Mindfulness meditation – mental training of being focused on the present moment without interpretation or judgment – was better than physical exercise at lessening depression symptoms and maintaining emotional stability in people with mild-to-moderate Parkinson’s disease.
That’s according to data from a small clinical trial conducted in Hong Kong that also showed both practices resulted in an immediate, positive effect on cognitive function.
Overall, “…mindfulness meditation appeared to be a feasible strategy for managing depressive symptoms and maintaining emotional stability, with comparable benefits in cognitive performance, among patients with mild-to-moderate Parkinson’s disease,” the researchers wrote.
The study, ‘A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest’, was published in the journal npj Parkinson’s Disease.
Parkinson’s disease is known for its hallmark motor symptoms, such as tremors and slow movement. However, patients often experience non-motor symptoms like depression, emotional instability, sleeping problems, fatigue, and cognitive decline.
Besides pharmacological approaches, “…non-pharmacological, lifestyle approaches including physical activity, stress management, and social support are recommended by clinical guidelines to provide additional symptomatic relief in the illness trajectory,” the researchers wrote.
Evidence suggests that physical activities, such as yoga, can lessen both motor and non-motor symptoms. However, the impact of mindfulness mediation in Parkinson’s patients remains largely unclear.
Now, a team of researchers in Hong Kong conducted a clinical trial (HKUCTR-2681) from August 2019 to February 2020 to assess the potential of mindfulness meditation to lessen anxiety and depression in people with mild-to-moderate Parkinson’s compared with stretching and resistance training exercise (SRTE).
In total, 68 patients (mean age 64.5 years, 57.4% women) were assigned randomly to undergo either the mindfulness program (33 patients) or the SRTE program (35 patients) for eight weeks.
The mindfulness meditation training program consisted of a 1.5-hour session per week, and 20 minutes of home-based practice, twice a week. The weekly session included: body scan, guided meditation with focus on the breath, guided meditation focusing one’s awareness to bodily sensations and non-judgmental awareness, and practicing awareness during daily life activities by using the breath as an anchor for the attention.
The SRTE program involved 90-minute weekly sessions of full-body physical exercise, in addition to 20 minutes of home-based practice, twice a week. The exercise protocol included warm-up, stretching, resistance training exercises with moderate intensity, and cool-down exercises.
At the trial’s start, most patients (60.3%) had moderate Parkinson’s. Also, 21 patients (30.9%) presented clinically significant anxiety symptoms and 20 (23.5%) had significant depression symptoms, as assessed with the Hospital Anxiety and Depression Scale.
Two patients in the mindfulness group did not attend any sessions, while those in the SRTE group attended at least two sessions. Most patients in both groups attended at least six sessions: 72.8% in the mindfulness group and 88.6% in the SRTE group.
Results showed that depressive symptoms were lessened significantly immediately after the mindfulness program, while they remained stable in the SRTE group. This meant that mindfulness meditation was associated with a significant reduction in depression, when compared with SRTE. This reduction reached marginal clinical significance.
However, no significant differences were seen between both groups at three months after the intervention.
Also, no significant differences in anxiety were seen within groups or between groups at any time point.
The mindfulness meditation program also was associated with significant improvements in overall mindfulness and overall cognitive performance immediately after the program, and in non-judging aspect of mindfulness at three months after the program.
The SRTE group showed a significant reduction in motor symptoms, as assessed with the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale –Part 3, immediately after completing the program. Also, delayed recall and overall cognitive function were improved significantly.
However, a significant worsening in non-reacting aspect of mindfulness – which allow experiences to come and go without reacting in an effort to change them – was observed at three months after the intervention.
Overall, compared with patients in the SRTE group, those undergoing the mindfulness program showed a slight improvement in quality of life immediately after the intervention, and significant improvements in the non-reacting aspect of mindfulness at the final evaluation.
Adverse events were reported in one patient in each group: temporary back pain in the mindfulness group and temporary mild knee pain during and after squatting exercises in the SRTE group.
All participants were satisfied with the study. More than half of patients in the mindfulness group (67.7%) and SRTE group (51.6%) reported less constipation and improvements in their sleep, which were not objectively quantified in the study.
“These findings suggest that mindfulness meditation might be a promising complementary lifestyle practice for cultivating non-reactivity and managing depressive mood among patients with PD, which exerts similar benefits on cognition as compared to conventional physical exercise,” the researchers wrote.
“The observed improvements were confirmative because interventions and assessments were conducted during the strikes of social unrest and/or the COVID-19 pandemic,” they added.
“Further investigation is warranted to establish the mechanistic effect and compliance of various forms of mindfulness practices,” the team concluded.
Summary article by Patricia Inácio, PhD
Study published in npj Parkinson’s Disease.