Objective: Patients with end-stage renal disease on maintenance haemodialysis are physically inactive. We describe the rationale and process of developing a targeted yoga therapy intervention to promote physical activity among this population.
Methods: An intra-dialysis yoga protocol was devised through a process of expert consensus. All yoga therapists were trained in the tradition of Tirumalai Krishnamacharya and his son T.K.V. Desikachar. Protocol development occurred in 4 stages: 1. Education of panel on end-stage renal disease and haemodialysis; 2. Discussion of potential therapeutic benefits of yoga for the population; 3. Identification of therapeutic goals for the population; and 4. Yoga protocol development. The protocol was subjected to critical feedback by other yoga therapists, clinical researchers, and nephrologists.
Protocol: A yoga practice was developed to be administered over 12-weeks during dialysis (intra-dialysis yoga; IDY) and offered during each dialysis session (3 times a week). The therapeutic goals of the practice were to improve physical function, reduce cardiovascular risk factors (hypertension, and cardiovascular disease), improve fatigue, reduce muscle cramps, improve mood, and help patients’ cope with chronic medical illness and dialysis treatment. The yoga tools selected for use were movement, breathing, and meditation. Movements (asana) were designed to be done during dialysis sessions recognizing the limitations of patients having to remain in a chair. Breathing practices emphasized relaxation by utilizing deeper breathing (langhana) and other specific techniques (sitali). A water meditation (dhyana) was chosen to further support relaxation and enhances the experience of purification which is akin to dialysis treatment.
Conclusion: We developed a yoga intervention through a process of expert consensus of yoga therapists, researchers and clinicians. Therapeutic goals for the yoga practice were identified a priori to protocol development. This process may be useful in future research design and to help focus outcome selections for clinical trials.