Mindful Chair Yoga (MCY) is a mind–body intervention designed for individuals with Parkinson's disease (PD). 1 This pilot study evaluated an 8‐week, telehealth‐delivered MCY program—consisting of twice‐weekly online sessions (60 min each) integrating seated joint‐release exercises, breathing techniques, and body‐scan meditation—on motor, cognitive, and affective outcomes in patients with mild‐to‐moderate PD. Sixteen patients completed the program. Outcomes were assessed pre‐ and post‐intervention by a movement disorders neurologist blinded to the intervention status, using validated clinical scales (Supplement 1).
Improvements were observed across multiple domains. Motor performance, as measured by MDS‐UPDRS‐III scores, suggested significant reductions in both OFF (P = 0.048, d = −0.56) and ON (P = 0.0034, d = −0.87) states, indicating enhanced motor control. Fear of falling showed promising improvements (FES‐I: P = 0.0233, d = −0.63), supporting the potential impact of MCY on balance confidence. Though measures like UPDRS‐IV and FOGQ did not reach significance, the overall pattern supports a positive motor trend.
Cognitive assessments revealed modest yet meaningful changes. The Standardized Mini‐Mental State Examination (SMMSE) and phonemic fluency improved significantly (P = 0.0271 and P = 0.0285, respectively), while MoCA scores showed a trend (P = 0.0544). These findings highlight the capacity of mindfulness‐integrated practices to selectively enhance cognitive domains such as language and executive function, even over a short duration. In contrast, visuospatial and attentional domains remained largely unchanged.
Psychological well‐being improved notably. Depression scores on HDRS decreased substantially (Δ = −3.25, P = 0.0004, d = −1.13), with moderate improvements in anxiety (HAM‐A: P = 0.0113, d = −0.72). These emotional benefits are consistent with the stress‐reduction potential of mindfulness‐based therapies and align with findings from prior yoga studies in PD populations. 2 , 3 Quality of life (PDQ‐39) and overall nonmotor symptoms (NMSS) also improved significantly (P = 0.0025 and P = 0.0089, respectively), with notable effects in mood/cognition and sleep/fatigue domains (Table 1, Supplement 2).
TABLE 1.
Baseline demographic characteristics and changes in motor, cognitive, neuropsychiatric, and quality‐of‐life outcomes before and after an 8‐week Mindful Chair Yoga intervention in individuals with Parkinson's disease. Values represent means unless otherwise indicated. Pre–post differences were analyzed using paired‐sample t‐tests or non‐parametric equivalents. Effect sizes are expressed as Cohen's d
| Measures | Pre‐mean | Post mean | Mean difference | Cohen's d | P‐value |
|---|---|---|---|---|---|
| Demographics | |||||
| Age (years), mean ± SD | 62.7 ± 12.2 | ‐ | ‐ | ‐ | ‐ |
| Gender (F/M) | 7 / 9 | ‐ | ‐ | ‐ | ‐ |
| Symptom onset side (R/L/Bilat) | 11/4 / 1 | ‐ | ‐ | ‐ | ‐ |
| Disease duration (median, mean ± SD) | 2 (4.6 ± 7.2) years | ‐ | ‐ | ‐ | ‐ |
| Disease subtype (TD/AR) | 12 / 4 | ‐ | ‐ | ‐ | ‐ |
| Comprehensive Clinical Outcomes | |||||
| SMMSE | 25.12 | 25.62 | 0.50 | 0.612 | 0.0271 |
| MoCA | 23.69 | 24.06 | 0.38 | 0.522 | 0.0544 |
| Stroop reaction time | 35.36 ± 9.91 | 34.14 ± 10.41 | −1.22 | −0.24 | 0.3846 |
| Stroop error | 5.29 ± 2.43 | 5.00 ± 2.29 | −0.29 | −0.25 | 0.3649 |
| Stroop correction | 3.71 ± 1.68 | 3.79 ± 1.37 | 0.07 | 0.08 | 0.7753 |
| Phonemic fluency | 3.44 ± 1.41 | 3.81 ± 1.33 | 0.38 | 0.61 | 0.0285 |
| Semantic fluency | 4.50 ± 1.26 | 4.88 ± 1.26 | 0.38 | 0.37 | 0.1639 |
| Visual–spatial | 16.25 ± 15.70 | 16.88 ± 16.21 | 0.62 | 0.11 | 0.6667 |
| MDS‐UPDRS‐1 | 7.75 | 8.44 | 0.69 | 0.187 | 0.4668 |
| MDS‐UPDRS‐2 | 6.12 | 5.94 | −0.19 | −0.109 | 0.6692 |
| MDS‐UPDRS‐3‐OFF | 16.87 | 15.67 | −1.20 | −0.56 | 0.048 |
| MDS‐UPDRS‐3‐ON | 12.44 | 11.75 | −0.69 | −0.867 | 0.0034 |
| MDS‐UPDRS‐4 | 0.94 | 0.69 | −0.25 | −0.25 | 0.3332 |
| FOGQ | 2.88 | 2.44 | −0.44 | −0.4 | 0.1304 |
| FES‐I | 22.88 | 19.81 | −3.06 | −0.631 | 0.0233 |
| VHI | 13.0 | 12.38 | −0.62 | −0.497 | 0.0655 |
| NMSS | 25.94 | 23.12 | −2.81 | −0.751 | 0.0089 |
| HAM‐A | 12.94 | 11.69 | −1.25 | −0.722 | 0.0113 |
| HDRS | 27.06 | 23.81 | −3.25 | −1.126 | 0.0004 |
| PDQ‐39 | 31.75 | 30.44 | −1.31 | −0.907 | 0.0025 |
Abbreviations: SD, standard deviation; TD, tremor‐dominant; AR, akinetic‐rigid; SMMSE, Standardized Mini‐Mental State Examination; MoCA, Montreal Cognitive Assessment; MDS‐UPDRS, Movement Disorder Society–Unified Parkinson's Disease Rating Scale; FOGQ, Freezing of Gait Questionnaire; FES‐I, Falls Efficacy Scale–International; VHI, Voice Handicap Index; NMSS, Non‐Motor Symptoms Scale; HAM‐A, Hamilton Anxiety Rating Scale; HDRS, Hamilton Depression Rating Scale; PDQ‐39, Parkinson's Disease Questionnaire‐39; Pre/Post Mean, pre−/post‐intervention mean values; Cohen's d, standardized effect size.
This study's telehealth model enhances its translational relevance, demonstrating feasibility, safety, and high adherence (mean attendance: 88%). The absence of adverse events supports the tolerability of MCY, particularly in patients with mobility limitations.
The most significant limitation of this study is the absence of a control group, which substantially restricts the ability to attribute the observed changes directly to the intervention. In addition, the small sample size limits the generalizability of the results. None of the participants had prior yoga or mindfulness experience, which may have influenced the magnitude of the observed improvements and should be considered when interpreting these findings. While several changes reached statistical significance, they did not meet established thresholds for clinical significance, 4 and further research is warranted to confirm their practical relevance. Even with these limitations, the observed improvements in motor, cognitive, and affective domains provide encouraging evidence for MCY as a holistic adjunctive therapy in PD management. Future studies should include larger sample sizes, a standardized MCY protocol, and longer intervention durations to optimize outcomes.
This study contributes novel evidence regarding selective cognitive and emotional benefits of tele‐yoga in PD and highlights its potential as an accessible, multidomain intervention. 5
Author Roles
(1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical analysis: A. Design, B. Execution, C. Review and critique; (3) Manuscript preparation: A. Writing of the first draft, B. Review and critique.
H.O.: 1A, 1B, 1C, 3A, 3B.
A.O.: 1A, 2A, 1B.
A.C.U.: 1C, 2B.
M.Y.:1B, 1C.
C.B.: 1B, 1C.
H.T.: 1A, 1B, 1C.
Z.Y.: 1A, 1B, 1C.
S.C.: 1A, 1B, 1C, 3B.
I.M: 1A, 1B, 1C, 3A, 3B.
Disclosures
Ethical Compliance Statement: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. The study was approved by the Ankara Etlik City Hospital Clinical Research Ethics Committee (approval number: AEŞH‐BADEK‐2024‐62, date: February 2, 2024), and all participants provided written informed consent.
Funding Sources and Conflicts of interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. The authors would like to thank Genveon Pharmaceuticals for providing technical support during the administration of the tele‐Yoga program.
Financial Disclosures for the previous 12 months: The authors declare that there are no additional disclosures to report.
Supporting information
Supplement S1. Full Methods Section.
Supplement S2. Alterations in the subitems of the Non‐motor symptom scale (NMSS) scores after Yoga therapy.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplement S1. Full Methods Section.
Supplement S2. Alterations in the subitems of the Non‐motor symptom scale (NMSS) scores after Yoga therapy.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.