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Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease: A Randomized Clinical Trial
Open accessAbstract
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.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“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.”
From A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest (2023) · cites this paper as [12]
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“its safety has been demonstrated in our previous published trial12.”
From A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest (2023) · cites this paper as [12]
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“Compared to our previous clinical trial of mindfulness yoga, there was inconsistency in the evidence of its effects on anxiety, motor symptoms, and HRQOL12,20,21.”
From A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest (2023) · cites this paper as [12]
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“The largest effectiveness trial found a significant reduction in Hospital Anxiety and Depression Scale (HADS) following Mindfulness Yoga (n = 71) compared to an active control (n = 67) (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
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“One effectiveness trial showed significant improvement in secondary outcomes measures including the Holistic Well-being Scale (HWS) and Health-Related Quality of Life (HRQOL) following Mindfulness Yoga compared to an active control (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
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“The current evidence on using mindfulness techniques to improve depression in PD consists of four RCTs (Kwok et al., 2019; Pickut et al., 2015; Rodgers et al., 2019; Son & Choi, 2018) and three uncontrolled pretest-posttest studies (Birtwell et al., 2017; Cash et al., 2015; Dissanayaka et al., 2016), and shows mixed results.”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
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“Significant improvements were also observed following the adoption of mindfulness-based yoga, which were maintained at 3-month follow-up (Kwok et al., 2019).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
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“The use of mindfulness-based interventions to address anxiety in PD has been evaluated by three RCTs (Kwok et al., 2019; Rodgers et al., 2019; Son & Choi, 2018) and two uncontrolled pretest-posttest studies (Birtwell et al., 2017; Dissanayaka et al., 2016).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
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“A total of 10 intervention studies have adopted approaches based on mindfulness to target psychological difficulties in PD. Of these, five were RCTs (Advocat et al., 2016; Kwok et al., 2019; Pickut et al., 2015; Rodgers et al., 2019; Son & Choi, 2018).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
The cited source says what the claim attributes to it.
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“The second most common psychotherapeutic model was mindfulness, with 10 studies adopting one of its many variations (e.g., MBCT, MBSR, mindfulness yoga), five of which were RCTs (Advocat et al., 2016; Kwok et al., 2019; Pickut et al., 2015; Rodgers et al., 2019; Son & Choi, 2018).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
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“Significant better outcomes for the mindfulness yoga group in anxiety, depression, and QoL at both post- intervention and follow-up.”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Kwok et al., 2019
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1 retracted
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RetractedThe Hospital Anxiety and Depression Scale
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Kabat-Zinn, J. (2003) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.bpg016 · Cited by 8,615
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Cited by
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Bloem, B. R., Okun, M. S., & Klein, C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00218-x · Cited by 3,920
The neuropsychiatry of Parkinson's disease: advances and challenges
Weintraub, D., Aarsland, D., Chaudhuri, К. R., Dobkin, R. D., Leentjens, A. F. G., Rodriguez-Violante, M., & Schrag, A. E. (2021) · The Lancet Neurology · doi:10.1016/s1474-4422(21)00330-6 · Cited by 480
“74 Another area of growing interest is the use of dance-based therapies (eg, ballet) for a range of non-motor symptoms in Parkinson’s disease.”
BackgroundHelmich, R. C., & Bloem, B. R. (2020) · Journal of Parkinson's Disease · doi:10.3233/jpd-202038 · Cited by 300
Medical, surgical, and physical treatments for Parkinson's disease.
Foltynie, T., Bruno, V., Fox, S. H., Kühn, A., Lindop, F., & Lees, A. (2024) · The Lancet · doi:10.1016/s0140-6736(23)01429-0 · Cited by 197
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Metadata
- 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
- Publisher
- American Medical Association (AMA)
- Published
- 2019-07-01
- Volume
- 76
- Issue
- 7
- Pages
- 755
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC6583059
- 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
- FWCI
- 36.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Clinical 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
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