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      The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study

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          Abstract

          Background

          Parkinson’s disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.

          Methods

          An exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012–2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18–75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.

          Results

          Group 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = −0.59) and at 6-month post intervention (t-score = −1.42) as reported by the PDQ-39 SI. However this finding was not significant ( p = 0.56 and 0.16 respectively). A small yet significant effect size ( β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score −1.8, p = 0.04). Four secondary measures are reported.

          Conclusions

          Our findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson’s disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.

          Trial Registration

          Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820, 17 th April 2012.

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          Most cited references35

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          The neuroscience of mindfulness meditation.

          Research over the past two decades broadly supports the claim that mindfulness meditation - practiced widely for the reduction of stress and promotion of health - exerts beneficial effects on physical and mental health, and cognitive performance. Recent neuroimaging studies have begun to uncover the brain areas and networks that mediate these positive effects. However, the underlying neural mechanisms remain unclear, and it is apparent that more methodologically rigorous studies are required if we are to gain a full understanding of the neuronal and molecular bases of the changes in the brain that accompany mindfulness meditation.
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            Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program.

            Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being.
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              Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects.

              Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.
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                Author and article information

                Contributors
                jenny.advocat@monash.edu
                Joanne.Enticott@monash.edu
                brooke.vandenberg@monash.edu
                craig.hassed@monash.edu
                Jennifer.Hester@bsl.org.au
                grant.russell@monash.edu
                Journal
                BMC Neurol
                BMC Neurol
                BMC Neurology
                BioMed Central (London )
                1471-2377
                8 September 2016
                8 September 2016
                2016
                : 16
                : 1
                : 166
                Affiliations
                [1 ]Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Victoria 3168 Australia
                [2 ]Department of Psychiatry, Southern Synergy, Monash University, 126-128 Cleeland Street, Dandenong, Victoria 3175 Australia
                [3 ]School of Primary Health Care, Monash University, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Victoria 3168 Australia
                [4 ]Department of General Practice, School of Primary Health Care, Monash University, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Victoria 3168 Australia
                [5 ]Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
                [6 ]Brotherhood of St Laurence, Melbourne, Australia
                Article
                685
                10.1186/s12883-016-0685-1
                5016929
                27608621
                6e54ba0c-564c-406c-9971-12802fb7bd3b
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 January 2016
                : 29 August 2016
                Funding
                Funded by: Parkinson's Victoria
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Neurology
                parkinson’s disease,neurological disorder,mindfulness,group program,meditation
                Neurology
                parkinson’s disease, neurological disorder, mindfulness, group program, meditation

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