Cited by 380Mindfulness and Compassion InterventionsParkinson's Disease Mechanisms and TreatmentsCancer survivorship and care

Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease: A Randomized Clinical Trial

Open access
Kwok, Jojo Y. Y., Kwan, Jackie C. Y., Auyeung, M., Mok, Vincent C. T., Lau, Claire K. Y., Choi, K. C., Chan, Helen Y. L.·2019·JAMA Neurology

Abstract

Importance: Clinical practice guidelines support exercise for patients with Parkinson disease (PD), but to our knowledge, no randomized clinical trials have tested whether yoga is superior to conventional physical exercises for stress and symptom management. Objective: To compare the effects of a mindfulness yoga program vs stretching and resistance training exercise (SRTE) on psychological distress, physical health, spiritual well-being, and health-related quality of life (HRQOL) in patients with mild-to-moderate PD. Design, Setting, and Participants: An assessor-masked, randomized clinical trial using the intention-to-treat principle was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. A total of 187 adults (aged ≥18 years) with a clinical diagnosis of idiopathic PD who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Eligible participants were randomized 1:1 to mindfulness yoga or SRTE. Interventions: Mindfulness yoga was delivered in 90-minute groups and SRTE were delivered in 60-minute groups for 8 weeks. Main Outcomes and Measures: Primary outcomes included anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included severity of motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Part III motor score), mobility, spiritual well-being in terms of perceived hardship and equanimity, and HRQOL. Assessments were done at baseline, 8 weeks (T1), and 20 weeks (T2). Results: The 138 participants included 65 men (47.1%) with a mean (SD) age of 63.7 (8.7) years and a mean (SD) MDS-UPDRS score of 33.3 (15.3). Generalized estimating equation analyses revealed that the yoga group had significantly better improvement in outcomes than the SRTE group, particularly for anxiety (time-by-group interaction, T1: β, -1.79 [95% CI, -2.85 to -0.69; P = .001]; T2: β, -2.05 [95% CI, -3.02 to -1.08; P < .001]), depression (T1: β, -2.75 [95% CI, -3.17 to -1.35; P < .001]); T2: β, -2.75 [95% CI, -3.71 to -1.79; P < .001]), perceived hardship (T1: β, -0.92 [95% CI, -1.25 to -0.61; P < .001]; T2: β, -0.76 [95% CI, -1.12 to -0.40; P < .001]), perceived equanimity (T1: β, 1.11 [95% CI, 0.79-1.42; P < .001]; T2: β, 1.19 [95% CI, 0.82-1.56; P < .001]), and disease-specific HRQOL (T1: β, -7.77 [95% CI, -11.61 to -4.38; P < .001]; T2: β, -7.99 [95% CI, -11.61 to -4.38; P < .001]). Conclusions and Relevance: Among patients with mild-to-moderate PD, the mindfulness yoga program was found to be as effective as SRTE in improving motor dysfunction and mobility, with the additional benefits of a reduction in anxiety and depressive symptoms and an increase in spiritual well-being and HRQOL. Trial Registration: Centre for Clinical Research and Biostatistics identifier: CUHK_CCRB00522.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamaneurol.2019.0534

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Yoga and mindfulness meditation improve health-related quality of life by reducing anxiety and depressive symptoms in neurodegenerative diseases.

    “To attenuate this effect, both yoga and mindfulness meditation have been shown to improve health-related quality of life by reducing anxiety and depressive symptoms in neurodegenerative diseases [216,217].”

    From The Impact of Neurotoxin Proteins Trafficked by Primary Cilia and Extracellular Vesicles in Neurodegenerative Diseases (2025) · cites this paper as [216]

    The Abstract (page unavailable) reports that mindfulness yoga reduced anxiety and depressive symptoms and improved health-related quality of life in people with mild-to-moderate Parkinson disease. The study did not test mindfulness meditation separately or other neurodegenerative diseases, and it does not establish that symptom reductions caused the quality-of-life improvement. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • The sample size of the current study is above the average of existing MBI clinical trials for PD patients (mean sample size = 50).

    “Nevertheless, the sample size of the current study is above the average of existing MBI clinical trials for PD patients (number of studies = 7; range = 13–138; mean sample size = 50)12,32–37.”

    From A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest (2023) · cites this paper as [12]

    The Results section (page unavailable) reports 138 participants randomized in this mindfulness-yoga trial, supporting the cited range’s upper endpoint. The paper does not report an average sample size of 50 across seven Parkinson disease MBI trials or establish the citing study’s comparison with that average. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Only one of the four effectiveness trials was adequately powered to detect differences in study outcome measurements.

    “it could be argued that only one was adequately powered to detect differences in study outcome measurements (Kwok et al., 2019).”

    From A Systematic Review of Third-Wave Therapies to Reduce Distress and Improve Wellbeing and Quality of Life in People with Parkinson's Disease. (2025) · cites this paper as Kwok et al., 2019

    The Sample Size section reports a calculation targeting 80% power, and Strengths and Limitations describes this trial as having adequate statistical power. The paper does not assess the other three trials, so it cannot establish that this was the only adequately powered one. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • There was evidence, based on data from the trial with the largest sample size, of an effect of Mindfulness Yoga on both its primary outcome (depression and anxiety) and on secondary outcomes (psychological well-being and quality of life), at the end of the 8-week intervention, sustained after 3 months.

    “there was evidence, based on data from the trial with the largest sample size, of an effect of Mindfulness Yoga on both its primary outcome (depression and anxiety) and on secondary outcomes (psychological well-being and quality of life), at the end of the 8-week intervention, which was sustained after 3 months (Kwok et al., 2019).”

    From A Systematic Review of Third-Wave Therapies to Reduce Distress and Improve Wellbeing and Quality of Life in People with Parkinson's Disease. (2025) · cites this paper as Kwok et al., 2019

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • A clinical trial of yoga involving 138 Parkinson's disease patients found significantly superior therapeutic effects on alleviating anxiety and depression compared with active exercise control (stretching and resistance training exercises), with similar physical benefits.

    “A clinical trial of yoga involving 138 PD patients demonstrated its significant superior therapeutic effects on alleviating anxiety and depression compared to active exercise control (stretching and resistance training exercises), with similar physical benefits12.”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

2 of the 52 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Authors
Kwok, J. Y. Y., Kwan, J. C. Y., Auyeung, M., Mok, V. C. T., Lau, C. K. Y., Choi, K. C., & Chan, H. Y. L.
Affiliations
  • University of Hong Kong (HK)
  • The Hong Kong Society for Rehabilitation, Hong Kong Special Administrative Region
  • Pamela Youde Nethersole Eastern Hospital (CN)
  • Chinese University of Hong Kong (HK)
  • Prince of Wales Hospital (CN)
Corresponding author
Kwok, Jojo Y. Y.
Venue
JAMA Neurology
Published
2019-07-01
Volume
76
Issue
7
Pages
755
ISSN
2168-6149 (ISSN-L)
OpenAlex
W2929550160
Cited by
379
References
52
Citations by year
2026: 43 · 2025: 69 · 2024: 79 · 2023: 61 · 2022: 59 · 2021: 38 · 2020: 23 · 2019: 6 · 2017: 1
FWCI
36.79
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
mindfulness yoga, Parkinson's disease, anxiety, depression, exercise therapy, spiritual well-being, health-related quality of life, motor symptoms, mobility (physical function), psychological distress, non-pharmacological treatment, community rehabilitation centers, MDS-UPDRS, Hospital Anxiety and Depression Scale, equanimity, older adults, community-dwelling
MeSH terms
Aged, Anxiety, Depression, Exercise Therapy, Female, Hong Kong, Humans, Male, Middle Aged, Parkinson Disease, Quality of Life, Severity of Illness Index, Yoga, Treatment Outcome, Muscle Stretching Exercises, Resistance Training, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review