DRAFT OUTLINE YOGA IN HOSPICE CARE PRESENTATION Michele Hoffman, E-RYT, CYT April 21, 2015

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1 DRAFT OUTLINE YOGA IN HOSPICE CARE PRESENTATION Michele Hoffman, E-RYT, CYT April 21, What is Yoga? Holistic practice over 5,000 years old which works on all levels of being mind, body and spirit. Main goal of yoga is to help a person live up to their full potential. A. Yoga is a practice which should be adapted to the needs and goals of the individual. B. Yoga techniques: 1. Breathing practices 2. Yoga Postures or gentle movement with breath awareness 3. Meditation practices including using mantra words with meaning 4. Visualization 5. Sound 6. Ritual 7. Self-Inquiry 2. What is Yoga Therapy? Yoga Therapy refers to the adaptation and application of Yoga techniques to help individuals facing health challenges at any level manage their condition, including at the end of life. A. Goals of Yoga Therapy: 1. Reduce the symptoms of suffering that can be reduced. 2. Manage the symptoms that cannot be reduced. 3. Improving life function. 4. Shifting attitudes and perspective in relation to life s challenges. 3. Yoga Therapy in Hospice Care emphasis is on compassion, reducing suffering & improving quality of life. A. YT can provide benefits to both hospice patients and care-givers to: 1. Reduce stress & promote relaxation 2. Increase strength and balance 3. Decrease muscle tension 4. Increase energy 5. Improve sleep 6. Pain management 7. Manage anxiety and depression 8. Help manage shortness of breath A. Most powerful YT technique is conscious breathing for promoting relaxation - emphasis in on lengthening the exhalation and linking the mind and the body through the breath. When you bring your consciousness to your breath, you activate the Relaxation Response or the parasympathetic nervous system which relaxes the mind and the body which in turn will help reduce stress, muscle tension, help manage pain, anxiety, depression and shortness of breath, improve sleep and increase energy.

2 B. Relaxation Response versus the Fight or Flight Response - describe the physiological changes that happen with each of these and the corresponding changes in the state of mind. C. Introduce Diaphragmatic or Belly breathing. Guide participants in conscious breathing exercise emphasizing lengthening the exhalation using an active exhalation. Then introduce counting the exhalation to focus the mind and relax the body. D. In Yoga postures or movements, we use the breath to support the spine. When you inhale you grow taller so we use the inhale to on movements which expand the chest and lengthen the spine. The exhalation is about supporting and stretching your low back so we use the active exhalation in forward bends, lateral bends and twists. Have participants raise and lower their arms with breath awareness. Have them bend forward with an active exhale. 4. Working with patients with shortness of breath symptoms. Many of my patients are suffering from SOB from COPD, CHF, lung cancer or cancer that has metastasized to the lungs. Most are on oxygen 24 hours a day. SOB is probably one of the hardest symptoms to live with because it is very immediate and provokes major anxiety and suffering. Major emphasis is on getting the air out (CO2), getting oxygen (O2) in, through breathing techniques and stretching breathing muscles and promoting relaxation to ease anxiety. A. Explain anatomy of breathing primary and secondary breathing muscles. Patients with SOB overuse secondary breathing muscles and don t use their diaphragm to breathe. B. Yoga therapy tools to help manage Shortness of Breath Symptoms: 1. Pursed-lip breathing guide participants in pursed-lip breathing exercise. 2. Diaphragmatic or belly-breathing. We already practiced that. 3. Combination of pursed-lip breathing and diaphragmatic breathing. Guide participants in combination of these two breathing techniques. 4. Stretch breathing muscles: Guide participants in the following gentle stretches with breath awareness : a. Neck muscles gentle neck stretches with breath awareness b. Back muscles seated forward bend in chair with emphasis on exhale c. Chest muscles - gentle chest openers with emphasis on inhale d. Intercostals seated twist and lateral bend & arm movements to mobilize the rib cage. e. Passive chest opener place rolled towel under shoulder blades of patient to open the chest to facilitate ease of breathing. 5. Idea of pacing using pursed-lip breathing when moving around and exerting on the exhalation eg. Standing up out of a chair and exhaling as you get up. 6. The use of sound can be helpful in helping people lengthen their exhalation and get out more CO2 in order to get more O2 in. A longer exhalation will also help relax the body and the mind, easy the anxiety of a patient with shortness of breath. Guide participants in practice using sound to lengthen the exhale.

3 5. Yoga Therapy techniques for pain management. If a person is in pain, they typically tense their muscles which only exacerbate the pain. People also tend to want to push the pain away. In YT, we teach techniques that help a person relax their bodies, distract their minds from the pain and focus on letting go of the pain. A. Conscious breathing techniques which emphasize lengthening the exhalation and activating the Relaxation Response we ve already discussed and practiced pursed-lip breathing, diaphragmatic breathing, the use of sound, and counting the exhalation. B. Gentle stretches to ease muscle tension which stretches I would use would depend upon where they have pain and tension in the body e.g. Leg stretches if they have pain and/or stiffness in their legs. C. Other techniques to focus the mind and distract from pain: 1. Meditation techniques there are many meditation techniques including mindful meditation, which we ve already practiced, focusing your awareness on the flow of the breath. If the mind wanders, bring it back to the breath and the present moment. a. Use of mantra which means repeating a word or words with meaning silently or out-loud to lengthen the exhalation, focus the mind and relax the body. Guide participants in an exercise using the mantra Peace, calm, serenity repeating silently on the exhalation. b. Focusing on an image which is meaningful to the person and helps promote a feeling of safety, peace and calm. Guide participants in focusing on an image of a clear, deep blue lake with no ripples; its surface still as glass and setting their intention for cultivating peace and calm. c. Focus on releasing the pain. Guide participants in the following practice: Placing your hand on the place in your body that has pain or putting your awareness in that place, visualize breathing healing energy, healing light into that place of pain and letting go of the pain on the exhale. The light can be anything that resonates with you the light of the sun, the light of the stars, the light of the moon, or the light of the Holy Spirit. 7. Yoga Therapy techniques for Enhancing Mood : Managing anxiety and depression A. Anxiety. Conscious breathing techniques with emphasis on lengthening the exhalation help reduce anxiety. Gentle stretching with emphasis on exhale relieves muscle tension in the body which relieves tension in the mind. Meditation techniques focusing on a mantra or an image also enhance mood, and promote relaxation.

4 B. Depression. Conscious breathing techniques with emphasis on lengthening the inhalation can help raise energy for depressed patients. Also the use of gentle movement with emphasis on opening the chest can be helpful in correcting a depressed posture which in turn can influence the state of mind. C. Anxiety and Depression. Setting an intention can be very useful in helping both anxiety and depression. It can be a very powerful YT technique especially combined with breath, movement and the healing power of touch. 1. The Caring Breath practice is a nurturing practice which promotes relaxation, eases neck tension, eases anxiety and enhances mood. It is helpful for depression and anxiety. Guide participants in Caring Breath exercise setting the intention of loving-kindness and compassion for themselves. 2. Guide participants in practice using power of intention and self-touch to enhance mood and increase well-being. Set intention of bringing peace to body and mind while bringing hands to various parts of body and breathing as if breathing peace into that place. 3. Guided Imagery or guided meditation is also very useful technique for enhancing and balancing mood. The imagery used would evoke all the senses and guide a person through an experience in their mind. The choice of imagery would be very specific to the person you are working with. Guide participants in a guided imagery experience of being in a beautiful spring garden. 8. Improving the quality of Sleep. Many of the techniques that we practiced thus far may help improve the quality of sleep. In order to sleep, a person needs to activate the parasympathetic nervous system, which we talked about before as the breaking system. Any of the yoga techniques which help a person relax and calm the mind and body will help promote restful sleep. Conscious breathing with emphasis on exhalation, mantra, focusing on an image or counting the breath are all useful in helping a person get to sleep and stay asleep. 9. Utilizing Yoga postures to Increase strength and balance. Some patients have a need or goal of increasing leg strength and balance and improving their ability to walk. We can use gentle yoga postures sitting in a chair or standing to accomplish this goal. These postures can also be used to increase circulation and reduce edema. Lead participants through the following: A. quadriceps strengthener in chair B. Adductor strengthener/stretch in chair C. Hamstring stretch in chair D. Balance pose - standing 10. Question and Answer Session 11. Summary. All of the Yoga techniques that we ve talked about and experienced today can be helpful to people in hospice care. It really comes down to establishing a relationship with the individual,

5 learning what their needs are and teaching them the appropriate yoga techniques that will help them be more comfortable and live a higher quality of life for as long as they do live. I often share these techniques with the care-givers to help them reduce their stress and learn to nurture themselves so that they can care for and nurture their loved one. A. End with Progressive Guided Relaxation exercise with relaxing music.