September Hot Topic: Postures and Pressure Points – Strategies for PD Improvement

Mature woman in yoga pose

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Symptoms of Parkinson’s disease (PD) may develop slowly over time and progress differently for each patient.1 Slowing motor and nonmotor symptomology and improving quality of life are key treatment goals for this incurable neurodegenerative disorder. 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.2 Adjunctive therapeutic strategies may help support improved quality of life for patients with PD and slow progression of complex disease symptoms. Recent systematic reviews and meta-analyses of randomized controlled trials (RCTs) have focused on yoga and acupuncture-related treatments for PD and suggest that these approaches may help improve both motor and non-motor symptoms associated with the disease.3,4

Yoga: Postural Training, Breathwork, and Meditation

To investigate how yoga may improve the disease symptomology of patients with mild to moderate PD, researchers conducted a meta-analysis of ten RCTs (359 total participants) that studied how yoga practices impact PD treatments.3 The average age of the participants ranged from 60 to 80 years. 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). The yoga treatments included in the RCTs were a combination of different elements such as:3

  • 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 exercise. Results from the meta-analysis showed that compared to the control group, the yoga treatment group showed statistically significant improvement of functional outcomes in terms of:3

  • 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.3 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.3

Bee Venom, Catgut Embedding, and Other Acupuncture-Related Therapies

A systematic review and meta-analysis (61 RCTs) published in July 2021 assessed the benefits of acupuncture-related therapies used in combination with conventional medication compared to only conventional medicine in patients with PD.4 The investigators noted that their meta-analysis is the first to investigate the effects of different types of acupuncture as adjunctive PD therapies. While the majority of RCTs included in this analysis 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:

  • Bee venom acupuncture – bee venom, a complex natural mixture with various properties for potential medical therapy, is injected into acupoints5
  • 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 therapies were given six to 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:4

  • Significantly benefited the Unified Parkinson’s Disease Rating Scale (UPDRS) total scores.
  • Significantly decreased the UPDRS motor sub-scores. (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.4 In addition, the review provided a breakdown of the different acupuncture types as mentioned above that may be used to personalize treatment approaches.

Adjunctive therapies that 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. For example, in addition to yoga and acupuncture, other alternative modalities including massage,6 chiropractic manipulation,7 mind-body practices such as tai chi and qi gong,7 herbal and nutrition-related approaches,8 aromatherapy,9 and music and art therapy10 have been studied. Inclusion of lifestyle and complementary medicine approaches promotes personalized treatment strategies that may offer symptom relief with fewer side effects.

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References

  1. What is Parkinson’s? Parkinson’s Foundation. https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons. Accessed September 3, 2021.
  2. Gandhi KR, Saadabadi A. Levodopa (L-dopa). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482140/ . Published August 6, 2021. Accessed September 3, 2021.
  3. 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:10.1155/2021/5582488.
  4. 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:10.3389/fnagi.2021.676827.
  5. Lin T-Y, Hsieh C-L. Clinical applications of bee venom acupoint injection. Toxins (Basel). 2020;12(10):618. doi:10.3390/toxins12100618.
  6. Angelopoulou E, Anagnostouli M, Chrousos GP, Bougea A. Massage therapy as a complementary treatment for Parkinson’s disease: a systematic literature review. Complement Ther Med. 2020;49:102340. doi:10.1016/j.ctim.2020.102340.
  7. Deuel LM, Seeberger LC. Complementary therapies in Parkinson disease: a review of acupuncture, tai chi, qi gong, yoga, and cannabis. Neurotherapeutics. 2020;17(4):1434-1455. doi:10.1007/s13311-020-00900-y.
  8. Mischley LK, Lau RC, Bennett RD. Role of diet and nutritional supplements in Parkinson’s disease progression. Oxid Med Cell Longev. 2017;2017:6405278. doi:10.1155/2017/6405278.
  9. Ferry P, Johnson M, Wallis P. Use of complementary therapies and non-prescribed medication in patients with Parkinson’s disease. Postgrad Med J. 2002;78(924):612-614. doi:10.1136/pmj.78.924.612.
  10.  García-Casares N, Martín-Colom JE, García-Arnés JA. Music therapy in Parkinson’s disease. J Am Med Dir Assoc. 2018;19(12):1054-1062. doi:10.1016/j.jamda.2018.09.025.