Can Yoga compliment Pulmonary Rehabilitation (PR) in the management of Chronic Obstructive Pulmonary Disease (COPD)? A cultural adaption of PR in India

Research Question: Can Yoga be integrated with conventional PR in the management of COPD in India?Background: Considering the huge burden of chronic respiratory diseases, access and availability of PR services are essential; however its needs are unmet globally. The diversity in the healthcare systems, availability of PR specialists, patient demographics and socio-cultural diversity requires contextualized PR. Culturally sensitive elements, such as Yoga, when added to conventional PR may improve uptake and adherence. Despite obvious differences, Yoga and PR are similar regarding their holistic nature, with emphasis on physical activities, behavioral change techniques and psychological support. However, benefits from cultural familiarity, mindfulness, breath regulation and lower intensity of physical activity from Yoga may add value to the conventional PR program. Standardizing the reporting of complex Yoga interventions is important to make them reproducible and clinically applicable.Possible methodology: Review and synthesis of available literature on Yoga and PR in the management of COPD as well as other supporting literature. Qualitative research with specialists in respiratory medicine, PR and Yoga, and with people living with COPD and their family members will help in developing the framework of an integrated Yoga and PR program. Randomized controlled trials could assess the feasibility of the integrated intervention. The feasibility of conducting trials of these integrated intervention needs to be explored followed by effectiveness trials.Questions to discuss: What is the theoretical framework for adding Yoga to PR? Is it feasible to conduct an integrated Yoga and PR program (either digitally or face-to-face) based on factors like acceptability (to patients, PR referrers, deliverers), ease of recruitment and uptake into the program? What are the appropriate outcome measures for this protocol? Declaration of Interest Declaration of interest: N/AFunding: This research was funded by the National Institute for Health Research (NIHR) (17/63/20) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care References and Clinical Trial Registry Information Trial registrations: ISRCTN - ISRCTN85689019: Is it possible to deliver Pulmonary Rehabilitation to people in India living with chronic obstructive lung disease?ISRCTN - ISRCTN91133848: Is it possible for people living with chronic obstructive lung disease in India to use a digital smartphone app to help them manage their illness?