The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study

Journal Pre-proof The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study Gülcan Bahçecioğlu Turan, Mehtap Tan PII:

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https://doi.org/10.1016/j.ctcp.2019.101070

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CTCP 101070

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Complementary Therapies in Clinical Practice

Received Date: 4 October 2019 Revised Date:

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Accepted Date: 25 October 2019

Please cite this article as: Bahçecioğlu Turan Gü, Tan M, The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study, Complementary Therapies in Clinical Practice (2019), doi: https://doi.org/10.1016/j.ctcp.2019.101070. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Ltd.

The Effect Of Yoga On Respiratory Functions, Symptom Control And Life Quality Of Asthma Patients: A Randomized Controlled Study

Gülcan BAHÇECĐOĞLU TURAN1, Mehtap TAN2

1

Gülcan Bahçecioğlu Turan, PhD , RN, Res. Asst. Ataturk University, Faculty of Nursing

Department of Internal Medicine Nursing Erzurum / Turkey [email protected] 2

Mehtap Tan.PhD, RN, Professor. Ataturk University, Faculty of Nursing

Department of

Fundamentals of Nursing Erzurum / Turkey. [email protected]

Correspondence address: Gülcan Bahçecioğlu Turan Res. Asst. Ataturk University, Faculty of Nursing

Department

of

Internal

Medicine

Nursing

[email protected] Phone: +90-442 231 5794,

Wordcount:6200 Wordcount 4000 (excluding reference and tables)

,25240,

Erzurum/Turkey

E-mail:

The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study

ABSTRACT Aim: This study was conducted to find out the effect of yoga applied to asthma patients on the patients’ respiratory functions, symptom control and quality of life. Methods: The sample of the study consisted of a total of randomly chosen 112 asthma patients, 56 in the experimental group and 56 in the control group, who met the research criteria and who agreed to participate in the study. A total of 12 yoga sessions, 2 sessions a week for 6 weeks, was applied to the patients in the experimental group. The patients in the control group did not receive any intervention.

Results: In the intragroup comparison of average pre-test and post-test scores of respiratory function and Asthma Control Test (ACT) and Asthma Quality of Life Scale (AQLQ) total and subdimension scores of the patients in the experimental and control group, the difference was found to be statistically significant (p<0.05). In addition, post-test score averages were found to increase in the experimental group, while they were found to decrease in the control group. Conclusion: It was found that yoga influenced respiratory functions, symptom control and quality of life positively in asthma patients. Key Words: Asthma, patient, nursing, yoga

The clinical trial registration number is NCT04107415/ https://clinicaltrials.gov/ct2/show/NCT04107415

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1.Introduction Asthma is a chronic inflammatory disease with respiratory symptoms such as wheezing, coughing, shortness of breath, and feeling of tightness in the chest. It is one of the most common chest diseases with an increasing morbidity and mortality rate affecting approximately 300 million people worldwide. Asthma is a disease that occurs in all age groups and both genders. This prevalence is expected to increase gradually as life shifts from village to city and people prefer a more modern life. It is estimated that four hundred million people will have asthma by 2025 [1-2]. It is estimated that there are about 3.5 million asthma patients in Turkey [2-4]. It is also estimated that 2-6% of this number is composed of adult individuals [2-4]. Non-pharmacological treatment methods are as important as pharmacological treatment in asthma patients in order to take symptoms under control and to prevent the frequency of exacerbation [1-2,5-7]. The use of traditional and complementary medicine, which is a nonpharmacological treatment method, is gradually becoming more important in asthma patients8-11 There are various studies conducted in the world which show that yoga provides symptom control and increases respiratory functions and quality of life in asthma patients [5,12-15]. In a study by Sharma et al., yoga was found to be effective on the quality of life and respiratory functions of asthma patients [16]. In a study by Satyanand et al., yoga was found to calm the minds and bodies of asthma patients, increase their energy levels and lung capacity and strengthen their chest muscles [17] ; in studies conducted by Harika et al. and Hoang et al., yoga was found to increase respiratory functions of asthma patients significantly [18-19]. Yoga is an old Hindu practice. Its therapeutical effect has been documented in western countries and it means the perfect control of the body, feelings and the mind. Yoga consists of breathing exercises, asanas (poses), relaxation and meditation exercises [20-22]. Breathing exercises, various poses and meditation in yoga help to gain health in a balanced way through a connection between the mind and the body [5,20-21,23]. It is reported that these regular practices stretch the spine, strengthen the muscles, relieve fatigue, regulate sleep, remove drug toxins to increase the oxygenation of the brain, increase awareness, self-orientation and self-recognition, provide a positive perspective and reduce stress. It is also reported in literature that these applications are effective in strengthening the respiratory muscles, increasing the capacity of the lungs and relieving shortness of breath and providing breath control [5,12-14,20-25]. In addition to improving pulmonary ventilation and gas exchange, they have been found to be effective in the treatment, rehabilitation and prevention of respiratory diseases by improving respiratory functions [14] As a result of previously conducted evidence-based studies, it has been found that yoga is an important practice in maintaining health and preventing diseases, and it is found to be effective in anxiety, arthritis, cardiovascular diseases, Carpal Tunnel syndrome, depression, diabetes, epilepsy, 2

insomnia, hypertension, irritable bowel syndrome, menopause, multiple sclerosis and low back pain [5,25-31] While there are studies conducted with yoga on different patient groups in Turkey, no studies have been found on asthma patients specifically [32-34]. For this reason, it was thought that studies are needed which will prove the effect of yoga practices in preventing and controlling symptoms of asthma patients and which will contribute to nursing literature. This study was conducted to find out the effects of yoga applied to asthma patients on the patients’ respiratory functions, symptom control and quality of life. The hypotheses of the study H0: Yoga does not improve breathing function, symptom control and quality of life H1: Yoga improves the respiratory function of asthma patients. H2: Yoga improves symptom control in asthma patients. H3: Yoga improves the quality of life of asthma patients 2. Materials and Methods 2.1.Design and Setting This study is a randomized experimental study with control group and pre-test post-test practice. 2.2.Sample The population of the study consisted of 440 patients registered in the Chest Diseases outpatient clinic of a university hospital and a public hospital. However, when the patients who did not meet the research criteria were excluded, 180 were left. Afterwards, 60 of these patients who refused to participate in the study were excluded from the list. The research was started with the remaining 120 patients (Figure 1) Inclusion criteria Patients who: •

were between 18 and 55 years old diagnosed with asthma at least for six months,

•

were living in the city centre,

•

had not participated in a regular exercise program in the last 6 months,

•

did not have another respiratory system disease,

•

were not in the exacerbation period,

•

did not have a physical disease or cognitive deficiency and a psychiatric disease diagnosis that could prevent understanding the training given,

•

were literate and volunteered to participated in the study , were included in the study.

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2.2.1. Sample size calculation. Power analysis conducted to find out whether the sample size was enough showed that effect size was 4.56 (high), while effect power was 0.99 at a significance level of 0.05 and confidence interval of 95%. These values show that the sample size was within required levels [35] Randomization; A total of 120 patients who met the research criteria were divided into two groups by using simple random numbers table, and then the first group which was drawn by lot method was named as the experimental group. Since 4 people from each group left while the study was being conducted, the study was completed with 112 people including two groups of 56 people. (Figure 1) 2.3.Instruments ‘Personal Information Form’, ‘Respiratory Functions Monitoring Form’, ‘Asthma Control Test (ACT)’ and ‘Asthma Quality of Life Scale (AQLQ)’ were used in data collection process. 2.3.1. Personal Information Form Personal information form, which was prepared by the researcher in line with the related literature [36-38]. includes a total of 18 questions, 7 questions including socio-demographic characteristics such as age, gender, social insurance and educational status and 11 questions including characteristics related with the disease such as the presence of asthma patients in the family, time of diagnosis and presence of another chronic disease. 2.3.2. Respiratory Functions Monitoring Form Respiratory Function tests are assessed to find out the degree of airway constriction with spirometer and also to find out whether the disease is reversible and to make asthma diagnosis [12]. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF) and FEV1/FVC measurements were used to evaluate airway constriction [1-2]. 2.3.3. Asthma Control Test (ACT) It was developed by Nathan et al in 2004 [37]. It was tested for validity and reliability again by Schatz et al. in 2006 [38]. The validity and reliability study was conducted by Uysal et al. in Turkey in 2013. Cronbach alpha coefficient was found as 0.84 [39]. In the present study, Cronbach alpha coefficient was found as 0.93. The test consists of 5 questions. In this 5-Likert type scale, the scores of the answers are added up and the patient’s state is evaluated. The maximum score one can get from this test is 25, while the minimum score is 5. While scoring ACT, 25 points is accepted as “full control”, 20-24 points is accepted as “good control” and less than 19 points is accepted as “no control”. The highest score indicates the best control, while scores less than 19 indicate that the disease is not under control and that modifications should be made in the treatment to reach control.

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2.3.4.Asthma Quality of Life Questionnaire (AQLQ) It was developed by Juniper et al. in 1999 [40]. It was tested for reliability and validity in Turkey by Şahin and Wan in 2008. Reliability coefficient of the scale was found as 0.96.41 It was tested for reliability and validity in Turkey by Alpaydın et al. again in 2011 and Cronbach alpha coefficients of the sub-dimensions in the scale were found to differ between 0.81and 0.87 [36]. In the present study, Cronbach alpha coefficients of the sub-dimensions in the scale were found to differ between 0.90 and 0.94 and the total Cronbach alpha coefficient was found as 0.96. AQLQ, which addresses both the physical and emotional aspects of the disease has 32 items and four subdimensions. These sub-dimensions are activity limitation (items 1, 2, 3, 4, 5, 11, 19, 25, 28, 31, 32), symptoms (items 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 29, 30), emotional functions (items 7, 13, 15, 21, 27) and environmental stimulants (items 9, 17, 23, 26). The scale is a 7-Likert type scale with “1” having the lowest point and “7” the highest point. Weights for the points of the questions are equal. General quality of life is calculated with the averages of all questions, while sub-dimensions are calculated by adding the scores of the related fields. Total score of the scale differs between 32 and 224. Higher total score and sub-dimension score averages mean higher quality of life. 2.4. Data Collection The data of the study were collected between December 2017 and October 2018. A quiet room was arranged in the chest diseases polyclinic of the university hospital so that the researcher could inform the patients and collect the data. The patients who met the inclusion criteria and who agreed to participate in the study were informed about the study. In the pre-test stage (first meeting), the experimental group and the control group were informed about the ‘Personal Information Form ’, ‘Respiratory Functions Monitoring Form’, ‘Asthma Control Test’ and ‘Asthma Quality of Life Questionnaire’. Later, these forms were given to the patients and they were asked to fill in the forms. Six weeks later, in post-test stage, Respiratory Functions Monitoring Form, ACT, AQLQ were applied again. 2.5. Nursing Interventions 2.5.1.Nursing Interventions conducted on the experimental group The researcher who would apply yoga training to the experimental group received 100 hours of theoretical and practical yoga training before starting the study. Yoga training was applied by the researcher. In order to ensure the continuity of the practice, patients’ contact information was taken by the researcher and a whatsapp group was formed. The experimental group was given a training handbook and yoga breathing techniques Cd by the researcher as intervention material.

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2.5.2. Intervention Material 2.5.2.1.Training Handbook: The handbook, which was prepared by the researcher in parallel with the related literature21,42 includes information about how to do breathing exercises. 2.5.2.2.Yoga Breathing Techniques Cd: Breathing techniques Cd prepared by Yoga Academy Course was used to teach the breathing techniques and to ensure the continuity of the practice. This Cd includes the yoga practices used in the training. 2.5.3. Yoga Intervention Yoga is done in groups for 60-90 minutes [44]. In literature, there are different yoga application sessions which have been found to be effective on asthma patients in the short and long run [15,4548]. By taking the studies conducted into consideration, the yoga application was conducted by the researcher as a total of 12 sessions, twice a week for 6 weeks. Groups of 6-10 were formed for the yoga application. The groups were arranged according to days and hours the patients were available. The groups were arranged as Monday-Thursday and Tuesday-Friday. The sessions were determined as between 12:00 and 13:10, 14:00 and 15:10 and 17:00 and 18:10. The patients participated in sessions that were suitable for them. The researcher was continually in touch with the patients so that they would continue their sessions regularly and so that they would not experience any problems in sessions. Basically, yoga consists of stages of breathing techniques, asanas (poses) and relaxing [43].Yoga stages applied were completed in 70 minutes as 15 minutes of breathing exercises while standing, 10 minutes of breathing exercise with asana while sitting, 10 minutes of breathing exercise with asana while lying, 25 minutes of breathing exercise while sitting and 10 minutes of deep relaxing while lying. At the end of each session, feedbacks were taken from the patients about each yoga application. 2.5.4.Nursing Interventions conducted on the control group No interventions were conducted on the control group during the study. However, at the end of the study, yoga was applied to 6 control patients who wanted to try the practice. In addition, training handbook and yoga breathing techniques Cd were given to all of the patients 2.6. Data analysis The data obtained from the study were assessed by using SPSS 17 program. Arithmetic mean, standard deviation, percentage Chi-square, t test for independent groups, t test for dependent groups, Mann-Whitney u test and Wilcoxon test were used in the statistical assessment of the data. 2.7.Ethical Considerations Approval was taken from Atatürk University Faculty of Nursing Ethics Board (16/11/2017 dated 2017-10/2 numbered) and written permission was taken from the institution for the study. In

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addition, written and oral consents were taken from the individuals who participated in the study after the purpose of the study was explained. . 3.Results As can be seen from Table 1, 39.3% of the patients in the experimental group are between the ages of 36 and 45, 87.5% are female, 35.7% are graduates of primary education and 69.9% are married. 55.4% of the patients are housewives, incomes of all patients are equal to their expenditure and they all have social insurance. 89.3% of the patients have a family member with asthma and 50% have been diagnosed for five years and longer. 7.1% of the patients have another disease. 50% of the patients have attacks 2-3 times a year and 83.9% are non-smokers. Average age of the patients is 37.43±9.58. In the control group, 37.5% are between the ages of 36 and 45, 80.4% are female, 32.1% are graduates of primary education and 87.5% are married. 51.8% of the patients are housewives, incomes of 96.4% of the patients are equal to their expenditure and they all have social insurance. 94.6% of the patients have a family member with asthma and 50% have been diagnosed for five years and longer. 17.9% of the patients have another disease. 46.7% of the patients have attacks 2-3 times a year and 73.2% are non-smokers. Average age of the patients is 40.28±9.23. The experimental and the control group were found to be statistically similar in terms of descriptive features except for marital status (p>0.05) (Table 1).

As can be seen in Table 2, the patients in the experimental and the control group were found to be statistically similar in terms of pre-test ‘respiratory function tests’ values (p>0.05). The difference between the groups was found to be statistically significant in terms of post-test pulmonary function values (p<0.05). Post-test respiratory function values (FEV1(%): 106.75±19.42, FEV1(lt): 3.14±0.83, FVC (%):

98.84±23.94, PEF

(%):

(lt):

respiratory function values FVC

(lt):

114.73±14.65, FVC

(lt):

3.82±0.92, FEV1 / FVC: 86.96±12.92, PEF

6.53±1.87 ) of the experimental group were found to be higher than (FEV1(%): 80.75±17.90, FEV1(lt): 2.36±0.72, FVC

3.11±0.89, FEV1 / FVC: 71.03±5.66, PEF

(%):

72.16±16.05, PEF

(lt):

(%):

91.21±17.88,

4.78±1.47 ) of the

control group. In the intragroup comparison of “respiratory function tests” of the patients in the experimental and control group, the difference between pre-test and post-test respiratory function values were found to be statistically significant (p<0.05). In the patients in experimental group, increases were found in FEV1(%) value from 92.55±18.53 to 106.75±19.42, in FEV1 (lt) value from 2.66±0.77 to 3.14±0.83, in FVC(%) value from 102.98±14.33 to 114.73±14.65, in FVC

(lt)

value from 3.37±0.80 to 3.82±0.92, in FEV1/FVC value

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from 74.79±9.11 to 86.96±12.92, in PEF (lt) value from 5.32±1.90 to 6.53±1.87 and in PEF(%) value from 82.02±22.40 to 98.84±23.94. In the patients in control group, decreases were found in FEV1(%) value from 86.00±18.36 to 80.75±17.91, in FEV1(lt) value from 2.46±0.76 to 2.36±0.72, in FVC(%) value from 97.48±18.00 to 91.21±17.88, in FVC(lt) value from 3.26±0.89 to 3.11±0.89, in FEV1/FVC value from 73.32±6.41 to 71.03±5.66, in PEF

(lt)

value from 5.10±1.56 to 4.78±1.47, in PEF

(%)

value from 76.77±16.24 to

72.16±1606. As can be seen in Table 3, the patients in the experimental and the control group were found to be statistically similar in terms of pre-test asthma control test, asthma quality of life total and activity limitation, symptoms, emotional functions and environmental stimulants sub-dimensions score averages (p>0.05) The difference between the groups was found to be statistically significant in terms of post-test ACT, AQLO total and subscale mean scores (activity limitation, symptoms, emotional functions and environmental stimulants) (p<0.05). Post-test ACT (23.21±1.57), AQLO total (6.72±0.27) and sub-dimension score averages (activity limitation: 6.74±0.31, symptoms: 6.71±0.30, emotional functions: 6.60±0.36 and environmental stimulants: 6.82±0.34) of the experimental group were found to be higher than ACT (12.66±2.87), AQLO total (2.62±0.55) and sub-dimension score averages (activity limitation: 2.52±0.59, symptoms: 2.42±0.61, emotional functions: 4.26±0.97 and environmental stimulants: 1.31±0.47) values of the control group. When “ACT” and “AQLQ” total and sub-dimension pre-test and post-test mean scores of the patients in the experimental and control groups were compared, increases were found in ACT score averages from 14.09±3.95 to23.21±1.57,

in AQLO total score averages from 3.06±0.77 to

6.72±0.27 and in AQLO activity limitation sub-dimension score averages from 2.95±0.75 to 6.74±0.3, in symptoms sub-dimension score averages from 3.05±1.06 to 6.71±0.30, in emotional functions sub-dimension score averages from 4.65±1.18 to 6.60±0.36 and in environmental stimulants sub-dimension score averages from 1.61±0.72 to 6.82±0.34 in the patients of the experimental group and the difference between was found to be statistically very significant (p<0.05). In the patients of the control group, decreases were found in ACT score averages from 13.16±3.00 to 12.66±2.87, in AQLO total score averages from 2.86±0.71 to 2.62±0.56, in AQLO activity limitation sub-dimension score averages from 2.72±0.66 to 2.52±0.59, in symptoms subdimension score averages from 2.70±0.76 to 2.42±0.61, in emotional functions sub-dimension score averages from 4.58±1.09 to4.26±0.97 and in environmental stimulants sub-dimension score averages from 1.41±0.76 to 1.31±0.47 and the difference between was found to be statistically significant (p<0.05). 4.Discussion 8

This study was conducted to find out the effects of yoga on respiratory functions, symptom control and quality of life in asthma patients. In the comparison of post test score averages of respiratory functions between groups, score averages of the experimental group were found to increase significantly when compared with the control group (p<0.05) (Table 2) Based on this finding, it can be said that application of yoga as a supplementary and integrated treatment in addition to pharmacological treatment has a positive effect on the recovery process of the disease. When the pre-test and post-test score averages of the respiratory functions tests were compared between groups, it was found that respiratory function test values increased in the experimental group while they decreased in control group patients (p<0.05) (Table 2). In their study they conducted with bronchial asthma patients, Agnihotri et al.(2016) found that regular yoga had a positive effect on the treatment process of asthma patients. In addition, they stated that yoga as a supplementary treatment in addition to pharmacological treatment improved the efficiency of respiration in patients [12]. As a result of the studies conducted by Karmur et al.( 2015) and Doijad et al.(2012), it was concluded that yoga can be used as an alternative treatment method to increase the efficiency of treatment in respiratory tract disease. As a result, the results of the present study are in parallel with the results of previous studies [13-14]. When the post-test score averages of asthma control tests were compared between the groups, the difference between groups was found to be statistically significant and the post-test score averages of the experimental group were found to be higher when compared with the control group (p<0.05) (Table 3). When the intragroup pre-test and post-test score averages of asthma control tests were compared in experimental and control groups, while the asthma control tests of the experimental group patients were found to increase in post-test, they were found to decrease in control group patients (p<0.05) (Table 3 ). In their study they conducted with asthma patients, Mekonnen and Mossie ( 2010) found that yoga decreased the number and duration of day and night exacerbation and asthma medication use in asthma patients. In their study they conducted with bronchial asthma patients [49], Agnihotri et al.(2016) stated that yoga had positive effects on asthma management. In their study they conducted on bronchial asthma patients [12], Bhatt and Rampallivar (2016) found that pranayama (yoga breathing techniques) decreased asthma exacerbation and was effective in decreasing patients’ hospitalization and drug expenses [50]. In their study on bronchial asthma patients, Saxena and Saxen ( 2009) found decrease in symptom scores and a significant increase in respiratory functions of pranayama group (yoga group) when compared with the control group [51]. In their study, Cooper et al.(2003) concluded that pranayama (yoga breathing techniques) were useful and that they could decrease asthma symptoms and bronchodilator use [52]. In their study, Sabina et al.( 2005) stated that yoga decreased stress, which is a trigger of asthma, and took asthma symptoms under control [53]. This result of the study was 9

found to be in parallel with the results of previous studies. Based on these results, it can be said that yoga as a supplementary treatment can be effective in taking asthma symptoms under control. When the post-test asthma Quality of life total and sub-dimensions average scores were compared between groups, average scores of the patients in the experimental group were found to be higher than those of the patients in the control group (p<0.05) (Table 3). This result of the study was found to be in parallel with the results of previous studies [15,54]. When the intragroup pre-test and post-test asthma Quality of life total and sub-dimensions average scores were compared, post-test average scores were found to increase in the experimental group (p<0.05)(Table 3), while they were found to decrease in the control group (p<0.05) (Table 3). As a result of the literature review conducted, it was found that there were studies which concluded that using yoga with pharmacological treatment had positive effects on symptom management of asthma and quality of life [13-14,16-17,48,55-58]. The results obtained from the present study were found to be in parallel with the results of previous studies. 4.1.Limitations of the Study: This study is limited to asthmatic patients who are not in exacerbation period and are not any exacerbated during the intervention and not exposed to any triggers 5. Conclusion It was found that the patients’ respiratory function values and symptom controls were positively influenced as a result of yoga application and their quality of life was found to increase. In line with these results, the following suggestions can be made; Yoga can be used as a supplementary to pharmacological treatment in asthma patients, It can be recommended for yoga to be used as a supplementary method to increase the efficiency of treatment in nursing practices. Similar studies can be conducted in different geographical areas with greater sample groups in longer periods of time Conflict of interest The authors have no conflict of interest to disclose Funding This study has been supported by grants from the Atatürk University Scientific Research Project (ID numbers 2018/6563) 6.References [1] GINA. Global Strategy for Asthma Management and Prevention NHLBI/WHO work-shop report. National Heart, Lung and Blood Institute update 2017. 2018:Retrieved from 10

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14

Table 1. Distribution of the patients according to their descriptive features Experimental group n %

Age Group

Gender

Education Status

Marital Status

Occupation

Income status The Status of being Asthma Patient in the Family Duration of Diagnosis The Status of Other Chronic Disease The Name of an Existing Disease Hospitalization Status Number of Attacks per Year

Smoking Status

Smoking Duration

Age

Control group n %

18-25 26-35 36-45 46-55 Famale Male Literate Primary education High school Unıversty Married Single Housewife Employee Officer Retired Student

9 14 22 11 49 7 4 20 14 18 39 17 31 9 5 2 9

16.1 25.0 39.3 19.6 87.5 12.5 7.1 35.7 25.0 32.1 69.6 30.4 55.4 16.1 8.9 3.6 16.1

4 14 21 17 45 11 11 18 17 10 49 7 29 14 7 4 2

7.1 25.0 37.5 30.4 80.4 19.6 19.6 32.1 30.4 17.9 87.5 12.5 51,8 25.0 12.5 6.7 3.6

Income < Expenses

-

-

2

3.6

Income= Expenses Yes

56 50

100 89.3

54 53

96.4 94.6

No

6

10.7

3

5.4

6 months-1 year 1- 3 year 3- 5 year 5 year and over Yes No DM HT

2 17 9 28 4 52 1 3

3.6 30.4 16.1 50.0 7.1 92.9 25.0 75.0

1 15 12 28 10 46 3 7

1.8 26.8 21.4 50.0 17,9 82.1 30.0 70.0

No

56

100

56

100

1-2 times 2-3 times 3-4 times No I've used before, now I do not use Yes 5- 10 year 10 year and ve over Experimental group X±SD n 37.43±9.58 56

17 28 11 47

30.4 50.0 19.6 83.9

9 26 21 41

16.1 46.4 37.5 73.2

1

1.8

8

14.3

8 3 6

14.3 33.3 66.7 n

7 12.5 3 20.0 12 80.0 Control group X±SD

56

40.28±9.23

Test value and significance x2=3.232 p=0.357 x2=1.059 p=0.303 x2=5.948 p=0.114 x2=5.303 p=0.021

x2=6.608 p=0.158

p=0.495*

p=0.489*

x2=0.887 p=0.829 x2=2.939 p=0.086 x2=0.035 p=0.852 x2=5.661 p=0.059 x2=5.920 p=0.052 p=0.635* Significance t=-1.607 p=0.111

* Fisher's exact chi square test

15

Tablo 2. Intergroup and intragroup comparisons of respiratory function tests of the experimental and control group patients Experimental group

Control group

Intergroup test value and

X±SD

X±SD

significance

Pre test

92.55±18.53

86.00±18.36

t=1.880

p=0.063

Post test

106.75±19.42

80.75±17.90

t=7.365

p=0.000

Respiratory Function Tests

FEV1 (%)

FEV1 (lt)

Intragroup test value and significance

p=0.000

Pre test

2.66±0.77

2.46±0.76

U=1289.000

p=0.104

Post test

3.14±0.83

2.36±0.72

U=684.500

p=0.000*

Intragroup test value and

*Z=-6.168

*Z=-5.481

p=0.000

p=0.000

Pre test

102.98±14.33

97.48±18.00

t=1.789

p=0.076

Post test

114.73±14.65

91.21±17.88

t=7.614

p=0.000

Intragroup test value and

t=-11.098

t=8.793

significance

p=0.000

p=0.000

Pre test

3.37±0.80

3.26±0.89

t=0.622

p=0.535

Post test

3.82±0.92

3.11±0.89

t=4.119

p=0.000

significance

FVC (%)

FVC (lt)

FEV1 / FVC

Intragroup test value and

t=-7.737

significance

p=0.000

PEF (lt)

t=-5.589 p=0.000

Pre test

74.79±9.11

73.32±6.41

U=1322.000

p=0.152

Post test

86.96±12.92

71.03±5.66

U=300.500

p=0.000*

*Z=-6.514 p=0.000

*Z=-5.849 p=0.000

Pre test

82.02±22.40

76.77±16.24

t=1.420

p=0.159

Post test

98.84±23.94

72.16±16.05

t=6.927

p=0.000

Intragroup test value and significance

PEF (%)

t=6.928

t=-11.173 p=0.000

Intragroup test value and

t=-7.502

significance

p=0.000

t=6.354 p=0.000

Pre test

5.32±1.90

5.10±1.56

t=0.651

p=0.516

Post test

6.53±1.87

4.78±1.47

t=5.511

p=0.000

Intragroup test value and

t=-6.245

t=5.275

significance

p=0.000

p=0.000

Mann Whitney- U test, Z = Will Coxon Test

16

Table 3. Intergroup and intragroup comparisons of ACT and AQLQ Total and Sub-dimension score averages of the patients in the experimental and control group

Asthma Control Test

Experimental

Control

group

group

X±SD

X±SD

Pre test

14.09±3.95

13.16±3.001

t=1.400

p=0.164

Post test

23.21±1.57

12.66±2.87

U=8.000

p=0.000*

Intragroup test value and significance

Z=-5.519 p=0.000

Intergroup test value and significance

Z=-3.193 p=0.001

Sub-dimensions

Asthma Quality of Life Pre test

2.95±0.75

2.72±0.66

U=1258.000

p=0.068

Activity

Post test

6.74±0.31

2.52±0.59

U=0.000

p=0.000*

Limitation

Intragroup test value and

Z=-6.516

Z=-3.797

significance

p=0.000

p=0.000

Pre test

3.05±1.06

2.70±0.77

U=1334.000

p=0.173

Post test

6.71±0.30

2.42±0.61

U=0.000

p=0.000*

Intragroup test value and

Z=-6.511

Z=-4.695

significance

p=0.000

p=0.000

Pre test

4.65±1.18

4.58±1.09

U=1497.500

p=0.681

Emotional

Post test

6.60±0.36

4.26±0.97

U=00.000

p=0.000*

Functions

Intragroup test value and

Z=-6.514

Z=-4.046

significance

p=0.000

p=0.000

Pre test

1.61±0.72

1.46±0.77

U=1334.500

p=0.173

Environmental

Post test

6.82±0.34

1.31±0.47

U=0.000

p=0.000*

Stimulants

Intragroup test value and significance

Z=-6.529 p=0.000

Z=-2.241 p=0.025

Pre test

3.06±0.77

2.87±0.71

U=1332.000

p=0.170

6.72±0.27 Z=-6.509

2.62±0.55 Z=-4.561

U=0.000

p=0.000*

p=0.000

p=0.000

Symptoms

Post test Asthma Quality of Life Total Score Intragroup test value and significance Mann Whitney- U test, Z = Will Coxon Test

17

Figure 1. Study design.

18

HĐGHLĐGHTS


It was found that yoga influenced respiratory functions, symptom control and quality of life in asthma patients positively
This study is considered to be of great importance in terms of showing that yoga can be used as a complementary and alternative treatment in nursing practices in order to increase the effectiveness of treatment in respiratory diseases.