# Exercise as it relates to Disease/Yoga Therapy: A way to Improve Functional Performance in People with Chronic Pulmonary Obstruction
## What is the Background to this research?

Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow obstruction, a gradual decline in lung function, loss of lung tissue, reduced quality of life, and high rates of mortality. Risk factors for COPD include tobacco smoke, occupational dust and chemicals, poulltion and infections. There has been limited research into yoga and its effects of chronic obstructive pulmonary disease (COPD), particularly in the area of yoga and its effects of Dsypnea; a symptom of COPD that involved laboured/troubled breathing. According to the global burden of disease study, COPD is expected to be the fourth leading cause of disability for males and the third for females in 2020. Medications are current treatments for COPD but in more severe cases; these are not enough and patients must rely on their own self-care techniques.
This particular study sought to find the safety, feasibility and efficiency of yoga exercises for decreasing dyspnea intensity and distress. A meta analysis on this area found that other studies have shown that Yogic exercises have had a positive effect on people with asthma, cardiac diseases, diabetes, tuberculosis, depressive disorders, osteoarthritis, and pleural effusion. Yoga derived breathing has been reported to improve gas exchange in patients with chronic heart failure and in patients with hypoxia. It is hypothesized in this study that the focus on prolonged exhalation may counteract the air trapping in the lungs that can cause dyspnea.
There are 4 severities of COPD:
* Stage 0: At Risk. Characterized by chronic cough and sputum production. Lung function is still normal.
* Stage I: Mild COPD. Characterized by mild airflow limitation At this stage, the individual may not be aware that their lung function is abnormal.
* Stage II: Moderate COPD. Characterized by worsening airflow limitation and usually the progression of symptoms, with shortness of breath typically developing on exertion.
* Stage III: Severe COPD. Characterized by severe airflow limitation (or the presence of respiratory failure or clinical signs of right heart failure).

## Where is the research from?

It was carried out by the General clinical research centre, Moffitt Hospital, University of California, San Francisco. It was published in the Journal of Alternative and Complementary Medicine in 2009.

## What kind of research was this?

This study is the first of its kind, making it a pilot study. It involved randomized distribution of which group the participants would be in with a control group and a yoga group.

## What did the research involve?

Patients were recruited between April 2004 and June 2005 from the American Lung Association better breathers club. The yoga therapies were developed by a group of expert yoga teachers. This study went for 12 weeks and the participants either completed a yoga program or were given a self-care pamphlet for them to follow at home.

#### Subjects

| Group | Males | Females | Average Age | Use of Oxygen |
| Yoga | 4 | 10 | 72 | 4 |
| Pamphlet | 4 | 11 | 67 | 1 |
The yoga group were offered 24 x 1 hour yoga sessions. Two types of yoga were included in this study:
* Asana: which consisted of easy poses and stretches
* Vishama vritti pranayama: breathing exercises and techniques. Which has been used in other conditions to increase the capacity of the lungs, strengthen the internal organs and improve mental control.
Safety of the yoga program was assessed by measuring heart rate, oxygen saturation, pain on a 0-10 scale and dyspnea on a modified borg scale (0 for no distress, 15 for most severe). Feasibility was measured by perceived difficulty of the yoga class and the enjoyment measure on a 0-10 scale. Two laboratory exercises and a questionnaire were undertaken to analyse dyspnea intensity (DI) and dyspnea distress (DD). The tests were the 6-minute walk (6MW) test, a upright bicycle test.

## What were the basic results?

DI ranged from 0.31- 0.77 ± 1.04, DD ranged from 0.02-0.55 ± 1.1 and pain 0.78-2.26 ± 2.23 after sessions. Yoga was found to decrease the DD experienced by the participant but the DI did not change. The pamphlet group reported that their DD increased.
The clients 6MW distance was longer, their cycle test results were improved and the DD experienced was decreased. Resting heart rate decreased over the course of 12 weeks of yoga. The participants self reported functional performance was increased.

## How did the researchers interpret the results?

The researchers said that the 6mw results could have increased because the patients felt like they were more in control of their symptoms. They suggested that the yoga dose may not have been big enough or gone for long enough. This was also stated by another study; Yoga training that lasts from 12 weeks to 9 months may improve lung function and functional exercise capacity in patients with COPD. They suggested that the results may not be conclusive because of the small sample size; thus more studies like this should be conducted.

## Conclusions and Implications of this research

The patients felt that they had a new strategy to help them manage their dyspnea. They also reported that they enjoyed the program, finding it beneficial. Other benefits reported from participants were a feeling of relaxation, positive social interaction, pain relief, bronchial drainage and improved control of breathing. Yoga therapy is safe for people with COPD. It improved functional performance and decreased dyspnea distress whilst not making pain or other symptoms worse. It can be used as a self care mechanism for those who learned new breathing techniques, ultimately it is up to the patient whether or not they incorporate it into their daily care based on their benefits. To help reduce error and limitations, larger scale trials should be conducted over long term to evaluate the effects of yoga in COPD patients.

## References

* 1 2 3 4 Xun-Chao Liu, Liang Dong. 'Effects Of Yoga Training In Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review And Meta-Analysis'. Journal of Thoracic Disease 6.6 (2014): 795.
* 1 2 Global Strategy for the Diagnosis, and Prevention of Chronic Obstructive Pulmonary Disease, and American Medicine. 'Global Strategy For The Diagnosis, Management, And Prevention Of Chronic Obstructive Pulmonary Disease (ATS Journals)'. American Journal of Respiratory and Critical Care Medicine (2015)
* ↑ Parshall, Mark B. 'An Official American Thoracic Society Statement: Update On The Mechanisms, Assessment, And Management Of Dyspnea'. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 185 (2012): 436-445. Print.
* ↑ Pomidori L, et al. 'Efficacy And Tolerability Of Yoga Breathing In Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study. - Pubmed - NCBI'. Ncbi.nlm.nih.gov. N.p., 2009. Web. 3 Oct. 2015.
* ↑ 6- Bihari, Shailesh. 'Role Of Pranayama In Rehabilitation Of COPD Patients - A Randomized Controlled Study'. Indian J Allergy Asthma 20 (2006): 98-104
* Donesky-Cuenco D, et al. 'Yoga Therapy Decreases Dyspnea-Related Distress And Improves Functional Performance In People With Chronic Obstructive Pulmonary Disease: A Pilot Study.THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15, Number 3, 2009, pp. 225–234.