title: Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study.
abstract: BACKGROUND
  Laughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research.
  
  
  METHODS
  Pre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (n = 11). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power.
  
  
  RESULTS
  One participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94 % retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients' mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample size calculations for future research indicated that a minimum of 207 participants would be required to provide sufficient power to detect change in key psychological variables.
  
  
  CONCLUSIONS
  This study provides evidence that Laughter Yoga is a safe, low-intensity form of intradialytic physical activity that can be successfully implemented for patients in dialysis settings. Larger studies are required, however, to determine the effect of Laughter Yoga on key psychological variables.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry - ACTRN12614001130651 . Registered 23 October 2014.
authors.affiliation: Deakin University, Burwood, VIC, Australia. p.bennett@deakin.edu.au.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Bennett
authors.affiliation: Queen's University, Kingston, ON, Canada. parsonst@queensu.ca.
authors.forename: Trisha
authors.initials: T
authors.lastname: Parsons
authors.affiliation: Laughlife Wellbeing Programs, Melbourne, VIC, Australia. r.benmoshe@latrobe.edu.au.|La Trobe University, Bundoora, VIC, Australia. r.benmoshe@latrobe.edu.au.
authors.forename: Ros
authors.initials: R
authors.lastname: Ben-Moshe
authors.affiliation: Laughter Yoga Australia, Melbourne, VIC, Australia. mervneal@laughteryoga.org.
authors.forename: Merv
authors.initials: M
authors.lastname: Neal
authors.affiliation: Deakin University, Burwood, VIC, Australia. melissa.weinberg@deakin.edu.au.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Weinberg
authors.affiliation: Moorabbin Dialysis Unit, Monash Health, Moorabbin, VIC, Australia. karen.gilbert@monashhealth.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Gilbert
authors.affiliation: Centre for Nursing Research - Deakin University and Monash Health Partnership, Clayton, VIC, Australia. cherene.ockerby@monashhealth.org.
authors.forename: Cherene
authors.initials: C
authors.lastname: Ockerby
authors.affiliation: Centre for Nursing Research - Deakin University and Monash Health Partnership, Clayton, VIC, Australia. helen.rawson@deakin.edu.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Rawson
authors.affiliation: Pulmonary Function Laboratory, Clayton, VIC, Australia. corinne.herbu@monashhealth.org.
authors.forename: Corinne
authors.initials: C
authors.lastname: Herbu
authors.affiliation: Centre for Nursing Research - Deakin University and Monash Health Partnership, Clayton, VIC, Australia. alison.hutchinson@deakin.edu.au.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000628:therapy; D001291:Attitude of Health Personnel; D001315:Australia; D003863:Depression / Q000628:therapy; D015444:Exercise / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D007845:Laughter; D027641:Laughter Therapy; D008297:Male; D019122:Meditation; D008875:Middle Aged; D009520:New Zealand; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012649:Self Concept; D015013:Yoga / Q000523:psychology*; D055815:Young Adult