Improve Veteran Health with In-Person and Telehealth Yoga
By John M. de Castro, Ph.D.
“The fact that veterans are embracing yoga and realizing its benefits speaks directly to the stigmas attached to both yoga and PTSD. Veterans practicing yoga illuminate the value of the practice for any person, from any walk of life, not just “new-age hippies.” It also demonstrates that suffering trauma that affects our mental health does not break us or make us any less human.” – Dana Santas
Mindfulness training has been shown through extensive research to be effective in improving the physical and psychological condition of otherwise healthy people and also treating the physical and psychological issues of people with illnesses and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be particularly effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.
The vast majority of the mindfulness training techniques, adopted so far, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, there has been attempts to develop alternative distance education approaches such as on-line mindfulness training programs and videoconferencing. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist physically present in on-line or videoconferencing programs may greatly reduce their effectiveness. It is not known if yoga practice can be successfully delivered through distance videoconferencing programs.
In today’s Research News article “Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga.” See summary below or view the full text of the study at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381127/
Schulz-Heik and colleagues compared the effectiveness of yoga classes provided to veterans with a wide variety of physical and mental health problems. The classes were either in-person or the same class delivered via videoconferencing to a remote site. The classes were offered 13 times per week. The participants were free to attend whichever classes and how many they wanted on their own schedules. All participants who attended any classes during a two-week period were asked to complete a questionnaire on their satisfaction with the classes, global health, and 16 different health symptoms. Satisfaction with classes was demonstrated as 82% rated them excellent and 98% stated that they enjoyed the classes and 98% would recommend them to a friend.
They found that the veterans reported significant improvement in a wide range of physical and mental health symptoms, including overall pain, back pain, headache, upset stomach, sleep problems, energy level, irritability, concentration, anger, depression, anxiety, jumpiness, disturbing memories, and other symptoms. Importantly, the in-person and videoconferencing programs demonstrated equal improvements with no significant differences found between them.
These are very interesting results but must be interpreted with caution. There was no active control condition. So, the reported benefits might be due to placebo effects, experimenter bias, demand characteristics, etc. The results though are similar to those reported for yoga practice in randomized controlled trials and it is reasonable to conclude that the current yoga program produced similar benefits. Regardless, it is striking that the videoconferencing program was equally effective as the in-person program. This is important as it suggests that inexpensive mindfulness training can be offered to widespread audiences. In addition, videoconferencing training is convenient for the participants, as they do not have to go to a practitioners site on a particular schedule. This, in turn, allows for the application of yoga training for the prevention and treatment of psychological and physical disorders with busy people, low income people, and even people in remote locations, thus greatly expanding the numbers of people who can benefit.
“yoga is being increasingly embraced by Veterans Affairs and the military looking to move veterans off addictive painkillers and offer them alternative treatments for pain.” – Emily Wax-Thibodeaux
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Schulz-Heik, R. J., Meyer, H., Mahoney, L., Stanton, M. V., Cho, R. H., Moore-Downing, D. P., … Bayley, P. J. (2017). Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC Complementary and Alternative Medicine, 17, 198. http://doi.org/10.1186/s12906-017-1705-4
Abstract
Background
Yoga is increasingly popular, though little data regarding its implementation in healthcare settings is available. Similarly, telehealth is being utilized more frequently to increase access to healthcare; however we know of no research on the acceptability or effectiveness of yoga delivered through telehealth. Therefore, we evaluated the feasibility, acceptability, and patient-reported effectiveness of a clinical yoga program at a Veterans Affairs Medical Center and assessed whether these outcomes differed between those participating in-person and those participating via telehealth.
Methods
Veterans who attended a yoga class at the VA Palo Alto Health Care System were invited to complete an anonymous program evaluation survey.
Results
64 Veterans completed the survey. Participants reported high satisfaction with the classes and the instructors. More than 80% of participants who endorsed a problem with pain, energy level, depression, or anxiety reported improvement in these symptoms. Those who participated via telehealth did not differ from those who participated in-person in any measure of satisfaction, overall improvement (p = .40), or improvement in any of 16 specific health problems.
Conclusions
Delivering yoga to a wide range of patients within a healthcare setting appears to be feasible and acceptable, both when delivered in-person and via telehealth. Patients in this clinical yoga program reported high levels of satisfaction and improvement in multiple problem areas. This preliminary evidence for the effectiveness of a clinical yoga program complements prior evidence for the efficacy of yoga and supports the use of yoga in healthcare settings.