Examining the safety, feasibility and efficacy of yoga for persons with arthritis

Arthritis is the leading cause of disability, affecting 21% of adults in the United States. The two most prevalent forms of arthritis are osteoarthritis (OA) or rheumatoid arthritis (RA). The costs of arthritis are enormous to the individual and society, including substantial healthcare costs and lost productivity as well as activity limitations, reduced participation in family and society. In addition to the physical symptoms that include pain, stiffness and swelling, persons with arthritis commonly experience psychosocial comorbidities such as depression, isolation and an inability to perform daily activities. Physical activity is recommended as an essential component of arthritis disease management to slow the loss of muscle, mobility and function. While many forms of exercise are safe and effective for people with arthritis, most people are not able to maintain an activity program for more than a few months. Yoga is a mind-body activity with origins in ancient India. It consists of deep breathing, centering, isometric poses that focus on strength, flexibility or balance, moving sequences, progressive relaxation, chanting and/or meditation. The combination of physical activity with stress-reduction techniques and an emphasis on individual modification has the potential to benefit persons with arthritis. Additionally, yoga can be practiced in a small space with limited resources. This dissertation is an examination of the effects of a regular program of yoga on selected health and psychosocial outcomes in examination of the feasibility and effects of yoga on selected clinical, physical and psychosocial outcomes for adults with OA and RA. The specific aims of this study were: (1) To conduct a systematic review of the literature on the use of yoga interventions for persons with OA and/or RA; (2) To identify factors related to program adherence; and (3) to estimate the effects of regular yoga on selected health and psychosocial outcomes. A review of the existing literature indicated that yoga appears to be safe and feasible for persons with rheumatoid and/or osteoarthritis, and may confer a variety of physical and psychological benefits. Our preliminary results suggested that yoga was associated with significant improvements in physical health, physical function, flexibility, balance, depressive symptoms, positive affect and pain for persons with arthritis, as well as a reduction in the number of tender/swollen joints for persons with rheumatoid arthritis. Adherence to our yoga program was the same or higher than traditional exercise programs (e.g., group aerobics, resistance training) and persons who began the program were likely to complete it. No related adverse events were reported during the trial, although 8 people were withdrawn from the study for health-related occurrences such as diagnosis of another inflammatory condition or unrelated surgery. Thus, results of this preliminary RCT suggest that a gentle, gradual yoga program tailored to the needs of people with arthritis was safe, feasible and potentially associated with improvements in physical health, which may be mediated by changes in physical fitness, psychological functioning and disease symptoms. There is a need for larger studies conducted in a variety of setting using standardized methodology to contribute additional evidence regarding the utility of yoga as a part of comprehensive arthritis self-management

Stability Index Formula and Description.

<p>Note: Under ideal conditions, all sensory systems work in concert therefore some redundancy exists. COP in conditions of increasing difficulty are measured. To determine the Stability Index, the visual and/or somatosensory systems are experimentally disrupted to derive the relative contribution of each system, however, the vestibular system is never experimentally disrupted. This protocol has been validated and has been used consistently for clinical assessment.</p><p>Stability Index Formula and Description.</p

Ashtanga-Based Yoga Therapy Increases the Sensory Contribution to Postural Stability in Visually-Impaired Persons at Risk for Falls as Measured by the Wii Balance Board: A Pilot Randomized Controlled Trial

<div><p>Objective</p><p>Persons with visual impairment (VI) are at greater risk for falls due to irreparable damage to visual sensory input contributing to balance. Targeted training may significantly improve postural stability by strengthening the remaining sensory systems. Here, we evaluate the Ashtanga-based Yoga Therapy (AYT) program as a multi-sensory behavioral intervention to develop postural stability in VI.</p><p>Design</p><p>A randomized, waitlist-controlled, single-blind clinical trial</p><p>Methods</p><p>The trial was conducted between October 2012 and December 2013. Twenty-one legally blind participants were randomized to an 8-week AYT program (n = 11, mean (SD) age = 55(17)) or waitlist control (n=10, mean (SD) age = 55(10)). AYT subjects convened for one group session at a local yoga studio with an instructor and two individual home-based practice sessions per week for a total of 8 weeks. Subjects completed outcome measures at baseline and post-8 weeks of AYT. The primary outcome, absolute Center of Pressure (COP), was derived from the Wii Balance Board (WBB), a standalone posturography device, in 4 sensory conditions: firm surface, eyes open (EO); firm surface, eyes closed (EC); foam surface, EO; and foam surface, EC. Stabilization Indices (SI) were computed from COP measures to determine the relative visual (SI_firm, SI_foam), somatosensory (SI_EO, SI_EC) and vestibular (SI_V, i.e., Foam_EC vs. Firm_EO) contributions to balance. This study was not powered to detect between group differences, so significance of pre-post changes was assessed by paired samples t-tests within each group.</p><p>Results</p><p>Groups were equivalent at baseline (all p > 0.05). In the AYT group, absolute COP significantly increased in the Foam_EO(t(8) = -3.66, p = 0.01) and Foam_EC (t(8) = -3.90, p = 0.01) conditions. Relative somatosensory SI_EO (t(8) = -2.42, p = 0.04) and SI_EC (t(8) = -3.96, p = 0.01), and vestibular SI_V (t(8) = -2.47, p = 0.04) contributions to balance increased significantly. As expected, no significant changes from EO to EC conditions were found indicating an absence of visual dependency in VI. No significant pre-post changes were observed in the control group (all p > 0.05).</p><p>Conclusions</p><p>These preliminary results establish the potential for AYT training to develop the remaining somatosensory and vestibular responses used to optimize postural stability in a VI population.</p><p>Trial Registration</p><p><a href="http://www.clinicaltrials.gov" target="_blank">www.ClinicalTrials.gov</a><a href="http://www.clinicaltrials.gov/ct2/show/NCT01366677" target="_blank">NCT01366677</a></p></div

Visually impaired students performing tree pose.

<p>Visually impaired students performing tree pose.</p

Participant Flow Chart.

<p>Participant Flow Chart.</p

Demographic and Visual History.

<p>OS, Left Eye; OD, Right Eye; CF, Counting Fingers; HM, Hand Motion; LP, Light Perception; BLP, Bare Light Perception; NLP, No Light Perception</p><p>Demographic and Visual History.</p

Feasibility and assessment of outcome measures for yoga as self-care for minorities with arthritis: a pilot study

Abstract Background While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. Methods The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potential facilitators and barriers to self-care and self-efficacy. The third objective determined the feasibility of using computer-assisted self-interview (CASI) for data collection. Results Enrolled participants (n = 30) were mostly female (93%), Spanish speaking (69%), and diagnosed with RA (88.5%). Feasibility was evaluated using practicality, acceptability, adaptation, and expansion of an arthritis-adapted yoga intervention, modified for this population. Recruitment (51%) and participation (60%) rates were similar to previous research and clinical experience with the study population. Of those enrolled, 18 started the intervention. For adherence, 12 out of 18 (67%) participants completed the intervention. All (100%), who completed the intervention, continued to practice yoga 3 months after completing the study. Using nonparametric tests, selected outcome measures showed a measurable change post-intervention suggesting appropriate use in future studies. An in-person computerized questionnaire was determined to be a feasible method of data collection. Conclusions Findings from this pilot study confirm the feasibility of offering yoga to this racially/ethnically diverse population with arthritis. This article provides recruitment/retention rates, outcome measures with error rates, and data collection recommendations for a previously under-represented population. Suggestions include allocating resources for translation and using a multicultural design to facilitate recruitment and retention. Trial registration ClinicalTrials.gov, NCT0161742

Comprehensive banking of sibling donor cord blood for children with malignant and non-malignant disease

Banking of cord blood (CB) for unrelated hematopoietic stem cell (HSC) transplantation is well established. However, directed-donor banking of CB for siblings in a current good tissue practices (cGTP) environment has not previously been investigated. Families were eligible for the present study if they were caring for a child with a disorder treatable by HSC transplantation and expecting the birth of a full sibling. We devised standard operating procedures and policies to address eligibility, donor recruitment, donor and recipient evaluation, CB collection, shipping, graft characterization, storage, and release of CB from quarantine