The Effect of a Yoga Intervention for Reducing Stress Among People Living With HIV in Indonesia: A Randomized Controlled Trial
Phase: NA
Conditions: Human Immunodeficiency Virus
Sponsor: National Taipei University of Nursing and Health Sciences

National Taipei University of Nursing and Health Sciences 
Doctoral Dissertation Proposal   
 
 
School of Nursing 
 
 
The Effect of a Yoga Intervention for Reducing Stress among People Living 
with HIV in Indonesia: A Randomized Controlled Trial 
(Study Protocol and Statistical Analysis Plan) 
 
 
 
Jufri Hidayat 
Advisor: Miao-Yen Chen RN, PhD 
 
 
 
NCT Number: NCT05503680 
Document date: January 7th, 20223 

1. Yoga protocol intervention  
Participants in the yoga group engaged in eight biweekly online Hatha yoga classes for 120 
minutes each at home. Classes began with 15 minutes of sitting meditation; breathing exercises; 
shoulder, neck, and back stretches; and sun salutations (either seated or standing). Following 
that, ten minutes of standing poses, fifteen minutes of balancing poses, and ten minutes of 
abdominal and back-bend positions will be performed. After 10 minutes of cool-down stretches 
and a final time of rest, all sessions was concluded. Physical postures and supportive props were 
modified to accommodate participants of all abilities. Participants was given an honorarium of 
Rp 50.000 or 3.49 USD at the baseline and final assessments. The full version of the yoga 
protocol is available in appendix III.  
Table 3: Yoga protocol  
Position 
Main content 
Length time 
1. Warm-up 
(1) Seated meditation, (2) Alternate (3) 
Nostril breathing, (4) Bellows breath, 
(5) Shoulder/neck stretches, (6) Cat-cow 
forward fold, (7) Sun salutations. 
10 minutes 
2. Standing poses 
(1) Warrior one, (2) Warrior two, (3) 
Triangle, (4) Extended side angle, (5) 
Reverse warrior, (6) High lunge with 
twist. 
10 minutes  
3. Balance poses 
(1) Tree pose, (2) Standing holding 
knee, (3) Modified warrior three (chair 
support), (4) Half-moon. 
10 minutes 

4. Abdominal and back 
bends  
(1) Bird-dog, (2) Side plank, (3) Bridge, 
(4) Cobra, (5) Sphinx, (6) Baby position 
10 minutes 
5. Meditation 
Full lotus, half lotus, Burmese 
10 minutes  
6. Cool down  
(1) Twist, (2) Cobbler’s pose, (2) Hip 
(3) Stretches, (4) Corpse pose, (5) Side-
lying, (6) Seated on. 
10 minutes  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

The Yoga Protocol 
 
 
 
 
A Hatha Yoga protocol to reduce stress among people living with HIV 
 
 
 
 
Jufri Hidayat  
Doctoral student 
 
 
 
National Taipei University of Nursing and Health Sciences  
 
YOGA 
 
Relieve your Stress 
60-Minute of  

Yoga intervention for stress reduction among people living with HIV  
Estimated length of time per session: 60 minutes 
 
Created by: 
Jufri Hidayat 
Doctoral student at National Taipei University of Nursing and Health Sciences 
 
Supervisor:  
Miao-yen Chen  
Associate Professor at National Taipei University of Nursing and Health Sciences 
 
 
 
 
 
All rights reserved 
 
 
 
 
 
 
 
 
 
 
 
 

Preface  
 
 
 
 
This 60-minute yoga protocol was developed for participants in the research project, “The 
effect of a yoga intervention for reducing stress among people living with HIV during the covid-
19 pandemic in Indonesia, a randomized controlled trial.” 
You have been given a copy of this protocol because you are an HIV positive person and are 
undertaking a yoga intervention program to reduce stress. This protocol has an instructor and 
pictures of yoga poses to help you to practice yoga correctly. Share this protocol with your 
family, friends, or community who might need help to recover from stress related to HIV.  
 
 
 
 
 
 
 
 
 
 
Jufri Hidayat 
 
Doctoral student  
 
February 3rd, 202

 
Position 
Activity/purpose 
Action plan 
Warm up 
(15 minutes)  
 
 
 
 
 
 
Activity: 
(1) Seated meditation, (2) Alternate 
nostril breathing, (3) Bellows breath, (4) 
Shoulder/neck stretching, (5) Cat-cow 
forward fold, (6) Sun-salutation.  
 
Maximum duration: 15 minutes  
 
Purpose: 
• Warming up for hatha yoga aims to 
help participants to prepare their 
minds to be centered, calm, and 
focused.  
• A distracted mind prevents 
participants from reaping the deepest 
psychological and spiritual benefits 
from yoga practice. 
 
Equipment:  
Yoga mattress, chair, sport clothes, chair 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Seated meditation 
 
 
 
 
 
 
 
 
 
2. Alternate nostril 
breathing  
 
 
 
 
 
 
 
 
3. Bellows breath 
Sit on yoga mat with 
legs crossed and body 
relaxed. 
Place both hands on 
legs. Keep your lower 
jaw parallel to the 
ground. Relax your 
abdomen, feet, pelvis, 
and shoulders. Sit 
upright so your spine is 
centered between your 
left and right shoulders, 
with your eyes closed. 
Observe the breath 
Sit on yoga mat with legs 
crossed and body 
relaxed. Place left hand 
on left knee. Raise your 
right hand towards your 
nose and exhale 
completely. Use your 
right thumb to close your 
right nostril while you 
inhale through the left 
nostril. Then close your 
left nostril with your 
index finger as you open 
the right nostril, exhaling 
Instruction:  
Sit as in seated meditation, 
with shoulders relaxed. 
Take a few deep breaths, 
breathing in and out from 
nose. With each inhale, 
expand your belly fully 
with your breath. Begin 
bellows breath by exhaling 
forcefully through your 
nose at the rate of one 
breath per second. These 
are a series of short sharp 
exhales, with passive 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
coming in and going 
out, letting thoughts 
float away like logs 
rolling down the river. 
through the right side. 
Next inhale through your 
right nostril, then close it 
as you open the left 
nostril and exhale 
through the left side. This 
is one cycle. Repeat 5 
times. 
inhalation happening in 
between. Make sure the 
breath comes from your 
diaphragm, with your belly 
moving in and out. head, 
neck, shoulders, and chest 
 
 
 
 
 
 
4. Shoulder/neck 
stretching  
 
 
 
 
 
 
5. Cat-cow forward fold 
 
 
 
 
 
 
6. Sun salutation 
Instruction: sit as in 
seated meditation. Place 
one of your hands 
behind your back with 
the other hand on top of 
your head. With the 
hand on your head, 
gently pull your ear 
toward your shoulder. 
Feel the stretch at the 
side of the neck. Hold it 
for 20 seconds and 
repeat three times. Then 
Instruction: Begin on 
your hands and knees in 
the table pose, with your 
spine relaxed. As you 
exhale, come into cat 
pose by rounding your 
spine outward like a cat 
arching its back, tucking 
your tailbone in, and 
drawing your stomach in. 
Next, as you inhale, 
move into cow pose by 
lifting your sit bones 
Instruction:  
Begin in a standing 
position with your feet 
slightly apart and parallel 
to each other, your palms 
turned out, and shoulders 
relaxed. Then follow this 
sequence of positions: 
mountain pose (i.e., 
standing with the palms of 
your hands facing towards 
your body alongside your 
thighs), Inhaling, lift both 
a 
b 
a 
b 
a 
b 
c 
d 
e 
f 
g 
h 
i 
j 

 
 
 
 
 
 
 
 
repeat these steps for 
the other side. 
upward, pressing your 
chest down and forward, 
lifting your head up and 
allowing your belly to 
sink. 
Relax your shoulders 
away from your ears, 
gazing straight ahead. 
 
arms up. Exhaling, fold 
forward at the hips 
bringing your hands down 
to the mat. Step the right 
leg back and lunge. Then 
step the left leg back in 
plank, keeping body 
parallel to the floor.  Then, 
bending yourelbows bring 
the chest down to the 
ground. Push up with your 
hands, straightening the 
elbows and sliding 
forward into up dog. Curl 
the toes under, press down 
on feet and hands, lifting 
your hips up. Straighten 
elbows and knees. Then 
step your right foot 
forward so your right foot 
is parallel with your hands. 
Bring left foot up to the 
right foot andyou are 
standing flexed at the hips 
in forward fold. Inhaling 
and standing up, swoop 
the arms out to the sides 
and above your head. 
Bring the palms together 

 
and lower them to your 
heart in namaste and back 
to mountain pose. The 
yoga instructor will 
demonstrate how to do 
this.  
 
Standing 
pose  
(10 minutes) 
Activity:  
(1) Warrior one, (2) Warrior two, (3) 
Triangle, (4) Extended side angle, (5) 
Reverse warrior, (6) High lunge with 
twist. 
 
Maximum duration: 10minutes  
 
Purpose:  
• Strengthen and stretch all muscle 
groups in the legs, particularly the 
thighs, hamstrings, buttocks, calves 
and ankles. 
• Build balance and stability and 
improve flexibility. 
• Reduce stress and promote better 
sleep.  
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Warrior one 
 
 
 
 
 
 
 
 
2. Warrior two 
 
 
 
 
 
 
 
 
3. Triangle 
Instruction:  
Begin by standing. Then 
extend your right foot 
forward. Bend your 
right knee into a lunge 
with your feet parallel 
and toes pointing 
forward. Keep your left 
leg straight behind you 
and turn your left heel  
approximately 45 
Instruction: 
Start in standing (i.e., 
mountain) pose. Step 
your right foot out to 
your side with your feet 
wider than shoulder 
length apart in a five-
pointed star position. 
Turn your right foot out 
to the right at a 45 degree 
angle. Bend your right 
Instruction: 
Begin standing, then 
spread your feet apart to 
a position wider than 
your shoulders. Bend 
your left leg slightly and 
raise your arms out from 
your sides until they are 
parallel to the ground, 
forming a “T” shape. 
Place your left hand 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
degrees outward. Raise 
your arms straight 
above your head, 
keeping shoulders 
down. Squeeze your 
shoulder blades together 
and pull them 
downward. Lift your 
chin to gaze at your 
hands overhead. Hold 
this pose, then lower 
your arms and repeat on 
the left side. 
 
  
knee until the knee is 
above your ankle.  
Extend your arms 
parallel to the ground.  
 Relax your shoulders 
downwards. Turn your 
left foot out 90 degrees, 
then bend your right knee 
into a lunge. Be sure to 
keep the knee of your 
right leg above your 
ankle and pointing past 
your toes. Turn your 
head to the left and look 
beyond your fingers. 
Repeat this on the other 
side. 
 
 
 
 
 
 
 
 
 
 
 
 
either on your left leg or 
touching the mat in the 
front of your left foot. 
Raise your right arm, 
extending it overhead 
and hold. Then repeat on 
the other side. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
4. Extended side angle 
 
 
 
 
 
 
 
 
5. Reverse warrior 
 
 
 
 
 
 
 
 
6. High lunge with twist 
Instruction:  
Start in warrior two 
pose and reach your left 
arm up. Then, extend 
your left arm up above 
your ear, turning your 
thumb up and your 
pinky down. Continue 
to plant your feet firmly 
on the mat as you reach 
up. Then lean back 
slightly to gently twist 
your chest and core 
open. Press your right 
knee open toward your 
little toe. As you reach 
over your ear, keep 
abdominal muscles 
active and extend your 
spine, reaching your 
Instruction:  
Start in warrior two, lift 
your right arm up to the 
ceiling. At the same time 
lower your left hand and 
slide it down your left 
leg. Move your shoulder 
blades together and pull  
your lower ribs in, lifting 
your chest as you come 
into a gentle backbend. 
Look at your raised hand. 
Stay in the pose for up to 
5 breaths. 
Instruction:  
Start in warrior one, bend 
the knee of the back leg a 
little, lengthen your 
tailbone towards the 
floor. Stretch through 
your back leg, opening 
and strectching the sole 
of the foot. Open your 
chest and draw your front 
ribs down into your 
torso. Stay in this 
position for five breaths.  

hand down to the floor 
or to a yoga block 
placed in front of your 
foot.   

Balance pose  Activity:  
(1) Tree pose, (2) Standing holding knee, 
(3) Modified warrior three (chair 
support), (4) Half moon. 
 
Maximum duration: 15 minutes  
 
Purpose:  
• Strengthening and lengthening the 
muscles. 
• Exploring your center of gravity and 
improving the body's equilibrium.  
• Improving focus, concentration, and 
memory and relieving stress 
 
 
 
 
 
 
 
 
 
 
1. Tree poses 
 
 
 
 
 
 
 
 
2. Standing holding knee 
 
 
 
 
 
 
 
 
3. Modified warrior 3  
(Chair support) 
Instruction:  
Begin in mountain pose. 
Shift your weight onto 
your left leg. Bend your 
right knee and place 
your right foot on the 
inside of your left leg, 
either above or below 
the knee joint, pressing 
your foot against your 
inner thigh. Pull your 
left hip in over your left 
foot (use chair or wall to 
help balance if needed). 
Lengthen your spine, 
loosen shoulders and 
tuck your chin slightly 
in and back, bringing 
Instruction:  
Begin in mountain 
pose. Place your left 
hand on your hip. 
Moving very slowly, 
draw your right knee up 
towards your chest. 
With your right hand, 
hug your knee to your 
chest. Lengthen your 
spine, tightening the 
muscles of your left 
side and abdomen. 
Stiffen your left leg, but 
do not lock your knee. 
Drop your right hip 
slightly until it is in line 
Instruction:  
Begin with warrior one on 
the right side. Bring your 
palms together and begin 
to lean forward. Lift the 
left leg off the floor, 
keeping the body, arms, 
and raised left leg parallel 
to the floor, flexing the 
toes. Strenghten the 
standing leg and your 
arms. Fix your gaze 
looking down, hold the 
pose and breathe. Then 
lower your leg back down 
into warrior 1 position, 
then practice on the other 
side.   

your hands in front of 
your heart (prayer 
position). Stay in this 
pose for 30 seconds or 1 
minute, then repeat on 
the other side.  
 
with your left hip. Hold 
for 1 minute.  
 
 
 
 
 
 
 
 
4. Half-moon pose 
(chair support) 
Instruction:  
Start in warrior 2 with a 
chair beside you. Bring 
your right hand to your 
hip and turn your head 
to look at the floor. 
Bend your front leg and 
shift your weight onto 
your front foot. Move 
your hand a little 
forward and place your 
forearm on the chair 

directly beneath your 
shoulder. Press down 
through your fingers to 
steady yourself. Lift 
your back leg until your 
thigh is parallel to the 
floor. Slowly turn your 
chest to face the right. 
Extend your other arm 
toward the ceiling. 
Either keep your gaze 
on the floor or slowly 
bring it to your hand 
above. 
 

Abdominal 
and back 
bends  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Activity:  
(1) Bird-dog, (2) Side plank, (3) Bridge, 
(4) Cobra, (5) Sphinx. 
 
Duration: 10 minutes 
 
Purpose:  
• Lengthen and strengthen spine, 
promoting flexibility, mobility, and 
good posture. 
• Stretch shoulders, chest, and 
abdomen. 
• Reduce stress and anxiety.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Bird-dog 
 
 
 
 
 
 
 
 
2.  Side plank 
 
 
 
 
 
 
 
 
3. Bridge 
Instruction:  
Begin with hands and 
knees on the floor in the 
tabletop position, with 
knees under hips and 
hands under your 
shoulders. Maintain a 
neutral spine by firming 
up your abdominal 
muscles. Draw your 
shoulder blades together, 
raising right arm and left 
leg. Keeping shoulders 
and hips parallel to the 
floor, extend the back of 
your neck and tuck your 
chin into your chest to 
gaze down at the floor. 
Hold this position for a 
Instruction:  
Begin with plank pose 
(with your weight on 
both forearms) and press 
your palms into the mat 
as you lift up through 
your shoulder). Turn onto 
the outside of your right 
foot, stacking your left 
foot on top of it. Rotate 
your entire body to face 
forward with your flank 
toward the floor. Press 
your right hand down, 
keeping your body even 
from heel to fingers, as 
you raise your left arm up 
toward the sky. Take 5 to 
10 deep breaths.  
Instruction:  
Lying on your back, 
place your feet flat on 
the floor, with your 
arms next to your 
ribcage. Inhale and 
press the back of your 
shoulders and your feet 
into the floor and lift 
your hips. Actively 
press the inside of feet 
down and keep your 
knees from spreading 
out wide. You’re your 
belly in and slide your 
shoulder blades down 
your back, keeping 
your  neck neutral. You 
can clasp your hands 
or 
a 
b 
a 
b 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
few seconds, then do the 
other side.  
behind your back. Stay 
in this position for 5 to 
15 breaths. 
 
 
 
 
 
 
 
 
4. Cobra 
 
 
 
 
 
 
 
 
5. Sphinx 
 
 
 
 
 
 
 
 
6.  Baby position 
Introduction:  
Lie on your stomach, 
with your toes pointing 
straight back. Position 
your hands underneath 
your shoulders, with 
elbows close to your 
body. With legs engaged, 
pull the belly in and up, 
lifting your chest from 
the back of your heart. 
Sticking your chest out, 
pull your shoulder blades 
together and down along 
the spine. Come down 
Introduction: Lying down 
on your belly with  your 
shoulders over your 
elbows, with your 
forearms flat on the floor. 
Bring your shoulder 
blades together sliding 
down your back and feel 
your chest pushing 
slightly foreward. 
Breathe into your lower 
back and abdomen. To 
come out of the pose, 
lower your torso, 
bringing your elbows 
toward your sides and 
Introduction: Place 
your hands and knees 
on the mat. Spread your 
knees the same width as 
the mat and extend your 
big toe with your big 
toe on the floor. Place 
your stomach between 
your thighs and your 
forehead on the floor. 
Relax your shoulders, 
chin and eyes. If you're 
not good at putting your 
forehead on the floor, 
put your forehead on a 

 
 
 
gradually as you exhale. 
Repeat that two times.  
rest your forehead on 
your hands. 
stack of fist blocks or 
two 
 
Cool down  
Activity:  
(1) Twist, (2) Cobbler’s pose, (3) Hip 
stretches, (4) Corpse pose, (5) Side-
lying, (6) Seated on. 
 
Duration: 10 minutes 
 
Purpose:  
• Gradually slow down allowing heart 
rate to return to normal, preventing 
muscle soreness.  
• Reduce stress and improve 
relaxation. 
 
 
 
 
 
 
 
 
 
 
1. Twist 
 
 
 
 
 
 
 
 
 
2. Cobbler’s pose 
 
 
 
 
 
 
 
 
 
3. Hip stretches 
Instruction:  
Begin in seated 
meditation pose with 
right leg crossed on top 
of your left. Inhale and 
bring you right hand 
straight up beside your 
right ear. Exhale and 
twist your torso to the 
left, bringing your right 
elbow to the outside of 
your left knee and place 
your left palm on the 
floor slightly behind 
Instruction: 
Bend your knees and 
bring the soles of 
your feet together. As 
you let your knees 
fall down to either 
side, draw your feet 
in towards your body 
as far as you 
comfortably can. 
Press the outer edges 
of your feet together 
firmly. You can use 
your hands to pull 
Instruction: 
Lie on your back with your 
knees bent and feet flat on 
the floor. Bend your right 
knee until your lower leg is 
perpendicular to the floor. 
Then bring your left knee 
up, rotating your left leg 
outward at the hip so you 
can rest your left ankle on 
your right thigh just above 
the knee. Bring your right 
hand to the outside of the 
right thigh and pass your left 

your sit bones. Direct 
your gaze over your left 
shoulder without 
straining your neck. On 
each inhale, lengthen 
your spine upwards. On 
each exhale, deepen the 
twist slightly.  
your feet together and 
toward your body.  
 
 
hand through the opening 
formed by your crossed left 
leg. As you pull your right 
thigh toward your chest with 
your hands, press your left 
thigh with your left elbow. 
Hold for 30 seconds. 
  
 
 
 
 
 
 
 
 
4. Corpse pose 
 
 
 
 
 
 
 
 
5. Side-lying 
 
 
 
 
 
 
 
 
6. Seated on 
Introduction: Lie on your 
back. Separate your legs 
slightly and allow your 
feet to fall open to either 
side. Bring your arms 
down alongside your 
body, at a small distance 
from your torso. Turn 
your palms to face 
upwards but let the 
fingers curl in. Tuck 
your shoulder blades into 
Instruction: 
Rest on the mat on 
your most 
comfortable side. Use 
your arm or a folded 
blanket to support 
your head and 
another to separate 
your knees. Roll the 
top hip slightly 
forward and shift the 
bottom hip slightly 
Instruction: 
This seated meditation pose 
is the last pose of the yoga 
series, exactly the same as 
the first one. Hold this 
position for one minute.  

your back. Once you 
have put your limbs in 
place, relax completely 
without making an effort 
to holding them in 
position. Relax your 
entire body, including 
your face. Feel the 
weight of your body 
against the floor. 
 
back so the hip joints 
are not stacked on top 
of each other. Relax 
the belly and breathe 
slowly and deeply. 
Feel the breath in 
your body as you 
gently observe each 
inhale and exhale. 
 

3. Statistical analysis plan  
 
Before performing statistical procedures, all data was entered into a computer and checked 
for errors. To analyze the data, the researcher then used SPSS computer software version 20. 
The data for all variables was manually coded before using the SPSS application, including 
demographic characteristics of patients, the perceived stress scale results brief health status 
survey, and coping self-efficacy. The alpha value was set at α=0.05 to determine the statistical 
significance of the variables. For demographic characteristics, the data analysis was descriptive 
statistics to identify the frequencies and percentages for categorical variables and the means and 
standard deviations for continuous variables. Before the statistical data processing begins, the 
data for independent and dependent variables was tested to determine its distribution and 
normality using plot histograms, logs and square roots, and checking residuals.  
This study took repeated assessments over time and used a Generalized Estimating 
Equation (GEE) approach to model each study outcome and to predict the relationship of the 
variables while accounting for correlated data within the repeated measures (Hardin & Hilbe, 
2007). The GEE technique, introduced by Liang and Zeger (1986), was the most often used 
strategy in marginal models, and it was a variation of Generalized Linear Modelling (GLM). 
GEE can handle correlated data with discrete, continuous, or binary outcomes. GEE is a non-
likelihood or quasi-likelihood data modeling approach that specifies one of many working 
correlation matrix architectures to account for within-subject correlations (Liang & Zeger, 
1986).