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Yoga for Persons With HIV-Related Distal Sensory Polyneuropathy

A Case Series

Kietrys, David M., PT, PhD, OCS, FCPP1; Galantino, Mary Lou, PT, PhD, MS, MSCE2,3,4; Cohen, Evan T., PT, PhD, MA, NCS1; Parrott, J. Scott, PhD5; Gould-Fogerite, Susan, PhD6; O'Brien, Kelly K., PhD, BScPT, BSc7

doi: 10.1097/01.REO.0000000000000089

Purpose: Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) disease. DSP-related symptoms have been associated with disability, reduced quality of life (QOL), and impaired function. Yoga has been shown to improve mental and physical status in people with chronic diseases. We assessed feasibility and measured the effect of a 4-week integrative yoga program in 3 persons with HIV-related DSP in the lower extremities.

Case Description: Of 22 patients with DSP scheduled to attend an HIV pain clinic over 6 months, 3 enrolled in and completed the yoga program. Inclusion criteria were diagnosis of HIV disease and DSP in the feet, controlled HIV disease status, average foot pain of at least 4/10 on a numerical scale, sensory symptoms in the lower extremity, and an established regimen of pharmacologic pain management. The age range of participants was 56 to 64 years. Time since HIV disease diagnosis ranged from 15 to 30 years; time with DSP ranged from 7 to 15 years. A battery of QOL, function, disability, pain, and physical performance outcomes was measured at baseline, after the yoga intervention, and at 4-week follow-up.

Outcomes: Overall attendance rate at the yoga classes was 88%. No adverse events occurred, and participants were highly satisfied with the program. Pain-related QOL and some gait parameters improved in all cases. It appeared that pain-related QOL improved without concurrent reduction in perceived pain severity or interference. Other outcomes, such a walking endurance, balance, and function, improved in some cases, but changes were inconsistent between individuals. No cases demonstrated improvement in vibration sensation or leg strength, nor reduction in self-reported disability.

Conclusions: Although recruitment challenges led to concern regarding feasibility of this intervention, the program appeared to be safe and viewed favorably by the participants. There were inconsistent outcomes between individual participants; however, all experienced improved pain-related QOL and improvement in some gait characteristics. Yoga may be a viable nonpharmaceutical approach to the management of HIV-related DSP, but further research is needed to assess effectiveness, identify optimal format and dosage, and determine characteristics of potential responders.

1Associate Professor, Doctor of Physical Therapy Program, Rutgers, School of Health Professions, The State University of New Jersey, Blackwood, NJ

2Professor of Physical Therapy, Stockton University, Galloway, NJ

3Research Scholar, University of Pennsylvania, Philadelphia, PA

4Visiting Faculty, University of Witwatersrand, Johannesburg, South Africa

5Associate Professor, Department of Interdisciplinary Studies, Rutgers, School of Health Professions, The State University of New Jersey, Newark, NJ

6Associate Professor of Clinical Laboratory Sciences and Primary Care, Rutgers, School of Health Professions, The State University of New Jersey, Newark, NJ

7Associate Professor, Department of Physical Therapy, Institute of Health Policy, Management and Evaluation (IHPME), and Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada

Correspondence: David M. Kietrys, PT, PhD, OCS, FCPP, Doctor of Physical Therapy Program-South, Rutgers, School of Health Professions, 200 College Drive, Blackwood, NJ 08012 (

Grant Support: This study was supported by a research grant from the Oncology Section of APTA. Kelly K. O'Brien is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award.

The authors declare no conflicts of interest.

©2018 (C) Academy of Oncologic Physical Therapy, APTA
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