Tele-Yoga Breathing for Respiratory Function Proves Feasibility in Amyotrophic Lateral Sclerosis

Jinny Tavee, MD

High adherence rates and acceptability ratings were observed through a recent nonrandomized pilot study with tele-yoga breathing in ALS patients.¹ The outcomes from the sessions of tele-yoga breathing and meditation with the participants in the study prove that it is a safe and feasible practice.

Due to the small sample size from a nonrandomized pilot study, there were no significant changes seen in the clinical outcome measures yet the average decline in percent-predicted forced vital capacity (pFVC) was 0% (95% CI, −1.6 to 1.6) and the average decline in upright forced vital capacity was −0.016 L per month (−0.13, 0.095, 95%CI).¹ More therapies focused on preserving respiratory function are needed, as yoga breathing has a beneficial effect on respiratory parameters even though noninvasive mechanical ventilation has been shown to prolong survival and slow respiratory decline in ALS.

Presented at the 2022 American Association of Neuromuscular & Electrodiagnostic Medicine Annual Meeting, held September 21-24, in Nashville, Tennessee, by Jinny Tavee, MD, neurologist at National Jewish Health, and colleagues, the data showed that of the patients who entered the study (n = 11), 7 (women, n = 5; men, n = 2) participated in the active intervention.¹ The participants partaking in the tele-yoga breathing practice rated it favorably and also deemed it well-tolerated. The intervention produced no adverse effects.

“Individual upright forced vital capacity remained stable or even improved in 4 of 6 subjects as noted in although not statistically significant due to small sample size,” Tavee et al noted. There were minimal technical issues and participants enjoyed the intervention. The sessions were conducted in a group format setting with a mean attendance rate of 85% by the 6 participants who completed the study.

The study comprised of 11 patients with ALS who completed 9 weekly online group sessions of yoga breathing, which featured a certified yoga therapist over the video-conferencing platform Zoom. The mean number of classes attended by each patient was 7.7 . The study was not powered for efficacy and no significant changes were observed in clinical outcome measures because of small sample size. The group sessions included a guided meditation using the iRest Yoga Nidra protocol and Viloma Krama breathing practices. The participants performed breathing exercises that focused on belly breathing, and stair step breathing on both inhalation and exhalation.

As for the primary outcomes in the study, they measured feasibility by adherence rates, acceptability of the intervention, and technical issues. The secondary outcome measures based on the group sessions were forced vital capacity along with using the Revised ALS Functional Rating Scale, the modified Borg dyspnea scale, and Short-Form 36 survey.¹ In the duration of the study with the participants, there was a 3 month follow-up.

Tavee and colleagues wrote, “Yoga breathing is a safe and easy practice that is feasible in ALS patients with respiratory compromise. Potential benefits due to slow relaxed breathing practice, which may improve strength and coordination of respiratory muscles resulting in longer expiration times and reduced CO2 retention.”

“In addition, the home-based program allows for ease of practice and scalability among the general ALS population,” Tavee et al noted. Another benefit of using yoga breathing for ALS patients is that it may also help with reducing anxiety levels.

The limitations of the study included the small size, there being a lack of a control group and a high dropout rate prior to intervention due to need for intubation, surgery, enrollment in other trial or for other unknown reasons.

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REFERENCES
1. Tavee J, Sanpitak P, Aaby D, et al. Feasibility of Tele-Yoga Breathing Meditation in Amyotrophic Lateral Sclerosis and its Effects on Respiratory Function. Presented at: AANEM 2022; September 21-24; Nashville, TN. Abstract 188.