• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.

I added practice to strengthening muscles and improve balance. Also, I added heel-dropping exercise to increase his bone density.

Mack’s primary goals are improving the symptoms of Parkinson’s disease and osteoarthritis.

I focused on joint freeing, balance, and lower body muscle strengthening first. I observed gradual progress in his physical level since he began routine practice despite his limitations, especially balancing. He still needs to strengthen his muscles, but he is making a progress.

Mack has shown gradual improvement in his energy levels since beginning yoga therapy. Initially, he struggled with significant fatigue due to his chronic pain and sleep apnea. Through regular practice of deep breathing techniques, particularly alternate nostril breathing, Mack has been able to better manage his energy throughout the day. He reported that these breathing exercises have helped him return to sleep more easily after waking up at night. The incorporation of gentle stretching and balancing exercises has also helped to maintain his energy flow, reducing the feeling of lethargy and improving his ability to engage in daily activities.

Mack’s emotional state has improved through sessions. Initially, he struggled with depression and stress due to chronic health conditions and physical limitations.
Over time, breathing exercises and affirmations helped calm his mind and manage sleep disturbances. Mack now reports feeling more relaxed, motivated despite ongoing concerns about his health and personal concerns.

Mack’s intellectual engagement and sense of self have grown, supported by an emphasize self-inquiry and viewing the self beyond physical limitations. The concept of “I am not the body, I am pure consciousness” has deeply resonated with him, and his use of the affirmation, “I am not limited by my body’s condition,” has helped elevate his emotional state.

Working on this area with Mack was not an easy task. He did not disclose any strong spiritual/religious beliefs. Also he sometimes experiences side effects of medication for prostate cancer that affects cognitive function, and this interrupts his meditation practice. Despite the challenges above and his physical limitations, his spiritual orientation has improved. He maintains good spirits through his daily routine practice, enjoyable social interactions—such as time spent with his brother—and his strong willingness to restore his physical, mental, and emotional well-being.

Mack reported his improvements in his balance, flexibility, quality of sleep, and most importantly reduction of mental stress and depression.

1. Balancing Exercise (one leg standing with knee 90 degrees angle)

2. Heel-to-toe walking

3. Heel-dropping exercise

4. Alternate nostril breathing

5. JAPA Meditation with Alternate Nostril Breathing, suggested combining his 10-minute daily practice with the affirmation, “I am not limited by my body’s condition”.

6. Gentle stretches in bed before getting up

7. Neck/shoulder stretch - neck movement needs to be very careful

If I approach him differently, I will focus more on the improvement of his mental and spiritual well-being. As I stated above, I need more research and experience working in this area.

Mack is over 80 years old and suffering from pain, cancer, Parkinson’s disease, he shows gradual progress at each session.
He said one point, “using keyboard is not easy due to his Parkinson’s disease, when I suggest new technology he can use instead, he said voice to text does not work because of his whispering due to vocal cord issue”. He can do very limited physical activities.
Is there anything I should pay attention to or focus on or I can say for the client like Mack?

Yes, I enjoyed working with Mack. He is the most challenging and vulnerable client I worked with, and he needed great care to plan as he is suffering from Parkinson’s disease and other conditions. However, observing his positivity toward the practice and seeing progress was a good experience as a yoga therapist.