Title: Testing a yogabased behavioral intervention as a complementary therapy for arthritis
1Testing 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
2Arthritis
- 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
3CDC 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
4Yoga 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
5How 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)
6Arthritis 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.
7Arthritis 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.
8Arthritis 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.
9Arthritis 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.
10Arthritis 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.
11Arthritis 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. -
12STAGES 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
13BASIC 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)
14BASIC 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
15RESULTS 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)
16RESULTS Process ratings
17RESULTS Paired t-tests
18RESULTS 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
19RESULTS 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
20RESULTS 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
21RESULTS 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
22RESULTS 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
23RESULTS 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.
24Conclusions
- 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
25Conclusions (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
26Implications
- 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