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Complementary Health Approaches for People With Parkinson Disease

      What is complementary and integrative medicine?

      Complementary and integrative medicine refers to health care approaches developed separately from conventional Western medicine. Complementary means that it is used together with conventional medicine. Integrative means that it centers a full range of physical, emotional, and environmental aspects in a person’s health. Approximately one-third of adults in the United States have reported the use of complementary and integrative medicine to improve health and wellness and relieve symptoms related to chronic disease.
      • Clarke T.C.
      • Black L.I.
      • Stussman B.J.
      • Barnes P.M.
      • Nahin R.L.
      Trends in the use of complementary health approaches among adults: United States, 2002–2012.
      Conventional medicine for Parkinson disease (PD) mainly focuses on treating motor symptoms such as tremors, slow movement, stiff muscles, and poor posture. In addition, some medical specialties such as physical therapy, occupational therapy, and speech-language pathology can provide treatments that manage beyond motor symptoms, but conventional medicine is often insufficient in managing all aspects of PD symptoms.
      • Bega D.
      • Gonzalez-Latapi P.
      • Zadikoff C.
      • Simuni T.
      A review of the clinical evidence for complementary and alternative therapies in Parkinson’s disease.
      Complementary and integrative medicine has become more popular among people with PD who seek a holistic approach to manage disease symptoms and improve quality of life.
      • Rajendran P.R.
      • Thompson R.E.
      • Reich S.G.
      The use of alternative therapies by patients with Parkinson's disease.

      Mind-body practice for PD

      Mind-body practices include a majority of complementary and integrative medicine approaches for PD. The use of mind-body practices such as yoga, tai chi, and qigong have increased significantly in recent years.
      • Clarke T.C.
      • Black L.I.
      • Stussman B.J.
      • Barnes P.M.
      • Nahin R.L.
      Trends in the use of complementary health approaches among adults: United States, 2002–2012.
      These practices foster awareness of the connection between the mind, physical functions, and well-being.

      Yoga

      • Description: A practice that combines physical exercise based on asana (physical poses), breathing, and meditation. It was developed in ancient India.
        • Colgrove Y.
        • Sharma N.
        • Kluding P.
        • Potter D.
        • Imming K.
        • VandeHoef J.
        Effect of yoga on motor function in people with Parkinson’s disease: A randomized, controlled pilot study.
        ,
        • Sharma N.K.
        • Robbins K.
        • Wagner K.
        • Colgrove Y.M.
        A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson's disease.
      • Benefits: Improvement of both physical and mental symptoms, such as gait, balance, flexibility, strength, fatigue, pain, anxiety, depression, and sleep.
      • Level of evidence: High.

      Tai chi

      • Description: A physical exercise delivered through a series of gentle and flowing poses combined with deep breathing and meditation. Tai chi originated from the ancient Chinese martial art for self-defense.
        • Song R.
        • Grabowska W.
        • Park M.
        • et al.
        The impact of tai chi and qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis.
        ,
        • Ni X.
        • Liu S.
        • Lu F.
        • Shi X.
        • Guo X.
        Efficacy and safety of tai chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.
      • Benefits: Improved strength, balance, physical function, cognition, pain, anxiety, and depression.
      • Level of evidence: Moderate.

      Qigong

      • Description: An ancient Chinese physical exercise combining deep breathing and meditation to improve vital energy flow in the body. Qigong shares some aspects of tai chi but is different in that qigong involves milder movements performed repeatedly.
        • Song R.
        • Grabowska W.
        • Park M.
        • et al.
        The impact of tai chi and qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis.
        ,
        • Moon S.
        • Schmidt M.
        • Smirnova I.V.
        • Colgrove Y.
        • Liu W.
        Qigong exercise may reduce serum TNF-α levels and improve sleep in people with Parkinson’s disease: a pilot study.
      • Benefits: Improved gait, muscle stiffness, balance, coordination, anxiety, depression, and sleep.
      • Level of evidence: Moderate.

      Music therapy

      • Description: A therapeutic approach using music or any of its components (sounds, harmony, melody, or rhythm) to promote physical, mental, and emotional health. Music therapy includes everything from simply listening to music (passive) to playing a musical instrument or physical activities with musical rhythm or cueing (active).
        • Raglio A.
        Music therapy interventions in Parkinson’s disease: the state-of-the-art.
      • Benefits: Improved gait, motor coordination, anxiety, depression, stress, and sleep.
      • Level of evidence: Moderate.

      Meditation

      • Description: A self-regulated practice focusing mind and sensory awareness. Mindfulness-based stress reduction, a type of mindful training using meditation techniques aimed at relaxation, is widely used in hospital settings. Additionally, multiple mobile applications are available to guide meditation, but there is lack of evidence for its effectiveness for PD.
        • Advocat J.
        • Enticott J.
        • Vandenberg B.
        • Hassed C.
        • Hester J.
        • Russell G.
        The effects of a mindfulness-based lifestyle program for adults with Parkinson's disease: a mixed methods, wait list controlled randomised control study.
        ,
        • McLean G.
        • Lawrence M.
        • Simpson R.
        • Mercer S.W.
        Mindfulness-based stress reduction in Parkinson's disease: a systematic review.
      • Benefits: Improved pain, stress, anxiety, depression, and sleep.
      • Level of evidence: Low to moderate.

      Relaxation and guided imagery

      • -
        Description: Guided imagination to achieve a relaxed state of mind and body. This practice uses your imagination to portray places, people, smells, or sounds that make you happy and relaxed.
        • Tamir R.
        • Dickstein R.
        • Huberman M.
        Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson’s disease.
      • Benefits: Improved slow movement, tremors, pain, and stress.
      • Level of evidence: Low.

      Body-based and external energy practice for PD

      Body-based practices involve techniques stimulating points of the body, manipulative techniques, or adjustment of muscles, joints, and bones to improve structural and systemic body imbalance. External energy practices are used to bring energy into the body or facilitate the balance of energy within a body.

      Acupuncture

      • Description: A traditional Chinese technique stimulating strategic points on the body by inserting very thin needles through the skin.
        • Lee S.-H.
        • Lim S.
        Clinical effectiveness of acupuncture on Parkinson disease: a PRISMA-compliant systematic review and meta-analysis.
      • Benefits: Improved motor symptoms and pain. More effective when combined with medications.
      • Level of evidence: Moderate.

      Manipulative practices

      • Description: Joint manipulation techniques (eg, chiropractic treatment), soft tissue manipulation techniques (eg, massage, myofascial release), and postural/muscle retraining (eg, Alexander technique) are popular methods for manipulative practices.
        • Stallibrass C.
        • Sissons P.
        • Chalmers C.
        Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease.
        ,
        • Woodman J.P.
        • Moore N.R.
        Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review.
      • Benefits: Alexander technique: improved gait, tremors, stiff muscles, pain, stress, and depression.
      • Level of evidence: Low to moderate.

      Energy practices

      • Description: Healing or therapeutic touch, Reiki, external qigong, magnet therapy, and light therapy are commonly used methods for energy practices.
      • Benefits: Empirically believed to help symptoms, but there is lack of reliable scientific evidence.
      • Level of evidence: Very low.

      Considerations based on your PD symptoms

      You may consider using the suggestions of complementary and integrative medicine approaches listed in table 1 to improve your PD symptoms.
      Table 1Considerations based on Parkinson disease symptoms
      TreatmentSymptomsEvidence Level
      Evidence level is based on the Grading of Recommendations Assessment, Development, and Evaluation system.16
      Stiff muscles, decreased flexibility, or shakingProblems with walking, balance, or freezingPainStress or fatigueAnxiety or depressionSleep problems
      YogaHigh
      Tai chiModerate
      QigongModerate
      Music therapyModerate
      AcupunctureModerate
      MeditationLow to moderate
      Manipulative practicesLow to moderate
      Relaxation and guided imageryLow
      Energy practicesVery low
      Evidence level is based on the Grading of Recommendations Assessment, Development, and Evaluation system.
      • Guyatt G.
      • Oxman A.D.
      • Akl E.A.
      • Kunz R.
      • Vist G.
      • Brozek J.
      • et al.
      GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.

      Safety precautions

      You should consult with your health care providers before using any complementary and integrative medicine approaches. Because not all complementary and integrative therapists have adequate training for people with PD, you may consider asking advice from complementary and integrative physicians in your local area. Mind-body practices are generally known to be safe for older adults and for all fitness levels, but some practices may require a considerable amount of physical ability or may cause unanticipated adverse events. Some complementary and integrative practices that require body movements with moderate intensity may be less suitable for you depending on your PD status and severity. You should clear your participation with your health care providers.

      Additional resources

      You can find more information about the use of complementary and integrative medicine in PD in the following links:

      Authorship

      This page was developed by Sanghee Moon, PT, PhD (e-mail address: s[email protected] ); Caio V. M. Sarmento, PT, PhD; Yvonne Colgrove, PT, PhD; and Wen Liu, PhD.

      Disclaimer

      This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This information/education page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.

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