A. Quigley1, M.-J. Brouillette2, J. Gahagan3, K.K. O'Brien4,5,6, M. MacKay-Lyons7,8,9
1Dalhousie University, Health, Halifax, Canada, 2McGill University, Psychiatry, Montreal, Canada, 3Dalhousie University, Health and Human Performance, Halifax, Canada, 4University of Toronto, Physical Therapy, Toronto, Canada, 5University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada, 6University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada, 7Dalhousie University, Physiotherapy, Halifax, Canada, 8Dalhousie University, Medicine, Halifax, Canada, 9Nova Scotia Health Authority, Halifax, Canada
Background: People living with HIV (PLWH) are susceptible to physical and cognitive impairments. There is a need to evaluate the feasibility and impact of interventions to enhance cognitive and physical function among PLWH.
Purpose: The purpose of this pilot randomized controlled trial (RCT) was to assess the feasibility and satisfaction with a 12-week yoga intervention for PLWH. Secondary objectives included evaluating change in cognitive function, physical performance, mood, medication adherence, physical activity, and health-related quality of life in yoga participants versus controls.
Methods: PLWH aged 35 years and older were recruited using posters and pamphlets from community and health organizations in Halifax, Canada. Assessments included demographic information, the Brief Cognitive Ability Measure (B-CAM), the Communicating Cognitive Concerns Questionnaire (C3Q), the Community Balance and Mobility Scale (CB&M), the 10-metre walk test, the Rapid Assessment of Physical Activity (RAPA), activity tracker data (Fitbit™), the Simplified Medication Adherence Questionnaire (SMAQ), the Medical Outcomes Survey-HIV (MOS-HIV), and the Hospital Anxiety and Depression Scale (HADS). Assessments by blinded assessors were conducted at baseline and 12 weeks. Participants were randomly assigned to the yoga intervention (n=11), who performed Hatha yoga classes 3 times a week for 12 weeks or the control group (n=11), who were instructed to maintain their regular physical activity levels. We recorded feasibility outcomes including participant recruitment, attrition, and adherence (a priori criterion was attendance at 70% of classes). Participant satisfaction was measured using a post-participation questionnaire. We analyzed secondary outcomes with intention-to-treat methods using univariate and mixed ANOVA with bootstrapped confidence intervals, Mann-Whitney, and Wilcoxon Signed Rank tests. We also performed a power analysis for the B-CAM to determine the sample size for a future RCT.
Results: We recruited 22 participants over the course of 23 months. Among the yoga participants, 89% met the a priori adherence goal of 70% attendance. All yoga participants indicated that they were satisfied, comfortable, and felt safe with the intervention. Two participants withdrew from the yoga group due to relocation outside of the province and illness. The two groups differed at baseline in age and cognitive performance. There were no within-group or between-group improvements in cognitive performance (B-CAM; yoga group post-test mean=22.3±4.4, mean change=.4±3.6; control post-test mean=18.2±5.7, mean change=2.0±4.3), self-reported cognition (C3Q; yoga post-test group mean=28.1±5.5, mean change=1.8±5.1; control post-test mean=25.5±7.2, mean change=2.3±11.2), or dynamic balance (CB&M; yoga group post-test mean=73.7±27.1, mean change=1.2±7.5; control group mean= 64.6±18.3, mean change=5.2±9.9). We observed within-group improvements on the MOS-HIV cognitive subscale among yoga group participants only (p=0.47) with trends toward improvements on the MOS-HIV health transition subscale (p=0.63) and HADS depression subscale (p=0.55). Based on our power analysis, sample size for a future RCT should include at least 55 participants.
Conclusion(s): This pilot RCT provides evidence of feasibility and potential benefits of a yoga intervention for PLWH. The participants had excellent adherence to the intervention, low attrition, and 100% satisfaction.
Implications: This study determined that yoga is a feasible and potentially useful intervention for improving self-reported cognition in people living with HIV.
Funding, acknowledgements: This work was supported by a CIHR Catalyst Grant (371452) and a Physiotherapy Foundation of Canada Neurosciences Division Award.
Keywords: HIV, Yoga, Rehabilitation
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? Yes
Institution: Nova Scotia Health Authority
Committee: Nova Scotia Health Authority Research Ethics Board
Ethics number: #1022158
All authors, affiliations and abstracts have been published as submitted.
