title: Development of a modified yoga program for pulmonary hypertension: a case series.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a hemodynamic condition in which the pressure in the bed of the pulmonary arteries is elevated. Although medications have improved both symptoms and mortality, PH remains a debilitating and devastating disease. Little is known about the effects of nonpharmacologic approaches, such as yoga and meditative breathing, in treatment of the disease.
  
  
  OBJECTIVE
  Given the unique hemodynamic concerns of PH patients, the research team intended to describe the development and subsequent initiation of a therapeutic treatment plan that uses modified yoga and to evaluate its benefits and safety.
  
  
  METHODS
  This study was a case series with 3 PH patients of varying functional abilities. Each patient was provided with a DVD, access to YouTube video segments, and a download of the Yoga for PH application. The patients were asked to document their use of the home exercise regimen and journal around their subjective observations. They were also administered the Health Promoting Lifestyle Profile II (HPLPII) at the beginning and end of the 8 wk.
  
  
  METHODS
  The study took place in a tertiary care, academic hospital in a large urban setting.
  
  
  METHODS
  In this case series, 3 patients with group 1 pulmonary arterial hypertension, with varying functional abilities, are described.
  
  
  METHODS
  Three discreet yoga programs were designed with modifications specific to PH patients: chair yoga, intermediate yoga with a chair assist, and experienced yoga. Patients were provided with a video, Yoga for PH, in the form of a DVD, a video on YouTube, and a downloadable application and were instructed to log activity and subjective markers of well-being.
  
  
  METHODS
  Subjective and objective effects on clinical, physical function, and psychological outcomes were measured. Subjective effects were identified through journaling as well as the self-administered questionnaire HPLPII. When available, 6-min walk distance (6MWD) testing and oxygen saturation were also used.
  
  
  RESULTS
  The modified yoga program proved feasible, safe, and effective in the 3 described cases. Patients described decreases in anxiety and joint pain, with improvements in health-promoting behaviors as measured by the HPLPII. Overall mean scores for health-promoting lifestyle increased in each patient, though due to the small sample size, statistical significance cannot be measured. No patient experienced an adverse event associated with the practice.
  
  
  CONCLUSIONS
  The modified yoga program for PH patients can provide a standardized, accessible starting point for further study on the feasibility, efficacy, and safety of such a program on a larger scale.
authors.forename: Rana
authors.initials: R
authors.lastname: Awdish
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Small
authors.forename: Hector
authors.initials: H
authors.lastname: Cajigas
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015013:Yoga