title: Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study.
abstract: BACKGROUND
  Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are highly prevalent and associated with a large symptom burden, that is compounded in a dual HF-COPD diagnosis. Yoga has potential benefit for symptom relief; however functional impairment hinders access to usual yoga classes. We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial. This paper reports on the appropriateness and acceptability of the intervention and the evaluation design.
  
  
  METHODS
  A controlled, non-randomised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control (information leaflets mailed to participants with one phone call a week). Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions. Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating, including views of study outcome measures and physiological tests. Transcribed interviews were analysed using thematic content analysis.
  
  
  RESULTS
  Fifteen people participated in the pilot study (7 in the intervention group, 8 in the control). Of these, 12 participants were interviewed, 6 in each group, mean age 71.2 years (SD 10.09); 3 were male. Themes are reported in the following categories: acceptability and appropriateness of the intervention, potential active ingredients of the intervention, acceptability and appropriateness of the control, participation in the research, and acceptability of the testing procedures. The intervention was acceptable and appropriate: the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation. However, technological problems resulted in poor video-streaming quality for some participants. Potential active ingredients included physical postures, breathing exercises and guidance in relaxation and meditation. The educational control intervention was acceptable and appropriate, with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga's effectiveness. The questionnaires and home physiological testing were acceptable to participants.
  
  
  CONCLUSIONS
  Tele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery. Findings provide guidance for researchers working in tele-interventions, yoga, and similar populations.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02078739 (4 March 2014).
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, U.K. Lucy.selman@kcl.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Selman
authors.affiliation: University of California, San Francisco, Osher Center for Integrative Medicine, 1545 Divisadero Street, 4th Floor, San Francisco, CA, 94115-3010, U.S.A. McDermottK@ocim.ucsf.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: McDermott
authors.affiliation: Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A. Doranne.Donesky@nursing.ucsf.edu.
authors.forename: DorAnne
authors.initials: D
authors.lastname: Donesky
authors.affiliation: Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A. tcitron@gmail.com.
authors.forename: Tracie
authors.initials: T
authors.lastname: Citron
authors.affiliation: Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A. Jill.Howie-Esquivel@nursing.ucsf.edu.
authors.forename: Jill
authors.initials: J
authors.lastname: Howie-Esquivel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001945:Breathing Exercises; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D020407:Internet; D008297:Male; D019122:Meditation; D008875:Middle Aged; D026441:Mind-Body Therapies; D010865:Pilot Projects; D011187:Posture; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D036301:Qualitative Research; D012063:Relaxation; D012107:Research Design; D011795:Surveys and Questionnaires; D017216:Telemedicine; D013690:Television; D015013:Yoga