This study reports the 15th year follow-up of a previously reported monocentric, randomized controlled trial comparing the effectiveness of yoga vs. conventional exercise-based cardiac rehabilitation (CR) on mortality and major adverse cardiovascular outcomes in middle-aged, male patients who underwent coronary artery bypass graft surgery (CABG). Three hundred male patients, aged 53.32 (SD, 6.72) years, were recruited for CABG at Narayana Institute of Cardiac Sciences, India, in 2005, followed by random assignment into a yoga-based cardiac rehabilitation program (YCRP) or conventional exercise-based cardiac rehabilitation program (CCRP). This legacy study reports the extended follow-up outcomes for all-cause mortality and cardiovascular events for a median of 14·14 years (IQR 13.82-14.47) since randomisation in 2005. The YCRP group received lectures on yoga philosophy combined with sequential phase-wise administration of yoga modules suited for their pre-and post-operative health status with gradual phase-wise addition of physical postures to initially administered relaxation-based techniques, under continued home-based practice model monitored telephonically until 12 months post-surgery related discharge from the hospital. The CCRP group received conventional exercise-based cardiac rehabilitation with similar phase-wise administration. Both study groups were under continued outpatient department-based care with 6 monthly review sessions until 2020. The exploratory follow-up outcomes [the all-cause mortality, and the major adverse cardiac events (MACE)] were analyzed using an intention-to-treat approach comparing the initially randomized study groups. MACE was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke. The study staff determined the occurrence of death from the medical records or telephonic calls and ascertained it by matching and identifying information reported by participants/or their family members. The Cox proportional hazard estimates and Kaplan-Meier Curve with Log-rank test estimates were used to compare the mortality and MACE outcomes between the study groups. Participants of the YCRP group exhibited significantly reduced risk of all-cause mortality [HR = 0.41 (95% CI = 0.16-0.91, P = 0.02)] and trends of reduction in MACE outcomes [HR = 0.57 (95% CI = 0·30-1.04, P = 0.065)] compared to the CCRP. No significant interaction effects were observed between the intervention and the baseline covariates, such as age, ejection fraction values, or presence of comorbidities. This first-ever long-term follow-up established the survival advantage of the YCRP over CCRP for patients who underwent coronary artery bypass graft surgery (CABG). The results support the utility of yoga-based CR as an alternative to CCRP in low-resource settings.

Depression is a severe heterogeneous mental illness that is highly co-morbid with other mental and somatic disorders. It poses a significant healthcare burden on both individuals and society. Currently, the use of single-target antidepressants exhibits suboptimal efficacy with significant adverse effects. Acupuncture has been advocated as a practical and effective treatment for depression, due to its low adverse effects rate compared to antidepressant medication. Currently, several studies have shown that acupuncture treatment for depression primarily involves multiple therapeutic mechanisms, including the regulation of specific gene expression, neuropeptide and neurotransmitter release, increasing the expression of neurotrophic factors, suppressing hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, attenuating inflammatory responses, and restoring gut microbiota balance. These therapeutic effects involve the regulation of critical signaling pathways, including the cAMP-responsive element binding protein (CREB) signaling pathway, mitogen-activated protein kinases (MAPK) signaling pathway, mechanistic target of rapamycin (mTOR) signaling pathway, and toll-like receptors (TLR) signaling pathway. Notably, depression-associated molecular mechanisms and signaling pathway dysregulations are closely linked to impaired neural and synaptic plasticity. Acupuncture synergistically modulates the neuro-immune-microbiome multidimensional network and integrates crosstalk among key pathways such as CREB, thereby systemically restoring synaptic plasticity. This multi-dimensional integrative mechanism likely underlies its therapeutic superiority over single-target antidepressants. This review aims to elucidate how acupuncture restores cerebral synaptic plasticity by rectifying depression-related systemic dysfunctions and signaling pathway abnormalities, which will advance our understanding of its regulatory potential in depression treatment and inform the development of precision therapeutic strategies.

The globus pallidus plays a pivotal role in the basal ganglia circuit. Parkinson's disease is characterized by degeneration of dopamine-producing cells in the substantia nigra, which leads to dopamine deficiency in the brain that subsequently manifests as various motor and non-motor symptoms. This review aims to summarize the involvement of the globus pallidus in both motor and non-motor manifestations of Parkinson's disease. The firing activities of parvalbumin neurons in the medial globus pallidus, including both the firing rate and pattern, exhibit strong correlations with the bradykinesia and rigidity associated with Parkinson's disease. Increased beta oscillations, which are highly correlated with bradykinesia and rigidity, are regulated by the lateral globus pallidus. Furthermore, bradykinesia and rigidity are strongly linked to the loss of dopaminergic projections within the cortical-basal ganglia-thalamocortical loop. Resting tremors are attributed to the transmission of pathological signals from the basal ganglia through the motor cortex to the cerebellum-ventral intermediate nucleus circuit. The cortico-striato-pallidal loop is responsible for mediating pallidi-associated sleep disorders. Medication and deep brain stimulation are the primary therapeutic strategies addressing the globus pallidus in Parkinson's disease. Medication is the primary treatment for motor symptoms in the early stages of Parkinson's disease, while deep brain stimulation has been clinically proven to be effective in alleviating symptoms in patients with advanced Parkinson's disease, particularly for the movement disorders caused by levodopa. Deep brain stimulation targeting the globus pallidus internus can improve motor function in patients with tremor-dominant and non-tremor-dominant Parkinson's disease, while deep brain stimulation targeting the globus pallidus externus can alter the temporal pattern of neural activity throughout the basal ganglia-thalamus network. Therefore, the composition of the globus pallidus neurons, the neurotransmitters that act on them, their electrical activity, and the neural circuits they form can guide the search for new multi-target drugs to treat Parkinson's disease in clinical practice. Examining the potential intra-nuclear and neural circuit mechanisms of deep brain stimulation associated with the globus pallidus can facilitate the management of both motor and non-motor symptoms while minimizing the side effects caused by deep brain stimulation.

This systematic review assessed use of third-wave psychotherapies in reducing psychological distress and improving psychological well-being and quality of life in people with Parkinson's disease and critically evaluated intervention adaptations.

A literature search, conducted across five databases identified randomized controlled trials (RCTs) evaluating third-wave psychotherapies for individuals with Parkinson's disease.

Ten RCTs were identified of which nine evaluated mindfulness-based interventions, and one acceptance and commitment therapy. Methodological quality ranged from moderate to high, but sample sizes were small, and only one study was adequately powered. Five reported on Parkinson's specific adaptations. The trial with the largest sample size reported a significant effect of Mindfulness Yoga on depression and anxiety, psychological well-being and quality of life. Other findings were mixed across all outcomes.

There was evidence of an effect of Mindfulness Yoga on our pre-defined outcomes. Pilot and feasibility trials showed that mindfulness-based interventions were well received and provided feedback on adaptations. There was a lack of data to draw conclusions regarding non-mindfulness-based therapies.

Larger trials of mindfulness-based interventions are required to establish the clinical meaningfulness of treatment effects. Further research is needed to adapt and explore on non-mindfulness-based interventions such as acceptance and commitment therapy.

Neuropsychiatric symptoms in Parkinson's disease (PD) are highly prevalent and profoundly disabling, often emerging even before the onset of motor symptoms. As the disease progresses, these symptoms usually become increasingly impairing and are now recognized as having the greatest impact on quality of life not only for patients but also for caregivers. In recent years, there have been significant advances in the diagnosis and management of neuropsychiatric symptoms. However, there are still substantial gaps in therapeutic approaches and algorithms, with limited pharmacological and nonpharmacological treatment options currently available. One of the main reasons for this is the complex molecular and neural bases of these symptoms, which involve both dopaminergic and nondopaminergic neurotransmission systems and extend far beyond the nigrostriatal pathway. As a result, the drugs currently recommended for treating neuropsychiatric symptoms in PD are few and supported by limited evidence. In this context, the experience of the treating neurologist remains critical in selecting the most appropriate individualized therapy. The aim of this paper is to review the available therapeutic options and provide an overview of current research efforts, particularly those focusing on pharmacological treatments.

Neuropathic pain is a common health problem, often accompanied by anxiety. The amygdala plays a crucial role in emotional processing and the basolateral amygdala (BLA) and the central amygdala (CeA) are primary components of the amygdala. The c-Fos is considered indicative of neuronal activation. We studied whether BLA and CeA are activated and their internal activation when chronic neuralgia occurs.

The spared nerve injury (SNI) model was employed for this investigation. Mechanical paw withdrawal thresholds (PWTs) were utilized for assessing pain hypersensitivity, followed by observation of anxiety-like behaviors using the elevated plus maze test (EPMT) and the open field test (OFT). The c-Fos in BLA and CeA were measured by immunofluorescence staining.

We found that SNI mice exhibit pain hypersensitivity and anxiety-like behaviors. The expression of c-Fos in the BLA and CeA was upregulated in SNI mice. Besides, there were spatial differences in c-Fos expression between BLA and CeA.

The BLA and CeA showed activation in chronic pain and associated anxiety, and there were spatial differences in this activation. Targeting the amygdala may hold promise for treating chronic nerve pain with anxiety-like behaviors.

Multiparous women of advanced maternal age are more susceptible to psychological stress.

This study examined the impact of mindfulness yoga on psychological well-being (anxiety and sleep quality) and pregnancy outcomes (Apgar scores and adverse perinatal events) in aging multiparous women.

Participants meeting the criteria were randomly assigned to a control or a mindfulness yoga intervention group. The Chinese version of the Childbirth Attitudes Questionnaire, the Chinese version of the Pregnancy-Related Anxiety Questionnaire, and the Self-Rating Scale of Sleep were utilized to assess fear of childbirth, anxiety levels, and sleep quality, respectively. Maternal and neonatal outcomes, including vaginal delivery rates, labor analgesic use, duration of labor, postpartum bleeding volume, fetal anomaly rates, and Apgar scores, were analyzed.

A total of 148 multiparous women of advanced maternal age participated in the study. No significant differences in baseline characteristics were observed between the two groups. Participants in the mindfulness yoga group exhibited significantly lower scores on the C-CAQ, PRAQ, and SRSS scales compared to those in the control group. Additionally, higher vaginal delivery rates, reduced analgesic use, and shorter durations across all three stages of labor were observed in the mindfulness yoga group, contributing to an overall reduction in total labor duration. Neonatal outcomes demonstrated notable differences, with higher Apgar scores and lower incidences of adverse perinatal events in the mindfulness yoga group.

Engagement in mindfulness yoga during pregnancy may contribute to improved psychological well-being and enhanced pregnancy outcomes in older multiparous women.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms. The non-motor features may precede the onset of motor symptoms and occur throughout all stages of PD. The non-motor symptoms reflect multisystem involvement of the central and peripheral nervous systems, multiple neurotransmitters, and multiple pathologies. PD management necessitates a comprehensive approach to address non-motor symptoms, including pharmacologic and non-pharmacological interventions and often multiple different disciplines or specialists in the PD care team. This review article discusses symptoms and treatments for the non-motor symptoms of PD including those affecting mood, cognition, behavior, sleep, autonomic function, and sensory systems.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. While incurable, exercise has shown therapeutic benefits. Stretching, an accessible and low-cost modality, may improve mobility, balance, and flexibility, warranting systematic evaluation for managing PD symptoms. This systematic review aimed to examine and critically analyze scientific evidence on the effects of stretching in people with Parkinson's disease.

A search was conducted in four electronic databases (Scopus, Web of Science, PEDro, and MEDLINE/PubMed) from inception to November 2024. The methodological quality of included studies was assessed using the PEDro scale.

Twelve randomized controlled trials were analyzed. Stretching programs lasted 4 weeks to 6 months. Positive effects were observed in motor symptoms and functional mobility for people with PD, although these were generally less pronounced compared to interventions like Tai Chi or WuQinXi Qigong. In contrast, mixed results to no significant improvements were observed for balance, gait, strength, cardiorespiratory fitness, mental health, neurocognitive function, sleep quality, physical activity levels, and fatigue.

Stretching improves motor symptoms and mobility in people with PD, but its benefits for gait, motor function, and mental health are limited compared to other exercises. Further studies are needed to assess its impact on motor and neurocognitive functions.

To analyze the short-term (12-wk post-intervention) and long-term (6-month follow-up) effects of two exercise interventions (functional training or Mat Pilates) compared to a control group and a healthy reference group on non-motor symptoms in people with Parkinson's disease.

35 individuals with Parkinson's disease were randomized into three groups: functional training, Mat Pilates, and control group, along with 11 age- and sex-matched healthy individuals for the healthy reference group. The exercise groups received twice-weekly 60-min sessions for 12 wk. The control group and healthy reference group maintained routine activities and also received educational lectures during the 12-wk period. Outcome measures included cognition (MoCA), depressive symptoms (BDI), anxiety (BAI), mood (BRUMS), and aging perspective (Sheppard Inventory).

Short-term effects were observed for the functional training group in the short term for depressive symptoms (p = 0.010) and cognition (p = 0.040), and in the short and long term for anxiety (p = 0.007) and happiness (aging perspective) (p = 0.002). For the Mat Pilates group, effects were observed in cognition (p = 0.048) and confusion (p = 0.049) in the short term, and in depressive symptoms (p < 0.001), anxiety (p = 0.033), happiness (p < 0.001), and loneliness (aging perspective) (p = 0.017) in the short and long term. The control group showed worsening in depressive symptoms (p = 0.030) and confusion (p = 0.033).

Mat Pilates and functional training classes were effective in improving cognition, depressive symptoms, anxiety, and happiness. The control group and healthy reference group did not show significant effects in most studied variables. Both types of exercise can be recommended by professionals working with people with Parkinson's disease.

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Numerous studies have shown that yoga can aid patients with Parkinson's disease (PD) in managing their motor function, functional mobility, balance, anxiety, and overall quality of life. However, most of the reported research either needed more power or evaluated the results during or after the intervention. Due to the long-standing nature of PD, there are still few longitudinal studies investigating the potential of yoga to decrease the progression of the disease.

We study whether sustained adjunct yoga intervention slows PD progression.

Over 18 months, this study will investigate the long-term benefits of yoga-based intervention in Parkinson's patients. The concept of "intention-to-treat (ITT)" will be employed. From the outpatient clinic of the Swami Vivekananda Yoga Anusandhana Samsthana in India, 160 patients with PD will be chosen. They will then be randomly assigned to either the interventional or control groups (1:1). The adjunct intervention group will participate in 21 daily contact yoga sessions (60 min) at the University Medical Center, followed by continued tele-supervised home practice and at-home self-practice. The effectiveness of the adjunct intervention will be evaluated at four different time points (baseline, 3-, 9-, 12-, and 18-month post-randomization). The primary endpoint will be the difference in the Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part III score at baseline and after 18 months of intervention. Secondary outcomes will include subscores of MDS-UPDRS I, II, and IV, Parkinson's Disease Questionnaire (PDQ)-39 scores, treatment adherence, the PDQ-39, the Depression, Anxiety, and Stress Scale-21, and the Scales for Outcomes in PD-Sleep Scale (SCOPA-S). The primary outcome will be analyzed using mixed-effect models for repeated measures, adjusted for covariates as fixed effects.

The protocol was conceptualized in October 2021 and approved by the Institutional Ethics Committee of SVYASA. Recruitment began in February 2022 and is underway with patient enrollment.

To our knowledge, this is the first controlled study to examine the long-term effects of yoga as an adjuvant therapy on the progression of PD.

This would be the first long-term trial to assess the potential of an adjunct yoga intervention to modulate disease progression in early Parkinson's patients.

Parkinson's disease (PD) resting tremor is thought to be initiated in the basal ganglia and amplified in the cerebello-thalamo-cortical circuit. Because stress worsens tremor, the noradrenergic system may play a role in amplifying tremor. We tested if and how propranolol, a non-selective beta-adrenergic receptor antagonist, reduces PD tremor and whether or not this effect is specific to stressful conditions.

In a cross-over, double-blind intervention study, participants with PD resting tremor received propranolol (40 mg, single dose) or placebo (counter-balanced) on 2 different days. During both days, we assessed tremor severity (with accelerometry) and tremor-related brain activity (with functional magnetic resonance imaging), as well as heart rate and pupil diameter, while subjects performed a stressful cognitive load task that has been linked to the noradrenergic system. We tested for effects of drug (propranolol vs placebo) and stress (cognitive load vs rest) on tremor power and tremor-related brain activity.

We included 27 PD patients with prominent resting tremor. Tremor power significantly increased during cognitive load versus rest (F[1,19] = 13.8; p = 0.001;η p 2  = 0.42) and decreased by propranolol versus placebo (F[1,19] = 6.4; p = 0.02;η p 2  = 0.25), but there was no interaction. We observed task-related brain activity in a stress-sensitive cognitive control network and tremor power-related activity in the cerebello-thalamo-cortical circuit. Propranolol significantly reduced tremor-related activity in the motor cortex compared to placebo (F[1,21] = 5.3; p = 0.03;η p 2  = 0.20), irrespective of cognitive load.

Our findings indicate that propranolol has a general, context-independent, tremor-reducing effect that may be implemented at the level of the primary motor cortex. ANN NEUROL 2025;97:741-752.

Objective: To assess the effectiveness of randomized clinical trials that utilized dance and yoga as interventions for individuals with Parkinson's disease in relation to anxiety, self-esteem, cognition, depressive symptoms, and fecal and urinary incontinence. Method: Five databases (Embase, PubMed, ScienceDirect, Scopus, and Web of Science) were consulted following PRISMA guidelines and registered in PROSPERO. Results: Seven studies were included in the meta-analysis, showing low risk of bias and high heterogeneity (I2 = 91%; p < .001). Yoga was effective for anxiety (I2 = 97%; p < .001) and dance showed positive effects on cognition, albeit with high variability (I2 = 90%; p < .001). Both interventions were beneficial for depressive symptoms (I2 = 75%; p < .001). Conclusion: Dance and yoga are promising interventions for anxiety and depressive symptoms in Parkinson's disease patients. Record: Prospero CRD42024533561.

This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on depressive symptoms in stroke patients.

Following PRISMA guidelines, We conducted searches in PubMed, Embase, CENTRAL, and Web of Science. The topic was the effect of exercise on depression levels in stroke patients. Patient's performance on depression scales after exercise was assessed using standardized mean difference (SMD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups conducted based on adherence to ACSM guidelines and the length of exercise interventions.

The analysis included 24 randomized controlled trials (RCTs) involving 1,757 participants. The meta-analysis revealed that exercise interventions had a significant positive effect on reducing depressive symptoms in stroke patients, with a standardized mean difference (SMD) of -0.43 (95% CI: 0.65, -0.21). Subgroup analysis indicated that high compliance with ACSM guidelines resulted in a more substantial reduction in depressive symptoms (SMD = -0.79, 95% CI: 1.10, -0.49), compared with low or uncertain compliance (SMD = -0.03, 95% CI: 0.16, 0.10). Longer exercise intervention was associated with greater mitigation of depressive symptoms. The differences between intervention groups of different lengths were statistically significant (p < 0.05).

These findings support the integration of tailored exercise programs into post-stroke care to optimize mental health outcomes. Compliance to ACSM-recommended exercise dosages significantly ameliorate depression levels in stroke patients. Further research is warranted to explore standardized exercise regimens in larger, multicenter trials.

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier PROSPERO(CRD42024579095).

Depression is a common comorbidity in Parkinson's disease (PD), significantly reducing patients' quality of life. This mini-review examines pharmacological and nonpharmacological therapies for managing depression in PD, analyzing their benefits, and limitations. Pharmacological options include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), levodopa, dopaminergic agonists, and monoamine oxidase B inhibitors. Nonpharmacological strategies involve brief psychodynamic therapy, cognitive-behavioral therapy (CBT), physical exercise, phytomedicine, massage therapy, music therapy, phototherapy, yoga, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, electroconvulsive therapy (ECT), and deep brain stimulation. SSRIs, SNRIs, and some dopamine agonists have shown effectiveness and good tolerability, especially when combined with CBT or rTMS. For severe or refractory cases, ECT remains a viable option. Although many of these therapies show promise, the limited number and scale of studies for each treatment restrict the strength of current evidence. Further large-scale, multicenter randomized-controlled trials are essential to validate these preliminary findings and establish evidence-based guidelines. In addition, the potential benefits of social support and brief psychodynamic therapy in the context of PD-related depression require further exploration to provide holistic care strategies for this population.

The health benefits of exercise have been well-established, but the specific role of yoga in multimorbidity was less understood. This study aimed to examine the association between yoga and multimorbidity in comparison with other exercises or non-exercise.

This cross-sectional study pooled nationally representative surveys from Behavioral Risk Factor Surveillance System (BRFSS) (2015, 2017, and 2019), and classified 279,885 participants aged 45 + years as yoga practitioners, other exercisers, and non-exercisers. Multinominal and binary logistic regressions were separately used for association of yoga with multimorbidity (coexistence of ≥ 2 conditions) and individual chronic conditions. Potential effect modification by age, sex, education level, and race/ethnicity was examined. We further assessed the dose-response association of duration and frequency of yoga practice with multimorbidity.

The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for yoga practitioners (n = 5081) vs. other exercisers (n = 192,718) were 0.69 (95% CI 0.55-0.86) for coexistence of two conditions, and 0.72 (95%CI 0.58-0.89) for coexistence of ≥ 3 conditions. The associations were stronger (ORs ranged from 0.43 to 0.52; P < 0.0001 for all) when comparing yoga practitioners with non-exercisers (n = 82,086), which were more pronounced in women relative to men (P-interaction < 0.05). Increased duration or frequency of yoga practice was associated with lower odds of multimorbidity in a dose-response manner (P for trend<0.0001 for all). Similar inverse associations were observed between yoga and individual chronic conditions.

Yoga was associated with lower odds of multimorbidity in middle-aged and older adults, relative to other exercises or non-exercise.

Monoamine oxidase-B (MAO-B) inhibitors, as an add-on therapy to levodopa, are widely used in Parkinson's disease (PD). The effects of MAO-B inhibitors on quality of life remain unclear, and the aim of this systematic review and meta-analysis was to assess the efficacy and safety of MAO-B inhibitors on quality of life in different domains.

We searched PubMed, Embass, and Cochrane Library databases for randomized controlled trials of PD patients who were administered MAO-B inhibitors. Outcomes were the change from baseline in the total score of life quality scales, change from baseline in domains of the Parkinson's Disease Questionnaire-39 (PDQ-39), and incidence of treatment-associated adverse events (TAEs).

Sixteen studies covering 4734 PD patients were included in the study. The PDQ-39 scores were lower with MAO-B inhibitors than with placebo (SMD: -0.26, 95 % CI: [-0.49, -0.04], P = 0.02). The European Quality of Life Questionnaire-5D (EQ-5D) scores were higher in the MAO-B inhibitor group. Patients treated with MAO-B inhibitors had better performance in the domains of mobility, activities of daily living, emotional well-being, stigma, communication, and bodily discomfort, except for social support and cognition. The incidence of TAEs was slightly higher in patients treated with MAO-B inhibitors.

Evidence has shown that MAO-B inhibitors, especially safinamide, are effective in improving the quality of life of PD patients, although with a slightly higher incidence of TAEs. The domains of quality of life were improved, except for cognition and social support, compared with placebo. Further studies are warranted to evaluate the effects of other MAO-B inhibitors on quality of life.

Exercise is a widely recognized non-pharmacological treatment for Parkinson's Disease (PD). The bidirectional regulation between the brain and peripheral organs has emerged as a promising area of research, with the mechanisms by which exercise impacts PD closely linked to the interplay between peripheral signals and the central nervous system.

This review aims to summarize the mechanisms by which exercise influences peripheral-central crosstalk to improve PD, discuss the molecular processes mediating these interactions, elucidate the pathways through which exercise may modulate PD pathophysiology, and identify directions for future research.

This review examines how exercise-induced cytokine release promotes neuroprotection in PD. It discusses how exercise can stimulate cytokine secretion through various pathways, including the gut-brain, muscle-brain, liver-brain, adipose-brain, and bone-brain axes, thereby alleviating PD symptoms. Additionally, the potential contributions of the heart-brain, lung-brain, and spleen-brain axes, as well as multi-axis crosstalk-such as the brain-gut-muscle and brain-gut-bone axes-are explored in the context of exercise therapy. The study highlights the need for further research into peripheral-central crosstalk and outlines future directions to address challenges in clinical PD therapy.

Yoga is a therapeutic practice renowned for its multifaceted benefits across the body's systems. Its positive impact spans the physical, mental and emotional realms, fostering harmony and well-being. Through a combination of postures, breathing techniques and meditation, yoga offers profound effects, enhancing flexibility, strength and balance while simultaneously promoting relaxation and reducing stress. This integrative approach not only cultivates physical resilience but also supports mental clarity, emotional balance and overall vitality, showcasing yoga as a comprehensive and impactful system for holistic health. The review delved into the multifaceted ways in which yoga exerts a positive influence on the body's various systems. It highlights how yoga serves as a beneficial tool in addressing and counteracting the underlying factors associated with different diseases. By examining yoga's effects on these systems and its potential in combating illness, the paper sheds light on the comprehensive therapeutic benefits that yoga offers. Please cite this article as: Pandey S, Pandey AC, Kotecha VR. Yoga-A complementary and traditional medicine for human health. J Integr Med. 2025; 23(2): 93-105.

Clinical guidelines recommend a holistic approach to Parkinson's disease (PD) care, yet randomized trials examining mindfulness-based interventions in this context are scarce. This study investigated the effects of two mindfulness practices - meditation and yoga - on biopsychosocial outcomes in PD patients, including anxiety symptoms, depressive symptoms, motor/nonmotor symptoms, health-related quality-of-life (HRQOL), mindfulness, and stress and inflammation biomarkers, compared to usual care.

159 participants with a clinical diagnosis of idiopathic PD and a Hoehn and Yahr stage of 1, 2, and 3, were randomized into meditation (n = 53), yoga (n = 52), and control (n = 54). Meditation and yoga were delivered in 90-min groups for 8 weeks. Primary outcomes included anxiety symptoms and depressive symptoms. Secondary outcomes included motor and nonmotor symptoms, HRQOL, mindfulness, and serum levels of interleukin-6, cortisol and TNF-alpha. Assessments were done at baseline (T0), 2 months (T1), and 6 months (T2). Linear mixed models were conducted following intention-to-treat principle.

Compared to control, both meditation, and yoga groups had significant improvements in anxiety symptoms (meditation: mean difference [MD] = -1.36, 95% CI: -2.46 to-0.26; yoga: MD = -1.61, CI: -2.70 to -0.52), motor symptoms (meditation: MD = -5.35, CI: -8.61 to-2.09; yoga: MD = -6.59, CI: -9.82 to-3.36), HRQOL (meditation: MD = -2.01, CI: -3.41 to-0.62; yoga: MD = -1.45, CI: -2.83 to-0.08), and describing skills (meditation: MD = 0.97, CI: 0.04-1.89; yoga: MD = 0.92, CI: 0.01-1.84) at T1, and significant reductions in serum interleukin-6 levels (meditation: MD = -1.14, CI: -2.18 to-0.10; yoga: MD = -1.11, CI: -2.09 to-0.13) at T2. Only meditation significantly reduced depression (MD = -1.44, CI: -2.57 to-0.30) at T1 and sustained the motor and HRQOL improvements at T2.

Meditation and yoga significantly improved anxiety symptoms, chronic inflammation, motor symptoms, mindfulness-describing facet, and HRQOL in PD patients. Meditation provided additional benefits in reducing depressive symptoms and sustaining motor and HRQOL improvements.

Clinical guidelines recommend a holistic approach to Parkinson's disease (PD) care, yet randomized trials examining mindfulness-based interventions in this context are scarce. This study investigated the effects of two mindfulness practices - meditation and yoga - on biopsychosocial outcomes in PD patients, including anxiety symptoms, depressive symptoms, motor/nonmotor symptoms, health-related quality-of-life (HRQOL), mindfulness, and stress and inflammation biomarkers, compared to usual care.

159 participants with a clinical diagnosis of idiopathic PD and a Hoehn and Yahr stage of 1, 2, and 3, were randomized into meditation (n = 53), yoga (n = 52), and control (n = 54). Meditation and yoga were delivered in 90-min groups for 8 weeks. Primary outcomes included anxiety symptoms and depressive symptoms. Secondary outcomes included motor and nonmotor symptoms, HRQOL, mindfulness, and serum levels of interleukin-6, cortisol and TNF-alpha. Assessments were done at baseline (T0), 2 months (T1), and 6 months (T2). Linear mixed models were conducted following intention-to-treat principle.

Compared to control, both meditation, and yoga groups had significant improvements in anxiety symptoms (meditation: mean difference [MD] = -1.36, 95% CI: -2.46 to-0.26; yoga: MD = -1.61, CI: -2.70 to -0.52), motor symptoms (meditation: MD = -5.35, CI: -8.61 to-2.09; yoga: MD = -6.59, CI: -9.82 to-3.36), HRQOL (meditation: MD = -2.01, CI: -3.41 to-0.62; yoga: MD = -1.45, CI: -2.83 to-0.08), and describing skills (meditation: MD = 0.97, CI: 0.04-1.89; yoga: MD = 0.92, CI: 0.01-1.84) at T1, and significant reductions in serum interleukin-6 levels (meditation: MD = -1.14, CI: -2.18 to-0.10; yoga: MD = -1.11, CI: -2.09 to-0.13) at T2. Only meditation significantly reduced depression (MD = -1.44, CI: -2.57 to-0.30) at T1 and sustained the motor and HRQOL improvements at T2.

Meditation and yoga significantly improved anxiety symptoms, chronic inflammation, motor symptoms, mindfulness-describing facet, and HRQOL in PD patients. Meditation provided additional benefits in reducing depressive symptoms and sustaining motor and HRQOL improvements.

Conventional medical management, while essential, cannot address all multifaceted consequences of Parkinson's disease (PD). This pilot study explores the potential of a co-designed creative arts therapy on health-related quality of life, well-being, and pertinent non-motor symptoms.

We conducted an exploratory pilot study with a pre-post design using validated questionnaires. Eight individuals with PD participated in the program. The investigated intervention was a 10-week creative arts therapy with weekly 90-120-min sessions, guided by three creative therapists. Participants were allowed to autonomously select from multiple creative media based on their personal preferences. Explored co-primary outcomes included health-related quality of life (PDQ-39), well-being (ICECAP-A), anxiety/depression (HADS), executive functioning (BRIEF-A), resilience/mental flexibility (FIT-60), and self-efficacy (GSES). We used paired sample t tests for pre-post analysis of the co-primary outcomes and Wilcoxon signed-rank tests for PDQ-39 sub-scores. We also included aesthetic responsiveness (AReA) and healthcare consumption (IMCQ adapted for PD) questionnaires reported as descriptive statistics.

The results showed a significant reduction in anxiety and an increase in well-being. We also observed a slight improvement in cognitive functioning. Finally, we noted a reduction in healthcare consumption (fewer visits at neurologists, specialized PD nurses, and allied healthcare professionals).

These findings cautiously suggest that our co-designed, multi-media creative arts therapy has the potential to increase well-being and reduce anxiety, while reducing healthcare consumption. These preliminary findings support the need for a larger, randomized controlled trial to explore the therapeutic potential of creative arts therapy in PD care.

Physical exercise effectively prevents anxiety disorders caused by environmental stress. The neural circuitry mechanism, however, remains incomplete. Here, we identified a previously unrecognized pathway originating from the primary motor cortex (M1) to medial prefrontal cortex (mPFC) via the ventromedial thalamic (VM) nuclei in male mice. Besides anatomical evidence, both ex vivo and in vivo recordings showed enhanced excitability of M1-VM inputs to the prelimbic (PrL) region of mPFC upon 14-day treadmill exercise on a chronic restraint stress (CRS) mouse model. Further functional interrogations demonstrated that the activation of this neural circuit is both necessary and sufficient to direct the anxiolytic effect of exercise training in CRS mice. Our findings provide more insights into the neural circuits connecting motor and mental regions under exercise paradigm and implicate potential targets for neuromodulation in treating anxiety disorders.

We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD).

We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation.

The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004).

Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability.

CTRI/2019/02/017564.

This study aimed to adapt, validate, and evaluate the feasibility of a mindful exercise program (Mindful Standing Yoga combined with Baduanjin) for older patients with primary osteoporosis.

The study was conducted in 3 stages. Stage 1 involved a qualitative focus group discussion with 6 experts to gather perspectives on modifying the exercise program. Stage 2 used a Delphi approach with another 6 experts to validate the program. In Stage 3, a feasibility study was conducted with 20 eligible patients (out of 23 initially enrolled) at a traditional Chinese medicine hospital, using a single-group pre- and posttest design. The strenuousness of the adapted exercise was assessed through heart rate (HR) and rating of perceived exertion (RPE). Its effects were measured using the Global Pain Scale (GPS), the Five Facets Mindfulness Questionnaire-Short Form (FFMQ-SF), the Tampa Kinesiophobia-11 Scale, and the Timed Up and Go test. Patient satisfaction and feedback were also collected.

The modified program, consisting of 9 movements and taking 30 min to complete, was validated by experts as suitable, safe, and effective for practice. HR and RPE measurements confirmed it as a low-intensity exercise and not strenuous for the study population. The program significantly improved back pain and mindfulness in the feasibility study, with most participants expressing satisfaction with the protocol.

Experts and participants affirmed that the program was appropriate and satisfactory for older patients with primary osteoporosis, particularly those with back pain. Further high-quality randomized controlled trials are needed to validate its effectiveness.

Grounded in the theory of planned behavior (TPB), this study evaluated the effectiveness of a yoga program intervention on the physical functioning and mental health in older adults.

This was a quasi-experimental two-group, pre- and posttest, single-blind study. The participants were older adults above 65 years of age and in the early stage of frailty. The intervention for the experimental group was a twice weekly 60-min yoga session for 12 weeks; the control group received physical activity lectures in the 1st and 8th weeks. Pretest is conducted before the intervention, posttest one is conducted in the 8th week, and posttest two is conducted in the 12th week. Outcome indicators include physical activity level, body balance, flexibility, lower limb muscle strength, mental health (Brief Symptom Rating Scale [BSRS]), exercise behavior questionnaire, etc.

After 12-week silver yoga intervention, there were 31 participants in the experimental group with a loss of 9% (29% loss rate), whereas there were 29 participants in the control group with a loss of 6% (20% loss rate). Results from generalized estimating equations that grip strength index (P = 0.000), right lower limb muscle strength (P = 0.000), left lower limb muscle strength (P = 0.000) were significant between groups for both experimental and control groups, whereas other outcome indicators such as physical activity level, balance, flexibility, and mental health were not significant between groups. However, experimental within-group mean differences at week 12 for grip strength (P = 0.000), BSRS (P = 0.016), physical activity level (P = 0.000), right lower limb muscle strength (P = 0.000), left lower limb muscle strength (P = 0.000), simple physical function assessment (P = 0.000), single-leg standing (P = 0.000), upper limb flexibility (P = 0.000), lower limb flexibility (P = 0.000), exercise behavior evaluation attitude (P = 0.000), and exercise behavior evaluation perceived behavioral control (P = 0.000) were all significant.

This study uses Ajzen's TPB as a basis to explore the behavioral intention after silver yoga intervention. This theory believes that an individual's specific behavior is affected by his or her behavioral intention, and the behavioral intention depends on the actor's attitude and subjective attitude toward the behavior. Norms perceived behavioral control. The research results show that yoga intervention attitude has the highest impact on behavioral intention, followed by perceived behavioral control and finally subjective norms. The experimental group has changed their attitudes and cognitions to increase their behavioral intentions. They have a deeper understanding of yoga asanas. They have broken through the difficult limb bending and kneeling postures seen in the past, which has increased their participation in yoga activities and confidence in their perceived behaviors. It also enhances behavioral intention, which means that the attitude and personal behavior of the research subjects after the intervention increase the elder's exercise intention, making the elder more clearly aware that yoga asanas are competent, thereby increasing the regularity of activity participation.

Exercise can effectively prevent and treat depression and anxiety, with gut microbiota playing a crucial role in this process. Studies have shown that exercise can influence the diversity and composition of gut microbiota, which in turn affects depression through immune, endocrine, and neural pathways in the gut-brain axis. The effectiveness of exercise varies based on its type, intensity, and duration, largely due to the different changes in gut microbiota. This article summarizes the possible mechanisms by which exercise affects gut microbiota and how gut microbiota influences depression. Additionally, we reviewed literature on the effects of exercise on depression at different intensities, types, and durations to provide a reference for future exercise-based therapies for depression.

The escalating global prevalence of type 2 diabetes mellitus (T2DM) and mental disorder (MD) including schizophrenia, bipolar disorder, major depressive disorder, and anxiety highlights the urgency for comprehensive therapeutic strategies. Aerobic exercise (AE) is a viable adjunct therapy, providing significant benefits for individuals dealing with both T2DM and MD. This review consolidates evidence on AE's role in alleviating the physiological and psychological effects of these comorbid conditions. It delves into the pathophysiological connections between T2DM and various MD, including depression, schizophrenia, anxiety, and bipolar disorder-emphasizing their reciprocal exacerbation. Key neurophysiological mechanisms through which AE confers benefits are explored, including neuroinflammation modulation, brain structure and neuroplasticity enhancement, growth factor expression regulation, and hypothalamic-pituitary-adrenal (HPA)/microbiota-gut-brain (MGB) axis normalization. Clinical results indicate that AE significantly improves both metabolic and psychological parameters in patients with T2DM and MD, providing a substantial argument for integrating AE into comprehensive treatment plans. Future research should aim to establish detailed, personalized exercise prescriptions and explore the long-term benefits of AE in this population. This review underscores the potential of AE to complement existing therapeutic modalities and enhance the management of patients with T2DM and MD.

Background: Reduced brain-derived neurotrophic factor (BDNF) levels have been linked to increased depression risk. While physical exercise is known to alleviate depressive symptoms and elevate BDNF levels, the effects of different exercise modalities and doses, along with their dose-response relationships, remain unclear. Objective: This study aims to systematically evaluate the effects of various exercise types and doses on BDNF levels in patients with depression through pairwise meta-analysis, network meta-analysis (NMA), and dose-response NMA and to provide personalized exercise prescription recommendations. Methods: A comprehensive search identified randomized controlled trials (RCTs) examining exercise's impact on BDNF levels in depression. Pairwise and NMA compared six exercise modalities: continuous aerobic exercise (CAE), resistance exercise (RE), combined aerobic and resistance exercise (AERE), yoga, Qigong, and mindfulness. Dose-response NMA was used to assess the relationships between exercise dose and BDNF levels. Results: Thirty-six RCTs with 2515 participants were included. The pairwise meta-analysis indicated that all exercise interventions significantly elevated BDNF levels in patients with depression, with AERE, RE, and yoga demonstrating the most substantial effects. NMA rankings suggested that AERE was the most effective intervention, followed by RE, yoga, Qigong, mindfulness, and CAE. Dose-response NMA revealed a positive nonlinear dose-response relationship between total exercise volume and BDNF levels, with an optimal effective dose identified at ~610 METs-min/week. Beyond 1000 metabolic equivalent of tasks (METs)-min/week, increases in BDNF levels appeared to plateau. Moreover, each exercise type had distinct dose-response patterns, with RE and AERE having relatively higher optimal effective dose ranges, while CAE, yoga, Qigong, and mindfulness exhibited lower optimal ranges. Conclusions: AERE, RE, and yoga are effective interventions for enhancing BDNF levels in patients with depression, with Qigong, mindfulness, and CAE being comparatively less effective. A positive nonlinear dose-response relationship between exercise volume and BDNF levels was observed. Further research is needed to refine dose-response relationships in this population.

Parkinson's disease is a neurodegenerative disorder that presents with motor symptoms such as tremors, slowness and gait difficulties, in addition to various non-motor symptoms such as anxiety, depression and autonomic and sleep disturbances. Pranayama (yogic breathing practices) has been studied as a part of yoga interventions in Parkinson's disease. Previous systematic reviews and meta-analyses have not detailed the pranayama practices used in clinical studies, and there is no clarity on the pranayama practices that would be most beneficial for Parkinson's disease. This scoping review aims to map the available scientific evidence on the effect of pranayama interventions for Parkinson's disease and identify the potential gaps in the literature.

A literature search will be conducted in major databases (JBI evidence synthesis, MEDLINE, Cochrane Library, including Cochrane Complimentary Medicine, and Scopus) from 1990 to date. Relevant grey literature will be searched. Two independent reviewers will initially review the extracted articles and will be further adjudicated by two independent reviewers. Data management will be done using Rayyan software throughout the review. Data extracted will include specific details of the population, concept, context and study methods specific to the scoping review objectives. The extracted data will be presented in tabular/diagrammatic form, reporting on items aligning with the review objectives, such as details of the pranayama intervention and its clinical outcomes. A narrative summary will accompany the tabulated results, identifying the gaps in evidence and areas for future research.

Ethics approval is not required for this scoping review. The findings will be disseminated through publications in peer-reviewed journals and conference presentations.

Protocol Registration in Open Science Framework - https://osf.io/jdwga/?view_only=82aa5afd46974416a402fa1a0ac39fce.

Depression is a major public health problem worldwide and is closely related with systemic inflammatory responses. Additionly, physical activity (PA) is thought to be associated with lower levels of depression and inflammatory markers. This study aimed to elucidate the complex interactions between PA, depression, and inflammatory markers. Based on the National Health and Nutrition Examination Survey (NHANES), various logistic regression were applied to analyze the pairwise correlations among the three. Restrictive cubic splines were constructed to explore the nonlinear relationship between PA and depression. Mediation models were used to identify the mediating role of inflammatory markers. The findings revealed a positive link between depression and inflammatory marker, whereas PA was inversely correlated with both inflammatory marker and depression. Particularly, we noticed the greatest reduction in the risk of depression when the level of PA was between 1200 and 1722 MET-min/week. Besides, we demonstrated that inflammatory markers mediate the potential effects of physical inactivity on depression, ranging from 1.72 % to 6.25 %. In conclusion, PA appear to protect against depression, in which inflammatory markers may play a mediating role. Moreover, we determined the optimal dosage of PA to minimize the likelihood of depression, thereby offering valuable guidance for managing depression.

This study aims to explore the correlation between physical exercise, rumination, and depressive symptoms in college students, as well as to investigate the potential pathways through which physical exercise may impact depressive symptoms. This exploration offers valuable insights for the development of clinical exercise interventions.

A cross-sectional study design was employed, with 2,902 participants recruited via convenience sampling. Structural equation modeling was utilized to explore the relationship between physical exercise and depressive symptoms in college students.

1) Statistically significant differences were observed between depressed and non-depressed college students in terms of rumination, symptom rumination, reflective pondering, and compulsive meditation (all P < 0.05); 2) Physical exercise was found to negatively predict symptom rumination (B=-0.083, P<0.001), compulsive thinking (B=0.034, P>0.05), reflective pondering (B=-0.038, P<0.01), and BDI-II scores (B=-0.103, P<0.001). Symptom rumination positively predicted BDI-II scores (B=0.648, P<0.001), while compulsive thinking and reflective pondering were found to predict BDI-II scores positively (B=0.028, P>0.05) and negatively (B=-0.041, P>0.05), respectively. 3) Physical exercise exerted a direct effect of 59.09% on BDI-II scores (B: -0.065, 95% CI -0.104, -0.028), indicating that higher levels of physical exercise were associated with lower BDI-II scores. The coefficients for duration, intensity, and frequency were statistically significant (all P < 0.05), with intensity and frequency exhibiting higher path coefficients. Rumination, as a latent variable, mediated 40.91% of the indirect effect (B: -0.045, 95% CI -0.077, -0.015), with symptom rumination emerging as a statistically significant pathway (P < 0.05).

Rumination may mediate the relationship between physical exercise and depressive symptoms, with varying mediating effects across different dimensions of rumination. The intensity and duration of physical exercise exert a stronger influence.

Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD.

Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate.

Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety.

Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson's correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD.

For people with Parkinson's disease (PwPD), high-intensity exercise in individual or group format can improve function and quality of life (QoL). Individualized virtual exercise programs have been effective for people with PD, but the feasibility and impact of group exercise in the virtual format has not been investigated.

To compare the effect of individual and group virtual exercise on functional mobility and QoL for PwPD.

Twenty PwPD were randomized to individualized (n = 10) or group (n = 10) virtual exercise 2 times per week for 8 weeks. Exercises were multi-dimensional, and intensity was monitored with a wrist-worn heart rate (HR) monitor. Outcomes were assessed before and after the program, including standing balance, gait speed, gait endurance, motor function, QoL, and self-efficacy. Within-and between-group changes were analyzed using a mixed model analysis of variance (ANOVA) and nonparametric tests were used for analysis.

Participants attended over 75% of scheduled sessions. Within-group analysis showed statistically significant improvements in Five Times Sit-to-Stand (p < .01), mini-BESTest (p = .03), comfortable (p < .01) and fast gait speeds (p = .02), and gait endurance (p < .01) with large effect sizes (partial eta squared > 0.25). There were no statistically significant differences between groups on any outcomes (p > .09). In more than 70% of sessions, participants reached an exercise intensity ≥ 65% HR maximum.

This high-intensity, virtual exercise program was safe and effective at improving balance and functional mobility for community-dwelling PwPD in individual and group format. Virtual exercise programs, either in an individual or group format, can increase access to high-quality programs for PwPD.

Depression in Parkinson's disease (DPD) has a high incidence rate among patients with Parkinson's disease (PD). It is a common nonmotor symptom of PD that seriously affects the quality of life of patients. Thus, improving DPD is important for improving the quality of life of patients. Psychotherapy for depression is limited for many reasons, and only a few patients are able to benefit from this therapy. Several studies have demonstrated that relaxation therapy, playing, and exercise therapy are effective treatments for depression. In recent years, virtual reality (VR) has rapidly developed as a form of rehabilitation due to its immersive characteristics and accessibility. It has also been applied in the psychological treatment of phobia and anxiety. However, no relevant research on the treatment of DPD has been conducted using VR. This study aims to assess the effects of immersive VR-assisted training on patients with DPD.

This single-blind randomized controlled trial will recruit 74 patients with DPD. The patients will then be randomly allocated into two groups. The patients in the VR group (n = 37) will receive VR-assisted training (40 min) three times a week for 8 weeks. The patients in the non-VR training group (n = 37) will receive treatment as usual. The outcome measures will be assessed before intervention, and after 8 weeks, 3 months, and 6 months of the intervention. The primary outcomes will include the Hamilton Depression Scale-24. The secondary outcomes will include the 36-Item Short-Form Health Survey questionnaire, neuroinflammation factors (brain-derived neurotrophic factor, interleukin-6, and C-reactive protein), and functional magnetic resonance imaging.

The traditional treatment of depression has limited resources and requires a lot of time and energy. It is not suitable for patients with PD having mobility difficulties and residing in remote areas. VR can make up for limitations in traditional treatment methods. An advantage of VR is that it makes patients more invested in active participation. This study may provide an improved method for the clinical treatment of patients with DPD, which is suitable for clinical decision-making and future practice.

The study has been registered in the Chinese Clinical Trial Registry ChiCTR2200065843, November 16, 2022. https://www.chictr.org.cn/showproj.html?proj=174551 {2a and 2b}.

Non-pharmacological complementary interventions, particularly mind-body practices, are of growing importance in the management of Parkinson's disease (PD). Among these, mindfulness meditation seems particularly effective, especially on anxiety and depression symptoms. However, current knowledge on mindfulness standardized programs in PD is still limited, particularly in France. Aiming at improving this knowledge we designed the M-PARK study in two phases. Phase 1 consisted in a French national survey to explore expectations, needs and initiatives for mindfulness meditation for PD patients. Phase 2 was a clinical trial with objectives to assess feasibility, acceptability and effects of a mindfulness (MBSR) program proposed to PD patients.

In phase 1, online questionnaires were addressed to members of a French PD patient's association (France Parkinson) and French MBSR qualified instructors. In Phase 2, a clinical trial involving 30 PD patients consisted of a standard MBSR program with two additional evaluation visits one month before and after the program. Data collection included a global clinical evaluation, assessment of depression and anxiety symptoms, sleep, pain and quality of life and a face-to-face interview for qualitative assessment of the acceptability and lived experience during the program. Three MBSR programs were proposed to three groups of ten patients: two were online due to the pandemic situation, one proposed to patients with no or minor fluctuations (group 1) and one for patients with slight to moderate fluctuations (group 2), and the last one face-to-face for patients with no or minor fluctuations (group 3).

French survey: 209 responses were collected for the questionnaire sent to the members of the association France Parkinson; and 68 for the questionnaire sent to the instructors. Two-thirds of patients surveyed had heard of mindfulness meditation (66%), but were unaware of what this approach really consisted and how it could really help them. Few instructors (29%) had had to deal with patients with PD in their current practice. Yet 90% of patients surveyed indicated they were in favor of introducing this type of approach into their care.

The results indicated that the program is feasible and acceptable both online and face-to-face for patients with PD. Among the 30 patients enrolled, 25 completed the program. No unwanted effects related to mindfulness meditation practice were observed. The results showed a statistically significant reduction in anxiety symptoms, depressive symptoms, and improvement in quality of life. Furthermore, no statistically significant change was measured for pain or sleep quality. There was no striking difference in results observed between the patient groups. For the qualitative analysis, major themes highlighted were in relation with: (i) the lived experience during program; (ii) changes in the daily life; and (iii) disease-related changes. A large majority of patients who completed the program (24/25) described their participation as positive or very positive. They reported better management of stress and emotions, as well as greater autonomy in implementing new behavioral strategies, particularly in terms of self-care, acceptance, and de-identification from the disease.

Despite high expectations, PD patients are poorly informed about available mindfulness programs. This study however shows that these programs, whether offered online or face-to-face, are particularly beneficial, especially for anxiety and depressive symptoms, at least in mild-to-moderate stages of the disease.

Acute exercise is a promising non-pharmacological therapy for alleviating anxiety. However, the effects of different types of acute exercise on anxiety in adolescents and young adults remain unclear. Therefore, our study aims to conduct a network meta-analysis to compare the effectiveness of various exercise interventions in improving anxiety in adolescents and young adults. We conducted an online literature search in five databases: PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. The search was conducted from inception to March 1, 2023, and was limited to English-language publications. Pairwise and network meta-analyses were performed using random-effects models. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to rate the certainty of evidence. A total of 33 studies involving 1121 participants were included. The network meta-analysis results revealed that mind-body exercise was the most effective intervention for reducing anxiety in adolescents and young adults (SMD = -0.36, 95% CI: -0.70, -0.03, moderate certainty). Additionally, aerobic exercise (SMD = -0.16, 95% CI: -0.28, -0.03, high certainty) showed significant reduction in anxiety, while resistance exercise (SMD = -0.09, 95% CI: -0.33, 0.14, moderate certainty) and multicomponent exercise (SMD = -0.01, 95% CI: -0.59, 0.57, moderate certainty) did not show significant reduction in anxiety. Moderate certainty evidence suggests that acute mind-body exercise may be the most effective type of exercise for reducing anxiety in adolescents and young adults. Future research should focus on conducting more multi-arm randomized controlled trials to provide more direct evidence on the relative effectiveness of different exercise interventions.

Non-motor symptoms (NMS) such as impaired cognition, anxiety, and depression can have a strong adverse effect on the quality of life (QoL) of Parkinson's disease (PD) patients. The clinical application of cognitive behavioral therapy (CBT) offers an opportunity to improve cognitive function, mental health, and overall QoL for these patients.

CBT is frequently applied as a treatment option aimed at benefiting the mental health of PD patients, but the relative utility of CBT in this patient population has yet to be rigorously assessed. The present review was thus conducted with the goal of examining the relative safety and efficacy of CBT as a treatment option for PD patients suffering from cognitive impairment, anxiety, and depression, with a particular focus on the impact of CBT on PD patient QoL.

The PubMed, Embase, Medline, and Cochrane Library databases were searched for all studies published from their inception to present using keywords including "cognitive behavioral therapy" and "Parkinson's disease". Two reviewers independently screened these published studies and extracted relevant data from studies that met with defined inclusion/exclusion criteria, in addition to assessing the risk of bias. Those randomized controlled trials (RCTs) assessing the impact of CBT on older PD patients were eligible for study inclusion. In total, 22 articles incorporating 1,053 patients were included in this meta-analysis. Study quality was examined as per the Cochrane risk of bias framework. Heterogeneity and associated outcomes were assessed based on mean difference (MD), I2, and 95% confidence interval (95%CI) values.

In total, 22 RCTs were ultimately found to be eligible for inclusion in the present meta-analysis. The results of this meta-analysis indicated that CBT significantly impacted cognition as compared to other treatment options (including placebo treatment, clinical monitoring, clinic-based treatment, psychoeducation, physical activity training, health enhancement) (I2 = 49%, MD = 0.23, 95%CI: 0.03-0.44, P = 0.03). CBT was also associated with significant improvements in PD patient QoL (I2 = 0%, MD = 3.45, 95%CI: 1.13-5.57, P = 0.04), anxiety symptoms (I2 = 57%, MD = -2.01, 95%CI: -4.01-0.01, P = 0.05), and depression symptoms (I2 = 74%, MD = -3.94, 95%CI: -6.47 to -1.42, P = 0.04).

These results reveal that CBT can have beneficial effects on PD patient cognitive status and QoL. Notably, CBT represents an effective option for treating NMS such as anxiety and depression in PD patients. These results offer strong evidence in favor of applying CBT as a means of enhancing the mental health, cognition, and QoL of individuals with PD. However, additional high-quality large-scale studies will be essential to confirm and expand upon these results.

To identify optimally therapeutic exercise interventions for improving motor ability among patients with Parkinson's disease (PD), we conducted a network meta-analysis (NMA) of randomized controlled trials comparing different exercise regimens.

Relevant RCTs were retrieved by searching PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, and other databases from inception to July 9, 2023 is available in English as the primary language. Exercise outcomes as measured by Movement Disorder Society- Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) score change were evaluated and ranked using STATA software version 18.0. All included studies were assessed for methodological quality using the Cochrane Risk of Bias tool.

The final NMA included 71 studies involving 3,732 participants, 87 intervention experiments, and 27distinct interventions. Although most exercise interventions showed some efficacy (reducing MDS-UPDRS-III score), cumulative ranking probability surface (SUCRA) values indicated that the best exercise interventions for motor function improvement were archery (95.6%), riding a bicycle (80.9%), and binary rhythm dance (80.8%).

An exercise intervention comprising archery, cycling, and(or) binary rhythm dance may yield superior improvements in motor function among patients with Parkinson's disease.

Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients.

A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool.

The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84).

Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.

Background People with visual impairment (VI) tend to face more psychological distress than normally sighted individuals due to mobility restrictions, fear of falling, and sleep disturbances. However, research to address these problems is rare. This study aims to investigate the effect of mindfulness-based yoga versus physical exercise on the psychological well-being of individuals with VI. Methods This study will be a single-blinded, three-armed, multicentered, randomized controlled trial (RCT). A total of 132 participants with VI (ages 15-25) will be recruited in the study and will be randomly assigned to either group 1 (mindfulness-based yoga), group 2 (physical exercise), or group 3 (wait-list control). Groups 1 and 2 will receive intervention for 40 hours (eight weeks, weekly five days, one hour/day), whereas group 3 will continue their daily activities as usual. The intervention will take place in the afternoon from Monday to Friday. The timing varies between 4-5 pm according to the different time schedules of the institutions of the blind. Three times, assessments will be conducted at T0 (baseline), T1 (eighth week at the completion of the intervention), and T2 (sixth month following the completion of the intervention). ANOVA will be used to find out the differences between groups; repeated measures ANOVA will be used to check within-group changes. Trial status The study was first screened in December 2021. The recruitment of participants has been completed in two centers covering 62 individuals with VI, and intervention started in August 2022. The data collection is still ongoing due to the nature of the study design, a specific demographic, complex logistics, and administrative bottlenecks. The study incorporates three different groups and a substantial sample size (n=132). The specific demographic, people with visual impairments, are rare and difficult to locate. In addition, a six-month follow-up assessment contributes to complex procedures while coordinating between various institutions and securing necessary authorizations. Discussion This study will be the first comprehensive RCT to investigate the psychological well-being of the VI population with various psychophysiological and hormonal parameters in multiple centers. The presence of physical exercise and a wait-list control group will further elucidate the potential mechanism of Mindfulness-based yoga. Mindfulness-based yoga can be integrated into educational and rehabilitation systems to enhance the well-being of individuals with VI.

Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies.

This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD.

From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively.

The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.