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Testing a yogabased behavioral intervention as a complementary therapy for arthritis

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British Journal of Rheumatology, 33, 787- 788. Arthritis & Yoga: Present Evidence ... The Journal of Rheumatology, 21, 2341-2343. STAGES of ASTHANGAYOGA ... – PowerPoint PPT presentation

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Title: Testing a yogabased behavioral intervention as a complementary therapy for arthritis


1
Testing a yoga-based behavioral intervention as a
complementary therapy for arthritis
  • Manoj Sharma, MBBS, CHES, Ph.D.
  • Associate Professor, University of Cincinnati
  • Bruce Rowe
  • Administrator, Nebraska Health Human Services

2
Arthritis
  • Arthritis and chronic joint symptoms affect
    nearly 70 million Americans, or about one out of
    three adults
  • Most prevalent disease in the US
  • Medical care for arthritis cost nearly 22
    billion (1995)
  • Total costs, including medical care and loss of
    productivity, exceeded 82 billion (1995)
    Source Praemer, A., Furner, S., Rice, D. P.
    (1999). Musculoskeletal conditions in the United
    States. Rosemont, IL American Academy of
    Orthopedic Surgeons. Taken from
    http//www.cdc.gov

3
CDC Recommendations
  • Increasing physical activity which has been found
    to decrease pain, improve function and delay
    disability
  • Maintaining an ideal body weight
  • Avoiding joint injuries
  • Obtaining an early diagnosis and starting
    appropriate management including self-management

4
Yoga Arthritis
  • Yoga is a complementary self-management technique
    that has been found to be useful but needs
    further study
  • What is yoga?
  • Origin is Sanskrit word Yog meaning union
  • Physiological paradigm Union of organ systems in
    the body (homeostasis)
  • Psychological paradigm Union of consciousness
    in the mind (balance)
  • Scientific paradigm Union of body and mind
    (psychosomatic equilibrium) in the environment

5
How Yoga Helps in Arthritis?
  • Stretching of the muscles relieves strain on the
    joints thereby relieving pain, tenderness,
    stiffness, and improving the range of motion
    (Physical)
  • Stress exacerbates the symptoms of arthritis
    (Crofford, Jacobson, Young, 1999 Journal of
    Womens Health Wahle et al., 2002 Annals of NY
    Academy of Sciences) -- Yoga relieves stress
    (Mental)
  • Improving perspective toward life (Spiritual)

6
Arthritis Yoga Present Evidence
  • Review-based article Considerable evidence that
    an array of mind-body therapies can be used as
    effective adjuncts to conventional medical
    treatment for a number of common clinical
    conditions including arthritis Astin, J. A.,
    Shapiro, S. L., Eisenberg, D. M., Forys, K. L.
    (2003). Mind-body medicine State of the
    science, implications for practice. The Journal
    of American Board of Family Practice,
    16(2),131-147.

7
Arthritis Yoga Present Evidence 2
  • Review-based article Benefits of yoga for
    healthy people and for people compromised by
    musculoskeletal and cardiopulmonary diseaseRaub,
    J. A. (2002). Psychophysiologic effects of Hatha
    Yoga on musculoskeletal and cardiopulmonary
    function A literature review. Journal of
    Alternative and Complementary Medicine, 8,
    797-812.

8
Arthritis Yoga Present Evidence 3
  • Review based article Yoga in osteoarthritis of
    the hands and carpal tunnel syndrome showed
    greater improvement in pain when compared to
    control groups
    Garfinkel, M., Schumacher, H. R. Jr. (2000).
    Yoga. Rheumatic Diseases Clinics of North
    America, 26, 125-132.

9
Arthritis Yoga Present Evidence 4
  • Clinical report Practice of yoga relieved
    stiffness and pain in arthritis
    Haslock, I., Monro, R.,
    Nagarathna, R., Nagendra, H. R., Raghuram, N.
    V. (1994). Measuring the effects of yoga in
    rheumatoid arthritis. British Journal of
    Rheumatology, 33, 787- 788.

10
Arthritis Yoga Present Evidence 5
  • Clinical trial Yoga practice improved hand grip
    strength (as measured by grip dynamometer) in
    normal persons and in patients with rheumatoid
    arthritis but the magnitude of improvement varied
    with factors such as gender and ageDash, M.,
    Telles, S. (2001). Improvement in hand grip
    strength in normal volunteers and rheumatoid
    arthritis patients following yoga training.
    Indian Journal of Physiology and
    Pharmacology, 45, 355-360.

11
Arthritis Yoga Present Evidence 6
  • Randomized Control Trial Yoga program was
    effective for providing relief in hand
    osteoarthritis pain, strength, motion, joint
    circumference, tenderness, and hand function as
    measured on the Stanford Hand Assessment
    questionnaire. Garfinkel, M. S.,
    Schumacher, H. R. Jr., Husain, A., Levy, M.,
    Reshetar, R. A. (1994). Evaluation of a yoga
    based regimen for treatment of osteoarthritis of
    the hands. The Journal of Rheumatology, 21,
    2341-2343.

12
STAGES of ASTHANGAYOGA
  • Yama Techniques for successful living in
    society
  • Niyama Techniques for managing and purifying
    self
  • Asaana Postures
  • Pranayama Breathing techniques
  • Pratihara Techniques for developing dispassion
    toward senses
  • Dharana Concentration techniques
  • Dhyana Meditation techniques
  • Samadhi Ultimate advanced meditation techniques
    and psychic procedures attained after regular
    practice for universal consciousness

13
BASIC COURSE IN KUNDALINI ENERGY YOGA FOR
ARTHRITIS
  • Duration Six weeks (class meets once a week for
    about an hour but you must practice everyday with
    the help of the video)
  • Week 1
  • Foundations of Yoga Arthritis self management
  • Strain relieving asanas (postures)
  • Stress relieving shava asana (corpse pose)
  • Week 2
  • Continued practice from week 1
  • Week 3
  • Continued practice from weeks 1 2
  • Pranayama (breathing) techniques
  • Initiation in Kundalini dhyana (meditation)

14
BASIC COURSE IN KUNDALINI ENERGY YOGA FOR
ARTHRITIS 2
  • Week 4
  • Continued practice from weeks 1, 2, 3
  • Refined practice of techniques asanas (postures)
    pranayama (breathing), and Kundalini dhyana
    (meditation)
  • Week 5
  • Continued practice from weeks 1, 2, 3, 4
  • Second stage of Kundalini dhyana (meditation)
  • Week 6
  • Continued practice from weeks 1, 2, 3, 4, 5
  • Directions for future practice

15
RESULTS Descriptive data
  • Months diagnosed with arthritis 2 - 204 (Mean
    60.39, s.d. 57.15)
  • Age 45 - 66 years (Mean 55.13, s.d. 5.41)
  • Gender 1 male (4.2), 23 females (95.8)
  • Race 24 Caucasian (100)
  • Education 8 completed high school (33.3), 16
    college education or more (66.7)

16
RESULTS Process ratings
17
RESULTS Paired t-tests
18
RESULTS Strengths
  • Very educational
  • Details were easily understood and explained
  • Felt it was helpful to learn relaxation
    techniques
  • Learning meditation
  • Emphasis on mind/body connection
  • Better movement of hand and knee
  • Stress reduction (n2)
  • Breathing much improved
  • Very well done, Keep it going

19
RESULTS Strengths (Continued)
  • The video (n2)
  • Individual attention by instructor
  • Flexibility of exercises to individual's
    capability
  • Great relaxation , exercises
  • Meeting with and yoga together
  • Joint pain relief
  • Having the tape for practice

20
RESULTS Strengths (Continued)
  • Extremely valuable
  • Group being led in prison of doing thing
  • Improves mobility (n2)
  • Teaches relaxation
  • Encourages quiet self focus relaxation
  • Relaxation techniques
  • Patience of the instructor
  • The noticeable results from practicing yoga

21
RESULTS Areas for Improvement
  • It would be nice if leader led us through asanas
    at class in person rather than always show video.
  • More weekly sessions i.e. noon M-F or 3 noons a
    week
  • Softer floors
  • Longer time for instruction both class length and
    duration of classes

22
RESULTS Areas for Improvement (Continued)
  • Greater time length
  • Would have liked class time to include things not
    on the tape
  • Emphasize before sign up that there is an
    expectation of daily practice
  • More time per session
  • More frequent session
  • The continuation of the program

23
RESULTS Testimony by one patient
  • I have been participating in a 6 week program
    using Kundalini Energy Yoga for the management of
    arthritis pain. I have noticed a remarkable
    improvement of some of my health problems. I
    have been diagnosed with connective disease and I
    also have Fuchs deficiency. While I have been
    practicing the yoga (eye exercise) the dry eye
    symptoms (associated with Fuchs deficiency) have
    improved. I do not need to use the eye drops
    during the day as often as I had before. The
    stiffness and joint pain has improved greatly. I
    am able to move freely and look over my shoulders
    without pain. I am confident that as I continue
    to practice yoga, I will keep improving. A
    perfect example of this is after 3 1/2 hours of
    housecleaning projects I could hardly stand up
    because of back pain. I started doing the video
    of yoga and after 90 minutes when I had finished
    I felt great!!! The back pain was gone and I felt
    like I was just starting the day. The yoga must
    have helped with stomach muscles firming because
    I can fit into a pair of jeans that I could not
    zip up before I started yoga. I am hoping that
    when I go back to Dr. _____ (Arthritis Center of
    _______) in May I will be able to share this
    exciting discovery.

24
Conclusions
  • All process ratings were found to be above
    average indicating acceptance and feasibility of
    the program
  • No side effects or adverse reactions were
    reported
  • Pain, swelling, stiffness, and functional
    independence did not show improvement in the
    6-week time period

25
Conclusions (Continued)
  • Significant improvement in performance of
    yoga-related behaviors was noted again indicating
    that these behaviors can be easily performed by
    arthritis patients
  • Qualitative subjective ratings were found to be
    positive
  • Duration of the intervention was mentioned as
    being short

26
Implications
  • Pilot test indicates need for an efficacy trial
    of longer duration with a control group
  • Need to enhance modification of the construct of
    self-efficacy by observational learning, verbal
    persuasion, and mastery of skills
  • Need to strengthen educational interventions by
    adding the constructs of SCT such as
    expectations, expectancies, and self control
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