Operationalizing Yoga Therapy Programs During Cancer Treatment: Evidence from Multiple Centers

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1 Operationalizing Yoga Therapy Programs During Cancer Treatment: Evidence from Multiple Centers Presented by: Jnani Chapman, RN,BSN, C IAYT, ERYT500 Founder of YCat Yoga Therapy Trainings Tina Walter, C IAYT YCat Oncology Trained Yoga Therapist Disclosure Statement Jnani Chapman, RN, and Tina Walter, Yoga Therapist, have indicated no financial relationships with any commercial interest relevant to this activity. 1

2 Faculty Affiliations Company: YCat Yoga Therapy Affiliation: Yogaville, Buckingham, VA Integral Yoga Institute, New York City, NY Yoga Therapy RX Loyola Marymount, Los Angeles, CA Prana Yoga, Ft. Wayne, IN TriYoga, Waltham, MA Company: Jnani Chapman, RN, BSN, C-IAYT, E-RYT500 Affiliation: Commonweal Company: Tina Walter, C-IAYT Affiliation: The Christ Hospital, UC Health Barrett Cancer Center, and St. Elizabeth Cancer Center Learning Outcomes Participants will: Gain knowledge of evidence-based, individuated yoga therapy interventions delivered to adults during cancer treatments Be able to distinguish between yoga therapy interventions and communitybased yoga classes and programs Be able to describe the YCat yoga therapy concepts and practices used with adults in cancer treatment in clinical practices and research studies around the US including The Christ Hospital, Cincinnati, and The Winship Cancer Institute of Emory University in Atlanta Describe the current status of certification and credentialing of yoga therapists in the US, and of specialty training programs like YCat Yoga Therapy for Cancer, Chronic Illness, Aging and End of Life. 2

3 YCat Yoga Therapy Interventions: Awareness Practices: The Witness Practice and Meditation The only place you can ever be is where you are Breathing Practices: The Complete Breath, Even In and Out Breath, & The Extended Exhalation Breath The breath is the bridge between the physical world and the invisible world Sri Swami Satchidananda, Founder Integral Yoga Institutes and Teaching Centers Movement Practices: Embodiment Easy, steady and comfortable pose or posture The Yoga Sutras of Patanjali, Book 2 YCat Yoga Therapy Interventions: Relaxation Practices: Yoga Nidra, Shavasana and Restorative Pratyahara: Self-Initiated and Guided Imagery Using the Mind, the Senses, and the Imagination consciously and intentionally The Yoga Sutras of Patanjali, Book 2 Yoga Philosophy: Meaning, Purpose and Transcendence Exploring the Nature of the Mind and the Nature of Reality The Yoga Sutras of Patanjali and Bhagavad Gita 3

4 What is Yoga Therapy? Yoga Therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practices of yoga. The International Association of Yoga Therapists (IAYT): Educational Standards for the Training of Yoga Therapists Yoga therapy refers to the adaptation and application of yoga techniques and practices to help individuals manage their conditions(s), reduce symptoms, restore balance, increase vitality, and improve attitude. Gary Kraftsow, American Viniyoga Institute Efficacy of Individualized Yoga Therapy Performed During Outpatient Oncology/Hematology Visits Purpose of Study Determine if basic yoga interventions, performed concurrently during the time of a cancer therapy infusion treatment, decreases patients perceptions of fatigue, pain, nausea, fatigue, anxiety and distress. Study Procedure After obtaining consent, participants rated pain, fatigue, nausea, anxiety and distress on a visual analogue scale. Then, the yoga intervention was performed. At the conclusion of session, patients rated pain, fatigue, nausea, anxiety and distress. Research Team: Tina Walter, C-IAYT500, Gigi Robison, MSN, RN, AOCN Jaimie Robinson, MSW, LISW-S, Judi Godsey, PhD., RN 4

5 Efficacy of Individualized Yoga Therapy Performed During Outpatient Oncology/Hematology Visits Intervention Photo Used with Permission YCat Yoga Therapy was provided individually to patients in their chair during the infusion therapy. Selection of yoga interventions was based on the patient s needs and symptoms. Intervention included minutes of breath practices, movement practices, guided imagery, witness practice (body scan meditation), and/or yoga nidra. Research Team: Tina Walter, C-IAYT500,Gigi Robison, MSN, RN, AOCN Jaimie Robinson, MSW, LISW-S, Judi Godsey, PhD., RN Efficacy of Individualized Yoga Therapy Performed During Outpatient Oncology/Hematology Visits Methods Design: A prospective, single convenience group using a pre/post design Setting: The Christ Hospital Health Network, an academic, comprehensive outpatient cancer center in Cincinnati Ohio Population: Hematology/Oncology Patients receiving infusion therapy Photo Used with Permission Research Team: Tina Walter, C-IAYT500,Gigi Robison, MSN, RN, AOCN Jaimie Robinson, MSW, LISW-S, Judi Godsey, PhD., RN 5

6 Efficacy of Individualized Yoga Therapy Performed During Outpatient Oncology/Hematology Visits Results The post-yoga therapy results demonstrated statistically significant reductions in these symptoms from pre-yoga to post-yoga patient evaluation: pain, fatigue, anxiety and distress. Conclusion This study suggests that yoga therapy may be an effective intervention for decreasing pain, anxiety, fatigue, and distress for cancer patients in infusion centers. Research Team: Tina Walter, C-IAYT500,Gigi Robison, MSN, RN, AOCN Jaimie Robinson, MSW, LISW-S, Judi Godsey, PhD., RN Efficacy of Individualized Yoga Therapy Performed During Outpatient Oncology/Hematology Visits Implications for Practice Through the use of yoga therapy, cancer patient s experience of symptoms related to Chemotherapy Biotherapy Infusion can be decreased. Intra-professional team collaboration is critical to success of a safe, effective yoga therapy program for oncology / hematology patients. Longitudinal studies, with larger sample sizes, are recommended which examine the effects of a regular yoga therapy program on the cancer patient s experience of related side effects. Also recommended, would be to determine if the yoga teaching sessions, offered during the yoga therapy session, led to increased patient utilization of these practices in their daily lives. Research Team: Tina Walter, C-IAYT500,Gigi Robison, MSN, RN, AOCN Jaimie Robinson, MSW, LISW-S, Judi Godsey, PhD., RN 6

7 Significant Symptom Burden Reduction in Inpatient Bone Marrow Transplant (BMT) Unit with YCat Yoga Therapy BACKGROUND The inpatient treatment of blood and lymphatic cancers with BMT patients can create marked symptom burden including extreme fatigue, pain, nausea, and anxiety associated with indeterminate hospital stay, potential engraftment failure, and long-term disease prognosis. Yoga therapy was delivered to BMT inpatients as an optional clinical service to assess symptom reduction and integration into standard medical care. METHODS Individualized 40 minute YCat yoga therapy sessions were delivered to assess symptom reduction and integration into standard medical care. Patients with high morbidity/ discomfort were pre-selected by nursing staff. Pre and post data were collected using FACT-BMT (version 4). The yoga therapy was delivered with patients reclined in bed or seated in a chair and included: body and breath awareness practices, gentle movement practices and imagery/relaxation practices. Research Team: T. Leonard, L. Wright, J. Chapman, EK Waller, RL Maynard, Dept. of Hematology and Medical Oncology, Winship Cancer Institute of Emory University Significant Symptom Burden Reduction in Inpatient Bone Marrow Transplant (BMT) Unit with YCat Yoga Therapy RESULTS Patients (n=221) completed both pre-and post-data interviews. Overall, patients reported significant (p<0.05 paired t-test) reduction in nausea, pain, side effects, sadness, nervousness, and lack of energy. The largest decreases in reported symptoms were feelings of nervousness and lack of energy. 162 (73%) patients reported a decrease in at least one of the six symptoms assessed, and only 21 (10%) patients reported an increase in some symptoms. Total pre- and post-session scores decreased significantly (p<0.05). Breathing awareness was the most frequently used yoga therapy practice (n=212, 96%), followed by body awareness (n=195, 88%), and imagery (n=122, 55%). Movement was the least used yoga therapy practice (n=66, 33%). DISCUSSION This data points to the efficacy of yoga therapy for symptom relief with in-patient BMT patients, most notably in their perceived reduction of nervousness and increase in energy. This suggests the benefit and adaptability of yoga therapy as a non-pharmaceutical adjunct to traditional medical care for BMT, even in cases of high symptom burden and decreased mobility. Research Team: T. Leonard, L. Wright, J. Chapman, EK Waller, RL Maynard, Dept. of Hematology and Medical Oncology, Winship Cancer Institute of Emory University 7

8 The International Association of Yoga Therapists: Certification and Accreditation History In 2012 IAYT published educational standards for the training of Yoga Therapists In 2014 IAYT began accrediting Yoga Therapy training programs that meet those standards. Thus far, 28 Yoga Therapy training programs are accredited by IAYT. IAYT upholds a rigorous accreditation process. The accreditation is intended to approximate an early professional master's degree. IAYT Accreditation Standards Are competency-based Require a minimum of 800 hours in training, after being certified by a 200 hour yoga teacher training program Require a minimum of two years to complete The International Association of Yoga Therapists Certification and Accreditation IAYT Yoga Therapist Certification: C-IAYT IAYT started certifying individuals as Yoga Therapists in 2016 To date approximately 3,000 yoga therapists have been certified, C-IAYT Grandparenting was a rigorous application process that closed in June of 2017 Specialty Yoga Therapy Training Programs IAYT is committed to providing an approval process for professional development programs offering continuing education to yoga therapists IAYT is committed to recognize specialty programs (SPs) offering training and education segments of 50 hours or less apiece, who also meet their rigorous standards IAYT is committed to recognize high quality programs taught by well qualified yoga therapists around the country IAYT Yoga Therapists have a scope of practice, an enforceable code of ethics and insurance that explicitly covers C-IAYT Yoga therapists 8

9 References Danhauer, SC, Sohl, SJ, Addington, EL, Chaoul, A, Cohen, L (2016). Chapter 16: Yoga Therapy During Cancer Treatment. In SBS Khalsa, L Cohen, T McCall, & S Telles s (Eds.) The Principles and Practice of Yoga in Health Care (pp ). Edinburgh, England: Handspring Publishing Limited. Walter, T., Robison, G., Robinson, J., & Godsey, J. (2017). Efficacy of Individualized Yoga Therapy Performed During Outpatient Visit Described by Oncology / Hematology Patients. Poster presented during Research Day Presentations at The Christ Hospital; Cincinnati, Ohio; October Unpublished manuscript. References Sohl, S.J., Birdee, G.S., Ridner, S.H., Wheeler, A., Gilbert, S., Tarantola, D., Berlin, J., & Rothman, R.L. (2016) Intervention Protocol for investigating Yoga Implemented During Chemotherapy. International Journal of Yoga Therapy, 26: Hart, J. (2013). Yoga as an Adjunctive Therapy in the Clinical Setting. Alternative and Complementary Therapies, 19(2),

10 Questions? Jnani Chapman, RN, BSN, C IAYT, E RYT500 Jnanicha@gmail.com Tina Walter, C IAYT tawalter@cinci.rr.com 10