips to the wall and walk them slowly up the wall, until they are in Downward-Facing Dog alignment, keeping your ears aligned with your arms. What a great shoulder opener and upper body stretch! I thought it would be wonderful for anyone who can’t bear weight on their hands due to hand or wrist problems, and I found it much more effective stretch—at least for me—than Half Downward-Facing Dog at the wall. My partner in the class and I decided to dub it “Quarter Dog,” and I hope to take a photograph of it one of these days.

If you are interested in learning more about chair yoga, Loren Fishman and Eric Small’s book Yoga and Multiple Sclerosis: A Journey to Health and Healing has some excellent examples (some even done in a wheelchair). And, uh, yeah, Yoga as Medicine also has a number of good ones. If you know of any other resources for these, do let me know!

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Interview with Vickie Russell Bell, Continued: Teaching Yoga to Students with Parkinson's

Baxter: Can you talk a bit about what sort of experience or training would be optimal for a teacher out there thinking about doing this sort of class for folks with Parkinson’s?

Vickie: Teachers interested in working with PWPD need to have a strong background in teaching asana and adapting classic poses. Assisting a teacher who works with disabilities or special populations (or even someone who is adept at working with seniors) would be very useful. If a teacher is interested in eventually working with a group, starting solo with a PD student who is mobile and only slightly limited might help her begin to understand this population.

There are often local PD organizations that offer classes or info sessions for those interested in furthering their knowledge. I am currently training a number of yoga teachers who want to take this work into the community and I hope to expand this educational opportunity further.

Baxter: And final advice to either students with Parkinson’s, or teachers interested in working with this population?

Vickie: The thing that drives my success in working with this population is this motto: Teach to their possibility, not their disability! Be willing to be light, to play ant, to constantly continue to learn. 

Vickie Russell Bell was born and raised in Ohio, and is a journalist by education. She teaches yoga because she loves to. Her intention is to help her students increase their level of daily awareness through their body, breath and experience. She is a graduate of the Piedmont Yoga Studio Advanced Training Program and is a certified “Relax and Renew Trainer” through Judith Lasater’s accredited program. See here for more information.

Read More

Interview with Vickie Russell Bell: Yoga for Parkinson's Disease

In October, we were fortunate to have long-time yoga teacher and yoga writer Richard Rosen contribute a post about his personal journey with Parkinson’s Disease and the recommendations he has for working with the condition. This month, I am pleased to share with you an interview with another yoga teacher, Vickie Russell Bell, who has been involved in serving the Parkinson’s community for several years now. You can learn more about her teaching here. 

Baxter: Vickie, I know that you have been offering a Parkinson’s Yoga Class at Piedmont Yoga Studio in Oakland for some time now. How did that come about, and what’s the class like?

Vickie: I’ve been teaching a yoga class for people with Parkinson’s Disease (PWPD) for a little more than three years now. I started off assisting Richard Rosen, teaching about 8-10 students, and then took over leading the classes. I now offer two classes weekly at Piedmont Yoga Studio through a local organization called PD Active! In a given week there are usually 12-18 participants per class. These students have varying physical abilities. I have two assistants helping in each class.

As Richard Rosen stated in a previous post about PD (see here): it is a progressive degenerative disorder of the central nervous system. Common physical symptoms are loss of muscular flexibility (PWPD become very stiff), loss of balance, loss of strength and often a noticeable resting tremor. Sometimes people who have been diagnosed with Parkinson’s are in denial, resentment or rejection of their condition. PD affects the body, mind and spirit and needs to be looked at holistically. Asana practice done regularly can help students to cultivate and refine their body awareness so as to work productively with some of these symptoms.

My students with Parkinson’s definitely need extra attention during classes. I attempt to adapt what I’m teaching in my public classes that week for the classes (for example, Downward Dog with hands on a chair seat, Warrior I with the front knee supported by a block and the wall, Bakasana (Crane pose) lying on the back). Often in class there is an extra emphasis on keeping the feet stretched, open and supple to increase awareness of the base, on balance, on opening the upper back/chest/lungs, and on restorative poses (PWPD are often taking various medications that can make them fatigued or affect sleep adversely).

Baxter: Can you share with our readers any observations of the benefits your students have discovered by regular attendance in your class?

Vickie: I can do even better! Here is some testimonial directly from one of mty PD Active yoga students:

“The yoga exercise class has helped me immensely and I feel it is due mostly to stretching of the muscles. Parkinson’s causes atrophy in our muscles and the yoga exercises are a direct hit against that atrophy. I walk straighter and breathe properly when I walk now. Learning to breathe properly in the yoga class has helped my freezing of feet problem as well. When my feet freeze now I stop, breathe, relax and off I go again. Before, I would go into panic mode, struggle and usually fall. I have had fewer falls since I started the yoga class. I used to fall about three times a week and now it is about twice a month and that’s usually due to my own inability to breathe properly and stay relaxed. Yoga has added to the quality of my life.”

Baxter: In Richard’s post, he mentioned the benefits of supported backbend over a bolster. Where do you see that pose fitting in, and what are two or three other essential poses you find helpful for your classes?

Vickie: I often incorporate the backbend over a bolster that Richard described in my classes. My students also love supported twists over a bolster as well as a Viparita Karani variation. Legs up the Wall is difficult for many Parkinson’s students due to tight hips and hamstrings, and rounded upper backs. So this is how I teach the Viparita Karani variation:

Fold two long, single fold blankets (Shoulderstand size in half long ways) and place them on the floor in front of a chair seat. Have the student sit with their tailbone right on the front edge of the blankets and lie back so that the blankets are perpendicular to the spine and support the lumbar curve and back of the pelvis. Some PD students may need help lying back safely, or may need help adjusting the blankets. The student then hooks the back of their knees on the front edge of the chair seat, resting the calves on the seat. If your student has a rounded upper back they might benefit from a lift under their head so that the chin and forehead are on the same level. Here's a photograph from one of my classes of a student in the pose:

Viparita Karani variation (also called Easy Inverted pose)

This pose allows the low back (lumbar spine) to have a neutral curve or for some a slight backbend and allows the shoulders and chest to gently open. This can be a delicious pose for someone who spends most of their day with the head and shoulders hunched forward! I also teach PWPD adaptations of many standing poses and other beneficial active poses.

Tune in tomorrow for the second half of Baxter's interview with Vickie Russell Bell, in which she will talk about how to teach students with Parkinson's Disease.

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Friday Q&A: Classes for People with Parkinson's Disease

Q: Richard Rosen’s post on yoga and Parkinson’s Disease this week was very informative. Do you know of any ongoing yoga classes especially for people with Parkinson’s Disease?

A: For those of you in the San Francisco Bay Area, Piedmont Yoga Studio in Oakland, CA, has two weekly classes for anyone with PD or for caregivers, taught by Vickie Russell Bell.

Classes are held on Tuesdays 3:00 pm - 4:15 pm and Thursdays 1:30 pm - 2:45. Advance registration is required. Both the Tuesday and the Thursday classes are now full, but a waiting list has been started. For more information or to sign up for the waiting list, call (510) 658-8899 or send email to yoga@pdactive.org.

Also, the PD Active blog has information about classes and support groups for people with PD. (PD Active is a group of Berkeley/Oakland-based people impacted by Parkinson’s disease who act to build and strengthen their local community through advocacy, dance classes and other activities.)

Readers: If you have information about PD yoga classes or resources that you’d like to share, please let us know, either in a comment or through email.

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Yoga and Parkinson's Disease, Part 1

by Richard Rosen, guest contributor

A Road Through the Woods by Brad Gibson

When we received a question last week about yoga and Parkinson’s Disease, we turned to our friend Richard Rosen. Richard Rosen is a senior yoga teacher, who has been practicing yoga for 31 years and who was diagnosed with Parkinson’s Disease about 9 years ago. Richard had so many interesting things to say in the response to the question that we decided to make it a separate post. —Nina
Q: Interested in suggestions for yoga for students with Parkinson's.

A: Parkinson’s Disease (I prefer Condition) is a progressive degenerative disorder of the central nervous system. Common symptoms include loss of muscular flexibility, balance, and strength. You may notice that these are the very physical qualities promoted by the physical practice of yoga postures and related exercises. To a certain undetermined extent then, yoga exercises help to not exactly counteract PD symptoms, but go a long way toward at least a temporary amelioration. These exercises (depending on the frequency and intensity of practice) also help cultivate and refine greater body awareness, which in turn (again to an undetermined extent) allows the individual to self-correct certain of the symptoms. I’m hedging everything I say here because, as in all of life, there are no guarantees. Some conditions progress very rapidly, others only gradually. But in any case the sooner a credible practice is established the better it will serve the individual. I can’t stress this enough: once the diagnosis of PD is confirmed, if you’re not already practicing some form of yoga exercise, get started immediately with a competent teacher.

This is a very difficult question to answer in 25 words or fewer as it’s stated here. I would ask first about the students’ condition: are they pretty much at the same level of development, or are some farther along? If the former, are they all still fairly mobile, is their balance still decent, their strength and flexibility? If the latter, how serious is the situation? Do some need canes or walkers? Is the shaking debilitating at times? Different strokes for different folks is the operative approach.

And then I’d need to know something about the teacher, if there is one. Training? Experience? Are there props like chairs and bolsters? What size is the class, if there is one? Are there assistants if there are more than, say, 6 to 8 students? Don’t mean to be evasive here but a PD class is definitely not like an average public class, these are students that need extra attention.

Or are you asking in general about individual students you might be working with in a private setting? Again it’s important to tailor the work to the student’s level of development. Without more detailed information I can only give general suggestions. 

Certainly one of the most useful exercises would be a passive backbend over a bolster or rolled blanket (see here for a photo). We PD people tend to slump after awhile and the backbend helps encourage a long (not "straight") front spine. The thickness of the support would depend on the student, both his/her level of development and previous experience with yoga-influenced exercises (I assume when you say “yoga” you’re talking about asana-like postures; please remember “yoga” is an umbrella term for a wide variety of schools and practices, and shouldn’t be equated solely with asana). Obviously the stiffer the student, the smaller the roll’s diameter should be, and stiffer students will likely need a blanket support under the back of their head to prevent jamming the neck, and should also keep knees bent and feet on the floor to avoid back strain. The roll should be positioned under the lower tips of the shoulder blades so that the arms can lay comfortably off to the sides, not higher than parallel to the line of the shoulders. Initially the student might stay for a couple of minutes, then slowly over time, depending on the student and the seriousness of his/her practice, increase the stay to 5-6 minutes. I should emphasize here that if the student isn’t ready or willing to practice regularly—every day would be ideal—then the exercises will have minimal impact if only practiced once weekly or less.

While in the pose it’s essential that some attention be paid to the breath. Have the student pretend he/she can channel the inhalations slowly and directly into the space behind the sternum (yes, I know that’s where the heart is, I said “pretend”), so that each intake creates more and more space in the upper chest. On the exhalations have the student imagine sinking down over the blanket, so that with each successive exhale, he/she seems to be releasing more and more over the roll.

I’m not, at this point, particularly comfortable going any farther until I learn something more about the teacher-student relationship, the former’s chops and the latter’s needs. Please write to this blog again with more information about yourself and the students, and of what you intend to do with this instruction. 

Richard Rosen is currently the director of Piedmont Yoga Studio in Oakland, CA. He is a contributing editor for Yoga Journal magazine, and is the author of three books, The Yoga of Breath (Shambhala 2002), Yoga for 50+ (Ulysses 2004), and Pranayama Beyond the Basics (Shambhala 2006). He’s also created a set of seven CDs titled The Practice of Pranayama, issued by Shambhala, and Shambhala will publish his Original Yoga, a book about traditional Hatha Yoga, in 2011. (To find out more about Richard and Piedmont Yoga Studio, see here.)

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