Changes in Nonmotor Symptoms Following an 8-Week Yoga Intervention for People with Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative disorder marked by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health-related quality of life (HRQoL). Previous studies have shown that yoga for individuals with PD improves balance, strength, and mobility. However, little research has been conducted to determine the effect of yoga on nonmotor symptoms of PD. The purpose of this study was to examine changes in nonmotor symptoms among individuals with PD following an 8-week yoga intervention. Data used for analyses were part of a larger study that researched improvements in motor function for individuals with PD. Participants (N = 27) were randomly assigned to experimental (n = 15) and control (n = 12) groups and completed pre- and postintervention quantitative measures. Within-group improvements were statistically significant for fatigue measured by the Parkinson's Fatigue Scale, balance confidence measured by the Activities Balance Confidence Scale, the belief in one's ability to manage falls measured by the Falls Management Scale, activity constraints measured by the Activities Constraint Questionnaire, and PD-specific quality of life measured by the Parkinson's Disease Questionnaire-8. Across-group changes were statistically significant for activity constraints. Findings indicate yoga may be an efficacious intervention for improving nonmotor symptoms as well as HRQoL for individuals with PD.

Corrigendum to "Functional Improvements in Parkinson's Disease Following a Randomized Trial of Yoga".

[This corrects the article DOI: 10.1155/2018/8516351.].

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

Individuals with Parkinson's Disease (PD) experience significant limitations in motor function, functional gait, postural stability, and balance. These limitations often lead to higher incidences of falls, which have significant complications for individuals with PD. Yoga may improve these functional deficits in individuals with PD. The objective of this study was to determine changes in motor function, functional gait, postural stability, and balance control for community dwelling individuals with PD. This randomized, wait-list controlled pilot study examined the influence of an 8-week yoga intervention for people with PD who met the following inclusion criteria: endorsing a fear of falling, being able to speak English, scoring 4/6 on the minimental state exam, and being willing to attend the intervention twice weekly for 8-weeks. Participants in the yoga group (n=15) experienced improvements in motor function, postural stability, functional gait, and freezing gait, as well as reductions in fall risk. Participants in the wait-list control (n=12) also significantly improved in postural stability, although their fall risk was not reduced. Individuals in the yoga group significantly reduced their fall risk. An 8-week yoga intervention may reduce fall risk and improve postural stability, and functional and freezing gait in individuals with PD. This clinical trial is registered as protocol record Pro00041068 in clinicaltrials.gov.

Perceived Activities and Participation Outcomes of a Yoga Intervention for Individuals with Parkinson's Disease: A Mixed Methods Study.

Parkinson's disease (PD) often leads to poor balance, increased falls, and fear of falling, all of which can reduce participation in life activities. Yoga, which usually includes physical exercise, can improve functioning and life participation; however, limited research has been conducted on the effects of yoga on life participation of individuals with PD. This study had two purposes: (1) to identify and understand the perceived activities and participation outcomes associated a therapeutic yoga intervention for individuals with PD; and (2) to compare the perceived activities and participation outcomes with the outcomes measured in the clinical trial. A single-blind, randomized, waitlist-controlled, phase II exploratory pilot study using an after-trial embedded mixed methods design (clinical trial Pro00041068) evaluated the effect of an 8-week Hatha Yoga intervention on individuals with PD. Directed content analysis was used to analyze focus group interviews with participants who completed the yoga intervention. Quantitative and qualitative data were merged and compared using a data comparison matrix. Qualitative analysis indicated many activities and participation outcomes. Comparison of qualitative and quantitative data indicated the yoga intervention led to improved balance, mobility, and functional gait, and fewer falls. These outcomes reached beyond the intervention and into participants' daily lives. Results support the use of Hatha Yoga as a community-based rehabilitation intervention for individuals with PD. Yoga, as part of an interdisciplinary approach to treatment, can improve many types of activities and participation outcomes (e.g., mobility, social relationships, self-care, handling stress, recreation).

Diabetes-specific nutrition algorithm: a transcultural program to optimize diabetes and prediabetes care.

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

A new electrode design to improve outcomes in the treatment of chronic non-healing wounds in diabetes.

BACKGROUND: Chronic wounds are life-threatening in people with diabetes. Some studies show that electrical stimulation (ES) can help wounds heal, while others do not. But, ES is usually applied using a two-electrode system, where current distribution is greatest in the center line between the electrodes. In the present study, a three-electrode system (three-channel ES) was developed. Current dispersion on the skin and in the quadriceps muscle was compared between the conventional two-electrode and three-electrode systems in controls and tested for its ability to heal chronic wounds in people with diabetes. METHODS: In controls, current was delivered via a biphasic sine wave at a frequency of 30 Hz and pulse width of 100 microseconds. Stimulation electrodes 5 cm x 5 cm and 5 cm x 10 cm were placed at 10 cm and 15 cm separation distances above the quadriceps muscle. Skin currents were measured using five pairs of surface electrodes positioned in five separate locations on the skin. Muscle currents were measured using three pairs of needle electrodes positioned in three different locations in the muscle belly. In chronic wounds in eight subjects with diabetes, stimulation was applied for 1 month, and healing and blood flow were measured. RESULTS: Current during three-channel ES was dispersed more evenly and more deeply than with conventional two-channel ES (P < 0.05). In wounds, there was almost complete healing in 1 month, and current was uniform in the wound. CONCLUSIONS: Three-channel ES is more effective than two-channel ES in terms of better current dispersion across the skin and penetration into tissue and will probably be better for wound healing.

Estimation of the distribution of intramuscular current during electrical stimulation of the quadriceps muscle.

Electrical stimulation is commonly used for strengthening muscle but little evidence exists as to the optimal electrode size, waveform, or frequency to apply. Three male and three female subjects (22-40 years old) were examined during electrical stimulation of the quadriceps muscle. Two self adhesive electrode sizes were examined, 2 cm x 2 cm and 2 cm x 4 cm. Electrical stimulation was applied with square and sine waveforms, currents of 5, 10 and 15 mA, and pulse widths of 100-500 micros above the quadriceps muscle. Frequencies of stimulation were 20, 30, and 50 Hz. Current on the skin above the quadriceps muscle was measured with surface electrodes at five positions and at three positions with needle electrodes in the same muscle. Altering pulse width in the range of 100-500 micros, the frequency over a range of 20-50 Hz, or current from 5 to 15 mA had no effect on current dispersion either in the skin or within muscle. In contrast, the distance separating the electrodes caused large changes in current dispersion on the skin or into muscle. The most significant finding in the present investigation was that, while on the surface of the skin current dispersion was not different between sine and square wave stimulation, significantly more current was transferred deep in the muscle with sine versus square wave stimulation. The use of sine wave stimulation with electrode separation distances of less then 15 cm is recommended for electrical stimulation with a sine wave to achieve deep muscle stimulation.