Research Projects
Effects of a Home-based Exercise Programme Incorporating Mindfulness and Yoga Practice on Balance and Mobility for People with Parkinson’s Disease: A Randomised Controlled Trial

Programme(s) to which this project applies:

☑ MPhil/PhD ☒ MRes[Med] ☒ URIS

Between 47% and 80% of patients with Parkinson’s disease (PD) experience freezing of gait (FOG), which is associated with impaired balance and mobility, a high fall risk, loss of independence and poor health-related quality of life (HRQOL). Clinical guidelines recommend a complementary mind-body approach for FOG rehabilitation. Most research to date has examined the effects of centre-based motor training combined with external cueing strategies (i.e.rhythmic auditory stimulation). However, such modalities cannot be implemented as ambulatory strategies to assist patients’ daily activities in real-life settings.

Evidence suggests that a mindfulness-based internal cueing strategy combined with motor training can multiply the avenues of balance and mobility improvement. Accordingly, we have tailored a home-based, interactive online programme – Mindfulness Yoga-Practice Awareness through Cognitive-based Exercise (MY-PACE) – which emphasises instilling mental awareness through yoga movements to enhance mind-body coordination. In the proposed research, MY-PACE will be delivered through a home-based tele-rehabilitation approach to overcome the common barriers to participation in centre-based programmes, including disability, resource limitations and COVID-19-induced social distancing measures. Investigating its effects will provide a wider repertoire of evidence-based interventions to support the physio-psycho-cognitive health of PD patients.

The proposed two-arm randomised controlled trial will adopt a sequential explanatory mixed-methods design to investigate MY-PACE’s effects on FOG symptoms and acceptability to PD patients compared with usual care over a 3-month period. One hundred and thirty-two PD patients will be randomly allocated to receive 12 weekly 90-minute MY-PACE sessions via Zoom (video conferencing software) or usual care. The primary outcome is perceived FOG, and the secondary outcomes perceived balance confidence, functional balance and mobility, PD-related motor symptoms, and HRQOL. Stress and mindfulness levels will be measured as mediating variables. All outcome evaluations will be assessed at baseline and 1-week and 3-months post-intervention. We will also invite 30 participants to attend individual interviews to explore their experiences of using mindfulness yoga as a lifestyle intervention for FOG management. Generalised estimating equation models with intention-to-treat analysis will be used to compare the changes in outcomes over time within and between the two arms (i.e.time-effect, group-effect, group*time effect). Inductive thematic analysis will be performed on these qualitative data.

The scientific evidence generated by the study will inform the application of mindfulness-based exercise as a public health practice for preventing FOG progression in PD patients to a clinically severe level. The self-help nature of such practice also implies its relevance to enriching primary care for this clinical cohort.

Dr YY Kwok, School of Nursing

Dr. Jojo Kwok is an Assistant Professor at the School of Nursing, The University of Hong Kong, as well as a registered nurse and certified yoga instructor in Hong Kong. Her research focuses on chronic illness care, gerontology, mental health and behavioral medicine, with a special emphasis on Parkinson’s disease. Her ongoing research projects include the effects and mechanisms of individual mindfulness techniques in people with Parkinson’s disease. Her research findings have been published in leading international journals such as JAMA Neurology, Journal of the American Medical Directors Association and Journal of Neurology, and featured as impactful news in both local and international mass media, including Reuters Health and Radio Television Hong Kong. She has also been invited to present in international conferences such as the International Conference on Frontiers in Yoga Research and its Applications (INCOFYRA) and Symposium on Yoga Research. She has received an Outstanding New Researcher Award, an Early Career Award and a Meritorious Scientific Abstract Award offered by the International Society of Behavioral Medicine (ISBM) in 2021 and 2018, respectively.

In addition to her research achievement, Dr. Kwok has received a Pi Iota Chapter Scholarship Award (Nurse Leader) in 2020 from The Sigma Theta Tau International Honor Society of Nursing in recognition of her significant contribution and leadership in community services. She has been appointed as an external reviewer for national competitive research grants such as the Dutch Research Council (NOW) Talent Programme and the Austrian Science Fund. She is dedicated to her profession. She has been appointed as a council member of the Hong Kong Parkinson's Disease Foundation (HKPDF) in 2022, and a committee member of the HKPDF Education and Training Committee since 2016 to contribute to quarterly education materials regarding evidence-based nursing practice for Parkinson’s disease.

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For more information or to express interest for this project, please email the supervisor or the specified contact point in the project description.  Interested candidates are advised to enclose with your email:

  1. your CV,
  2. a brief description of your research interest and experience, and
  3. two reference letters (not required for HKUMed UG students seeking MRes[Med]/URIS projects).

Information on the research programme, funding support and admission documentations could be referenced online at the Research Postgraduate Admissions website. General admission enquiries should be directed to

HKUMed MBBS students interested in the Master of Research in Medicine (MRes[Med]) programme may visit the programme website for more information.  

HKUMed UG students interested in the Undergraduate Research Internship Scheme (URIS) may visit the scheme’s website for more information.