Strength, Flexibility, And Balance Therapy After Stroke

BACKGROUND: Approximately 780,000 people suffer a stroke annually in the United States;
200,000 are recurrent strokes. The 17,000 veterans who suffer a stroke yearly are at great
risk for a second stroke and therefore should be targeted for stroke risk factor management
and prevention interventions.

Balance and fear of falling negatively impact activity and function. Decreased activity and
blood pressure (BP) are important modifiable stroke risk factors. These can be addressed
through a yoga exercise intervention. yoga, like tai-chi, is old world alternative medicine
that has the potential to greatly impact the lives of older adults.

OBJECTIVES: Our long term goal is to develop and test a yoga exercise intervention in a
large VA trial for veterans who have survived a stroke. The objective of this pilot
application was to obtain necessary information to support such a trial through the
following specific aims: 1) determine the feasibility (including recruitment) of an 8 week
yoga based intervention for veterans with stroke; 2) establish an appropriate dosing
strategy for a post-stroke 8 week yoga exercise intervention for a future VA yoga
implementation trial (Yoga Group, bi-weekly in-person vs Yoga Group Plus, bi-weekly
in-person paired with almost daily at home yoga); and 3) estimate the effect size of yoga on
variables of interest to determine the appropriate VA trial sample size.

METHODS: We completed a mixed methods study to address the feasibility, dosing strategy, and
estimation of effect size for the current pilot study. We recruited 45 people with stroke to
participate in the Yoga Group or Yoga Group Plus; 15 participants were wait-listed to be
used as a control. A registered yoga therapist (RYT) taught all classes. Qualitative data
include semi-structured interviews after completion of the intervention regarding: perceived
ability to do yoga exercise; satisfaction with the yoga intervention; satisfaction with the
RYT; general health benefits for the intervention; and whether they would continue yoga
practice. Quantitative data included compliance and recruitment information as well as
multiple standardized assessments before and after the 8 week intervention including: blood
pressure readings; fear of falling; balance; balance confidence; gait and mobility
assessments; and quality of life. We compared those in yoga to those wait-listed and also
completed within group analyses to determine change between baseline and 8 week scores.

Inclusion Criteria:

- veteran

- in the Indianapolis, IN area

- survived a stroke

- on blood pressure medication

- completed all rehabilitation

- ability to stand with or without a device

- able to speak and understand English

- a score >4 out of 6 on the short mini mental status exam (MMSE)

Exclusion Criteria:

- would not commit to the yoga intervention

- self report of: serious cardiac conditions; history of serious chronic obstructive
pulmonary disease or oxygen dependence; severe weight bearing pain; a history of
significant psychiatric illness; uncontrollable diabetes with recent weight loss; and
current enrollment in another research trial