insights

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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 therapy^11-14 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
• Meditation

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
• Self-acupressure
• 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.

Conclusion

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).

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