Strength, Flexibility, And Balance Therapy After Stroke
Strength, Flexibility, And Balance Therapy After Stroke
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.
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