Effectiveness of Yoga and Meditation on Quality of Life Among Patients Undergoing Hemodialysis

Introduction

Chronic kidney disease (CKD) is a prevalent global health concern with a significant impact on the quality of life (QoL) of affected individuals. Among the therapeutic modalities for managing CKD, hemodialysis is a common intervention. Still, it is associated with various physical, psychological, and social challenges that can compromise patients’ QoL.¹ As the demand for effective and holistic interventions grows, there is increasing interest in exploring complementary approaches such as yoga and meditation.^2-4 Yoga and meditation have been recognized for their potential benefits in improving physical and mental health across various populations. These practices emphasize the integration of mind and body, promoting relaxation, stress reduction, and overall well-being. Previous research has shown promising results regarding the positive impact of yoga and meditation on QoL in diverse medical conditions.^5-9 However, limited research has addressed their effectiveness in hemodialysis.¹⁰ This study aims to bridge this gap by investigating the effectiveness of yoga and meditation interventions in enhancing QoL among hemodialysis patients. By delving into the multidimensional aspects of QoL, including physical function, emotional well-being, and social interaction, the research seeks to provide a comprehensive understanding of the potential benefits of these practices in hemodialysis.¹¹ The theoretical framework for this study draws upon established principles of mind-body medicine and psychoneuroimmunology, highlighting the intricate connections between psychological states and physiological responses.¹² This research aspires to contribute valuable insights into improving overall patient outcomes and well-being by integrating these complementary modalities into the conventional care regimen for hemodialysis patients.¹³ Through a robust methodology encompassing randomized controlled trials, patient-reported outcome measures and objective physiological assessments, this study aims to generate empirical evidence that informs clinical practice and enhances our understanding of the role of yoga and meditation in promoting QoL¹⁴ among individuals undergoing hemodialysis. The research findings can potentially guide healthcare professionals, policymakers, and patients in optimizing therapeutic strategies and ultimately improving the lives of those navigating the challenges of hemodialysis.^15-18

Materials and Methods

The research adopted in this study was a quantitative research approach, focusing on the effectiveness of yoga and meditation on QoL among chronic renal failure patients undergoing hemodialysis treatment for more than six months. Utilizing a non-probable convenient sampling technique, the study investigated the independent variables across multiple levels to see the effect on the dependent variable. The study involved 100 CKD patients undergoing hemodialysis treatment for over six months. The study excluded individuals who were seriously ill, mentally ill and not able to perform yoga and meditation. The data collection instrument comprises two main sections. Section A on demographic data encompassing socio-demographic variables such as gender, age in years, religion, marital status, education, occupation, type of family, family monthly income in Rs, area of residence, duration of illness, no. of hemodialysis cycle in a week and comorbidity. Section B involved the standardized WHOQOL-BREF used to analyse the quality of life of patients with CKD undergoing hemodialysis treatment regularly. This tool encompasses a set of 26 ordinal scale items designed to assess the QoL among individuals with CKD. These items comprehensively cover general health, physical health, psychological health, social relationships, and environment. The study was approved by the Institutional Review Board at Muljibhai Patel Society for Research in Nephro-Urology, number EC/597/2019, dated 18 September 2019. The scoring methodology involves converting raw scores into transformed scores, with three items incorporating reverse anchor scores. Notably, 23 items contribute positive scores to the overall assessment. The interpretation of the scores and the computation of domain scores adhere to the guidelines outlined in the World Health Organization’s Brief Version of Quality of Life (WHO-BREF), ensuring standardized and meaningful evaluation of QoL in the specified domains. A pilot study confirmed the positive impact of yoga & meditation by improving QoL among dialysis patients.

Participants were supervised three times a week during their hemodialysis sessions in the HD unit. On the other days, they remained connected through a WhatsApp group for updates and support. Individual participants were provided with video guidelines to assist them with their practice. The researcher introduced herself to eligible participants and obtained their informed consent. Participants were then instructed to sit or lie down comfortably. One-on-one sessions were conducted to demonstrate yoga and meditation, which included

• Breath work- pranayama: 5-6 minutes

• Anulom vilom-alternate nostril meditation: 5-6 minutes,

• Bhramari: 5-6 minutes

• Kapalbhati: 5-6 minutes

• Mindful meditation-mindful drinking and mindful eating activities: 12-15 minutes

Alongside their usual care. Before the intervention, a pre-test was administered to assess the demographic variables and level of QoL using the WHOQOL questionnaire for the study group. Throughout the twelve weeks, the investigator conducted three times on weekly in-person meetings to provide yoga and meditation. Video-assisted teaching sessions were also shared to facilitate daily meditation practice at home. Follow-up support was provided to the participants via a WhatsApp group every fortnight, reinforcing the importance of yoga and meditation practice for improving QoL. At the end of the twelve weeks, a post-test was conducted for participants during their regular hemodialysis sessions. Subjects were evaluated for their QoL levels in conjunction with their routine care.

All participants were examined thrice a week at a hemodialysis centre. The data collection phase spanned 12 weeks, conducted with the necessary permissions and adherence to study selection criteria. Consent from the participants was also obtained before their inclusion. The tools employed for data collection were the WHO-BREF before and after yoga and meditation activities for QoL assessment. The study collected data using the aforementioned assessment scales, aiming to analyze it using descriptive and inferential statistics, including frequency, percentage, and T-test analyses, to assess the effectiveness of the intervention.

Results

The study population had a predominance of males (75%) and individuals aged 49 years or older (55%) [Supplementary Table 1]. The majority identified as Hindu (55%), were married (70%) and lived in joint families (76%). In terms of education, a significant proportion had received primary-secondary education (45%), and most were employed (44%). Family income distribution indicated that 34% had an income greater than Rs. 30,000/- per month. The study encompassed a balanced representation of residents of rural (52%) and urban (48%). Regarding the duration of illness, a substantial number had been experiencing disease for more than three years (39%). Notably, the majority of subjects underwent three hemodialysis cycles per week (93%).

There were significant improvements in the QoL among participants following the intervention. Notably, there were substantial mean differences in various domains [Supplementary Table 2 and Figure 1]: general health improved by 5.4, physical health by 14.3, psychological health by 14.2, social relationships by 7.5, and environmental health by an impressive 6.1.

Close

Figure 1:

Bar graph showing comparison of domain wise mean score of pretest and post test QoL score. QoL: Quality of Life.

Export to PPT

The findings reveal a substantial improvement in the overall QoL among [Supplementary Table 3] participants following the intervention, as indicated by a significant mean difference of 57.760 between pre-test and post-test scores. The pre-test mean QoL score was 51.57, while the post-test mean score substantially increased to 109.4. The calculated ‘t’ test value of 65.070 tabulated was 1.645 with a corresponding p-value of less than 0.0001.

Discussion

The present study investigated the effect of yoga and meditation on the QoL among CKD patients taking hemodialysis treatment. The intervention resulted in a significant enhancement across all aspects of quality of life among CKD patients. In general, overall health scores physical health scores and psychological health scores showed a marked improvement. Similarly, social relationships and environmental health scores also rose significantly. The study results also demonstrated a substantial increase in the overall QoL score. Furthermore, the QoL scores in each domain exhibited a significant increase post-intervention, underscoring the effectiveness of the intervention. These results are consistent with the findings of previous studies. In the study by Pandey et al.¹⁸ the effect of yoga on renal functions and QoL among CKD patients indicated a mean difference of 15.38 between the experimental and control groups and a significant improvement in QoL of patients as well as improved renal functions. The study by Kashinath et al.,¹⁹ concluded that yoga is a non-invasive, cost-effective therapeutic intervention with a positive effect on physical and psychological levels and selected biomarkers in patients with kidney failure. These study results are consistent with Kalita²⁰ and Chu²¹ and support the findings of the previous study related to the impact of yoga in reducing anxiety among menopausal women²² and on chronic illness²³. These studies collectively underscore the effectiveness of yoga and meditation in enhancing various domains of QoL among CKD patients and overall improvements in their well-being. Possible mechanisms of benefit include stress reduction, improved coping, and modulation of physiological responses.

The study was primarily limited by the absence of a control group, restricting the ability to conduct comparative analysis effectively. The yoga program only lasted 12 week. The COVID-19 pandemic posed limitations in reaching out to participants, affecting the study’s approach to client engagement. Another limitation arose from the unwillingness of certain participants to engage in all 12 yoga and meditation sessions. To ensure the continuation of yoga and meditation at patients’ homes had to rely on their self-reporting. There was a lack of assessment and correlation of biomarkers to investigate any potential effects of yoga and meditation.

Future studies should include a control group, and include patients on peritoneal dialysis. A mixed-method study would allow for a deeper understanding of the experiences and perceptions of CKD patients regarding yoga and meditation interventions.

Conclusion

The findings underscore the positive effect of yoga and meditation: Breathwork- pranayama, anulom vilom- alternate nostril meditation, bhramari, kapalbhati and mindful meditation- mindful drinking and mindful eating activities on various domains of QoL among individuals with chronic illness undergoing hemodialysis. To enhance the QoL across diverse domains, targeted and long-term interventions should be considered, aligning with the nuanced needs of patients undergoing hemodialysis.