+ Reducing Stress and Improving Social Participation Through Yoga Marieke Van Puymbroeck, Ph.D., CTRS, FDRT Associate Professor Recreational Therapy Coordinator.

+Reducing Stress and Improving

Social Participation Through Yoga

Marieke Van Puymbroeck, Ph.D., CTRS, FDRTAssociate ProfessorRecreational Therapy CoordinatorClemson [email protected]

+Introduction & OutlineRehabilitation Scientist and

Recreational Therapist

Conceptual foundation

Overview of yoga

Discussions of 2 yoga studies Breast cancer survivors Chronic stroke

Tying it all together- what does it mean?

+Conceptual foundation

How do we understand what occurs for someone with a health condition?

+Previous models of disability and disease (e.g. Nagi, 1965)

YT?

OT?

RT?

PT?

MD?

+World Health Organization’s International Classification of Functioning, Disability, and Health (ICF)

Health Condition(disorder or

disease)

ActivityBody Function& Structures

Participation

PersonalFactors

Environmental Factors

+Participation

Areas of participation most commonly impacted after acute or chronic disease/disability:Roles Family relationshipsSexual relationshipsSocial activities Return to workFinances

+Components of YogaAsana (Postures)

Standing, sitting, supine, or prone (Lee, 2004)

Full body ROM- strengthening, balancing, and stretching each part (Collins, 1998)

Periods of relaxation throughout yoga to refocus or maintain internal attention

Pranayama (Breath work) Intentional regulation of rhythmic breathing patterns Coordinated with asanas- either static or moving (Fieldstone, 2000)

Goal is to reduced or slow breathing to increase consciousness (Feuerstein, 1974)

Dhyana (Meditation) Stilling or emptying the mind- goal is a state of “detached

observation” (Moy, 1996; Sridvi, Sitamona, &Krishna-Rao, 1995)

Focused on increased concentration, a still mind, increased awareness of the present (Lee, 2004)

+ The Importance of Synergy

Asanas, pranayama and dhyana must occur together for maximum benefit. (Raub, 2005)

Yoga participants showed greater benefit than those in an MBSR, mall-walking, or control group in LB strength, UB strength, and endurance. (Van Puymbroeck, Hsieh, & Pernell, 2008)

+Yoga Studies Examining Stress Reduction and Participation

Breast cancer survivors (qualitative data)

Chronic stroke (quantitative and qualitative data)

+Yoga and Breast Cancer SurvivorsMethodsDESIGN/GROUPS

Single blind, 2-arm (yoga vs. light stretching), quasi-randomized trial

INCLUSION CRITERIAAt least 9 mo post-tx, dx at least 1 year prior to trial, able to commit to class times.

DURATION2x/per week @1.25 hrs x 8 weeks

INTERVENTIONISTAdvanced training in yoga therapeutics

Van Puymbroeck, M., Schmid, A., et al. (2011). Intl J Yoga Ther.Van Puymbroeck, M., Schmid, A.A., et al. (2013) Amer J Health Promotion.

+Yoga InterventionProgressively difficult

Designed to opening chest, focus on breath work, improve upper body flexibility and strength

+Breast cancer survivor demographics

Characteristic N=11Age 53.72

Race (white) 11

Education HS >College

38

Marital status Single Married Widowed

272

Gender Male Female

011

+Yoga and Breast Cancer Survivors Qualitative data: Emotional Health and Stress ReductionYoga classes helped women feel stronger, both

emotionally and mentally, and more peaceful. After yoga classes, I felt “a sense of healing, and it’s really nice seeing a

whole bunch of women who are still here just like you, and having normal lives, and they’re all trying to improve the quality of their lives- physically, as well as, I don’t know if you’d call it spiritually or emotionally, but you feel very centered after this, very de-stressed.”

Yoga and yoga breathing were important components of reducing stress And I’ve gotten a wonderful benefit of taking the relaxation from the

yoga---the stretching and the breathing that I’ve learned how to do with the class, it’s helped me tremendously. I have a very stressful job. I’ve just gone through a divorce. And the stretching, the breathing, and just focusing on what your body’s telling you, I’ve really taken from the class and I’ve really enjoyed learning that, and that’s helped me tremendously.

+Yoga and Breast Cancer SurvivorsQualitative Data: Social Participation

Participants spoke mainly about individual experiences, but being part of a larger community had benefits as well. I think we all had the common bond of breast cancer, so we’re similar in

that aspect. It’s like joining a club. We joined the breast cancer club, but now we’re the breast cancer yoga club.

The environment of the “breast cancer yoga club” was important and made the women feel less physically inhibited. It was nice to be in a group, have people who had all kind of shared the

same thing. You know, it was especially true at certain exercises we all knew that some of us would be limited.

Well I enjoyed doing it because nobody was looking at you like you looked funny, cause one boob, no boob, you know [laughter].

+Yoga and Breast Cancer SurvivorsQualitative Data: Yoga as a Catalyst for Participation

Yoga prompted greater engagement in life activities I turned into a real couch potato 4 years ago when my

husband died, and this helped me come out of it.

Well, it’s given me the incentive to exercise for 20 minutes every morning. So I’m doing a lot of the stretches, a lot of the poses that work on those core muscles and the obliques. And so it’s helping to get my muscles back in shape.

+Yoga for Chronic Stroke StudyMethods

DESIGN/GROUPSRandomized controlled trial into yoga (n=37) or WL control (n=10)

INCLUSION CRITERIASurvived a stroke, required rehab post-stroke, completed all inpatient rehabilitation, at least 6 months post-stroke

DURATION2x/per week @1 hr x 8 weeks

INTERVENTIONISTAdvanced training in yoga therapeutics

Week 1-2

Entire practice is seated with seated relaxation

Week 3-4

Seated and standing practices with a seated relaxation

Week 5-8

Seated, standing, and supine on floor poses with on floor relaxation

+

Demographics

ICF Measure of Participation and Activity (IMPACT) subscales

Stroke Survivor Quality of Life (SSQOL) (aggregate)

Focus groups

Paired t-tests were utilized to compare the baseline and 8-week scores on each of the measures for both groups

Qualitative analysis

Yoga for Chronic Stroke: Measures and Analysis

+

Variable All (N=47) Yoga (n=37)

Wait-list (n=10)

Age 63.1±8.8 63.9±8.7 60.2±8.9

Race, white 28 (60%) 22 (59%) 6 (60%)

Gender, male

38 (81%) 20 (54%) 10 (100%)

Months since stroke

51±40.4 54.9±43.2 36.4±23.6

Yoga for Chronic StrokeResults: Demographics

+

For individuals in the yoga group: activity improved (t=2.45, p=.02) participation improved (t=2.10, p=.045) quality of life improved (t=-2.187, p=.04)

For those in the WL control, activity, participation, and quality of life did not statistically significantly improve over the 8-week period.

Yoga for Chronic StrokeQuantitative Results

+Yoga for Chronic StrokeQualitative Data: Stress/Emotional RegulationAfter stroke, emotional regulation is difficult to

manage.

Changes attributed to yoga intervention: I don’t cry at Hallmark commercials any more. About for the first three

weeks from the hospital when I first got home I was like a little girl, every time a Hallmark commercial would come on, I’m serious I would be like wooo [gesturing crying].

Reductions in anxiety also attributed to yoga intervention: Well, I remember first getting home from the hospital and starting stuff,

like walking on my own and doing stuff around the house. Again, I would get so anxious and so nervous about stuff you know, how am I going to do that? I think with this program that doesn’t even enter into it anymore.

+Yoga and Chronic StrokeQualitative Results: Participation

Much improvement in participation stemmed from increases in body function.

Participants focused on their increased ability to be more active in their own lives by being able to properly and independently perform essential tasks and actions.

“I think one of the things that has affected me is, I’m gonna cry [crying], it’s improved my life, I can take a shower and I’m not afraid of falling. I couldn’t, I was just scared and now I’m not. [sniffles]…”

“I believe it’s given me greater, um, amount of confidence…two days ago I was up on uh, Continental Divide, and I had to go up probably another fifty feet up some stairs and the wind was probably fifty miles an hour… but I kept going on up there. [I was determined that] I’m gonna make it all the way to the top. I’m gonna view this glorious view that I have in front of me. And, a lot of it is just due to the confidence that this class has instilled. A year ago I couldn’t have done it—today I can.”

+

The 8-week yoga intervention for individuals with chronic stroke resulted in improved body function, participation, and quality of life.

Those in the control group did not see improvements in these areas.

These findings support future research in these areas to determine the mechanisms from yoga that improved activity, participation, and quality of life for individuals with chronic stroke.

Yoga for Chronic StrokeDiscussion

Schmid, A.A., Van Puymbroeck, M., et al. (2012). Stroke.Van Puymbroeck, M., Schmid, A.A. et al (2015). Am J Recreational Ther.

+ Tying it all together

Increased participation and reductions in stress and anxiety

July 2014- Yoga Journal- Dr. Tim McCall talked about yoga increasing emotional intelligence.

Broaden and Build Theory of Positive Emotions- Barbara FredericksonPositive emotions expand an individual’s

mindsetThis expanded mindset allows or even

encourages new activities

+Broaden and Build- exemplary quote

“by broadening an individual’s momentary thought- action repertoire- whether through play, exploration, or similar activities- positive emotions promote discovery of novel and creative actions, ideas and social bonds, which in turn build that individual’s personal resources; ranging from physical and intellectual resources, to social and psychological resources.” (p. 1367)

+So what does it all mean?

Concepts of stress reduction and participation are important factors to consider in our research.

Explore positive emotion and participation simultaneously.

Yoga is a powerful tool to improve holistic well-being.

Appears that yoga acts as a gateway to engagement in other activities.

+

Primary collaborator: Dr. Arlene Schmid, OTRColorado State University, Dept. of OT

Our yoga therapists, the yoga teachers in training, and the students who assisted.

With sincere gratitude, I acknowledge…

+Thank you so much for your

time!

[email protected]

[email protected]