Stroke Survivors May Benefit From Yoga

July 27, 2012 — Eight weeks of modified yoga exercises led to clinically meaningful improvements in balance in a small pilot study of patients with a history of stroke who completed rehabilitative care. Yoga participants also experienced improvement in motor function, independence, and quality of life.

"Yoga is a mind-body approach and thus may fit well into rehab efforts and stroke recovery," Arlene A. Schmid, PhD, who led the study, told Medscape Medical News.

Dr. Arlene A. Schmid

"Rehabilitation therapists, such as occupational therapists [OTs], may consider embedding yoga into stroke rehab," added Dr. Schmid, a rehabilitation research scientist at the Roudebush Veterans Administration Medical Center and Indiana University in Indianapolis.

The study was published online July 26 in Stroke.

"Important Contribution"

Reached for comment, Maarten A. Immink, PhD, director of the Human Movement and Clinical Exercise Physiology program at the School of Health Sciences, University of South Australia, in Adelaide, said this report of post-stroke balance improvements with yoga "is an important contribution to a fledgling group of work that provides promising results in terms of the benefits of yoga for people who have had a stroke."

"The potential, as suggested by this set of preliminary studies, is that yoga might be an effective component of rehabilitation and long-term management approaches to promoting functional capacity, participation in activities of daily living, and quality of life," he added.

Dr. Schmid and colleagues studied 47 adults who had suffered stroke more than 6 months earlier who had completed all stroke-related rehabilitation and were able to stand with or without a device at the outset.

Nineteen were randomly allocated to twice-weekly group yoga for 8 weeks, 18 to yoga plus at-home yoga/relaxation audio recordings (yoga-plus group), and 10 to a wait-list control group. The yoga-plus group was included to incorporate standard clinical practice of home exercise prescription, the authors say. The 2 yoga groups were collapsed into a general yoga group for analyses.

The yoga classes were taught by a registered yoga therapist and included modified yoga postures, relaxation, and meditation. The classes grew more challenging each week. "We focused on hip and ankle range of motion and strength as we wished to improve balance," Dr. Schmid said. "We developed a standardized protocol, so everyone received the same intervention."

Researchers assessed balance with the Berg Balance Scale (BBS), balance self-efficacy with the Activities-Specific Balance Confidence Scale, fear of falling (FoF) with a dichotomous yes/no question, and quality of life with the Stroke-Specific Quality of Life Scale.

All yoga participants were physically able to do all planned yoga activities, and no injuries were sustained, the researchers say. Twenty-nine of the 37 completed all 8 weeks of the study (with post-assessments). Of the remaining 8 participants, 3 did not complete post-assessments, 4 attended 5 or fewer sessions, and 1 was hospitalized for reasons unrelated to the yoga classes.

The researchers say there were no significant changes in the variables of interest in the control group, but positive changes were seen in the yoga group, including a "clinically meaningful" improvement in balance.

After Bonferroni correction, BBS scores improved from 41.3 at baseline to 46.3 at 8 weeks (P < .001). BBS scores range from 0 to 56, with higher scores indicating better balance.

"Interestingly," say the researchers, there was even greater improvement for those with baseline balance impairment. The improvements in balance, they note, are "larger than what is typically found in the older adult yoga literature and thus indicate an opportunity for even more improvement for older adults with stroke-related balance impairments."

Less Fearful

At 8 weeks, fewer patients in the yoga group said they were worried or concerned about falling, and a significant increase was seen in the number of patients identified as "independent" on the modified Rankin Scale (mRS).

Effects on Fear of Falling and Functional Independence by Treatment

Endpoint	Yoga	Control	P
Fear of falling, %	51	46	< .001
Independent on mRS, %	68	57	< .001

mRS, modified Rankin Scale.

A trend toward significant improvement in quality of life (P = .037) and toward balance self-efficacy (P = .035) was also noted.

Dr. Immink told Medscape Medical News that another recent study by his team suggests that the "mental health and perceived function of stroke patients can benefit from participation in yoga, which might be an important factor in yoga derived benefits for movement capacity and balance."

Dr. Schmid hopes to continue her studies of yoga post-stroke. "We have grants that are in review to support a larger study with more people, as well as including 8 weeks of yoga as we did here, but also 12 weeks of yoga to help understand the best frequency and duration of yoga as an aspect of post-stroke rehab," she told Medscape Medical News.

She noted that this study included only people with chronic stroke. "We do not know whether it is appropriate to do yoga during the more acute phases of stroke recovery."

"Although this is a small pilot study," added Dr. Immink, "it represents the largest study to date that evaluates the efficacy of yoga in a post-stroke population. The increasing uptake of yoga in society and in clinical applications, coupled with a set of work that supports the concept that yoga can benefit stroke patients, calls for well-funded, larger-scale trials of yoga for stroke patients."

The study was supported by the Veterans Administration. The authors have reported no relevant financial relationships.