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

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.

Professor YY Kwok, School of Nursing

Prof. Jojo Kwok is an Assistant Professor at the School of Nursing and the Associate Director at the Centre on Behavioral Health, The University of Hong Kong. She is a registered nurse and a certified yoga instructor in Hong Kong, holding a BNurs (First Class Honours), MPH and PhD degrees from the Chinese University of Hong Kong. Prof. Kwok's research portfolio centers around neurology care, behavioral science and rehabilitation medicine, focusing on nurse-led, compassionate-based care models for movement disorders. Her pioneering research has been published in top-rank journals in clinical neurology, gerontology and behavioral medicine, such as JAMA Neurology, Psychotherapy and Psychosomatics, and npj Parkinson's Disease. Her scholarly works have gained international attention and have been featured in regional and international news media outlets such as Reuters and Radio Television Hong Kong. The impact of her research is evident, with her publications cited in international guidelines such as the 2021 and 2024 Lancet Seminar on Parkinson's disease, and she was listed in the top 2% of the world's most cited scientists in 2023 by Stanford University. With her dedication to advancing health and social care services for aging populations, Prof. Kwok successfully obtained a substantial donation (HK$12.87M; US$1.6M) to support her leadership in developing and implementing a territory-wide, community-based compassionate care model for managing Parkinson's disease.

In recognition to her research achievement and contribution to the nursing profession, Prof. Kwok has been recognized as a Fellow of the American Academy of Nursing in 2024, and an Emerging Nurse Researcher/Scholar Award from the Honor Society of Nursing, Sigma Theta Tau International in 2023. She has also received an Early Career Award from the Hong Kong Society of Behavioral Health in 2022, an Outstanding New Researcher Award in 2021, an Early Career Award and a Meritorious Scientific Abstract Award in 2018 from the International Society of Behavioral Medicine (ISBM). She has been appointed as an external reviewer for national competitive research grants such as the Dutch Research Council and the Austrian Science Fund. Additionally, Prof. Kwok serves as a council member and education and training committee member of the Hong Kong Parkinson's Disease Foundation, contributing to PD-specific education and training for patients, caregivers, and allied health professionals.

Furthering her research expertise, Prof. Kwok is also a Research Scholar (Visiting) at the Osher Center for Integrative Health, Harvard Medical School and Brigham and Women's Hospital. She is actively engaged in international collaboration on mechanistic and effectiveness investigation of integrative care and mind-body modalities, complementing her primary work on nurse-led, compassionate-based care models for movement disorders.

Prof. Kwok is currently accepting PhD applications, please reach out for more information.

Biography
Scholars Hub
ORCID
jojoyyk@hku.hk

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 rpgmed@hku.hk.

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.