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Experiences of hatha yogic exercises among patients with obstructive pulmonary disease: A qualitative study

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Experiences of hatha yogic exercises among patients with obstructive pulmonary disease: A qualitative study

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... Fifteen studies included only females [28,36,39,46,48,49,52,55,61,62,71,83,84,90,94] and one study included only males [70]. Ten studies had 1-24% males [25,27,28,39,51,64,65,73,89,92], another 10 had 25-49% males [25,34,38,58,69,73,74,92,95,97] and 10 studies had greater than 50% males as participants [27,29,32,53,54,60,76,89,92,93]. All of the study participants were older adults, 11 studies did not report additional age information [37,46,52,57,68,86,88,90,91,97,99]. ...
... All of the study participants were older adults, 11 studies did not report additional age information [37,46,52,57,68,86,88,90,91,97,99]. Six studies provided an age range [28,35,41,77,94,95], seven studies included participants with a mean age 50-59 years [36,51,66,67,69,80,83], 19 studies with a mean age of 60-69 [25,40,42,43,48,50,56,59,63,70,71,73,81,84,85,87,93], 21 studies with a mean age of 70-79 [22, 27, 29, 30, 32-34, 38, 39, 46, 53-55, 58, 60, 72, 75, 76, 79, 82, 96] and 10 studies included participants with a mean age greater than 80 years [44,47,49,61,62,64,65,74,78,92]. The majority of these studies, 22 [29, 33, 35, 38, 41, 44, 45, 50-52, 59, 62, 64, 71, 73, 75, 76, 78, 79, 80, 84, 90] of 75, were focused on community dwelling older adults, 11 of which were healthy. ...
... The orthopaedic diagnoses were lower extremity osteoarthritis (n = 13) [22, 25, 27, 28, 30-32, 34, 46, 53, 65, 66, 95], vertebral impairments (n = 2) [55,72] and osteopenia (n = 1) [48]. The remaining diagnostic categories include cardiopulmonary disorders (n = 5) [42,43,57,93,98], neurologic disorders (n = 7) [40,56,80,82,85,87,89], cancer (n = 8) [36,63,67,70,81,83,86], institutionalized [49,61,77,94] and chronic symptoms. The Western Ontario and McMaster University Osteoarthritis Index was the most prevalently used measure for osteoarthritis. ...
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Chair yoga is a specific form of yoga practiced while seated on a chair, or standing using a chair for support; this adaptation allows those with impaired standing ability to practice safely. The purpose of this scoping review was to analyze the published literature regarding the use of chair/adapted yoga with older adults. Two researchers performed the review. Data sources: PubMed Central, CINAHL, Medline Full Text, Nursing and Allied Health, SPORT discus and TRIP were accessed. Study selection: Inclusion criteria included pre-test/post-test studies with a yoga intervention for older adults using a chair. Exclusion criteria were studies with seated exercise interventions not specific to yoga, mindfulness or breathing techniques with no physical activity, yoga with no use of a chair, not specific to older adults and reviews. The search strategy was performed by two reviewers. Data extraction: Covidence, a systematic review production tool, was utilized to aid article analysis. Data synthesis: Summation of study type, sample, dosing, intervention type, setting, outcome domains and results were included. Of the 3147 studies initially identified, 75 met the inclusion criteria. This review included 32 RCTs, 11 quasi-experimental, 21 cohort, nine qualitative studies and 2 case-series studies. Most studies reported affective and psychomotor domains of learning (n = 51) and favored chair/adapted yoga as an intervention over the control. A few studies included a second intervention. Twenty two of the 75 studies were focused on community dwelling older adults, followed by participants with orthopedic diagnoses (n = 16), and cognitive impairment (n = 9). The quality of literature supporting chair/adapted yoga is fairly substantial for both community dwelling and those with certain physical and cognitive diagnoses. It is recommended that this intervention continue to be utilized and studied.
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Introduction and objective Multiple sclerosis is a neurological autoimmune disease. Different disease-modifying treatments exist; however, they do not control the neurodegenerative processes and often result in adverse events. Therefore, many people with multiple sclerosis turn to complementary or integrative health (CIH) practices. Yoga is one of the more popular CIH practices among people with multiple sclerosis, and evidence points to an association between yoga and improved body awareness. The objective of this study was to investigate if a 12-week yoga course can improve body awareness in patients with multiple sclerosis as measured with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Material and methods In this non-controlled pilot study, 22 patients participated in a 12-week yoga course. They attended weekly classes with the instructor and were encouraged to practice the exercises at home twice weekly. Before and after the course, all participants filled in the MAIA questionnaire, which consists of the eight dimensions: Noticing, Not-distracting, Not-Worrying, Attention regulation, Emotional awareness, Self-regulation, Body-listening and Trusting. Changes in mean scores were estimated with two-tailed paired t-tests. Results After the 12-week yoga course, participants’ total mean scores for body awareness improved significantly. Significant improvements were detected within three of the eight subscales from the MAIA, Attention regulation, Emotional awareness and Trusting. Conclusion The results of this non-controlled pilot study suggest that yoga may have a positive effect on body awareness in patients with multiple sclerosis. Improvements were found in all subscales of body awareness although only improvements in three of the eight subscales were significant.
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Background: With more women being diagnosed with obstructive pulmonary disease, it is important to know how women experience non-pharmacological rehabilitation including different types of physical activity and exercise. Objective: This study aimed to explore how women with obstructive pulmonary disease experienced participating in pulmonary rehabilitation including yoga or strength- and endurance training to promote physical activity. A second aim included exploring experiences of physical activity and exercise through life. Methods: Fifteen women with asthma or chronic obstructive pulmonary disease were interviewed about their experiences of participating in an exercise intervention and about their experiences of physical activity and exercise in their lives. The transcribed interviews were analyzed using qualitative content analysis. Results: An overall theme, "Wishing to succeed in attending physical activity and exercise," emerged. Three categories were identified: 1) strategies to overcome insecurity; 2) a life situation which enables and hinders; and 3) an inner drive and focus on myself. Conclusions: The women's wishes to be physically activity and exercise involved hindering and enabling factors. Specifically, their gender roles as women were described as a hinder. This suggests a need to include a gender perspective when promoting physical activity and exercise to women with obstructive pulmonary disease.
Chapter
Mind–body interventions (MBIs) include a wide range of behavioral therapies, such as meditation, Tai Chi, yoga, and relaxation techniques. Though heterogeneous, most MBIs are multimodal and include therapeutic components, such as mindfulness, breath awareness, and physical movement. These interventions modulate key neurocognitive, psycho-emotional, and biophysical processes that may be involved in promotion of positive health behaviors and healthcare engagement. This chapter focuses on three particularly salient self-care behaviors for pulmonary patients: medication adherence, smoking cessation, and physical activity. For example, MBIs improve processes such as attention, memory, and planning behavior, as well as increase mindfulness and disease awareness, which may support medication adherence. Similarly, for smoking cessation, MBIs cultivate awareness and engage cognitive and emotional processes such as cognitive decentering and emotion regulation that may help patients notice triggers and resist cravings. Changes in mood, self-efficacy, motivation, physical function, and cardiorespiratory fitness with various MBIs may facilitate engagement in physical activity. Healthcare professionals can successfully guide patients by actively inquiring about MBI use and preferences, and by making appropriate recommendations or referrals based on patient needs, functional status, and available community resources.
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Purpose of review: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely available in the community and have been shown to be beneficial in patients with COPD as well as many of the co-morbid conditions associated with COPD. Recent findings: Yoga and Tai Chi have been found to be more effective than usual care in COPD with clinically meaningful improvements in 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and health-related quality of life (HRQoL). They have also been found to be comparable to pulmonary rehabilitation interventions. Summary: Yoga and Tai Chi provide community-based options for patients with COPD to improve their physical activity, quality of life, and pulmonary function.
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Background: Knowledge of hatha yogic exercises, the most used yoga style, for increasing functional capacity in patients with obstructive pulmonary diseases remains limited. Aim: The aim was to evaluate the effects and feasibility of hatha yoga (HY) compared to a conventional training program (CTP) on functional capacity, lung function and quality of life in patients with obstructive pulmonary diseases. Design: RCT (randomized clinical trial). Setting: The study was performed at the Karolinska University Hospital, Stockholm, Sweden among outpatients. Population: Thirty-six patients with obstructive pulmonary disease. Methods: Forty patients were randomized with 36 (24 women, median age=64, age range: 40-84 yrs) participating in HY (n=19) or CTP (n=17). Both HY and CTP involved a 12-week program with a 6-month follow-up. Functional capacity (using the 6-minute walk test, 6MWT), lung function (spirometry), respiratory muscle strength (respiratory pressure meter), oxygen saturation (SpO2), breathlessness (Borg), respiratory rate (f) and disease-specific quality of life (CRQ) were measured at baseline, at 12 weeks and at a 6-month follow-up. Results: Testing for interactions (group x time) with ANOVAs showed significant effects on the CRQ fatigue (p=0.04) and emotional (p=0.02) domains, with improvements in the CTP group after the 12-week intervention (p=0.02 and 0.01, respectively) but not in the HY group. Within each group, significant improvements emerged for the 6MWD after 12-week intervention (HY: mean difference 32.6 m; CI 10.1-55.1, p=0.014; CTP: mean difference 42.4 m; CI 17.9-67.0, p=0.006). Within-group improvements in CRQ appeared in both groups. Within the HY group, the respiratory rate (f) decreased and SpO2 increased. Improved effects after follow-up emerged only for the CTP group for 6MWD (p=0.04), diastolic blood pressure (p=0.05) and CRQ emotional domain (p=0.01). Conclusions: After 12 weeks, 6MWD improved significantly within both groups. Within the HY group, improvements in the CRQ mastery domain, f and SpO2 emerged. Within the CTP group, there were improvements in lung function parameter forced vital capacity (FVC), respiratory muscle strength and all CRQ-domains. The CTP also exhibited effects on CRQ after the 6months follow-up. Clinical rehabilitation impact: Similar effects of HY and CTP show that HY seems feasible and safe as a form of physical exercise for pulmonary disease patients. As part of the rehabilitation, HY may constitute an alternative to other physical training activities and may be a useful addition to formal rehabilitation programs.
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Background: Coal mine dust exposure causes chronic airflow limitation in coal miners resulting in dyspnea, fatigue, and eventually chronic obstructive pulmonary disease (COPD). Yoga can alleviate dyspnea in COPD by improving ventilatory mechanics, reducing central neural drive, and partially restoring neuromechanical coupling of the respiratory system. Objectives: To evaluate the effectiveness of Integrated Approach of Yoga Therapy (IAYT) in the management of dyspnea and fatigue in coal miners with COPD. Materials and methods: Randomized, waitlist controlled, single-blind clinical trial. Eighty-one coal miners (36–60 years) with stable Stages II and III COPD were recruited. The yoga group received an IAYT module for COPD that included asanas, loosening exercises, breathing practices, pranayama, cyclic meditation, yogic counseling and lectures 90 min/day, 6 days/week for 12 weeks. Measurements of dyspnea and fatigue on the Borg scale, exercise capacity by the 6 min walk test, peripheral capillary oxygen saturation (SpO2%), and pulse rate (PR) using pulse oximetry were made before and after the intervention. Results: Statistically significant within group reductions in dyspnea (P
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BACKGROUND: Asthma is a common chronic inflammatory disorder affecting about 300 million people worldwide. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally. A number of clinical trials have been carried out to evaluate the effects of yoga practice, with inconsistent results. OBJECTIVES: To assess the effects of yoga in people with asthma. METHODS: Search methods: We systematically searched the Cochrane Airways Group Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched PEDro. We searched ClinicalTrials.gov and the WHO ICTRP search portal. We searched all databases from their inception to 22 July 2015, and used no restriction on language of publication. We checked the reference lists of eligible studies and relevant review articles for additional studies. We attempted to contact investigators of eligible studies and experts in the field to learn of other published and unpublished studies. Selection criteria: We included randomized controlled trials (RCTs) that compared yoga with usual care (or no intervention) or sham intervention in people with asthma and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events. Data collection and analysis: We extracted bibliographic information, characteristics of participants, characteristics of interventions and controls, characteristics of methodology, and results for the outcomes of our interest from eligible studies. For continuous outcomes, we used mean difference (MD) with 95% confidence interval (CI) to denote the treatment effects, if the outcomes were measured by the same scale across studies. Alternatively, if the outcomes were measured by different scales across studies, we used standardized mean difference (SMD) with 95% CI. For dichotomous outcomes, we used risk ratio (RR) with 95% CI to measure the treatment effects. We performed meta-analysis with Review Manager 5.3. We used the fixed-effect model to pool the data, unless there was substantial heterogeneity among studies, in which case we used the random-effects model instead. For outcomes inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and summarized the findings narratively. MAIN RESULTS: We included 15 RCTs with a total of 1048 participants. Most of the trials were conducted in India, followed by Europe and the United States. The majority of participants were adults of both sexes with mild to moderate asthma for six months to more than 23 years. Five studies included yoga breathing alone, while the other studies assessed yoga interventions that included breathing, posture, and meditation. Interventions lasted from two weeks to 54 months, for no more than six months in the majority of studies. The risk of bias was low across all domains in one study and unclear or high in at least one domain for the remainder. There was some evidence that yoga may improve quality of life (MD in Asthma Quality of Life Questionnaire (AQLQ) score per item 0.57 units on a 7-point scale, 95% CI 0.37 to 0.77; 5 studies; 375 participants), improve symptoms (SMD 0.37, 95% CI 0.09 to 0.65; 3 studies; 243 participants), and reduce medication usage (RR 5.35, 95% CI 1.29 to 22.11; 2 studies) in people with asthma. The MD for AQLQ score exceeded the minimal clinically important difference (MCID) of 0.5, but whether the mean changes exceeded the MCID for asthma symptoms is uncertain due to the lack of an established MCID in the severity scores used in the included studies. The effects of yoga on change from baseline forced expiratory volume in one second (MD 0.04 liters, 95% CI -0.10 to 0.19; 7 studies; 340 participants; I² = 68%) were not statistically significant. Two studies indicated improved asthma control, but due to very significant heterogeneity (I² = 98%) we did not pool data. No serious adverse events associated with yoga were reported, but the data on this outcome was limited. AUTHORS CONCLUSIONS: We found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms in people with asthma. There is more uncertainty about potential adverse effects of yoga and its impact on lung function and medication usage. RCTs with a large sample size and high methodological and reporting quality are needed to confirm the effects of yoga for asthma
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Background: Some patients receiving treatment in conventional health care systems access therapeutic yoga outside their mainstream care to improve cancer symptoms. Given the current knowledge gap around patient preferences and documented experiences of yoga in adult cancer, this study aimed to describe patient-reported benefits, barriers and characteristics of programming for yoga practice during conventional treatment. Methods: In depth semi-structured interviews (n = 10) were conducted in men and women recruited from cancer care clinics in Vancouver, Canada using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed and analyzed using Interpretive Description methodology and constant comparative analysis methods. Results: Four themes emerged from the data to address our research objectives: patient-perceived benefits of yoga, reasons and motivations for practising yoga, hurdles and barriers to practising yoga, and advice for effective yoga program delivery in adult cancer. Several patients reported yoga reduced stress and other symptoms associated with cancer treatment. Thematic analysis found the social dimension of group yoga was important, as well as yoga's ability to encourage personal empowerment and awareness of physical body and self. Barriers to yoga adherence from the patient perspective included lack of time, scheduling conflicts and worries about financial burden. Conclusion: This small, diverse sample of patients reported positive experiences and no adverse effects following yoga practice for management of cancer and its symptoms. Results of this qualitative study identified patient-reported preferences, barriers and characteristics of yoga intervention optimal during adult cancer treatment.
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Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are highly prevalent and associated with a large symptom burden, that is compounded in a dual HF-COPD diagnosis. Yoga has potential benefit for symptom relief; however functional impairment hinders access to usual yoga classes. We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial. This paper reports on the appropriateness and acceptability of the intervention and the evaluation design. A controlled, non-randomised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control (information leaflets mailed to participants with one phone call a week). Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions. Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating, including views of study outcome measures and physiological tests. Transcribed interviews were analysed using thematic content analysis. Fifteen people participated in the pilot study (7 in the intervention group, 8 in the control). Of these, 12 participants were interviewed, 6 in each group, mean age 71.2 years (SD 10.09); 3 were male. Themes are reported in the following categories: acceptability and appropriateness of the intervention, potential active ingredients of the intervention, acceptability and appropriateness of the control, participation in the research, and acceptability of the testing procedures. The intervention was acceptable and appropriate: the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation. However, technological problems resulted in poor video-streaming quality for some participants. Potential active ingredients included physical postures, breathing exercises and guidance in relaxation and meditation. The educational control intervention was acceptable and appropriate, with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga's effectiveness. The questionnaires and home physiological testing were acceptable to participants. Tele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery. Findings provide guidance for researchers working in tele-interventions, yoga, and similar populations. ClinicalTrials.gov Identifier: NCT02078739 (4 March 2014).
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Background: This paper reviews evidence and quality of Systematic Reviews (SRs) on the effects of breathing control exercises (BCEs) and respiratory muscle training (RMT) on breathlessness/dyspnea and other symptoms, and quality of life (QOL) for individuals with chronic obstructive pulmonary disease (COPD). Methods: A search for BCE and RMT literature in COPD published between January 1, 2002 and December 31, 2013 was performed in the following databases: PubMed, Ovid, CINAHL, PsycINFO, AMED, Cochrane and PEDro. The AMSTAR criteria were used to evaluate quality. Results: After reviewing 642 reports, seven SRs were identified on RMT and BCEs. Three SRs were of high quality, three were of moderate quality, and one was of low quality. Two high-quality SRs reported significantly beneficial effects of RMT on dyspnea, and one reported significant effects on disease-specific QOL and fatigue. In these SRs, pooled data analyses were performed with three to fourteen single randomised control trials (RCTs) included in the analysis. In one of the SRs the quality of the single RCTs were rated by the authors to be between 5-7 (with10 best) and in the other one the quality of the single RCTs were rated to be between 30-83% of the maximum score.One high-quality SR found a significant positive effect of BCE based on pooled data analysis with two single RCTs in regard to pursed-lip breathing (PLB) on breathlessness. In this SR, one single RCT on diaphragmatic breathing (DB) and another one on yoga breathing (YB) showed effect on disease-specific QOL. The single RCTs included in the SR were rated by the authors in the SRs to be of low and moderate quality. Conclusions: Based on three high-quality SRs performing pooled data analyses, there is evidence that RMT has effect on breathlessness, fatigue and disease-specific QOL and PLB on breathlessness. There is also evidence that single studies on DB and YB has effect on disease-specific QOL. Few RCTs are available and the variable quality of the single RCTs in the SRs, seem to require more RCTs in particular for BCEs, but also RMT before conclusions regarding effects and high quality SRs can be written.
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Research suggesting the beneficial effects of yoga on myriad aspects of psychological health has proliferated in recent years, yet there is currently no overarching framework by which to understand yoga's potential beneficial effects. Here we provide a theoretical framework and systems-based network model of yoga that focuses on integration of top-down and bottom-up forms of self-regulation. We begin by contextualizing yoga in historical and contemporary settings, and then detail how specific components of yoga practice may affect cognitive, emotional, behavioral, and autonomic output under stress through an emphasis on interoception and bottom-up input, resulting in physical and psychological health. The model describes yoga practice as a comprehensive skillset of synergistic process tools that facilitate bidirectional feedback and integration between high- and low-level brain networks, and afferent and re-afferent input from interoceptive processes (somatosensory, viscerosensory, chemosensory). From a predictive coding perspective we propose a shift to perceptual inference for stress modulation and optimal self-regulation. We describe how the processes that sub-serve self-regulation become more automatized and efficient over time and practice, requiring less effort to initiate when necessary and terminate more rapidly when no longer needed. To support our proposed model, we present the available evidence for yoga affecting self-regulatory pathways, integrating existing constructs from behavior theory and cognitive neuroscience with emerging yoga and meditation research. This paper is intended to guide future basic and clinical research, specifically targeting areas of development in the treatment of stress-mediated psychological disorders.
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Introduction: Currently, several studies have assessed the effect of yoga training on the management of chronic obstructive pulmonary disease (COPD), but these studies involved a wide variation of sample and convey inconclusive results. Hence, the present study was performed a systematic review and meta-analysis to investigate the efficacy of yoga training in COPD patients. Methods: PubMed, EMBASE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov databases were searched for relevant studies. The primary outcomes were forced expiratory volume in one second (FEV1), FEV1% predicted (% pred). Secondary outcomes included 6-min walking distance (6 MWD), arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I(2) test. Results: Five randomized controlled trials (RCTs) involving 233 patients fulfilled the inclusion criteria. Yoga training significantly improved FEV1 (WMD: 123.57 mL, 95% CI: 4.12-243, P=0.04), FEV1% pred (WMD: 3.90%, 95% CI: 2.27-5.54, P<0.00001), and 6 MWD (WMD: 38.84 m, 95% CI: 15.52-62.16, P=0.001). However, yoga training had no significant effects on PaO2 (WMD: 1.29 mmHg, 95% CI: -1.21-3.78, P=0.31) and PaCO2 (WMD: -0.76 mmHg, 95% CI: -2.06-0.53, P=0.25). Conclusions: The current limited evidence suggested that yoga training has a positive effect on improving lung function and exercise capacity and could be used as an adjunct pulmonary rehabilitation program in COPD patients. However, further studies are needed to substantiate our preliminary findings and to investigate the long-term effects of yoga training.
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Over the past decades, cognitive neuroscience has witnessed a shift from predominantly disembodied and computational views of the mind, to more embodied and situated views of the mind. These postulate that mental functions cannot be fully understood without reference to the physical body and the environment in which they are experienced. Within the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. However, the cultivation of interoceptive, proprioceptive and kinesthetic awareness is also said to lie at the core of many movement-based contemplative practices such as Yoga, Qigong, and Tai Chi. In addition, it likely plays a key role in the efficacy of modern somatic therapeutic techniques such as the Feldenkrais Method and the Alexander Technique. In the current paper we examine how these practices are grounded in the concepts of embodiment, movement and contemplation, as we look at them primarily through the lens of an enactive approach to cognition. Throughout, we point to a series of challenges that arise when Western scientists study practices that are based on a non-dualistic view of mind and body.
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Qualitative content analysis is commonly used for analyzing qualitative data. However, few articles have examined the trustworthiness of its use in nursing science studies. The trustworthiness of qualitative content analysis is often presented by using terms such as credibility, dependability, conformability, transferability, and authenticity. This article focuses on trustworthiness based on a review of previous studies, our own experiences, and methodological textbooks. Trustworthiness was described for the main qualitative content analysis phases from data collection to reporting of the results. We concluded that it is important to scrutinize the trustworthiness of every phase of the analysis process, including the preparation, organization, and reporting of results. Together, these phases should give a reader a clear indication of the overall trustworthiness of the study. Based on our findings, we compiled a checklist for researchers attempting to improve the trustworthiness of a content analysis study. The discussion in this article helps to clarify how content analysis should be reported in a valid and understandable manner, which would be of particular benefit to reviewers of scientific articles. Furthermore, we discuss that it is often difficult to evaluate the trustworthiness of qualitative content analysis studies because of defective data collection method description and/or analysis description.
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BACKGROUND: Meditative movement (MM; tai chi/yoga/qi gong) may be beneficial for people with cystic fibrosis (CF) as a form of gentle exercise incorporating meditation, breathing and relaxation. Respiratory function is the most common issue in CF. This systematic review synthesised the evidence for MM for respiratory function to provide a clinical summary and inform research into MM for CF. METHODS: Chinese and English language databases were searched using keywords for tai chi/yoga/qi gong, and respiratory function/cough/dyspnoea. Articles were screened and selected by two researchers. Controlled studies published in English/Chinese after 1980 were included. Data were extracted using a specially designed spreadsheet. Two researchers independently evaluated study quality and reporting using three standardised checklists. Meta-analysis was not possible due to heterogeneous methodology. RESULTS: 1649 papers were identified, 43 included (30 English language, 13 Chinese), 23 RCTs, 20 nonrandomised trials. None studied CF; 11 studied patients with respiratory disorders, 27 healthy people. Very few were high quality. The main bias with RCTs was randomisation and nonrandom/poorly reported sampling, for non-randomised studies poor reporting of samples and non-equivalent groups. Although no clinically significant changes were shown, MM may improve FEV1 in healthy people compared to no treatment/exercise (intervention groups showed changes from 0.07 to 0.83) but MM did not appear to affect FEV1/FVC ratio in COPD. Key study limitations were: poor reporting of sampling or methods; small, potentially underpowered samples; non-randomised design; lacking description of randomisation; randomisation by centre; no blinding; lack of reporting of important aspects of MM; short-term follow up. CONCLUSION: There is no evidence for MM in CF, and very limited evidence for respiratory function in healthy populations. Due to heterogeneity of populations and lack of sampling information, clinicallyrelevant conclusions cannot be drawn and more research is needed in this area, in particular powered, randomised studies.
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There is limited knowledge on the prevalence of disease in total populations. Such studies have historically been difficult to conduct but the development of health data registers has facilitated large-scale studies on recorded diagnoses in entire regions. The aim of this study was to analyze the prevalence of diagnosis of six common diseases in the Swedish capital region. The study population included all living persons who resided in Stockholm County, Sweden, on December 31st 2011 (N = 2 093 717). Information on all consultations between 2007 and 2011 was obtained from primary health care, specialist outpatient care and inpatient care. Prevalence was defined as the proportion of individuals with a recorded diagnosis of diabetes, depression, anxiety disorders, hypertension, asthma and chronic obstructive pulmonary disease during the five year period, respectively. Analyses were done by age and gender. Hypertension had the highest five-year prevalence (12.2%), followed by depression (6.6%), diabetes mellitus (6.2%), asthma (5.9%), anxiety disorders/phobia (4.8%), and COPD (1.8%). Diabetes was more common in men (5.3% of women and 7.1% of men) while depression (8.7% in women and 4.4% in men) and anxiety (6.3% in women and 3.4% in men) were considerably more common in women. Smaller gender differences were also found for hypertension (13.0% in women and 11.4% in men), asthma (6.4% in women and 5.4% in men) and COPD (2.1% in women and 1.6% in men). Diabetes, hypertension and COPD increased markedly with age, whereas anxiety, depression and asthma were fairly constant in individuals above 18 years. During one year of observation, more than half of all patients had only been diagnosed in primary health care, with hypertension being the diagnosis with the largest proportion of patients only identified in primary health care (70.6%). The prevalence of common diseases in the population can be estimated by combining data gathered during consecutive years from primary care, specialist outpatient care and inpatient care. However, accuracy of disease prevalence is highly dependent on the quality of the data. The high prevalence of the six diagnoses analysed in this study calls for preventive action to minimize suffering and costs to society.
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To assess the effects of an Iyengar yoga program (IYP) on patients with chronic respiratory diseases. Patients attending lung transplant clinics in a tertiary institution were invited to participate in a two-phase, 12-week IYP that included 2 h biweekly classes. Doctors completed a formal physical and clinical assessment on candidates before enrollment. Patients with New York Association Class III or IV, or dyspnea grade IV were excluded. At baseline and at the end of 12-weeks, patients completed the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ) and Health Utilities Index (HUI). Medication(s), 6 min walk test results and other clinical parameters were also recorded. Patients recorded the effects of the IYP on their daily living in journals. Nonparametric and qualitative methods were used to analyze the data. Twenty-five patients diagnosed with pulmonary arterial hypertension and chronic obstructive pulmonary disease (mean age 60 years) were invited to participate. At the end of the 12-week period, changes in HADS anxiety and CRQ fatigue scores were statistically significant (P<0.05) and changes in HUI ambulation, pain, emotion and overall score were clinically important. The content of the journals revealed patients' improvement in breathing capacity, mobility, energy, sleep and included positive feedback such as: "increased tidal volume with slowing expiration", "I have an overall feeling of wellbeing" and "excellent amount of energy". The findings suggest that yoga has significant potential to produce benefits. Potential benefits will be further explored in a national multisite study.
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Objectives: This study investigated the perceived influence of yoga on body perception and psychosocial aspects of life for patients with chronic neck pain. Design: This qualitative study was conducted using semistandardized interviews. Setting: The interventions and interviews took place in a referral center's research department. Subjects: Eighteen (18) patients with chronic nonspecific neck pain were recruited from a larger randomized controlled trial of yoga for chronic neck pain. Interventions: Participants attended 90 minutes of Iyengar yoga once a week for 9 weeks. Outcome measures: Participants completed a drawing of their neck and shoulder regions to reflect their subjective body perceptions before and after their yoga program. Semistandardized interviews were used to explore their body perception, emotional status, everyday life and coping skills, as well as any perceived changes in these dimensions postparticipation. An interdisciplinary group analyzed the study data using content analysis techniques. Results: Participants reported change on five dimensions of human experience: physical, cognitive, emotional, behavioral, and social. Physically, most participants cited renewed body awareness, both during their yoga practice and in their daily lives. Such change was echoed in their postparticipation body drawings. Cognitively, participants reported increased perceived control over their health. Emotionally, they noted greater acceptance of their pain and life burdens. Behaviorally, they described enhanced use of active coping strategies. Finally, socially, they reported renewed participation in an active life. Conclusions: Participants linked yoga to change on all dimensions of human experience, attributing reduced pain levels, increased coping ability, better pain acceptance and increased control to it. Body awareness appeared a key mechanism in these changes.
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To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation. Qualitative study using semi-structured interviews. Interviews conducted at participants' homes. Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic. Patients' beliefs about pulmonary rehabilitation, self-set treatment goals and anticipated reasons for drop-out. Patients' beliefs about pulmonary rehabilitation comprised positive aspects (participation as an opportunity for improvement, a safe and multidisciplinary setting, presence of motivating and supporting patients) and negative aspects of exercising in a rehabilitation centre (e.g. disruption of normal routine, being tired after training, transportation difficulties, limited privacy and confrontation with severely ill patients). Four types of treatment goals were formulated: increase in functional performance, weight regulation, reduction of dyspnoea, and improvement of psychosocial well being. Four clusters of anticipated reasons for drop-out were identified: the intensity of the programme, barriers to attending (e.g. transportation problems, sudden illness and other duties/responsibilities), lack of improvement and social factors. Four different attitudes towards pulmonary rehabilitation could be distinguished: optimistic, 'wait and see', sceptic and pessimistic. Follow-up data revealed that whereas a pessimistic attitude (high disability, low self-confidence, many concerns) was related to decline, the 'sceptic' patients had dropped out during the course. Uptake and drop-out may be related to patients' perceived disabilities, expected benefits and concerns with regard to rehabilitation, practical barriers and confidence in their own capabilities.
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Objective: To determine whether the odds of positive conclusions in randomized controlled trials (RCTs) of yoga, differ between yoga styles. Design: Systematic review of yoga RCTs. Medline/PubMed, Scopus, the Cochrane Library, IndMED and the tables of content of specialist yoga journals, not listed in medical databases, were screened up to 12 February, 2014 for RCTs comparing yoga interventions to non-yoga interventions. The RCTs' conclusions were classified as positive (yoga is helpful for a respective condition) or not positive; and these were compared between different yoga styles using the Chi squared test and multiple logistic regression analysis. Results: A total of 306 RCTs were included. These applied 52 different yoga styles, the most commonly used of which were: hatha yoga (36 RCTs), Iyengar yoga (31 RCTs), pranayama (26 RCTs), and the integrated approach to yoga therapy (15 RCTs). Positive conclusions were reached in 277 RCTs (91%); the proportion of positive conclusions did not differ between yoga styles (p=0.191). Conclusion: RCTs with different yoga styles do not differ in their odds of reaching positive conclusions. Given that most RCTs were positive, the choice of an individual yoga style can be based on personal preferences and availability.
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Objective: To explore the experiences of low-income minority adults taking part in a yoga dosing trial for chronic low back pain. Design: Individual semi-structured interviews were conducted with nineteen participants recruited from a randomized yoga dosing trial for predominantly low-income minority adults with chronic low back pain. Interviews discussed the impact of yoga on low back pain and emotions; other perceived advantages or disadvantages of the intervention; and facilitators and barriers to practicing yoga. Interviews were audio taped and transcribed, coded using ATLAS.ti software, and analyzed with inductive and deductive thematic analysis methods. Setting: Boston Medical Center, Boston, MA, USA. Results: Participants viewed yoga as a means of pain relief and attributed improved mood, greater ability to manage stress, and enhanced relaxation to yoga. Overall, participants felt empowered to self-manage their pain. Some found yoga to be helpful in being mindful of their emotions and accepting of their pain. Trust in the yoga instructors was a commonly cited facilitator for yoga class attendance. Lack of time, motivation, and fear of injury were reported barriers to yoga practice. Conclusions: Yoga is a multidimensional treatment for low back pain that has the potential to favorably impact health in a predominantly low-income minority population.
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Heart disease, stroke, and chronic obstructive pulmonary disease (COPD) are the leading causes of death and disability worldwide. Although individuals with these conditions have been reported to benefit from yoga, its effectiveness remains unclear. To perform a systematic review of the effectiveness of yoga on exercise capacity, health related quality of life (HRQL), and psychological well-being for individuals with chronic disease and describe the structure and delivery of programs. We performed a systematic review of randomized controlled trials examining yoga programs for individuals with heart disease, stroke, and COPD compared with usual care. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.3. The protocol was registered on PROSPERO (CRD42014014589). Ten studies (431 individuals, mean age 56±8 y) were included and were comparable in their design and components, irrespective of the chronic disease. The standardized mean difference for the mean change in exercise capacity was 2.69 (95% confidence interval, 1.39-3.99) and for HRQL it was 1.24 (95% confidence interval, -0.37 to 2.85). Symptoms of anxiety were reduced after yoga in individuals with stroke, although this was not observed in individuals with COPD. The effect of yoga on symptoms of depression varied across studies with no significant effects compared with usual care. Yoga programs have similar designs and components across chronic disease populations. Compared with usual care, yoga resulted in significant improvements in exercise capacity and a mean improvement in HRQL. Yoga programs may be a useful adjunct to formal rehabilitation programs.
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Skeletal muscle dysfunction and physical inactivity are two clinically important features of a wide range of acute and chronic respiratory conditions. Optimisation of both of these features is important in order to improve physical function, prevent clinical deterioration and maximise community participation. One of the most potent and evidence-based interventions to address these physical deficits is pulmonary rehabilitation (PR). Whilst the majority of PR research has been conducted in patients with chronic obstructive pulmonary disease, there is widespread recognition that PR can benefit many other respiratory patient groups. These include patients with interstitial lung diseases, asthma, pulmonary hypertension, pre-/post-lung surgery (e.g. lung cancer, transplantation) and cystic fibrosis to name a few. Exercise training must be appropriately prescribed by a skilled healthcare professional with comprehensive knowledge of the pathology and physiology of these conditions, as well as a sound understanding of the exercise physiology and core principles of exercise prescription, monitoring and progression. It has also become increasingly recognised that people with respiratory conditions, particularly those with chronic disease, are considerably less active than those of good health. PR should therefore aim to induce behavioural change to facilitate the adoption and maintenance of an active lifestyle. In addition, PR should pay attention to the psychological well-being of patients and self-management of their lung disease in all its aspects. To that end, multidisciplinary individualised programs should be offered. This review sets the scene of PR principles for a series of papers that will focus on specific diseases other than chronic obstructive pulmonary disease where rehabilitation may offer a clinically important aspect of care over and above conventional pharmacological treatment. © 2015 S. Karger AG, Basel.
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Although yoga is frequently used by patients with asthma, its efficacy in alleviating asthma remains unclear. To systematically assess and meta-analyze the available data on efficacy and safety of yoga in alleviating asthma. MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through January 2014. Randomized controlled trials of yoga for patients with asthma were included if they assessed asthma control, symptoms, quality of life, and/or pulmonary function. For each outcome, standardized mean differences (SMDs) or risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane tool. Fourteen randomized controlled trials with 824 patients were included. Evidence for effects of yoga compared with usual care was found for asthma control (RR, 10.64; 95% CI, 1.98 to 57.19; P = .006), asthma symptoms (SMD, -0.37; 95% CI, -0.55 to -0.19; P < .001), quality of life (SMD, 0.86; 95% CI, 0.39 to 1.33; P < .001), peak expiratory flow rate (SMD, 0.49; 95% CI, 0.32 to 0.67; P < .001), and ratio of forced expiratory volume in 1 second to forced vital capacity (SMD, 0.50; 95% CI, 0.24 to 0.75; P < .001); evidence for effects of yoga compared with for psychological interventions was found for quality of life (SMD, 0.61; 95% CI, 0.22 to 0.99; P = .002) and peak expiratory flow rate (SMD, 2.87; 95% CI, 0.14 to 5.60; P = .04). No evidence for effects of yoga compared with sham yoga or breathing exercises was revealed. No effect was robust against all potential sources of bias. Yoga was not associated with serious adverse events. Yoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.
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Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing. We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT. A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies. Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses. Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV1, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV1 or PEF) and training hours on QoL and exercise performance. In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1 and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity. EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.
Article
Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.
Article
Objectives: Yoga is a popular form of exercise in the Western world, and yoga's effects on pulmonary function have been investigated previously. The purpose of this article is to review this research systematically and determine if regular yoga training improves pulmonary function in apparently healthy individuals. Methods: Using the Alternative Health Watch, the Physical Education Index, Medline,(®) and the SPORTdiscus databases; and the keywords yoga, respiration, and pulmonary function, a comprehensive search was conducted that yielded 57 studies. Of these studies selections were made to include only experimental studies written in English, published in peer-reviewed journals after 1980, and investigating the effects of regular yoga practice on pulmonary function in healthy individuals participating in the studies. Results: Yoga improved pulmonary function, as measured by maximum inspiratory pressure, maximum expiratory pressure, maximum voluntary ventilation, forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate, in all (N=9), but 1, study. Conclusions: Overall, pulmonary function appears to improve with a minimum of 10 weeks of regular yoga practice, and the magnitude of this improvement is related to fitness level and/or the length of time the subjects spend practicing pranayama (i.e., breathing exercises). In other words, greater improvements in pulmonary function are more likely to be seen in less-fit individuals and/or those that engage in longer periods of pranayama. Additional studies examining various yoga practices are warranted to gain a more comprehensive understanding of the effects of yoga techniques on pulmonary functions.
Article
Objective: To study the add-on effects of pranayama and meditation in rehabilitation of patients with Guillain-Barré syndrome (GBS). Patients and method: This randomized control pilot study was conducted in neurological rehabilitation unit of university tertiary research hospital. Twenty-two GBS patients, who consented for the study and satisfied selection criteria, were randomly assigned to yoga and control groups. Ten patients in each group completed the study. The yoga group received 15 sessions in total over a period of 3 weeks (1 h/session), one session per day on 5 days per week that consisted of relaxation, Pranayama (breathing practices) and Guided meditation in addition to conventional rehabilitation therapeutics. The control group received usual rehabilitation care. All the patients were assessed using Pittsburgh Sleep Quality Index, Numeric pain rating scale, Hospital anxiety and Depression scale and Barthel index score. Mann-Whitney U test and Wilcoxon's signed rank test were used for statistical analysis. Results: Quality of sleep improved significantly with reduction of PSQI score in the yoga group (p = 0.04). There was reduction of pain scores, anxiety and depression in both the groups without statistical significance between groups (pain p > 0.05, anxiety p > 0.05 and depression p > 0.05). Overall functional status improved in both groups without significant difference (p > 0.05). Conclusions: Significant improvement was observed in quality of sleep with yogic relaxation, pranayama, and meditation in GBS patients.
Article
Yoga is adjunctively utilized outside the United States in the treatment of a variety of diseases, including chronic obstructive pulmonary disease (COPD), but there are no studies assessing its adjunctive efficacy in the United States. We prospectively evaluated the effects of yoga training on the quality of life (QOL) and the parameters of lung function in patients with COPD. Thirty-three patients with documented COPD, per Global Initiative for Obstructive Lung Disease criteria, were recruited. All patients received standard COPD care. The QOL was assessed by the St. George Respiratory questionnaire. Standard spirometry and maximum inspiratory (maximal inspiratory pressure) and expiratory pressure (maximal expiratory pressure) were measured. Patients were taught selected yoga exercises including breathing exercises, meditation, and yoga postures for 1 hour, thrice a week for 6 weeks by a certified yoga therapist. The quality of life and lung function were again assessed at the end of 6 weeks. Twenty-two patients completed the study. Differences in preyoga versus postyoga scores were evaluated using paired t-tests. Statistically significant improvements (P < 0.05) were observed for the St. George Respiratory questionnaire [95% confidence interval (CI) 43.13-58.47], vital capacity (95% CI 2.53-7.65), maximal inspiratory pressure (95% CI 6.62-23.64), and maximal expiratory pressure (95% CI 1.63-13.81). Yoga when practiced by patients with COPD results in improvement in the QOL and lung function on a short-term basis. Additional research is needed to confirm these findings in a randomized controlled trial and in the longer term.
Article
Physical activity (PA) has been reported to be reduced in severe chronic obstructive pulmonary disease (COPD). Studies in moderate COPD are currently scarce. The aim of the present study was to investigate physical activity in daily life in patients with COPD (n=70) and controls (n=30). A multi-center controlled study was conducted. PA was assessed using a multisensor armband device (SenseWear, BodyMedia, Pittsburgh, PA) and is reported as the average number of steps per day, and the time spent in mild and moderate physical activity. Patients suffered from mild (n=9), moderate (n=28), severe (n=23) and very severe (n=10) COPD. The time spent in activities with mild (80 + or - 69 min vs 160 + or - 89 min, p<0.0001) and moderate intensity (24 + or - 29 min vs 65 + or - 70 min; p<0.0036) was reduced in patients compared to controls. The number of steps reached 87 + or - 34%, 71 + or - 32%, 49 + or - 34% and 29 + or - 20% of control values in GOLD-stages I to IV respectively. The time spent in activities at moderate intensity was 53 + or - 47%, 41 + or - 45%, 31 + or - 47% and 22 + or - 34% of the values obtained in controls respectively with increasing GOLD-stage. These differences reached statistical significance as of GOLD stage II (p<0.05). No differences were observed among centers. Physical activity is reduced early in the disease progression (as of GOLD-stage II). Reductions in physical activities at moderate intensity seem to precede the reduction in the amount of physical activities at lower intensity.
Article
The current study examined whether yoga would increase levels of mindfulness in a healthy population. Forty-six participants were randomly assigned to an 8-week yoga intervention group or a wait-list control group. Mindfulness was assessed pre and post yoga, using the Freiburg Mindfulness Inventory (FMI). Results indicate that the yoga group experienced a significant increase in Overall mindfulness, and in three mindfulness subscales; Attention to the present moment, Accepting and open attitudes toward experience, and Insightful understanding (p < .01). The control group experienced a significant increase in overall mindfulness (p < .02) and insightful understanding (p < .01). Findings suggest that a yoga intervention may be a viable method for increasing levels of trait mindfulness in a healthy population, potentially implicating yoga as a preventive method for the later development of negative emotional mood states (i.e. anxiety and depression). The control group also experienced moderate elevations of mindfulness at the second assessment.
Article
Most of the effort of controlling breathlessness happens at home. Therefore, it is important to explore how patients and carers respond to breathlessness, what their self-care entails and what they experience as helpful. Data were collected from a purposive sample of 18 chronic obstructive pulmonary disease patients through participant observation during outpatient consultations and in-depth interviews at a large hospital and in the community in London. Data were analysed with the Grounded Theory approach. As information regarding the management of breathlessness was lacking and access to treatment was difficult, patients reverted to alternative strategies. Some patients developed considerable expertise and managed their symptoms competently within the limits of current care. Patients who coped successfully were involved in pulmonary rehabilitation and had adopted this as a way of life. Benefits and challenges to participation in these programmes were identified. Those patients who self-manage maintain an acceptable quality of life through self-acquired expertise relating to symptoms, medication and help-seeking. Well-being needs to be understood not as the end point, but as a precarious balance needing skillful maintenance and hard work. The findings have implications for notions such as adherence, patient involvement and responsibility in the management of chronic obstructive pulmonary disease.
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Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
Article
This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.
Article
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.
Article
This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
A pilot study measuring the impact of yoga on the trait of mindfulness
  • D V Shelov
  • S Suchday
  • J P Friedberg
  • T Troosters
  • F Sciurba
  • S Battaglia
  • D Langer
  • S R Valluri
  • L Martino
  • R Benzo
  • D Andre
  • I Weisman
  • M Decramer
Shelov, D.V., Suchday, S., Friedberg, J.P., 2009. A pilot study measuring the impact of yoga on the trait of mindfulness. Behav. Cogn. Psychother. 37, 595e598. Troosters, T., Sciurba, F., Battaglia, S., Langer, D., Valluri, S.R., Martino, L., Benzo, R., Andre, D., Weisman, I., Decramer, M., 2010. Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir. Med. 104, 1005e1011.