ICF-based improvements in body structures and function, and activity and participation in chronic stroke following a yoga-based intervention


  • Marieke Van Puymbroeck, PhD, CTRS, FDRT
  • Jared Allsop, MS, CTRS
  • Kristine K. Miller, PhD, PT
  • Arlene A. Schmid, PhD, OTR




yoga, International Classification of Functioning, Disability, and Health, recreational therapy, chronic stroke, rehabilitation


Purpose: The purpose of this study was to understand the perceived outcomes following a yoga intervention for individuals with chronic stroke, framed within the context of the International Classification of Functioning, Disability, and Health.

Method: Twenty-six individuals with chronic stroke participated in one of five focus groups immediately following completion of an 8-week yoga intervention.

Results: Primary themes emerged related to body structure and function (with subthemes of improved emotional regulation, increased stability and range of motion, and unexpected improvements in body function), and improvements in activity and participation. The improvements in body function led to participants more fully participating in their lives.

Conclusions: While rehabilitation is not typically offered in the chronic poststroke period, the participants in this yoga study perceived changes in body functions, activity, and participation that they associated with the yoga intervention. Larger studies need to quantify these changes to make specific policy recommendations.

Author Biographies

Marieke Van Puymbroeck, PhD, CTRS, FDRT

Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina

Jared Allsop, MS, CTRS

Department of Recreation, Park, and Tourism Studies, Indiana University, Bloomington, Indiana

Kristine K. Miller, PhD, PT

School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana.

Arlene A. Schmid, PhD, OTR

Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.


Newman B, Ganguly A, Kim JE, et al.: Comparison of different methods of calculating CT radiation effective dose in childrens. AJR Am J Roentgenol. 2012; 199(2): W232-W239.

Page SJ, Gater DR, Bach YRP: Reconsidering the motor recovery plateau in stroke rehabilitation. Arch Phys Med Rehabil. 2004; 85(8):1377-1381.

Cabral P, Meyer HB, Ames D: Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: A meta-analysis. Prim Care Companion CNS Disord. 2011; 13(4).

Cramer H, Lauche R, Haller H, et al.: A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5): 450-460.

Cramer H, Lauche R, Langhorst J, et al.: Effectiveness of yoga for menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials. J Evid Based Complementary Altern Med. 2012; 2012: article ID 863905.

Lin KY, Hu YT, Chang KJ, et al.: Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: A meta-analysis. Evid Based Complement Alternat Med. 2011; 2011: 659876.

Ross A, Thomas S: The health benefits of yoga and exercise: A review of comparison studies. J Altern Complement Med. 2010; 16(1): 3-12.

Bastille JV, Gill-Body KM: A yoga-based exercise program for people with chronic poststroke hemiparesis. Phys Ther. 2004; 84(1): 33-48.

Lynton H, Kligler B, Shiflett S: Yoga in stroke rehabilitation: A systematic review and results of a pilot study. Top Stroke Rehabil. 2007; 14(4): 1-8.

Garrett R, Immink MA, Hillier S: Becoming connected: The lived experience of yoga participation after stroke. Disabil Rehabil. 2011; 33(25-26): 2404-2415.

Schmid AA, Van Puymbroeck M, Altenburger PA, et al..: Poststroke balance improves with yoga: A pilot study. Stroke. 2012; 43(9): 2402-2407.

World Health Organization: International Classification of Functioning, Disability and Health. Geneva: World Health Organization, 2001.

Frontera WR, Fuhrer MJ, Jette AM, et al.: Rehabilitation Medicine Summit: Building research capacity. Am J Phys Med Rehabil. 2005; 84(12): 913-917.

American Therapeutic Recreation Association: News release: ATRA affirms supports for the ICF. Available at https://www.atra-online.com/resources/icf-who. Accessed December 14, 2014.

Jette AM: Physical disablement concepts for physical therapy research and practice. Phys Ther. 1994; 74(5): 380-386.

Beninato M, Portney LG, Sullivan PE: Using the International Classification of Functioning, Disability and Health as a framework to examine the association between falls and clinical assessment tools in people with stroke. Phys Ther. 2009; 89(8): 816.

Salter K, Jutai J, Teasell R, et al.: Issues for selection of outcome measures in stroke rehabilitation: ICF Body Functions. Disabil Rehabil. 2005; 27(4): 191-207.

Salter K, Jutai J, Teasell R, et al.: Issues for selection of outcome measures in stroke rehabilitation: ICF participation. Disabil Rehabil. 2005; 27(9): 507-528.

Stuart M, Chard S, Roettger S: Exercise for chronic stroke survivors: A policy perspective. J Rehabil Res Dev. 2008; 45(2): 329-335.

Paveza GJ, Cohen D, Blaser CJ, et al.: A brief form of the Mini-Mental State Examination for use in community care settings. Behav Health Aging. 1990; 1(2): 133-139.

Callahan CM, Unverzagt FW, Hui SL, et al.: Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002; 40(9): 771-781.

Smith JA: Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychol Health. 1996; 11: 261-271.

Smith JA, Osborn M: Interpretative phenomenological analysis. In Smith JA (ed.): Qualitative Psychology: A Practical Guide to Research Methods. London: Sage, 1999: 51-79.

Eatough V, Smith JA: Interpretative Phenomenological Analysis. London: Sage, 2008.

Patton MQ: Qualitative Evaluation and Research Methods. Newbury Park, CA: Sage Publishing, 1990.

Glaser BG, Strauss AL: The Discovery of Grounded Theory; Strategies for Qualitative Research. Chicago: Aldine Pub, 1967.

Taylor GH, Todman J, Broomfield NM: Post-stroke emotional adjustment: A modified social cognitive transition model. Neuropsychol Rehabil. 2011; 21(6): 808-824.

Eslinger PJ, Parkinson K, Shamay SG: Empathy and social-emotional factors in recovery from stroke. Curr Opin Neurol. 2002; 15(1): 91-97.

Berger BG, Owen DR: Mood alteration with yoga and swimming: Aerobic exercise may not be necessary. Percept Mot Skills. 1992; 75(3 Pt 2): 1331-1343.

Pearson N: Yoga for people in pain. Int J Yoga Ther. 2008; 18(1): 77-86.

Behere R, Arasappa R, Jagannathan A, et al.: Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia. Acta Psychiatr Scand. 2011; 123(2): 147-153.

Schmid AA, Van Puymbroeck M, Koceja DM: Effect of a 12-week yoga intervention on fear of falling and balance in older adults: A pilot study. Arch Phys Med Rehabil. 2010; 91(4): 576-583.

Van Puymbroeck M, Schmid A, Shinew KJ, et al.: Influence of Hatha yoga on physical activity constraints, physical fitness, and body image of breast cancer survivors: A pilot study. Int J Yoga Therap. 2011; (21): 49-60.

Schmid AA, Van Puymbroeck M, Altenburger PA, et al.: Balance and balance self-efficacy are associated with activity and participation after stroke: A cross-sectional study in people with chronic stroke. Arch Phys Med Rehabil. 2012; 93(6): 1101-1107.

Salmon P, Lush E, Jablonski M, et al.: Yoga and mindfulness: Clinical aspects of an ancient mind/body practice. Cogn Behav Pract. 2009; 16(1): 59-72.

Elkins G, Johnson A, Fisher W, et al.: Efficacy of Mindbody Therapy on Stress Reduction in Cancer Care. Evid Based Nonpharmacol Ther Palliat Cancer Care. 2013; 4: 153-173.

Agte VV, Tarwadi K: Sudarshan kriya yoga for treating type 2 diabetes: A preliminary study. Altern Complement Ther. 2004; 10(4): 220-222.

Bijlani RL, Vempati RP, Yadav RK, et al.: A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med. 2005; 11(2): 267-274.

Innes KE, Vincent HK: The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med. 2007; 4(4): 469-486.

Kyizom T, Singh S, Singh K, et al.: Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event related evoked potential (ERP). Indian J Med Res. 2010; 131: 636-640.

Malhotra V, Singh S, Tandon OP, et al.: The beneficial effect of yoga in diabetes. Nepal Med Coll J. 2005; 7(2): 145.

Nagarathna R, Nagendra H: Yoga for bronchial asthma: A controlled study. Br Med J. 1985; 291(6502): 1077.

Ruprai RK, Kamble P, Kurwale M: Effect of yoga training on breathing rate and lung functions in patients of bronchial asthma. Int J Recent Trend Sci Technol. 2013; 5(3): 127-129.

Singh V, Wisniewski A, Britton J, et al.: Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 1990; 335(8702): 1381-1383.

Brown RP, Gerbarg PL: Sudarshan kriya yogic breathing in the treatment of stress, anxiety, and depression: Part II—Clinical applications and guidelines. J Altern Complement Med. 2005; 11(4): 711-717.

Tran MD, Holly RG, Lashbrook J, et al.: Effects of hatha yoga practice on the health-related aspects of physical fitness. Prev Cardiol. 2001; 4(4): 165-170.

Badsha H, Chhabra V, Leibman C, et al.: The benefits of yoga for rheumatoid arthritis: Results of a preliminary, structured 8-week program. Rheumatol Int. 2009; 29(12): 1417-1421.

Chen KM, Chen MH, Hong SM, et al.: Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises. J Clin Nurs. 2008; 17(19): 2634-2646.

Greiner P, Snowdon D, Schmitt F: The loss of independence in activities of daily living: The role of low normal cognitive function in elderly nuns. Am J Public Health. 1996; 86(1): 62-66.

Lister R: Loss of ability to drive following a stroke: The early experiences of three elderly people on discharge from hospital. Brit J Occup Ther. 1999; 62(11): 514-520.

Kitzmüller G, Häggström T, Asplund K: Living an unfamiliar body: The significance of the long-term influence of bodily changes on the perception of self after stroke. Med Health Care Philos. 2013; 16(1): 19-29.

Greenwood N, Mackenzie A, Cloud G, et al.: Loss of autonomy, control and independence when caring: A qualitative study of informal carers of stroke survivors in the first three months after discharge. Disabil Rehabil. 2010; 32(2): 125-133.

Raju RS, Sarma PS, Pandian JD: Psychosocial problems, quality of life, and functional independence among Indian stroke survivors. Stroke. 2010; 41(12): 2932-2937.

Brown C, Hasson H, Thyselius V, et al.: Post-stroke depression and functional independence: A conundrum. Acta Neurol Scand. 2012; 126(1): 45-51.

Drummond A: Leisure activity after stroke. Disabil Rehabil. 1990; 12(4): 157-160.

Caty GD, Detrembleur C, Bleyenheuft C, et al.: Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait. Stroke. 2008; 39(10): 2803-2808.

Desrosiers J, Noreau L, Rochette A, et al.: Predictors of long-term participation after stroke. Disabil Rehabil. 2006; 28(4): 221-230.

Frühwald S, Löffler H, Eher R, et al.: Relationship between depression, anxiety and quality of life: A study of stroke patients compared to chronic low back pain and myocardial ischemia patients. Psychopathology. 2001; 34(1): 50-56.

Clarke DM, Currie KC: Depression, anxiety and their relationship with chronic diseases: A review of the epidemiology, risk and treatment evidence. Med J Aust. 2009; 190(7): S54.

Barker-Collo SL: Depression and anxiety 3 months post stroke: Prevalence and correlates. Arch Clin Neuropsych. 2007; 22(4): 519-531.



How to Cite

Van Puymbroeck, PhD, CTRS, FDRT, M., Allsop, MS, CTRS, J., Miller, PhD, PT, K. K., & Schmid, PhD, OTR, A. A. (2014). ICF-based improvements in body structures and function, and activity and participation in chronic stroke following a yoga-based intervention. American Journal of Recreation Therapy, 13(3), 23–33. https://doi.org/10.5055/ajrt.2014.0076




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