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Balance and Movement with Parkinson’s

Yoga for Balance and Movement with Parkinson’s

The stoop arrived before you noticed it. Turning around takes more steps than it used to, a low chair takes a run up, and what has quietly changed most is how much you are willing to attempt.

This guide is for early to moderate Parkinson’s. What the research supports and where it stops, why the most effective balance poses are also the riskiest ones, how to make standing work safe without making it pointless, and an eight week program.

Who this guide is for

Signs this guide was written for you

This is for early to moderate Parkinson’s, where you can stand and walk unaided or with a stick, alongside physiotherapy rather than instead of it.

  • ·You have early to moderate Parkinson’s and can stand and walk unaided or with a stick.
  • ·Your medication is settled and you know roughly when your on-periods fall.
  • ·You have not fallen in the past year and you do not have freezing of gait.
  • ·You have a solid chair, a wall, and ideally somebody else in the house.
  • ·You are doing this alongside physiotherapy and your neurologist.

Research based yoga sequences for Balance and Movement with Parkinson’s

8 Week Yoga Program for Balance in Early to Moderate Parkinson’s

Our yoga teachers built this eight week program on the dosage that the two largest trials in this field used, and on the one thing those trials could not put in a video: a chair in front of you for every standing position, and a slow, staged way of getting up at the end of every session.

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What causes Balance and Movement with Parkinson’s

The poses with the best evidence for balance are the same ones with the highest chance of a fall.

The reasoning behind single leg standing poses in Parkinson’s is good: they load the quadriceps, the shins and the calves, which are the muscles standing balance actually runs on. That is why tree pose, warrior three and half moon appear in the protocols. It is also why they are the poses most likely to put someone on the floor when postural stability is already reduced and nobody is there to catch them.

The way out is not to drop the standing work. It is to keep the same muscles and remove the fall. A heel lift with both hands on a chair loads the calf and the ankle stabilisers in the same way and can be abandoned in a second. A wider stance is more stable than a narrow one and still asks the legs to hold something. That is the trade this program makes everywhere.

  • ·A meta-analysis of 10 trials with 359 people found improvements in motor symptoms, balance, functional mobility, anxiety, depression and quality of life.
  • ·In the largest direct trial, yoga beat a structured exercise programme for anxiety, depression and quality of life, and the differences held twelve weeks later.
  • ·In that same trial, mobility was not an outcome where yoga did better than exercise. This belongs alongside your other movement, not instead of it.
  • ·Every trial ran in person with a qualified teacher present. Single leg work here goes no further than a heel lift with both hands on a chair.
  • ·Blood pressure drops on standing are common. Every session ends with getting up in stages, and that is a technique rather than a caution.

Safety

When to practise and when to get it looked at

Three things about how this program is built, and two lines where somebody physically present is the right answer.

How to practise so it works

  • ·Every standing position keeps a chair back under one hand. Single leg work goes no further than a heel lift with both hands holding, which is deliberate rather than cautious.
  • ·Every session ends with getting up in stages: roll to your side, wait, sit up, wait, then stand holding something. Blood pressure drops on standing are common and this is how they are handled.
  • ·Practise during an on-period, when medication is working, rather than as it wears off.
  • ·A fall in the past year, freezing of gait, or an untreated drop in blood pressure on standing all mean this needs a physiotherapist in the room rather than a screen.
  • ·If you need a walking frame or a wheelchair, none of the research behind this program covers that, and a physiotherapist can build something that does.

The asanas

The yoga poses that matter for Balance and Movement with Parkinson’s

Grouped by what each one asks the body to do. Tap any pose to see how it is done, what it works on and who should leave it out.

Where the first two weeks happen

Thunderbolt Pose

Thunderbolt Pose

Vajrasana

Cat Pose

Cat Pose

Marjaryasana

Cow Pose

Cow Pose

Bitilasana

Revolved Easy Pose

Revolved Easy Pose

Parivrtta Sukhasana

Butterfly Pose

Butterfly Pose

Baddha Konasana

Standing, chair always in reach

Mountain Pose

Mountain Pose

Tadasana

Mountain Pose with Side Bend

Mountain Pose with Side Bend

Parshva Tadasana

Warrior II

Warrior II

Virabhadrasana II

Tree Pose

Tree Pose

Vrkasana

Chair Pose

Chair Pose

Utkatasana

Against the forward stoop

Baby Cobra

Baby Cobra

Ardha Bhujangasana

Locust Pose

Locust Pose

Shalabhasana

Bridge Pose

Bridge Pose

Setu Bandha Sarvangasana

Downward-Facing Dog

Downward-Facing Dog

Adhomukha Shvanasana

Corpse Pose

Corpse Pose

Savasana

For yoga teachers

Teaching a class for Balance and Movement with Parkinson’s

Make the chair the default rather than the modification. In this population the poses with the best rationale for balance are single leg standing poses, and they are also the ones most likely to produce a fall. A heel lift with both hands on a chair back loads the same muscles and can be abandoned instantly. Save the full versions for a room where you can reach someone.

Teach the transitions as poses in their own right. Rolling to the side, sitting up, waiting, standing with a hand on something. Drops in blood pressure on standing are common, and the one fall documented in this literature happened during a change of position rather than in a posture.

Give extension the same time as flexion, or more. The typical posture here is forward and closed, and most classes spend far more time rounding than extending. Sphinx, small locust lifts and bridge on the floor are where that gets corrected, safely.

Two practical things:

  • ·Ask when their medication is working and schedule around it. An on-period class and an off-period class are two different sessions with the same plan.
  • ·Slow movement is harder to produce with bradykinesia and easier to feel. Cue slower than you would normally, and count out loud for the sit to stand.

And the boundary: a fall in the past year, freezing of gait, untreated orthostatic hypotension, or the need for a frame or wheelchair all mean this belongs with a physiotherapist rather than a class. None of the research covers those groups.

Hand made yoga sequences for Balance and Movement with Parkinson’s

Full sequences you can teach or practise today

Our yoga teachers built each of these around the same trials the guide above is based on. The order of the poses, the length of the holds and the props are not a stylistic choice. They follow what the studied programmes actually did.

If you teach, take one of them straight into your class. Every pose comes with its timing, the cue that matters and the reason it sits where it sits.

10 Minute Daily Yoga Sequence for Parkinson’s

10 min · Beginner

10 Minute Daily Yoga Sequence for Parkinson’s

Ten minutes on the days between. Standing at a chair, a little spine, and down to the floor.

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30 Minute Yoga Sequence for Parkinson’s, Weeks One and Two

30 min · Beginner

30 Minute Yoga Sequence for Parkinson’s, Weeks One and Two

Standing at a wall, then the floor. Slow enough that you can feel what your body is actually doing.

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30 Minute Balance Yoga Sequence for Parkinson’s

30 min · Intermediate

30 Minute Balance Yoga Sequence for Parkinson’s

The last two weeks and afterwards. Standing balance, the sit to stand, and the transitions themselves.

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35 Minute Yoga Sequence for Parkinson’s Strength and Posture

35 min · Intermediate

35 Minute Yoga Sequence for Parkinson’s Strength and Posture

Weeks three to six. Leg strength standing, then the back extension that argues with the stoop.

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Build your own

Put together your own class for Balance and Movement with Parkinson’s

The sequence builder gives you all 108 asanas and lets you arrange them yourself. While you build, it watches the shape of the class: whether the intensity rises and falls the way a practice should, whether every strong pose gets its counterpose, and whether the order makes anatomical sense.

Save what you build, come back to it, and teach it. It is the fastest way to turn what you just read into a class of your own.

The research

What the studies actually found

This is one of the better researched conditions on this site, and the picture is unusually consistent. A meta-analysis of 10 trials with 359 people found improvements in motor symptoms, balance, functional mobility, anxiety, depression and quality of life. The largest single trial found yoga clearly better than a structured exercise programme for anxiety, depression and quality of life, and not better for mobility. The trial closest to this program’s aim reduced fall risk over eight weeks in a group who reported being afraid of falling. All of it ran in person with qualified teachers, which is the line this program is built around rather than past.

Complementary Therapies in Medicine2021

The Effects of Yoga on Patients with Parkinson’s Disease: A Meta-Analysis of Randomized Controlled Trials

10 randomised trials with 359 participants. Motor symptoms improved by 5.64 points on the UPDRS motor scale, balance and functional mobility both improved significantly, and anxiety, depression and quality of life all moved in the same direction. For a neurological condition that is a strikingly consistent set of results, though the individual trials are small.

Read the source →
JAMA Neurology2019

Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease

138 adults with mild to moderate Parkinson’s, randomised to eight weeks of mindfulness yoga or to structured stretching and resistance training. Yoga was significantly better for anxiety, depression and disease-specific quality of life, both at eight weeks and at twenty. Mobility was not among the outcomes where it came out ahead, which is why this program sits alongside other exercise rather than replacing it.

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Evidence-Based Complementary and Alternative Medicine2018

Functional Improvements in Parkinson’s Disease Following a Randomized Trial of Yoga

27 people with Parkinson’s who reported a fear of falling, randomised to eight weeks of yoga twice a week or a waiting list. The yoga group improved in motor function, postural stability, functional gait and freezing of gait, and significantly reduced their fall risk. The waiting list group improved in postural stability but did not reduce their fall risk. It is small and it was taught by a certified yoga therapist.

Read the source →
Pilot and Feasibility Studies2018

Effects of yoga on oxidative stress, motor function, and non-motor symptoms in Parkinson’s disease: a pilot randomized controlled trial

20 people, twelve weeks of Hatha yoga twice a week against a waiting list. Motor scores moved in the right direction. The reason we include it is what else it found: some quality of life subdomains did not improve, and self-reported general physical activity fell in the yoga group, as though yoga had replaced other movement rather than adding to it. It is small, and it is a useful warning against treating this as a substitute.

Read the source →

Frequently Asked Questions

Does yoga help Parkinson’s disease?

More consistently than for most conditions. A meta-analysis of 10 trials with 359 people found significant improvements in motor symptoms, balance, functional mobility, anxiety, depression and quality of life. The trials are small and were all delivered in person by qualified teachers, so the size of the claim should stay modest.

How does it compare to ordinary exercise?

In the strongest direct comparison, 138 people did either eight weeks of yoga or a structured stretching and resistance programme. Yoga was better for anxiety, depression and quality of life, at eight weeks and still twelve weeks later. Mobility was not one of the outcomes where it came out ahead.

Which poses actually help balance?

The rationale points at single leg standing poses because they load the quadriceps, shins and calves. The problem is that those are also the poses most likely to cause a fall when postural stability is reduced. A heel lift with both hands on a chair keeps the muscle work and removes the risk, which is the version used here.

Can I do this if I have freezing of gait?

Not on your own. Freezing is the situation where somebody physically present matters most, and it should be worked on with a physiotherapist. The same goes for a fall in the past year or an untreated drop in blood pressure on standing.

Why does it matter when I practise?

Because an on-period and an off-period are two different bodies. Practising while medication is working means the session trains movement rather than fights for it, and it is the single most useful scheduling decision available.

Will this stop my symptoms getting worse?

Nothing in this research supports that claim and we are not going to make it. What the trials show is improvement in measured function, mood and quality of life over eight weeks. In one of them the motor gains had faded by six months while the anxiety gains had not, which is the clearest argument there is for continuing rather than finishing.

Related Practices

Balance & StabilitySpinal MobilityPosture & Alignment

Creator of this guide

Manish Rana

Manish Rana

Founder of Asanaverse.de. Manish writes about yoga, Ayurveda and meditation, and owes his deep connection to yoga to his Indian roots. With over 1,000 hours of Yoga Alliance Teacher Training, he shares his knowledge with the community.

More about Manish →
Registered Experienced Yoga Teacher, E-RYT 500

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