Mindfulness Training May Improve Outcomes for People With Parkinson Disease

Mindfulness training integrated into motor-oriented Parkinson disease (PD) rehabilitation protocols may help increase resilience and reduce psycho-cognitive morbidities in patients with mild-to-moderate PD, finds a study conducted during a tumultuous period in Hong Kong.

The study, published in npj Parkinson’s Disease, compared the impact of a modified mindfulness meditation program against stretching and resistance training exercise (SRTE) in patients with mild-to-moderate PD in Hong Kong, China.

Out of 126 possible participants enrolled by way of convenience sampling, 68 met eligibility. The 68 participants were randomized 1:1 to get 8 weekly 90-minute sessions of mindfulness meditation or SRTE, with 33 patients in the meditation group and 35 in the conventional STRE group. The mean (SD) age of all participants was 65.5 (8.4), and most (57.4%) were female, although PD is 1.5 more common in males than females. Generalized estimating equation analyses were used to review the data.

There were 3 assessment time points. The baseline (T0) period, in August 2019, was marked by Hong Kong protests against a Chinese extradition bill. The period during the intervention and during the first assessment at T1 in the fall of 2019 was marked by increased violence. The 3-month post-intervention (T2) period in early 2020 coincided with the beginning of the COVID-19 pandemic and related shutdowns.

The researchers found that mindfulness meditation looked to be an attainable and hopeful strategy for depressive symptom management and emotional stability, with similar advantages on cognitive performance, compared with SRTE.

Outcomes of those in the mindfulness group were significantly improved, with depressive symptoms reduced at week 8 (d, −1.66; 95% CI, −3.31 to −.02), and emotional stability maintained at week 20 (d, 2.08; 95% CI, .59 to 3.56).

Both groups showed significant instant, small to moderate effects on cognition, reaching marginal clinical significance (effect size [d] = 0.36–0.37, P = .006–.011).

It was also found that patients in the mindfulness meditation group had more improved psychospiritual outcomes than the physical exercise group. They additionally showed improved mindfulness and cognitive performance at T1 and increased non-judging awareness at T2.

The physical exercise group participants showed improved motor symptoms, delayed recall and overall cognitive performance at T1, with no statistically significant superiority.

For the exercise group, emotional reactivity worsened at T2 (during that start of the COVID -19 pandemic) and remained a statistically significant difference when compared with the mindfulness meditation group

While it was not intended by the authors to measure the effects of mindfulness against stressful triggers like the COVID-19 pandemic and social unrest, they noted that these circumstances further confirmed the effectiveness of mindfulness. To the authors’ knowledge, this is the first clinical trial of mindfulness-based intervention (MBI) for PD administered during social unrest and the COVID-19 pandemic.

For public benefit, the authors encourage “anti-pandemic measures” to include mindfulness tips and techniques to alleviate emotional reactivity and pandemic-related distress.

The authors suggested that health care professionals integrate mindfulness into evidence-based exercise treatment for PD rehabilitation, due to the toll the disease takes psychologically, physically, and cognitively, to help mitigate the impact PD makes in these areas.

The authors noted some limitations in the study. There was a smaller sample size due to the COVID-19 pandemic and associated barriers, but still above average for other MBI clinical trials.

A face-to-face examination was not able to be done at T2 because of COVID-19 pandemic guidelines and the assessment was conducted by telephone. Therefore, prolonged MBI effects on motor symptoms, functional mobility, and cognition are not known. Participant expectation about the effects of each intervention or physical activity level measurement was not collected during the study period. Also, selection bias might have happened because participants joined through convenience sampling.

Reference

Kwok JYY, Choi EPH, Wong JYH, et al. A randomized clinical trial of mindfulness meditation versus exercise in Parkinson's disease during social unrest. NPJ Parkinsons Dis. 2023;9(1):7. Published online January 21, 2023 doi:10.1038/s41531-023-00452-w