“Inhale. Raise your arms out wide and overhead.” Charles’ right arm lifted 45 degrees off his hips. His left arm lagged, though it pivoted a few inches higher. His left hand bent at an odd angle. “Can you straighten your wrist to create a continuous line from shoulder to fingers?” He flashed a smile that indicated he knew what I requested, but his hand didn’t budge. Charles was oblivious to it being skew.

This large man in gym shorts and a scrub tee sitting on the edge of a straight chair with his arms cocked like a broken-winged bird was striking Tadasana. Mountain Pose, the tallest of yoga poses. For most Tadasana is an arrow of energy reaching proud to the sky. But for an 82-year-old with Parkinson’s Disease, it looks very different. I noticed that Charles’ arms rose higher than the previous day, if only by half an inch. His effort was genuine. It was a good Tadasana.

I focus on teaching yoga to middle-aged and elderly men with compromised mobility. Some suffer from too many sedentary years and too much food; others have tender backs or nagging sciatica. The most severe, like Charles, suffer debilitating conditions that make everyday movements difficult. Regardless how old and infirm a person is, I develop a sequence of breath and asana he can execute with satisfaction, and then we work to extend mobility beyond that benchmark.

My work with Charles, a native of India visiting Boston for an extended period of medical treatment, highlighted the benefits yoga can bring to people with complex medical conditions. It also illustrated how yoga could be integrated into a comprehensive treatment plan. I incorporated Charles’ physical therapy exercises into our sessions, yet remained focused on the specific benefits of asanas: breath; control; and alignment.

Parkinson’s disease is a progressive movement disorder that occurs when our brain doesn’t make adequate amounts of the neurotransmitter dopamine. Dopamine disseminates messages from our brain to our muscles. Without enough dopamine we have uncontrolled movement. Parkinson’s most familiar manifestation is tremors, particularly in the arms and legs, but the disease can also produce stiffness, slowing movement, changes in speech, and erratic gait. There is no cure. Medications help people control Parkinson’s and exercise is effective in alleviating symptoms and extending mobility.

Any type of movement can benefit Parkinson’s patients. However, activities that incorporate pattern and sequence, like Tai Chi, zumba, and dance, are most effective. Yoga, which integrates pattern and sequence along with breath control, is particularly effective.

Parkinson’s Disease has five discrete stages. Tremors are common during Stages One and Two. Charles was in Stage Three, when shaking often gives over to an eerie calm. Charles stood still for moments before he moved, concentrating on his first step. Then he made quick, tentative wobbles. Once underway, he stepped forward at a steady pace and often accelerated until he encountered some obstacle or needed to change direction. Then he stopped, recalibrated, and began the hesitating sequence again. If I set my foot directly in front of his, Charles immediately stepped over me and continued walking, as if the obstacle added urgency to the message from his brain to his leg.

I had outlined a Parkinson’s-based posture sequence derived from Iyengar, Renee Le Verrier, and literature about yoga for Parkinson’s, but anticipated adjusting it according to Charles’ capabilities.

His son Frank shared Charles’ physical therapy exercise diagrams and expressed concern about his father’s lost leg strength. Although I wanted our sessions to complement Charles’ medical treatment, my emphasis was yoga, so I began with breath.

Charles sat on a straight chair with his knees out straight. We inhaled and exhaled to a regular rhythm. I hovered my palm two inches above his thigh and. “Inhale, raise your right thigh to touch my hand. Exhale, release your foot back to the floor.” Charles maintained his breath, but couldn’t correlate movement. His thigh lifted, slowly, then abruptly fell. It rose again and again with increasing speed until I lowered my hand to his knee and steadied his leg to the floor.

We spent fifteen minutes doing toe raises; heel raises; hip flexes. He lifted one leg and crossed it over the other. I focused on consistent breath even when his movements were erratic. We stood. He held the back of his chair. More toe and heel raises, full leg flexes, and knee bends. We ended our half hour by marching in place, one of his PT exercises. After four or five steps, either Charles’ knees trembled or his legs rooted in stillness. It was remarkable how the same sequence would dissemble in such contradictory ways.

During our first week we established a warm-up routine, incorporated his PT exercises, and added new poses. Charles couldn’t get up and down from the floor, so we concluded sessions with supine twists and savasana on his bed. I massaged his legs and feet. His muscles were taut despite not being able to move them as he desired.

The second week, we extended our sessions to 45 minutes. Charles’ movements became more controlled; sometimes they even corresponded with his breath. One day, after Savasana, I eased him into a sitting position. “Can we do yoga breathing?” he asked. Before I could answer, he brought two fingers to his nose and initiated Nadi Shodhin, alternate nostril breathing. Then he stiffened his belly and began percussive Uddiyana breath. After twenty or thirty quick exhales he brought his hands over his eyes and let out a trio of Om’s. Charles never explained where he learned these breathing techniques, but we established a new way to end each session.

At the beginning of our third week Charles wanted to move his reclined poses from bed to floor. I was concerned about getting this 190-pound man onto the carpet, and even more concerned about getting him back up. But his initiative was strong, so I tailored our standing series to prep for lying down. I discovered that Charles could raise his hands full overhead if he moved his arms forward rather than laterally. We practiced squats, albeit shallow ones. We moved into Halfway Lift, first with hands on thighs, then hands on shins. Using his chair as an aid, Charles descended to his knees and got into Table Top. He struck Cow/Cat and maintained his balance through gentle forward shifts. Finally, Charles lowered all the way to the floor, rolled on his back and grinned at his success. The firm surface improved his floor exercises. Getting back up took more than a minute as he shifted to a seat, knelt to Table Top, and pressed against his chair to stand.

Every day Charles greeted me with a smile, proclaimed he was stronger, and demonstrated that conviction. I came to expect continuous improvement. Then, in the middle of our fourth week, his smile faltered and his movements were slow. He stumbled moving into Table Top. I broke his fall. He rolled onto his back. Then he laughed.

“Why do you always laugh?” I asked about his odd reaction to anything that proved difficult.

“What else can I do?” He shrugged his large, awkward body, raised his eyebrows, and chortled some more. After his floor postures Charles took a long savasana and I gave him a gentle massage. I supported his sitting position for our final breathing with my legs. The vibration of his Om’s resonated through my shinbones.

I discussed the change with Frank, who explained the doctor’s had taken Charles off his Parkinson’s medications to test his functioning without them. I was glad to understand the reason for Charles’ sudden dip, and marveled at how close our body chemistry is linked to our abilities.

For the next week, every day was different. One day Charles was strong, executing all his poses and working from the floor. The next day he was so fatigued he remained in his chair. Frank reported improvements in other aspects of Charles’ health attributed to reduced drugs, so we continued to explore how to regain balance and strength with his new regimen. Eventually Charles spent more time standing and, on good days, executed his entire sequence.

Rotational movements were very difficult, which made sense since moving in multiple planes is complex. I introduced seated and standing twists, lateral movement synchronized with breath, and angled steps with a torso shift to open the centerline of his body. Charles turned in a circle by shuffling through dozens of tiny weight shifts rather than taking discrete steps. I slowed his movement down, encouraged him to place one foot with one breath, and he learned how to turn a full circle in only six steps. The number six became our threshold limit. Whether straight or in a circle, Charles could not maintain a steady gait beyond six steps.

We practiced yoga five times a week for six weeks until Charles returned to India. Six weeks is insufficient time to make definitive claims for yoga’s influence on a Parkinson’s patient’s health, movement, or disease progression. Due to Charles’ age and advanced disease stage, much of what we did was a hybrid of yoga, elder fitness, and physical therapy. It is difficult to separate the benefits of our yoga from Charles’ drug regimen and physical therapy. However, Charles, Frank and I can each attest to improved balance and strength. Hopefully, more controlled scientific studies will be done to reinforce and refine the link between yoga and Parkinson’s. In the meantime, the anecdotal evidence is strong that regular yoga can be a powerful adjunct to medical treatment.