An Exploration of the Experience of Individuals Undertaking Yoga or Exercise as part of a Continuing

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An Exploration of the Experience of Individuals
Undertaking Yoga or Exercise as part of a
Continuing Cardiac Rehabilitation Programme

• Doctoral Study
• Kay Byatt

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Study Aims

• To describe the characteristics of individuals
  who choose yoga or exercise continuing cardiac
  rehabilitation programmes
• To explore over time the process of adaptation
  and change together with the perceived benefits
  described by individuals with CHD who undertake
  the continuing yoga and exercise rehabilitation
  programmes

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Research Questions

• Meaning of the Cardiac event
• Reasons for choice of intervention
• Characteristics of those who chose yoga or
  exercise
• What is promoted within each programme
• Stress levels at beginning and following 1 year
• Quality of life
• Self esteem
• Benefits from yoga or exercise
• How might emerging evidence inform practice and
  policy

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Research Design

• Exploratory Mixed Method Triangulated Design
• Longitudinal Study ( Duration 1 year)

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Method

• Self Reports
• (used at start of programme and at 1year)
• - Questionnaires
• - Semi-structured interviews
• Between Methods Triangulation
• combining qualitative and quantitative methods
  in the examination of one or more concepts or
  variables

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Self Reports

• Questionnaires
• Self Perception Profile
• (Messer Harter,1986)
• Self Evaluation of Individual Quality of Life
  (O Boyle, 1993)
• Perceived Stress Scale
• (Cohen, 1983 )

• Semi Structured Interviews
• Self Image
• Quality of Life
• Stress
• Adaptation process
• (Frenn,1989)
• Experience of yoga/exercise

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Sample

• Purposive Sample
• Individuals who selected the continuing exercise
  or yoga programme on completion of a 6 week
  cardiac rehabilitation programme
• Yoga Group (n25) (women,14 men,11)
• Exercise (n35) (women, 3 men, 32)

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Data Analysis

• Questionnaires
• Descriptive statistics
• Transcripts
• Thematic and Content analysis
• Descriptive Statistics
• Triangulation
• Combination of data

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Yoga and Exercise Group Characteristics

• Yoga n25
• Age 50-78 (mean62)
• Retired 16
• Employed 5
• Unemployed 4
• MI 12
• Hypertension 3
• Angina 2
• Pre-surgery 1
• Post-surgery 4
• Other 2

• Exercise n 35
• Age 48-84 (mean66)
• Retired 27
• Employed 3
• Unemployed 4
• MI 23
• Pre-surgery 1
• Post-Surgery 7
• Angina 3

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Yoga A Complementary Therapy

• To bring together, to unite, to make whole
• (Ornish, 1990)
• A mindbody discipline
• A system of health
• Co-ordinated total body movements and breathing
  under the quiet meditative focus of the mind
  (Chandler, 2001)
• The physiologic state produced by regular
  practice is the opposite of the flight/fight
  stress
• response (Schatz,1992)

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Yoga and Exercise Programmes

• Yoga programme
• Activation Exercises
• Energy Block Release
• Movement Sequences
• Posture Work
• Deep Relaxation
• Concentration Visualisation
• Meditation
• (Agnew,2001 Jones,2002)

• Exercise programme
• Gymnasium Based
• 12 weeks then further 20weeks

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Findings

• Questionnaires
• Stress Levels - Average in both groups
• Global Self Worth - High in both groups
• Quality of Life - Good-Very good in both
  groups

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Findings What participants felt about their CHD?

• I would put it at the positive end. Its not a
  nice thing and at first despair, you feel at the
  bottom of the pit. But since then Ive felt
  really optimistic about things, quite pleased (if
  that doesnt sound crazy) about doing these
  little things. (Yoga 1-8)

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Findings What participants felt about their CHD?

• In some ways it was quite a good thing really
  because it changed my life - and the change has
  been for the better. (Yoga 1-6)
• I think its positive, because if I hadn't had my
  HA I'd still be wolfing all the cholesterol. It
  gives you a little bit of apprehension, going
  abroad I'd worry. The apprehension is only in
  relation to something like that. (Exe 1-12)

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Findings What participants felt about their CHD?

• A very positive experience. I wasn't sure before
  the op but now I know it's done me a lot of good.
  It's made me less apprehensive about having
  another op. I don't think there are any negative
  effects. (Exe 1-9)

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Findings What Self Changes did participants
report ?

• I think that I am taking more notice of me,
  giving myself time and believing in myself a bit
  more. I've always thought I wasn't capable of
  doing some things, but now I think I can. I like
  myself a bit better, I think. I want to enjoy the
  rest of my life a lot better, to be able to cope
  a lot better, which I think I have. (Yoga1-4)
• I don't rush around as much. I take things more
  calmly
• I'm more relaxed now. (Yoga 1-59)

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Findings What Self Changes did participants
report ?

• If I did the same as before the HA, it would
  happen again, so I knew I had to change
  something's. I don't know if it was a build up -
  I can change some things like my diet and
  drinking and more exercise, I can't change my
  stress. (Exe 1-14)
• I've come to enjoy life more, even the smaller
  things, I appreciate things more now, like a view
  or a landscape or a holiday. Before it happened
  I was very tired a lot. I've changed my diet, I
  don't drink as much and I do more swimming (Exe
  1-43)

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Findings Why Yoga or Exercise?

• Yoga Participants
• Did not like gymnasium exercise
• Wanted a different approach to exercise
• Some had an interest in trying yoga

• Exercise Participants
• Enjoyed exercise
• Many had always exercised

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Findings What Participants Hoped to Achieve?

• Yoga
• Relaxation
• Calmness
• Reduction of Stress and Anxiety

• Exercise
• Fitness
• Health

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Findings What Benefits Participants achieved?

• Yoga
• Ability to relax
• Self awareness
• Greater calmness
• Positive, uplifting feelings
• Flexibility, suppleness
• Group Support

• Exercise
• Fitness
• Feeling Better
• Group Support

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Findings What Benefits Participants achieved?

• I think the whole thing gives you self-awareness.
  Whether it was the postures or the relaxation.
  Ive remained self-aware. I used to be
  self-aware but I let it go and then got it back,
  of which Im glad of. I got that back through
  yoga. I stopped in my tracks and reconsidered
  myself. (Yoga 2-7)
• Everything has changed since Ive been coming.
  Youre more friendly towards people and things
  like that. I put my confidence down to the yoga.
  Its done an awful lot to help. (Yoga 2-59)

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Findings What Benefits Participants achieved?

• Being aware of yoga movements with the mind has a
  very calming and very pleasant effect, basically
  I'm very happy that I'm in touch with myself and
  I intend to keep coming to yoga to keep in touch
  and stay in touch with myself. After relaxation
  and visualisation I give myself a message every
  day that everyday in every way I'm getting better
  and better and better and negative thoughts won't
  intrude on me, only positive thoughts and I'm
  very happy and content with my life. I repeat
  each of these three times and I relax and feel
  good. (Yoga 1-7)

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Findings What Benefits Participants achieved?

• It stimulates the heart, the exercise Im doing.
  Yes ,Ive become aware of my body more now than
  what I was before. (Exe 2-29)
• Its just that I feel fitter. (Exe 2-10)

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Findings What Benefits Participants achieved?

• Exercise -Well I think its made me appreciate
  things a lot more, funny enough. Er.. and its
  helped me grow in confidence as I said before,
  but I think because, that time is put aside, one
  thing I never, never done really is put time
  aside. (Exe 2-36)

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Key Findings

• Yoga Group
• Mind/Body Benefits
• Enhanced self awareness
• Self - central focus of life
• Reduction in stress and anxiety
• Greater calmness
• Positive feelings/attitude
• Body flexibility suppleness
• Being in control of life

• Exercise Group
• Enhanced physical fitness
• General well-being

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Implications for Policy and Practice

• CR should Empower Lifestyle Change as well as
  cardiovascular fitness
• A wider range of Interventions may be utilised
  with CR to help facilitate this
• Evolution of Content of CR programmes
• Wider Evidence base
• Education and skill base of health professionals
• Interdisciplinary approaches to provision