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Cohen E.1, Kietrys D.1, Gould-Fogerite S.1, Parrott J.S.1, Galantino M.L.2,3,4
1Rutgers, The State University of New Jersey, Newark, United States, 2Stockton University, Galloway, United States, 3University of the Witwatersrand, Johannesburg, South Africa, 4University of Pennsylvania, Philadelphia, United States
Background: Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. DSP-related pain has been associated with disability, reduced quality of life (QOL), and impaired gait and function. Yoga has been shown to improve mental and physical status in people with a number of chronic diseases. Previously, we reported that the 4 weeks of yoga in this case series improved strength, function, pain, QOL and/or disability in some of the individuals. Here, we report on gait data.
Purpose: To measure the impact of 4 weeks of yoga on gait in persons with HIV-related DSP in the feet.
Methods: Inclusion criteria for this case series were DSP in the feet, controlled HIV disease status, average foot pain of at least 4/10, sensory symptoms (indicative of DSP) in the feet, an established regime of pharmacologic management, and ability to ambulate for 6 minutes. The yoga intervention consisted of 4 weeks of twice-weekly 90 minute classes and home yoga practice on non-class days, including: breathing exercises, postures, meditation, and deep relaxation. Outcomes were measured at baseline (W0), post-intervention (W5) and follow up (W9). Walking endurance was measured with 6-Minute Walk Test (6MWT) distance. The 6MWT was conducted along a 17.7m oval track. Temporospatial parameters of gait were measured during the 6MWT on a 4.27m GAITRite instrumented walkway (CIR Systems, Franklin, NJ, USA) that was laid along one straightaway of the track. GAITRite data from each walking pass was collected and averaged for each participant using PKMAS software (Protokinetics, Inc. Havertown, PA, USA). Descriptive statistics were used.
Results: Three males (mean age: 58.7 years) with gait dysfunction attributable to DSP completed the program. One participant showed clinically meaningful improvements in 6MWT distance at W5. All 3 participants showed improvements in the following parameters: step length (range: 3.8%-11.7%), stride velocity (range: 2.6%-20.7%), single and double-limb support time (range: 1.0%-1.7%, 2.3%-5.5%, respectively), and velocity (range: 2.6%-20.9%) at W5. Persistence at W9 was inconsistent. Other parameters, such as cadence and stride width, did not change across all participants.
Conclusion(s): Although walking activities were not included in the program, each participant showed improvements in gait after 4 weeks of yoga. The participant with the largest improvements in gait also showed greater improvements in endurance, function, and self-reported disability. Although we interpret these findings with caution, it seems likely that elements of the yoga program may have had a direct or indirect impact on gait and walking. It is possible that improvements in other variables such as endurance, and in variables that were not measured (e.g. flexibility), may have contributed to changes in gait. A study with a longer duration program is needed to elucidate the effects of yoga on individuals with HIV-related neuropathy.
Implications: Each of the participants in the case series showed improvements in some elements of walking and gait. These improvements may have been the result of participation in the yoga program, but additional research with appropriate controls should be conducted to confirm or refute this.
Funding acknowledgements: This study was funded by a grant from the Oncology Section of the American Physical Therapy Association (APTA) (PI: Kietrys)
Topic: Oncology, HIV & palliative care
Ethics approval: This study was approved by the Rutgers Institutional Review Board (Newark, NJ, USA)
All authors, affiliations and abstracts have been published as submitted.
