Linking measured and perceived changes in physical function after a tele-yoga intervention in patients with long-term cardiac illness: a mixed-methods study

Abstract Background Digital yoga is a feasible and safe form of tele-rehabilitation for patients with long-term illnesses and shows to improve physical function. How patients perceive physical changes after tele-yoga is important, as the perceptions can explain and shape intervention engagement, satisfaction and effectiveness. Purpose This study aims to explore the association between the measured and perceived physical changes in patients with long-term cardiac illness after a tele-yoga intervention. Methods A convergent mixed-method design was used (Figure 1). Data from 79 intervention group patients with long-term cardiac illnesses who participated in a randomised controlled trail, evaluating Teleyoga (NCT03703609), were analysed. Qualitative data consisted of interviews on perceived physical changes after 3 months of tele-yoga. Interviews were analysed using summative content analysis and ‘improved physical flexibility’ and ‘improved breathing’ were identified as perceived changes in physical function. Interview data was dichotomised into ‘mentioned’ and ‘did not mention’ improvement. Improvement in measured physical function consisted of a clinically significant change (baseline to 3 months) defined as ≥30 meters on the six-minute walking test (6MWT). The association between the dichotomized perceived physical changes and the measured changes in the 6MWT was examined with Cohen’s Kappa. Further, metainferences were subsequently developed. Results Of the patients, 89% had heart failure and 35% diabetes. The mean age was 65 years (±11) and 32% were female. In the interview data 51% perceived ‘improved physical flexibility’, and 57% perceived ‘improved breathing’. A total of 43% of the patients, improved in the 6MWT (≥30 meters). Mixed method findings suggested a trend (p=0.09) towards differences in perceived physical flexibility between the patient group that improved on the 6MWT and those not, and no significant difference was found between the groups in breathing (p=0.87) (Table 1). Furthermore, patients who both had an improved 6MWT, and perceived improvement of physical flexibility (n=21) or breathing (n=19) described that tele-yoga made them feel more flexible and better overall and that breathing exercises helped them be calm and improve breathing. Some patients with no change in the 6MWT (walked 30 meters), described a perceived improvement of physical flexibility (n=19), by for example being able to stretch further, or breathing (n=26). Breathing exercises helped them perform daily tasks, like walking stairs, better by breathing slower and more controlled. Conclusion Although perceived improvements in flexibility and breathing were not consistently aligned with clinical significant change on the 6MWT, patients clearly described these changes. Perceived physical changes, such as feeling more flexible and breathing more freely may explain motivation, engagement, and adherence to tele-yoga, even when the 6MWT does not detect these changes.Fig 1.Convergent mixed-method design. Table 1.Measured and perceived change.