From Postures to Pressure Points: Beneficial Therapeutic Strategies for Parkinson’s Disease
Read Time: 7 Minutes
Parkinson’s disease (PD) is a progressive neurological condition with a global prevalence that has risen substantially in the past few decades,1 with more than 10 million people reportedly living with the disease worldwide.2 PD is the second-most common neurodegenerative disease in the US. Approximately 90,000 people are diagnosed each year, and while incidence of PD increases with age, an estimated 4% of those with PD were diagnosed before the age of 50.2,3 An exact cause of PD is not known; however, interactions among many genetic and environmental factors such as exposure to pesticides and other toxicants influence PD risk and lead to a range of physiological issues such as mitochondrial dysfunction, impaired autophagy and mitophagy, protein aggregation, oxidative stress, gut dysbiosis, and neuroinflammation.4-7 Ultimately, this complex disease is associated with dopamine deficiency and both motor and nonmotor deficits.
Symptoms of PD may develop slowly over time and progress differently for each patient. Abating motor and nonmotor symptomology and improving quality of life are key treatment goals. Primary medications such as levodopa help to replace low levels or missing dopamine in the brain, yet long-term use of antiparkinsonian medications can present additional motor complications.8 Research studies continue to explore lifestyle-based and complementary treatments that support patients with PD and reduce the progression of their disease symptoms. What adjunctive therapies have shown benefit and may be appropriate for a patient’s personalized treatment strategy?
Exercise Routines & Mind-Body Therapies
Establishing therapeutic exercise routines, from aerobic and strength training to balance and flexibility conditioning, is an essential component of a PD treatment plan and helps maintain mobility and everyday activities and manage overall disease progression. Various exercises have been evaluated for their PD treatment efficacy. For example, clinical trials have suggested that among adults with PD, power training benefits motor symptoms and muscle strength, treadmill training improves balance and gait velocity, resistance training enhances sleep quality and cognition, and several exercise modalities, including dance, improve depression.9,10 Complementary treatments such as music and art therapy11-14 have been evaluated for their PD benefit. Mind-body therapies such as tai chi, qi gong, Pilates, and yoga have also been studied heavily for their significant benefits in PD treatment.15-17
A 2023 scoping review synthesized the evidence from 19 relevant systematic reviews to evaluate the effects of qi gong, tai chi, and yoga in people with neurological diseases, including stroke and PD.16 Researchers found that in people with PD, all three approaches helped to improve balance while tai chi increased functional mobility.16 A 2022 network meta-analysis of 60 randomized controlled trials (RCTs) (n=2,037 total participants) compared the efficacy of yoga, tai chi, Pilates, qi gong, and dance in PD treatment.17 Results indicated that among patients with PD:17
- Pilates was most effective in improving functional mobility and balance performance.
- Yoga and dance were most effective in improving motor function.
- Qigong was most effective at improving gait speed.
- Dance was most effective for health-related quality of life improvement.
Specific to tai chi, a 2022 comprehensive systematic review (n=16 systematic reviews and meta-analyses) evaluated its benefits in PD treatments.18 Investigators reported significant beneficial effects of tai chi on balance (SMD = -0.777), functional mobility (SMD = -0.719), and falls (SMD = -0.456) when compared to no intervention group.18 For balance and fall occurrence in patients with PD, tai chi was also found to be superior to resistance training, stretching, and walking.18
the practice of yoga – Breathwork, meditation, and postural training
Research studies continue to highlight the benefits of yoga practice for people with PD, including improvement of motor and non-motor symptoms, reduced anxiety and depression, and increased well-being and health-related quality of life.19-21 A 2021 meta-analysis of 10 RCTs (n=359 total patients with mild to moderate PD aged 60 to 80 years) studied how yoga practices impact PD treatments.22 The yoga treatments were implemented from eight to 12 weeks and were conducted once or twice a week (~70% were two times/week). Individual sessions lasted from 30 to 90 minutes (~70% had a 60-minute duration), and the yoga practices combined different elements such as:22
- Deep breathing
- Relaxation techniques
- Postural training
Comparative control groups noted in the RCTs were routine care, health education, conventional balance exercise, and stretch and resistance exercises. Results indicated that compared to controls, yoga treatments significantly improved functional outcomes in terms of:22
- Motor status
- Balance function
- Functional mobility
- Anxiety scale scores
- Depression scale scores
- Quality of life questionnaire scores
Researchers noted that the smaller number of included studies was a limitation for the meta-analysis that precluded some outcome measures such as gait scale, walk tests, and cognitive assessment and prevented any conclusions about the optimal amount of yoga training.22 However, investigators did conclude that as a treatment approach to PD, yoga may significantly improve some motor and nonmotor symptoms and quality of life for patients.22
Bee Venom, Catgut Embedding, and Other Acupuncture-Related Therapies
In addition to exercise and mind-body therapy approaches, acupuncture-related therapies may also benefit individuals with PD.23,24 In a first of its kind comprehensive investigation, a 2021 systematic review and meta-analysis (61 RCTs) assessed the effects of different types of acupuncture as adjunctive PD therapies.25 While the majority of included RCTs investigated classical acupuncture treatments with or without electrical stimulation, manual or scalp acupuncture, and ear acupuncture or acupressure, 19 were RCTs that adopted special methods of acupuncture and combined treatments, including:25
- Bee venom acupuncture – bee venom, a complex natural mixture with various properties for potential medical therapy, is injected into acupoints26
- Abdominal acupuncture
- Acupoint injection of herbal medications
- Catgut embedding – catgut (a tough cord often used for surgical sutures) is used instead of needles in the acupuncture treatment
- Moxibustion – this type of traditional Chinese medicine burns ground mugwort leaves near acupuncture points for heat stimulation
- Herbal decoction – an herbal preparation is created by boiling herbs, usually in water
Heterogeneity was a limitation in this analysis, with RCT treatment durations ranging from daily to approximately twice per month for two weeks to 11 months; however, the majority of acupuncture-related and combination treatments were given three or seven times per week, and most treatments were given for approximately one to three months. Analysis results indicated that overall, compared with controls (conventional medicine only and/or placebo acupuncture treatment), the different acupuncture-related therapies:25
- Significantly benefited the Unified Parkinson’s Disease Rating Scale (UPDRS) total scores.
- Significantly decreased the UPDRS motor subscores. (Note: higher scores indicate more severe impairment).
- Improved the UPDRS activities of daily living scores.
- Improved behavior, mood, and depression scale scores.
Investigators concluded that acupuncture-related therapies combined with conventional medication may benefit individuals with PD.25 In addition, the review provided a breakdown of the different acupuncture types as mentioned above that may be used to personalize treatment approaches.
While there is no cure for PD, personalized treatments based on a patient’s disease symptoms and disease progression may include medications, anti-inflammatory nutritional interventions that may include probiotics,27-29 or other adjunctive approaches such as exercise, dance, mind-body therapies, and acupuncture. Complementary therapies that may help slow the progression of PD, benefit long-term management of symptoms, and potentially reduce the need for PD-related medications continue to be investigated. Learn about the latest research into how the functional medicine approach may benefit neurodegenerative disease interventions at IFM’s Bioenergetics Advanced Practice Module (APM).
Neurodegenerative Disease: Improving Outcomes Through Nutrition
Slowing Neurodegeneration With Exercise
Flexibility for Improved Physiology and Health
Ketogenic Diet in Neurodegenerative Diseases
Environmental Toxicants: A Risk Factor for Neurodegenerative Diseases
- World Health Organization. Parkinson disease. Published June 13, 2022. Accessed March 29, 2023. https://www.who.int/news-room/fact-sheets/detail/parkinson-disease
- Parkinson’s Foundation. Who has Parkinson’s? Accessed March 29, 2023. https://www.parkinson.org/understanding-parkinsons/statistics
- Willis AW, Roberts E, Beck JC, et al. Incidence of Parkinson disease in North America. NPJ Parkinsons Dis. 2022;8(1):170. doi:1038/s41531-022-00410-y
- Simon DK, Tanner CM, Brundin P. Parkinson disease epidemiology, pathology, genetics, and pathophysiology. Clin Geriatr Med. 2020;36(1):1-12. doi:1016/j.cger.2019.08.002
- Qu Y, Li J, Qin Q, et al. A systematic review and meta-analysis of inflammatory biomarkers in Parkinson’s disease. NPJ Parkinsons Dis. 2023;9(1):18. doi:1038/s41531-023-00449-5
- Dong-Chen X, Yong C, Yang X, Chen-Yu S, Li-Hua P. Signaling pathways in Parkinson’s disease: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther. 2023;8(1):73. doi:1038/s41392-023-01353-3
- Mani S, Sevanan M, Krishnamoorthy A, Sekar S. A systematic review of molecular approaches that link mitochondrial dysfunction and neuroinflammation in Parkinson’s disease. Neurol Sci. 2021;42(11):4459-4469. doi:1007/s10072-021-05551-1
- Gandhi KR, Saadabadi A. Levodopa (L-dopa). StatPearls. Updated May 2, 2022. Accessed March 30, 2023. https://www.ncbi.nlm.nih.gov/books/NBK482140/
- Yang Y, Wang G, Zhang S, et al. Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis. BMC Geriatr. 2022;22(1):813. doi:1186/s12877-022-03510-9
- Tian J, Kang Y, Liu P, Yu H. Effect of physical activity on depression in patients with Parkinson’s disease: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(11):6849. doi:3390/ijerph19116849
- Lee H, Ko B. Effects of music-based interventions on motor and non-motor symptoms in patients with Parkinson’s disease: a systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(2):1046. doi:3390/ijerph20021046
- Jola C, Sundström M, McLeod J. Benefits of dance for Parkinson’s: the music, the moves, and the company. PLoS One. 2022;17(11):e0265921. doi:1371/journal.pone.0265921
- Machado Sotomayor MJ, Arufe-Giráldez V, Ruíz-Rico G, Navarro-Patón R. Music therapy and Parkinson’s disease: a systematic review from 2015-2020. Int J Environ Res Public Health. 2021;18(21):11618. doi:3390/ijerph182111618
- Cucca A, Di Rocco A, Acosta I, et al. Art therapy for Parkinson’s disease. Parkinsonism Relat Disord. 2021;84:148-154. doi:1016/j.parkreldis.2021.01.013
- Jin X, Wang L, Liu S, Zhu L, Loprinzi PD, Fan X. The impact of mind-body exercises on motor function, depressive symptoms, and quality of life in Parkinson’s disease: a systematic review and meta-analysis. Int J Environ Res Public Health. 2019;17(1):31. doi:3390/ijerph17010031
- García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (qigong, tai chi, and yoga) beneficial for stroke and Parkinson’s disease? A scoping review. Complement Ther Med. 2023;72:102912. doi:1016/j.ctim.2022.102912
- Mustafaoglu R, Ahmed I, Pang MYC. Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson’s disease? A systematic review with network meta-analysis. Acta Neurol Belg. 2022;122(6):1433-1446. doi:1007/s13760-022-02070-4
- Aras B, Seyyar GK, Fidan O, Colak E. The effect of tai chi on functional mobility, balance and falls in Parkinson’s disease: a systematic review and meta-analysis of systematic reviews. Explore (NY). 2022;18(4):402-410. doi:1016/j.explore.2021.12.002
- Suárez-Iglesias D, Santos L, Sanchez-Lastra MA, Ayán C. Systematic review and meta-analysis of randomised controlled trials on the effects of yoga in people with Parkinson’s disease. Disabil Rehabil. 2022;44(21):6210-6229. doi:1080/09638288.2021.1966522
- Kwok JYY, Kwan JCY, Auyeung M, et al. Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with Parkinson disease: a randomized clinical trial. JAMA Neurol. 2019;76(7):755-763. doi:1001/jamaneurol.2019.0534
- Kwok JYY, Choi EPH, Lee JJ, et al. Effects of mindfulness yoga versus conventional physical exercises on symptom experiences and health-related quality of life in people with Parkinson’s disease: the potential mediating roles of anxiety and depression. Ann Behav Med. 2022;56(10):1068-1081. doi:1093/abm/kaac005
- Ban M, Yue X, Dou P, Zhang P. The effects of yoga on patients with Parkinson’s disease: a meta-analysis of randomized controlled trials. Behav Neurol. 2021;2021:5582488. doi:1155/2021/5582488
- Sun Y, Sheng J, Liu T, et al. Combination treatment of acupoint therapy and conventional medication for motor function of Parkinson’s disease: a systematic review and meta-analysis. Complement Ther Clin Pract. 2023;50:101677. doi:1016/j.ctcp.2022.101677
- Fan JQ, Lu WJ, Tan WQ, et al. Effectiveness of acupuncture for anxiety among patients with Parkinson disease: a randomized clinical trial. JAMA Netw Open. 2022;5(9):e2232133. doi:1001/jamanetworkopen.2022.32133
- Wen X, Li K, Wen H, et al. Acupuncture-related therapies for Parkinson’s disease: a meta-analysis and qualitative review. Front Aging Neurosci. 2021;13:676827. doi:3389/fnagi.2021.676827
- Lin T-Y, Hsieh C-L. Clinical applications of bee venom acupoint injection. Toxins (Basel). 2020;12(10):618. doi:3390/toxins12100618
- Bianchi VE, Rizzi L, Somaa F. The role of nutrition on Parkinson’s disease: a systematic review. Nutr Neurosci. Published online June 22, 2022. doi:1080/1028415X.2022.2073107
- Dos Santos MG, Schimith LE, André-Miral C, Muccillo-Baisch AL, Arbo BD, Hort MA. Neuroprotective effects of resveratrol in in vivo and in vitro experimental models of Parkinson’s disease: a systematic review. Neurotox Res. 2022;40(1):319-345. doi:1007/s12640-021-00450-x
- Xie L, Chen D, Zhu X, Cheng C. Efficacy and safety of probiotics in Parkinson’s constipation: a systematic review and meta-analysis. Front Pharmacol. 2023;13:1007654. doi:3389/fphar.2022.1007654