Chair Yoga for Stress in Dementia

Study Overview
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Brief Summary
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Dementia is widely prevalent and results in high direct and indirect health costs. Dementia is associated with stress, anxiety, and depression in both patients and caregivers, and caregiver burden is extremely common. Treatment protocols for patients and caregivers are unclear and insufficient; drug treatments to manage behavioural and psychological symptoms of dementia can yield serious negative side effects, and caregivers may not have access to one-on-one psychotherapy due to high costs and long wait times. Yoga is an ancient Indian mind-body practice that uses physical postures, breathing exercises, and meditation. Yoga may be a viable therapeutic modality to address the psychological challenges associated with dementia in patients and caregivers, as it has been shown to decrease stress and improve anxiety and depressive symptoms in various populations. Recent research has suggested that patients with dementia and their caregivers may also experience positive effects on their mental health from practicing yoga. Furthermore, when yoga is taught in a gentle and mindful manner, it is generally not associated with any negative side effects. While there is preliminary data on dyadic exercise interventions for dementia patients and their caregivers, to date no research has examined the effectiveness of a dyadic yoga intervention on stress, anxiety, and depression. The investigators propose an 8-week study of a dyadic chair yoga program for patients with mild to moderate dementia and their caregivers (n = 30-40 participants). Our primary outcome of interest is changes in perceived stress, while secondary outcomes include changes in symptoms of depression and anxiety. The investigators will also look at the effects of the chair yoga program on caregiver burden, quality of interactions, well-being, mindfulness, and self-compassion. All outcomes will be assessed before the program starts and upon its termination. Participants will attend a 1-hour weekly group yoga class (4-10 participants per group) with their dyad for 8-weeks, and will also be given a video recording of a yoga class to practice together at home as often as possible. The investigators hypothesize that after the 8 week yoga program, patients and caregivers will report lower stress, as well as reduced symptoms of anxiety and depression. Results will be available mid-2020.

Official Title
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Effectiveness of a Dyadic Chair Yoga Intervention for Reducing Stress in Patients With Dementia and Their Caregivers

Conditions
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Dementia, Stress

Intervention / Treatment
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* Behavioral: Chair Yoga


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients will have mild cognitive impairment or mild to moderate dementia (MMSE score between 10-26 inclusive) OR a diagnosis from his/her clinician of mild cognitive impairment or mild to moderate dementia Patient and caregiver have contact at least 3 times per week Either patient and/or caregiver will have a score of at least 10 on the PSS Sufficient hearing to follow verbal instructions Able to sit for 45 minutes without discomfort Exclusion Criteria: Patients will not have severe dementia (MMSE score < 10 OR diagnosis from his/her clinician) Caregivers will not have dementia (MMSE score < 24) Acute psychotic symptoms Acute suicidal ideation or intent
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Chair Yoga|8-week dyadic chair yoga program for one hour per week. Chair yoga is an effective way to offer modified yoga postures and relaxation techniques to individuals with limited mobility and/or advanced age for whom mat-based classes may not be accessible. The weekly yoga classes will be lead by a certified instructor and will include 4-10 participants (or 2-5 patient-caregiver dyads).|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in perceived stress scores as measured by the Perceived Stress Scale (PSS) | Using an 8-week single arm pilot trial, assess the effects of chair yoga on perceived stress in patients and caregivers, using the PSS. Scores on the PSS can range from 0-40, with higher scores indicating higher perceived stress Hypothesis: Following participation in an 8-week gentle chair yoga program, patients with dementia and their caregivers will report lower perceived stress, as measured by the Perceived Stress Scale (PSS) | Baseline, 8-weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9) | Using an 8-week single arm pilot trial, assess the effects of chair yoga on patient and caregiver depressive symptoms using the PHQ-9. Scores on the PHQ-9 can range from 0-27, with higher scores indicating more severe depression. Hypothesis: Patients with dementia and their caregivers will report less severe symptoms of depression, as measured by the full version of the Patient Health Questionnaire (PHQ-9), following participation in an 8-week gentle chair yoga program. | Baseline, 8-weeks | 
| Changes in symptoms of anxiety as measured by the Generalized Anxiety Disorder 7-item scale (GAD-7) | Using an 8-week single arm pilot trial, assess the effects of chair yoga on symptoms of anxiety in patients and caregivers using the GAD-7. Scores on the GAD-7 range from 0-21, with higher scores indicating more severe anxiety. Hypothesis: Patients with dementia and/or their caregivers will report fewer symptoms of anxiety, as measured by the Generalized Anxiety Disorder 7-Item Scale (GAD-7), following participation in an 8-week gentle chair yoga program. | Baseline, 8-weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dementia, Stress, Caregiving, Mind-body therapy, Anxiety, Depression