Practical Outcomes Measures for Mindful Exercise Instructors

Assessing Meaningful Outcomes There are a variety of practical methods available to objectively measure the response to mindful exercise particularly for meditation, yoga, gigong, and Tai Chi inspired programs. Below are some examples that have been employed in the research domain for years: Quality of Life. Quality of life measures as assessed and scored on a variety of quality of life inventories such as the SF-8 and SF-12 self-report instruments are reasonably well suited for characterizing the overall functional response. The Center for Disease Control's National Center for Chronic Disease Prevention and Health Promotion is one source of a simple measure of health related quality of life (CDC, 2002). QualityMetric also has several on-line quality of life instruments, eg. SF-8 & SF-12, that may be useful (www.qmetric.com). Blood Pressure. With great interest in the newly published JNC VII hypertension guidelines for health care professionals - there is a resurgence of interest in utilizing mindful therapies to treat hypertension, especially State I hypertension. Baseline and serial resting blood pressure measurement in response to four to six weeks of mindful exercise, e.g., restorative yoga - especially if the participant has a resting blood pressure in the high normal or higher range (135/85 - 140/90+). Pulmonary function. This a particularly useful measure for yogic breathing programs. Pulmonary function measures such as FEV-1 (maximum forced expiratory volume in one second) are valid indicators when baseline FEV-1 <80%. Vital capacity itself is not likely to change but some studies have demonstrated increases in lung volumes and FEV-1 with yoga programs that incorporate significant breathwork. Bottom line for mindful exercise teachers, the use of relatively inexpensive portable spirometers have come of age for yoga and pranayama therapists. Balance control. The Tinetti Falls Efficacy Scale (Li F, et. al. J Gerontol B Psychol Sci Soc Sci. 2005;60:34-40) and the backward tandem walk are appropriate for evaluating balance especially in response to mindful therapies (eg. qigong exercise, Tai Chi, select yoga asanas) where balance control is a primary component. Anxiety and tension. Anxiety measures may also be helpful in evaluating stress and tension. The Spielberger State Trait Anxiety Inventory (STAI) is a two 20-item self-report scale that assess anxiety-proness (trait) and report the current level of anxiety (state). The STAI Computer Program is an inexpensive administration and scoring program that is an alternative to paper-an-pencil versions and takes about 10 minutes to administer (reference: www.mhs.com/onlineCat/product productID=STAIWIN). Stress biomarkers. There are a number of laboratory markers of chronic stress that can be routinely measured in most physician offices. In particular C-reactive protein (CRP) which is an inflammatory marker (cytokine protein) that decreases with weight loss, reduced anxiety and tension, smoking cessation, aerobic fitness. Ideally, CRP should be below 3 mg/dL. Spirituality. Although very few mindful exercise studies objectively examine spirituality (they should!) it is an outcome measure most worthy of consideration. There are a number of validated spirituality assessment tools that may be useful for evaluating a client's sense of spirituality before and after a period of mindful exercise training. The following are three examples: The Spiritual Well-Being Scale (Paloutzian, 1982) is a 20-item self-administered scale with two dimensions: religious and existential and the Index of Core Spiritual Experiences or INSPIRIT (Kass, 1991) which is an 18-item interview scale used in a general population. Lastly, the Spirituality Index of Well-Being (SIWB) see refernce in Tim Daaleman's study in Annals of Family Medicine 2004;2:499-503. Each of these examples can be found with internet search engines.