Yoga

Episode 24, 30 January 2020

Yoga is very popular with stroke survivors as a form of exercise and as an activity to connect with the community. In this podcast, we speak physiotherapist and researcher Professor Susan Hillier, stroke survivor Sue Bowden, and Simone Russell and Jude Czerenkowski from StrokeLine, about the benefits people get from yoga, and how you can get into practising it if you’ve had a stroke.

Please note that yoga as a treatment is not specifically recommended by the Clinical Guidelines for Stroke Management, or by the Stroke Foundation. You should talk to a health professional before starting any new exercise such as yoga.

 

Podcast transcript

Announcer: Welcome to the EnableMe podcast series, where we bring together stroke survivors, health professionals and researchers, providing you with practical advice to enable you on your journey to reclaim your life after stroke.

The advice given in this podcast is general in nature and you should discuss your own personal needs and circumstances with your healthcare professionals.

You can join the conversation at enableme.org.au. This series is presented by Australia's Stroke Foundation, working to prevent, treat and beat stroke.

Chris: [00:45] It's summer now while we're recording this podcast, and so we thought it was fitting to talk about a more relaxed topic than usual.

Yoga is hugely popular with our stroke survivor community and with the team at the Stroke Foundation. Many people use it as a form of exercise, and as an activity that connects them with their community.

Now, I do need to state that yoga as a treatment is not specifically recommended by the Clinical Guidelines for Stroke Management, or by the Stroke Foundation. And you should talk to a health professional before starting any new exercise such as yoga.

But with that in mind, we’re going to look at some of the benefits that people do get out of yoga, and if you’ve had a stroke, how you can get into practising it.

And we didn't have to bend over backwards to find people willing to discuss these questions. Joining us soon will be yoga aficionados, Simone Russell and Jude Czerenkowski from StrokeLine, and later on we'll be speaking to researcher Professor Susan Hillier.

First though, we have on the line from Bathurst, stroke survivor and valued member of the EnableMe online community, Sue Bowden.

Sue, welcome to our podcast.

Sue: [01:43] Hello Chris. Thank you for having me.

Chris: [01:45] Now, the first question is the usual one that I always ask our guests: could you tell us your stroke story?

Sue: [01:52] Okay. My stroke story happened a long time ago in 1993 when I was 22 years old, and I had my stroke, a brainstem stroke, two weeks after I'd developed severe preeclampsia, and lost our first baby.

So my stroke left me needing to blink to communicate initially, and then needing to learn to walk, talk, eat, become continent, and basically live again. So the long journey from then to now has been quite difficult. There was not much assistance around back then, and I took what I could in terms of attending outpatients rehab.

Once I left rehab, I was always very good at turning up to my appointments, however, there was a huge gap between where I was at and where I needed to go. So I just continued to move forward the best I could. So nothing like yoga really was offered to me back then, or even, I guess, the knowledge of how it may have helped, was not there. So I just went on with my exercises as I needed to and as I saw fit in what helped me.

Really, I did a lot of self-guided rehabilitation and recovery on my own to get me to where I am.

Chris: [03:29] Sounds like you have come a very long way, and it sounds though also that recovery is still an ongoing process, and I think that many people have that same experience. So you have gotten into yoga recently. Can you tell us a bit about how that came about?

Sue: [03:44] Okay, so what happened was, I guess I started a new year a few years ago thinking, "What am I going to do differently this year?" Not a New Year's resolution as such, but, "What am I going to do differently?"

And I thought that I might begin stretching. And so I just downloaded one of those free apps on my phone. I spoke to my doctor to say that I was beginning to stretch with the view to do some yoga later on. So I did the stretching morning and night for three months, and then I found a DVD that I bought, it was $5 at a stall that I found. And I began doing that DVD at home. Just in the comfort of my home, so it was private and I could concentrate and I found it really quite difficult, but I think with all the stretching that I'd done, I could see that that had been helpful.

So I just continued persevering and getting better and better. At one stage I was doing the yoga DVD three times a day, because I felt like I needed to. But that doesn't happen anymore.

So yeah, and I still continue to do that same DVD.

Chris: [05:11] Fantastic. Now, as I mentioned in the introduction, yoga is so popular with the Stroke Foundation team that we have not one but two special guests from StrokeLine, occupational therapist Simone Russell, hello Simone.

Simone: [05:23] Hello.

Chris: [05:24] And social worker and StrokeConnect National Manager, Jude Czerenkowski. Hi Jude.

Jude: [05:28] Hello.

Chris: [05:29] Okay Simone, now you are an OT but you're also someone who knows a lot about yoga. Now me, though, I'm coming from a position of relative ignorance, so for people like me, can you explain what is yoga?

Simone: [05:41] It can mean lots of different things to different people, but I guess my understanding of it is that it is an ancient practice or series of philosophies and principles and techniques that really come from the Vedic tradition. So from India and the Himalayas, and started somewhere around two and a half thousand years ago. So quite an old practice, but made up of a range of different philosophies and techniques, as I said.

So the way I see it is it's a way of life. It's a way of being. And so a lot of people, I think, when they first come to think about practising yoga, particularly in, I guess, the modern world, we see a lot of people doing lots of fancy poses and a very physical practice.

And so a lot of people go for the physical benefits initially, but it's much, much more than just the physical benefits, and in fact they call it Asana or the physical practice. The postures and the poses that we make in yoga are just one part of the practice. So really yoga is about that union between the body, the mind, and the spirit. So it's about cultivating health and wellbeing from a physical, a mental, emotional, spiritual, and even social wellbeing perspective. So really a practice of self-inquiry, increasing self-awareness and cultivating a greater sense of inner peace and mental clarity. A practice of really continuing to come back to that present moment.

So I guess it's something I think that you need to experience yourself. It's one of those things where a lot of people perhaps don't get a real sense of what it is until they start to practise it. So that's kind of my definition of it. Jude, feel free to jump in if there's anything you want to add.

Jude: [07:28] I think you've described it perfectly, Simone.

Simone: [07:30] But really it includes the breath, it includes meditation, it includes focus and concentration, as well as that physical practice and philosophy as well.

Chris: [07:41] Okay. So Jude, you are also a long time yoga practitioner. What are the benefits that you get from it personally?

Jude: [07:49] So there are physical and personal benefits, and yoga's always made my body feel really good. It helps my fitness, strength, flexibility and it makes me feel really comfortable in my body. As I'm getting older, I definitely feel the benefits actually more rather than less and I think it will help me age well.

I quite enjoy going to classes and being with other people and practising together. You're often doing it in your local community, so it's people that are your neighbours and colleagues, and I quite like the social interaction without always having to build social interaction around conversation.

It's a different way of being together with a group of people, but the main thing really for me is that it gives me a chance, it actually forces me really, to check in, just to stop and actually check in on what's going on for you, and I'll often realise that I'm feeling something either in my body or in my emotions that I actually had no idea that I was feeling, until I stopped and checked in. And that's the main thing that I find is the big benefit for me.

Chris: [08:50] I guess another question for both of you is, the sort of thing that Sue's talking about. Is this typical from the kind of things we'll hear from people on StrokeLine? About people who want to get into yoga not knowing much about it, or do we also get people who may have been practising before they had their stroke and want to get back into it?

Simone: [09:08] Yeah, we get both. There's definitely a group of stroke survivors that come to us that have heard about yoga or perhaps seen about yoga on social media or perhaps have friends or family practising, maybe someone suggested that they try it. So we do get people that may have not had any experience of yoga at all, that are really wanting to look into it as a hobby or a leisure pursuit or physical activity to add to their rehabilitation and to their, I think Sue touched on, really self-managing her recovery. So really at that later stage of having it as an adjunct to their therapy or perhaps their self-management.

Certainly though, we have stroke survivors call us who have a practice prior to their stroke and that are really wanting some guidance, and sometimes it's around fears around practising again or whether or not actually they can, whether it's something that that people do go back to after their stroke.

So we get a bit of both, some that are new to the practice, wanting to try it out, and some that are wanting some guidance around returning to their practice.

Chris: [10:17] Okay. Now Sue, as you said, you started with a DVD, but I believe now you've started attending some classes as well. Can you tell us a bit about that?

Sue: [10:27] Yes, so I decided to go along to a class that a friend was going along to and she was very encouraging saying, "Oh, it's floor yoga. It's just a very relaxed class. It's called chill yoga."
So I decided to get brave and go along to the classes. I was feeling pretty comfortable practising on my own, my DVD that I was comfortable with, so I went along and I just loved it, loved walking into the class and it smelt beautiful, and all the mats were there ready for us and, because it's on the floor and it's Yin Yoga, I think, where you do lots of stretches and poses which are held for a long time. So there's bolsters and blocks to assist with that.

I guess, after my first class, I was very happy to return and very happy that I'd gone.

Chris: [11:29] Great. Now, there were some nods here in the studio when you mentioned Yin Yoga. Jude and Simone, are you aware of this? Are there many different types of yoga that are like this?

Simone: [11:42] Yeah, there are a number of different types of yoga and Yin is one, and I think it's becoming maybe one of the most popular. I think in this busy world that we're living in, a lot of people are craving that quiet downtime and that time to just slow down and press pause after a busy day perhaps of work or whatever it might be in your week.

So it is one type, it is predominantly floor-based, really slow long-held poses. As Sue mentioned, there's usually a lot of props to help support your practice, so things like bolsters, they're like a cushion, and blocks and straps and things to help, where the teacher will guide you through how to use those props.

But there's a range of other different styles as well. So people might have heard of Hatha Yoga or Iyengar. Bikram is the one that is done in a very hot temperature, so not always appropriate for everybody, and there's also another slower practice called Restorative Yoga, which again, it's a little bit different to Yin, but another slower-paced class.

People might hear the term "flow" a lot, which is a sort of a more higher intensity, faster pace, so there's really something for everybody across all areas.

I don't know, Jude, if you want to touch on any other types or benefits of the types that you practise.

Jude: [13:02] I probably just would give Yin a bit more of a plug, I think, because it tends to be the class in the yoga school that you'll see more people with different levels of ability, and you'll see people that live with a disability in a Yin class more often.

It is more accessible and I think the other thing is too that because the poses are held for longer, it gives the teacher much more time to actually assist an individual person within the class with the modifications and the changes that they might need to make that pose comfortable for them. So if you have a different type of ability or some restrictions, it's a great place to start.

Chris: [13:42] Okay.

Simone: [13:43] There are also many community groups as well that do chair-based yoga, so it's worth touching on that as well, and certainly some therapists or yoga practitioners are trained to do yoga therapy. So there are some alternatives as well, that combine a range of different practices but look at really chair-based practices.

So yeah, there really is a type of yoga for everyone. It's just about finding it.

Chris: [14:07] Sue, have you had any experience with chair-based yoga?

Sue: [14:10] The chair-based yoga? Yes, that sounds familiar.

I'm involved up in Bathurst, the Central West Brain Injury Action Group and last year or the year before, I helped organise a chair-based yoga event for the group, and unfortunately I wasn't able to attend on the day, but the feedback I heard, it was well-received, and the group would like to look at doing another chair-based yoga session sometime in the New Year. So yeah, and I hope that I'll be able to get to that one.

Chris: [14:49] Great. Now I just want to ask you, with having started doing classes, how does that compare to practising at home, do you think?

Sue: [15:00] Well for me, I really enjoy, like I mentioned, the smell of the yoga studio. It's nicely scented, and the vibe of everyone being together.

Yeah, it's a social occasion, but I think like Jude mentioned, without needing to get into that regular social talk. You talk about the yoga and the poses and it was very enjoyable.

Chris: [15:32] Jude and Simone, do you have any perspectives on practising at home versus joining in a class or having an instructor?

Jude: [15:40] I do think a lot of people do prefer to start at home, and it can definitely be a bit scary to front up to a class as a complete newbie, often because most people in the class have being going for a while and know what they're doing, and you can feel a bit out of place.

There are a lot of good videos and things available, classes available online, but it can be a bit of trial and error to find something appropriate for you. Probably one of the things, it's interesting listening to Sue talk about doing the same video over and over, because actually it would be a great way to notice the changes in your body as you get more familiar and you do things more often, so I can see why that would work really well for some people.

The main drawback, of course, would be that you don't get feedback from a teacher, and having a teacher is an important part of yoga. It's been taught from teacher to student for a really long time. And getting that feedback about how you can make things easier or get a little bit more stretch, it is quite an important part of the practice I think.

Simone: [16:43] Yeah, I would agree with that as well. And I think that it is dependent on the individual. I think home practice has a really good place as well for people that may not be able to get out to get to classes. So if access is an issue or, perhaps, you're living in a really rural area where there just isn't access to yoga. So I think home practice is always going to have a really good place.

Talking to health professionals, if you've got a physio or an OT, can be a good way to start your home practice to make sure that it's going to be tailored to the level of where you're at, and that it's a positive experience, I think, like what Sue has had.

But yeah, totally agree with Jude around having a teacher can be really beneficial as well, and to help progress your practice, if you like. So yeah, there's definitely benefits of both.

Chris: [17:30] Great. So, Sue, how do you see the future of you and yoga progressing?

Sue: [17:37] Okay, well that was really interesting to listen to Jude and Simone talk about the benefits of having a teacher and a home-based practice, because it's only been about four weeks since I've been attending this yoga class, and I'm already seeing the changes to my home practice by doing the Yin Yoga or the Restorative Yoga.

So I'm thinking, looking to the future, that I'm just going to keep continuing to improve and become more aware of the benefits that I can see and feel in doing both. I might branch out into more group yoga classes as time goes on, but I'm just going to take it as I feel, really. I'm not going to push myself to do something that I don't feel ready for yet.

Chris: [18:33] So, is there anything else that you would say to other stroke survivors who are contemplating yoga?

Sue: [18:38] I guess, to look around at what's available, what they might want to get out of yoga, and to keep an open mind about the improvements that might come by participating, and just giving it a go as to what they're able to do, because I'm so aware of the different levels that people might be at. If somebody's able to manage chair yoga at the time and then move on to something else, it's really a personal experience isn't it? Depending on where everybody's at.

Chris: [19:15] Yes. Thank you very much and best of luck with continuing your practice. Is it okay for me to say "Namaste"? Is that the thing we do?

Sue: [19:24] Namaste.

Chris: [19:25] Namaste. Okay, thank you, Sue.

Announcer: [19:28] Did you know you can customise the EnableMe website to suit all your viewing needs? You can choose large-size fonts or different alignment of text on your screen, a high contrast screen so that different parts stand out, automatically underline the start and end of each sentence, read in easy English, and many more options. Set up once, and your personal settings are saved for all your future visits. Just click on the accessibility icon at the top of the screen at enableme.org.au.

Chris: [19:57] Our next guest is physiotherapist and researcher, Professor Susan Hillier from the University of South Australia. Susan is a member of the Stroke Foundation's Clinical Council and she's also been a guest on the podcast previously in our episode on touch and sensation.

Welcome back, Susan.

Susan: [20:13] Thanks Chris.

Chris: [20:14] Now I believe that you and your colleagues have actually done some research on yoga for stroke survivors. What kinds of things did you study?

Susan: [20:15] Yeah, we did a couple of pilot clinical trials working with stroke survivors around using yoga as a form of rehabilitation after their stroke.

There were two trials, and one was comparing yoga to just a regular exercise class, and the other one was comparing yoga to usual care.

So we were particularly interested in questions about whether it is feasible because as you can imagine, everybody immediately says, "Oh well, I've had a stroke, I can't do a downward dog." So we needed to explore what aspects of yoga were feasible for people with stroke, and that it was safe. And we also wanted to get some data about whether it is actually effective and if it is, what kinds of benefits might it offer people who've had a stroke. So we were really pleased with the trials. People were really keen to recruit for the trials.

We did them in a very strong kind of way. We randomised people so that they didn't necessarily know what they were getting or what we were particularly interested in. And we measured them before they did the classes and we measured them after they did the classes. And we had people who were blinded to which classes they did.

So we did it properly, and we were really happy to report those results in a couple of journals. And we found that, not surprisingly, our numbers weren't big enough to enable us to calculate big effects, but we could certainly show that the yoga was safe and it was feasible, and we trained teachers specially, so that they could adapt, and they had us as advisors so that they knew how to adapt things safely.

And then we did interviews with the stroke survivors afterwards. And I think that was probably the most interesting thing that we found.

Chris: [22:22] What came out of the interviews?

Susan: [22:24] People reported a whole bunch of things. It's actually not surprising, but it was surprising. They reported that they felt better about their body, and it wasn't a direct thing that the yoga teachers go in saying, "Feel better about your body. Feel better about your body."
But by getting to know themselves better, through the mindfulness stuff, they felt more aware of what their bodies were capable of, and they felt calmer in their mind. So those very traditional kinds of benefits of yoga really popped out in a way that surprised even us. I think at the time, we were doing a lot of radio interviews, and every interviewer would say, "Well, how can someone with stroke do yoga? It's so vigorous." I think that was real testament to the way we set up the classes. There was always something that somebody could do, and if they couldn't do it standing, they could do it in sitting. But then the majority of the classes actually spent a lot of time on the mindfulness aspect. So calming the mind and controlling your thoughts, doing really nice gentle body scan, so that people just became more aware of their whole body, rather than trying to ignore their side that the stroke affected and only ever using the less stroke-affected side.

So yeah, I think that that was very inspiring, actually, to hear their stories.

Chris: [23:54] That certainly fits in the discussion that we've had so far about yoga. I'm interested though also in some of those comments about it being vigorous, or comparing it to other exercise. Is it also a form of cardio exercise, as well as just the mindfulness and the other aspects of it?

Susan: [24:19] Well, this is an interesting question because traditionally we think that you have to raise a sweat and you have to breathe hard, you have to work hard, for an aerobic effect. But actually, traditional yoga is the opposite. It's meant to be very calm and you're meant to keep very quiet. You hold the poses and they're strenuous, so it's good for muscle strength.

Interestingly though, what people found was that because there's a lot of breathing exercises, their breathing felt easier. So I think there's a whole lot of research to be done about if people learn to breathe more efficiently, is that as good as an aerobic exercise, because there's a bit of evidence coming out that probably aerobics exercise isn't necessarily the best thing for people after stroke. It was only one study, but you know, it's something that we're watching. And I'm just thinking that learning how to breathe better, kind of has the same effect, doesn't it? You get more oxygen, you feel calmer.

So I think that there's a really great opportunity for us to explore a whole different notion of what it means to have better cardiovascular health through better breathing techniques.

Chris: [25:33] And how about other benefits people might get? Say, for instance, just by being part of the class and that sort of community. Did people find that as well?

Susan: [25:41] That's exactly right, people really enjoyed the group. You know, we did control for that in one of the studies by having the other group doing exercises together. But I think we can't underestimate the value of peer support, being with people who understand, being with a teacher that you trust, who understands what you've been through. I think they're really powerful things to think about.

And then on the other hand, what drew me to be interested in using yoga ... there's a few of us now, I've got colleagues in Melbourne as well who are really interested in doing more study, is of course yoga is ubiquitous. It's everywhere. It's on every street corner, practically. And some of our stroke survivors are telling us, "I don't want to go to some fancy clinic. It's expensive." They feel like it just reminds them they've got a stroke. So I guess my kind of long-term vision is that people with stroke can go to any yoga class.

You know, if yoga teachers generally can feel confident working with people who've got some physical or cognitive difficulties, impairments, then this is a great normalising thing. It's something that you can walk to your local corner gym and do yoga, whether you've got a stroke or not. I think that's something that we're really keen to look at.

And then I've got a colleague here in Adelaide, Saran Chamberlain, who's a young stroke survivor, and we want to do exactly that. We want to work with yoga centres or Pilates centres or whatever, and almost give them the tick of approval that they're stroke-friendly, because we're never going to get enough stroke services, are we? We have to be honest about that.

But how marvellous it would be if people with stroke could feel that they could just jump into a mainstream class.

Chris: [27:28] Right. So it's really a way to get that activity and community involvement that is recommended by rehabilitation guidelines.

Susan: [27:37] Yes. Yeah, absolutely. It ticks all the boxes. It keeps people engaged. They're weight-bearing, they're stretching, getting into different postures, stimulating muscles, and what was really nice for us to find out, they're stimulating their minds as well. It is the whole package, and the cardiovascular system.

We're really pleased with the studies. It'd be nice to get more funding to do the definitive trials so that we can be really confident. But I think in the meantime, what I would suggest to stroke survivors is, talk to their therapist about finding a class, maybe asking their therapist to be an advocate for them in a class, to work with the teacher, look at some of the poses, how they can adapt them, what they can do, how they can challenge themselves. Because that's the other thing that people really liked. They liked the very gentle challenge in a very supportive environment. But you know, they didn't want to play it safe necessarily. They wanted to take a few little mini-risks. Go from there. Give it a try.

Chris: [28:45] Great! Well, thank you very much Susan and I do hope that you get to continue this research and get the larger trials that you're you're aiming for.

Susan: [28:55] Great. Thanks Chris.

Chris: [28:56] Thanks for joining us. That was researcher Professor Susan Hillier.

Announcer: [28:59] Setting goals is crucial to stroke recovery. Goals can be as simple as walking to the letterbox to check the mail, or bigger goals like getting back to work. EnableMe has a unique tool where you and your carer or family can plan what you want to achieve, track how you are progressing and celebrate your successes. You can also connect with other people who set goals similar to yours, and challenge or inspire each other. You can even set up a blog to write down how you are feeling and share your own story. And don't forget our professionals from StrokeLine can help with personalised and confidential advice to help you grow stronger after stroke. Visit enableme.org.au.

Chris: [29:39] Now to finish off, Jude and Simone, I'd like to talk to you about your advice for people who are wanting to into yoga or to get back into it, as the case may be. Simone, I thought I might start with you. What should stroke survivors consider physically when taking up yoga?

Simone: [29:54] I would always say, and I think Susan's touched on this, but having a conversation with your doctor to start with, just to get that medical clearance, is important. And if there is a therapy team involved, like a physiotherapist or an occupational therapist, to have a chat to them about where to start. And then really, I don't know, Jude, I think, has got some great tips around thinking about how to find a studio. Obviously, access is something that you want to check in on if that's something that is going to be a consideration for you. So a lot of studios can sometimes be on first floors or upstairs. So if stairs are a problem for you, or if access is a problem, that's something to also consider if you're going to start your practice in a studio.

But did you want to talk a bit more, Jude, about how to find a studio?

Jude: [30:39] Sure. So you definitely had a lot of options. As Susan's mentioned, there is a yoga school pretty much on every street corner these days, which is a really big change over the last couple of decades in Australia.

So you've got your yoga schools, and a lot of those will advertise a lot and they'll be really present in the community and online. You've also got classes at community and neighbourhood houses. So it's worth checking out what's available through your local council as well, just checking their website. They often have information on accessible exercise options.

Once you get online to have a look, you'll find that websites and class descriptions, they help you, but they're not always easy to understand, as a newbie in particular. So, Simone and I have been talking about Yin, and Sue talked about Chill, and there's a lot of different words and descriptions that get bandied around.

So do your research online, ask anyone you can think of for a recommendation, but then when you're narrowing in on a yoga school, send an email or phone and outline what you're looking for and what you might need, and I think it's helpful to have that conversation before you front up. It's sometimes helpful too, to speak to the founder or the owner of the school. They're often a good point of call really to get those questions answered and answered well.

When you go to your first class, go early and have some time to speak to the teacher, and I think that's a really important part of it as well. I would say that there are as many types of yoga as there are schools and teachers, and it's a bit like buying a house. It might take you a bit of time to find your yoga home. You might need to visit a few different places. Then, if the first few places you visit aren't for you, then just like finding a home, keep looking.

You're not just looking for a good school, but you're often looking for a good teacher at that school as well. So yeah, shop around.

Chris: [32:35] Okay.

Simone: [32:36] And a good community, I think getting that vibe. I think Sue talked about the vibe, I think it is looking around and going, "Yeah, I feel like I belong here." I think that's really important. If you're someone that is perhaps feeling a little bit fearful of going to a class, you're probably not going to front up to a class where there's lots of really young, fit, beautiful people in the room. You may not feel at home there. So it's really about knowing who you are, knowing where you feel like you belong, and finding that community, and that's different for everybody.

I think too, if you're thinking about starting a home practice, then that's really where I would talk a lot more with your therapy team, if you have a therapy team, around what your abilities are, and around any recommendations around where to start and whether a particular DVD or class for home practice might be good, looking at equipment, that kind of thing. And having a set-up.

I know some stroke survivors, certainly I've practised with stroke survivors in my class before, and have seen them progress. Things like thinking about, "Do I need to stand near a wall to start with, just for security and for my balance," and then progressing that over time.

So there's lots of different considerations, but if you find a good teacher or if you've got therapists involved, if you're doing a home practice, then that can be really helpful and ensure that you're feeling like you're well-equipped and that you have a safe practice as well, I think. Yeah.

Chris: [33:58] Are there any other things that might be specific to stroke survivors? You talked about sometimes accessibility, in terms of stairs and those sorts of things, might be something to look out for. But what about, I think something we touched on earlier, was the idea that having a teacher who is able to help you and give you feedback. Is there something about having a smaller class, or having that sort of slower approach?

Simone: [34:22] Yeah, yeah. I definitely think having a smaller class can be helpful. If you're new to yoga or coming back to yoga after a stroke, I actually often recommend people that call StrokeLine to consider one-on-one classes to start with. So you get one-on-one attention. The teacher gets a really good understanding of your abilities, and particularly if there's anything else like spasticity or sensory changes after your stroke, or perhaps there's balance issues, vision issues or something else. So I think having a one-on-one is also a good option, if that's available for you. That can be a really good way to start.

But often, yes, smaller classes. Sometimes finding out too from the teacher what's the best class, what's the smallest class, they'll be able to say to you, "Look, come on a Wednesday at lunchtime. The class is quite small. You'll get more attention."
The teacher maybe has a background in working with other people with disability, or there are many teachers now that may have a background in health, so occupational therapists, physiotherapists and other health practitioners that also are now looking at teaching yoga.

So you know, really just finding out, asking those questions, and something that some people don't realise, but often the studios will have a little note on your file as well. So when you sign into the class, it might bring up that you've got a history or an injury, and so you can, if you consent, you can elect to have that information available to the teacher. So if there's a new teacher or a fill-in teacher, then they get a quick notification when you sign into that class that there may be something they need to have a chat to you about.

That's also a good way to make sure that the teacher knows about your history as well. And really that open communication with the teacher, I think Jude said, the Yin classes can be good because the teachers get a lot more time to actually work with you and to see what feels good. You know, we obviously don't want people to be practising yoga and putting themselves through pain, and pain can be an issue for stroke survivors. So really allowing that space to communicate with the teacher as well, around making sure that you're not crossing that point of pain.

Chris: [36:20] Okay. Jude, do you concur?

Jude: [36:22] I do. I think it's really helpful to think about a quick script before you arrive as well. You're going into a new environment, it's different, it can be a bit overwhelming. So just think about what are the three things you want a teacher to know about you, and sort of script it for yourself. So it becomes really regular. You do it every time with a new teacher and it doesn't feel embarrassing or difficult to do.

I think it can really help the teacher to give you some tips to start with. So that thing about, "Yeah, maybe grab a spot near the wall if your balance is not good," and what to do if you're feeling tired or need to rest, but also too it will flag for them, "Oh, you might find this pose is not accessible to you, so I need to start thinking now about what I might come over and suggest for you instead."
So yeah, have a script.

Chris: [37:10] Yep. Now, Simone also talked about how people can ask some questions on StrokeLine. What other help can StrokeLine provide?

Simone: [37:17] Yeah look, I think we can really have a chat to you about where you're at and sort of what your level of ability is, whether you've practised yoga before. We can find out a bit about your history and maybe what you've tried before. We can find out a little bit more about what your intention is. I think we've all touched on when you're thinking about practising, or getting back to yoga, what's the intention behind it? Is it to build strength or balance, or is it for the community aspect, or perhaps it's for an emotional, a spiritual aspect, but getting a bit of information from the person who calls us around what the intention is.

You know, we can obviously have a chat about the different types of yoga. We can go through some of the things we've covered on the podcast around good questions to ask, how to find a studio, or thinking about a home practice. There's lots of different things that we can cover.

I think something that does come up on StrokeLine with stroke survivors is around the fears as well, around, "Oh, I'm feeling a bit scared to go to a class. What will people think?" So we can actually help work through some of those blocks or barriers or reasons that might be holding someone back as well.

So yeah, there's a whole range of things that we can do, but really tailored advice to get you in the right direction and to give it a go. You know, there's lots of myths around, like you need to be flexible to go to yoga. Well, it's just not true. You don't have to be flexible, you don't have to be able to touch your toes. So there is really something for everybody.

Chris: [38:37] Great. And Jude, do you have any other final advice that you would give stroke survivors?

Jude: [38:41] I'm just laughing because we do actually call StrokeLine the Yogi Hotline some days, because we get so many questions, and most people on StrokeLine do practise yoga. So yeah, call the Yogi Hotline.

Look, my last thing would just be to say that you're looking for a yoga school and a teacher that will be welcoming and inclusive, but think also too about how you will include yourself and how you'll treat yourself as someone that can practise yoga and deserves to practise yoga and deserves to be in the room.

There are definitely moments in your yoga practice when it's too hard, you're too different to other people and you get really out of your depth, and it's very easy to freak out. And I know for me there's often a point where I just panic because I don't actually know what I'm meant to be doing and I'm on the left and everyone else is on the right, all that kind of thing. But if you drop that feeling of not being good enough, if you include yourself, don't worry about feeling like you stand out. That's not a bad thing. It can be amazing how liberating that is.

You don't have to be perfect. We always say in yoga that it's all about just showing up on your mat. So switch the focus from what hurts, what you can't do, what feels bad, to what feels good and really concentrate on not, "I'm trying to do this post perfectly," but, "I'm actually trying to make myself feel good." And that's a very simple thing and it feels really empowering.

Chris: [40:04] Great.

Simone: [40:05] And there's always child's pose.

And there's a saying that goes around, "I regret going to yoga today or practising yoga today, said no one." And that really rings true for me too. I think that one of the big things I've learned about yoga is that, keep your eyes on the four corners of your own mat. You know, it's really teaching you about your own self-awareness, and yeah, really stay focused on what's going on for you on your mat.

Just go along with that open mind, and as Jude said, everything will be okay.

Chris: [40:37] Fantastic. I love the enthusiasm there.

Now, if you want to speak to a health professional about yoga or any other topic, you can call StrokeLine on 1800 787 653 or 1800 STROKE, or you can go onto EnableMe and ask a question and get a response from health professionals and other stroke survivors.

If you like what you've heard today, please give us a good rating and review on iTunes or Apple Podcasts or whatever other app you can, as that helps lift us up in the search ranking so that other people can find our podcast.

Thanks once again to our guests, Sue Bowden, Susan Hillier, Simone Russell and Jude Czerenkowski.

Announcer: That's all for today's EnableMe podcast. You can find out more on this topic and continue the conversation or listen to other podcasts in the series at enableme.org.au. It's free to sign up, and you can talk with thousands of other stroke survivors, carers, and supporters. You can also suggest a topic or provide feedback on this podcast.

EnableMe has qualified health professionals from StrokeLine who can answer your questions and give evidence-based advice. The advice given here is general in nature, and you should discuss your own personal needs and circumstances with your healthcare professionals.

The music in this podcast is "Signs" by stroke survivor Antonio Iannella and his band The Lion Tamers. It's recorded at Antonio's studio, which you can find out more about at facebook.com/studiofour99. This EnableMe podcast series is produced by the Stroke Foundation in Australia, working to prevent, treat and beat stroke. See strokefoundation.org.au.

Yoga

Episode 24, 30 January 2020

Yoga is very popular with stroke survivors as a form of exercise and as an activity to connect with the community. In this podcast, we speak physiotherapist and researcher Professor Susan Hillier, stroke survivor Sue Bowden, and Simone Russell and Jude Czerenkowski from StrokeLine, about the benefits people get from yoga, and how you can get into practising it if you’ve had a stroke.

Please note that yoga as a treatment is not specifically recommended by the Clinical Guidelines for Stroke Management, or by the Stroke Foundation. You should talk to a health professional before starting any new exercise such as yoga.

 

Podcast transcript

Announcer: Welcome to the EnableMe podcast series, where we bring together stroke survivors, health professionals and researchers, providing you with practical advice to enable you on your journey to reclaim your life after stroke.

The advice given in this podcast is general in nature and you should discuss your own personal needs and circumstances with your healthcare professionals.

You can join the conversation at enableme.org.au. This series is presented by Australia's Stroke Foundation, working to prevent, treat and beat stroke.

Chris: [00:45] It's summer now while we're recording this podcast, and so we thought it was fitting to talk about a more relaxed topic than usual.

Yoga is hugely popular with our stroke survivor community and with the team at the Stroke Foundation. Many people use it as a form of exercise, and as an activity that connects them with their community.

Now, I do need to state that yoga as a treatment is not specifically recommended by the Clinical Guidelines for Stroke Management, or by the Stroke Foundation. And you should talk to a health professional before starting any new exercise such as yoga.

But with that in mind, we’re going to look at some of the benefits that people do get out of yoga, and if you’ve had a stroke, how you can get into practising it.

And we didn't have to bend over backwards to find people willing to discuss these questions. Joining us soon will be yoga aficionados, Simone Russell and Jude Czerenkowski from StrokeLine, and later on we'll be speaking to researcher Professor Susan Hillier.

First though, we have on the line from Bathurst, stroke survivor and valued member of the EnableMe online community, Sue Bowden.

Sue, welcome to our podcast.

Sue: [01:43] Hello Chris. Thank you for having me.

Chris: [01:45] Now, the first question is the usual one that I always ask our guests: could you tell us your stroke story?

Sue: [01:52] Okay. My stroke story happened a long time ago in 1993 when I was 22 years old, and I had my stroke, a brainstem stroke, two weeks after I'd developed severe preeclampsia, and lost our first baby.

So my stroke left me needing to blink to communicate initially, and then needing to learn to walk, talk, eat, become continent, and basically live again. So the long journey from then to now has been quite difficult. There was not much assistance around back then, and I took what I could in terms of attending outpatients rehab.

Once I left rehab, I was always very good at turning up to my appointments, however, there was a huge gap between where I was at and where I needed to go. So I just continued to move forward the best I could. So nothing like yoga really was offered to me back then, or even, I guess, the knowledge of how it may have helped, was not there. So I just went on with my exercises as I needed to and as I saw fit in what helped me.

Really, I did a lot of self-guided rehabilitation and recovery on my own to get me to where I am.

Chris: [03:29] Sounds like you have come a very long way, and it sounds though also that recovery is still an ongoing process, and I think that many people have that same experience. So you have gotten into yoga recently. Can you tell us a bit about how that came about?

Sue: [03:44] Okay, so what happened was, I guess I started a new year a few years ago thinking, "What am I going to do differently this year?" Not a New Year's resolution as such, but, "What am I going to do differently?"

And I thought that I might begin stretching. And so I just downloaded one of those free apps on my phone. I spoke to my doctor to say that I was beginning to stretch with the view to do some yoga later on. So I did the stretching morning and night for three months, and then I found a DVD that I bought, it was $5 at a stall that I found. And I began doing that DVD at home. Just in the comfort of my home, so it was private and I could concentrate and I found it really quite difficult, but I think with all the stretching that I'd done, I could see that that had been helpful.

So I just continued persevering and getting better and better. At one stage I was doing the yoga DVD three times a day, because I felt like I needed to. But that doesn't happen anymore.

So yeah, and I still continue to do that same DVD.

Chris: [05:11] Fantastic. Now, as I mentioned in the introduction, yoga is so popular with the Stroke Foundation team that we have not one but two special guests from StrokeLine, occupational therapist Simone Russell, hello Simone.

Simone: [05:23] Hello.

Chris: [05:24] And social worker and StrokeConnect National Manager, Jude Czerenkowski. Hi Jude.

Jude: [05:28] Hello.

Chris: [05:29] Okay Simone, now you are an OT but you're also someone who knows a lot about yoga. Now me, though, I'm coming from a position of relative ignorance, so for people like me, can you explain what is yoga?

Simone: [05:41] It can mean lots of different things to different people, but I guess my understanding of it is that it is an ancient practice or series of philosophies and principles and techniques that really come from the Vedic tradition. So from India and the Himalayas, and started somewhere around two and a half thousand years ago. So quite an old practice, but made up of a range of different philosophies and techniques, as I said.

So the way I see it is it's a way of life. It's a way of being. And so a lot of people, I think, when they first come to think about practising yoga, particularly in, I guess, the modern world, we see a lot of people doing lots of fancy poses and a very physical practice.

And so a lot of people go for the physical benefits initially, but it's much, much more than just the physical benefits, and in fact they call it Asana or the physical practice. The postures and the poses that we make in yoga are just one part of the practice. So really yoga is about that union between the body, the mind, and the spirit. So it's about cultivating health and wellbeing from a physical, a mental, emotional, spiritual, and even social wellbeing perspective. So really a practice of self-inquiry, increasing self-awareness and cultivating a greater sense of inner peace and mental clarity. A practice of really continuing to come back to that present moment.

So I guess it's something I think that you need to experience yourself. It's one of those things where a lot of people perhaps don't get a real sense of what it is until they start to practise it. So that's kind of my definition of it. Jude, feel free to jump in if there's anything you want to add.

Jude: [07:28] I think you've described it perfectly, Simone.

Simone: [07:30] But really it includes the breath, it includes meditation, it includes focus and concentration, as well as that physical practice and philosophy as well.

Chris: [07:41] Okay. So Jude, you are also a long time yoga practitioner. What are the benefits that you get from it personally?

Jude: [07:49] So there are physical and personal benefits, and yoga's always made my body feel really good. It helps my fitness, strength, flexibility and it makes me feel really comfortable in my body. As I'm getting older, I definitely feel the benefits actually more rather than less and I think it will help me age well.

I quite enjoy going to classes and being with other people and practising together. You're often doing it in your local community, so it's people that are your neighbours and colleagues, and I quite like the social interaction without always having to build social interaction around conversation.

It's a different way of being together with a group of people, but the main thing really for me is that it gives me a chance, it actually forces me really, to check in, just to stop and actually check in on what's going on for you, and I'll often realise that I'm feeling something either in my body or in my emotions that I actually had no idea that I was feeling, until I stopped and checked in. And that's the main thing that I find is the big benefit for me.

Chris: [08:50] I guess another question for both of you is, the sort of thing that Sue's talking about. Is this typical from the kind of things we'll hear from people on StrokeLine? About people who want to get into yoga not knowing much about it, or do we also get people who may have been practising before they had their stroke and want to get back into it?

Simone: [09:08] Yeah, we get both. There's definitely a group of stroke survivors that come to us that have heard about yoga or perhaps seen about yoga on social media or perhaps have friends or family practising, maybe someone suggested that they try it. So we do get people that may have not had any experience of yoga at all, that are really wanting to look into it as a hobby or a leisure pursuit or physical activity to add to their rehabilitation and to their, I think Sue touched on, really self-managing her recovery. So really at that later stage of having it as an adjunct to their therapy or perhaps their self-management.

Certainly though, we have stroke survivors call us who have a practice prior to their stroke and that are really wanting some guidance, and sometimes it's around fears around practising again or whether or not actually they can, whether it's something that that people do go back to after their stroke.

So we get a bit of both, some that are new to the practice, wanting to try it out, and some that are wanting some guidance around returning to their practice.

Chris: [10:17] Okay. Now Sue, as you said, you started with a DVD, but I believe now you've started attending some classes as well. Can you tell us a bit about that?

Sue: [10:27] Yes, so I decided to go along to a class that a friend was going along to and she was very encouraging saying, "Oh, it's floor yoga. It's just a very relaxed class. It's called chill yoga."
So I decided to get brave and go along to the classes. I was feeling pretty comfortable practising on my own, my DVD that I was comfortable with, so I went along and I just loved it, loved walking into the class and it smelt beautiful, and all the mats were there ready for us and, because it's on the floor and it's Yin Yoga, I think, where you do lots of stretches and poses which are held for a long time. So there's bolsters and blocks to assist with that.

I guess, after my first class, I was very happy to return and very happy that I'd gone.

Chris: [11:29] Great. Now, there were some nods here in the studio when you mentioned Yin Yoga. Jude and Simone, are you aware of this? Are there many different types of yoga that are like this?

Simone: [11:42] Yeah, there are a number of different types of yoga and Yin is one, and I think it's becoming maybe one of the most popular. I think in this busy world that we're living in, a lot of people are craving that quiet downtime and that time to just slow down and press pause after a busy day perhaps of work or whatever it might be in your week.

So it is one type, it is predominantly floor-based, really slow long-held poses. As Sue mentioned, there's usually a lot of props to help support your practice, so things like bolsters, they're like a cushion, and blocks and straps and things to help, where the teacher will guide you through how to use those props.

But there's a range of other different styles as well. So people might have heard of Hatha Yoga or Iyengar. Bikram is the one that is done in a very hot temperature, so not always appropriate for everybody, and there's also another slower practice called Restorative Yoga, which again, it's a little bit different to Yin, but another slower-paced class.

People might hear the term "flow" a lot, which is a sort of a more higher intensity, faster pace, so there's really something for everybody across all areas.

I don't know, Jude, if you want to touch on any other types or benefits of the types that you practise.

Jude: [13:02] I probably just would give Yin a bit more of a plug, I think, because it tends to be the class in the yoga school that you'll see more people with different levels of ability, and you'll see people that live with a disability in a Yin class more often.

It is more accessible and I think the other thing is too that because the poses are held for longer, it gives the teacher much more time to actually assist an individual person within the class with the modifications and the changes that they might need to make that pose comfortable for them. So if you have a different type of ability or some restrictions, it's a great place to start.

Chris: [13:42] Okay.

Simone: [13:43] There are also many community groups as well that do chair-based yoga, so it's worth touching on that as well, and certainly some therapists or yoga practitioners are trained to do yoga therapy. So there are some alternatives as well, that combine a range of different practices but look at really chair-based practices.

So yeah, there really is a type of yoga for everyone. It's just about finding it.

Chris: [14:07] Sue, have you had any experience with chair-based yoga?

Sue: [14:10] The chair-based yoga? Yes, that sounds familiar.

I'm involved up in Bathurst, the Central West Brain Injury Action Group and last year or the year before, I helped organise a chair-based yoga event for the group, and unfortunately I wasn't able to attend on the day, but the feedback I heard, it was well-received, and the group would like to look at doing another chair-based yoga session sometime in the New Year. So yeah, and I hope that I'll be able to get to that one.

Chris: [14:49] Great. Now I just want to ask you, with having started doing classes, how does that compare to practising at home, do you think?

Sue: [15:00] Well for me, I really enjoy, like I mentioned, the smell of the yoga studio. It's nicely scented, and the vibe of everyone being together.

Yeah, it's a social occasion, but I think like Jude mentioned, without needing to get into that regular social talk. You talk about the yoga and the poses and it was very enjoyable.

Chris: [15:32] Jude and Simone, do you have any perspectives on practising at home versus joining in a class or having an instructor?

Jude: [15:40] I do think a lot of people do prefer to start at home, and it can definitely be a bit scary to front up to a class as a complete newbie, often because most people in the class have being going for a while and know what they're doing, and you can feel a bit out of place.

There are a lot of good videos and things available, classes available online, but it can be a bit of trial and error to find something appropriate for you. Probably one of the things, it's interesting listening to Sue talk about doing the same video over and over, because actually it would be a great way to notice the changes in your body as you get more familiar and you do things more often, so I can see why that would work really well for some people.

The main drawback, of course, would be that you don't get feedback from a teacher, and having a teacher is an important part of yoga. It's been taught from teacher to student for a really long time. And getting that feedback about how you can make things easier or get a little bit more stretch, it is quite an important part of the practice I think.

Simone: [16:43] Yeah, I would agree with that as well. And I think that it is dependent on the individual. I think home practice has a really good place as well for people that may not be able to get out to get to classes. So if access is an issue or, perhaps, you're living in a really rural area where there just isn't access to yoga. So I think home practice is always going to have a really good place.

Talking to health professionals, if you've got a physio or an OT, can be a good way to start your home practice to make sure that it's going to be tailored to the level of where you're at, and that it's a positive experience, I think, like what Sue has had.

But yeah, totally agree with Jude around having a teacher can be really beneficial as well, and to help progress your practice, if you like. So yeah, there's definitely benefits of both.

Chris: [17:30] Great. So, Sue, how do you see the future of you and yoga progressing?

Sue: [17:37] Okay, well that was really interesting to listen to Jude and Simone talk about the benefits of having a teacher and a home-based practice, because it's only been about four weeks since I've been attending this yoga class, and I'm already seeing the changes to my home practice by doing the Yin Yoga or the Restorative Yoga.

So I'm thinking, looking to the future, that I'm just going to keep continuing to improve and become more aware of the benefits that I can see and feel in doing both. I might branch out into more group yoga classes as time goes on, but I'm just going to take it as I feel, really. I'm not going to push myself to do something that I don't feel ready for yet.

Chris: [18:33] So, is there anything else that you would say to other stroke survivors who are contemplating yoga?

Sue: [18:38] I guess, to look around at what's available, what they might want to get out of yoga, and to keep an open mind about the improvements that might come by participating, and just giving it a go as to what they're able to do, because I'm so aware of the different levels that people might be at. If somebody's able to manage chair yoga at the time and then move on to something else, it's really a personal experience isn't it? Depending on where everybody's at.

Chris: [19:15] Yes. Thank you very much and best of luck with continuing your practice. Is it okay for me to say "Namaste"? Is that the thing we do?

Sue: [19:24] Namaste.

Chris: [19:25] Namaste. Okay, thank you, Sue.

Announcer: [19:28] Did you know you can customise the EnableMe website to suit all your viewing needs? You can choose large-size fonts or different alignment of text on your screen, a high contrast screen so that different parts stand out, automatically underline the start and end of each sentence, read in easy English, and many more options. Set up once, and your personal settings are saved for all your future visits. Just click on the accessibility icon at the top of the screen at enableme.org.au.

Chris: [19:57] Our next guest is physiotherapist and researcher, Professor Susan Hillier from the University of South Australia. Susan is a member of the Stroke Foundation's Clinical Council and she's also been a guest on the podcast previously in our episode on touch and sensation.

Welcome back, Susan.

Susan: [20:13] Thanks Chris.

Chris: [20:14] Now I believe that you and your colleagues have actually done some research on yoga for stroke survivors. What kinds of things did you study?

Susan: [20:15] Yeah, we did a couple of pilot clinical trials working with stroke survivors around using yoga as a form of rehabilitation after their stroke.

There were two trials, and one was comparing yoga to just a regular exercise class, and the other one was comparing yoga to usual care.

So we were particularly interested in questions about whether it is feasible because as you can imagine, everybody immediately says, "Oh well, I've had a stroke, I can't do a downward dog." So we needed to explore what aspects of yoga were feasible for people with stroke, and that it was safe. And we also wanted to get some data about whether it is actually effective and if it is, what kinds of benefits might it offer people who've had a stroke. So we were really pleased with the trials. People were really keen to recruit for the trials.

We did them in a very strong kind of way. We randomised people so that they didn't necessarily know what they were getting or what we were particularly interested in. And we measured them before they did the classes and we measured them after they did the classes. And we had people who were blinded to which classes they did.

So we did it properly, and we were really happy to report those results in a couple of journals. And we found that, not surprisingly, our numbers weren't big enough to enable us to calculate big effects, but we could certainly show that the yoga was safe and it was feasible, and we trained teachers specially, so that they could adapt, and they had us as advisors so that they knew how to adapt things safely.

And then we did interviews with the stroke survivors afterwards. And I think that was probably the most interesting thing that we found.

Chris: [22:22] What came out of the interviews?

Susan: [22:24] People reported a whole bunch of things. It's actually not surprising, but it was surprising. They reported that they felt better about their body, and it wasn't a direct thing that the yoga teachers go in saying, "Feel better about your body. Feel better about your body."
But by getting to know themselves better, through the mindfulness stuff, they felt more aware of what their bodies were capable of, and they felt calmer in their mind. So those very traditional kinds of benefits of yoga really popped out in a way that surprised even us. I think at the time, we were doing a lot of radio interviews, and every interviewer would say, "Well, how can someone with stroke do yoga? It's so vigorous." I think that was real testament to the way we set up the classes. There was always something that somebody could do, and if they couldn't do it standing, they could do it in sitting. But then the majority of the classes actually spent a lot of time on the mindfulness aspect. So calming the mind and controlling your thoughts, doing really nice gentle body scan, so that people just became more aware of their whole body, rather than trying to ignore their side that the stroke affected and only ever using the less stroke-affected side.

So yeah, I think that that was very inspiring, actually, to hear their stories.

Chris: [23:54] That certainly fits in the discussion that we've had so far about yoga. I'm interested though also in some of those comments about it being vigorous, or comparing it to other exercise. Is it also a form of cardio exercise, as well as just the mindfulness and the other aspects of it?

Susan: [24:19] Well, this is an interesting question because traditionally we think that you have to raise a sweat and you have to breathe hard, you have to work hard, for an aerobic effect. But actually, traditional yoga is the opposite. It's meant to be very calm and you're meant to keep very quiet. You hold the poses and they're strenuous, so it's good for muscle strength.

Interestingly though, what people found was that because there's a lot of breathing exercises, their breathing felt easier. So I think there's a whole lot of research to be done about if people learn to breathe more efficiently, is that as good as an aerobic exercise, because there's a bit of evidence coming out that probably aerobics exercise isn't necessarily the best thing for people after stroke. It was only one study, but you know, it's something that we're watching. And I'm just thinking that learning how to breathe better, kind of has the same effect, doesn't it? You get more oxygen, you feel calmer.

So I think that there's a really great opportunity for us to explore a whole different notion of what it means to have better cardiovascular health through better breathing techniques.

Chris: [25:33] And how about other benefits people might get? Say, for instance, just by being part of the class and that sort of community. Did people find that as well?

Susan: [25:41] That's exactly right, people really enjoyed the group. You know, we did control for that in one of the studies by having the other group doing exercises together. But I think we can't underestimate the value of peer support, being with people who understand, being with a teacher that you trust, who understands what you've been through. I think they're really powerful things to think about.

And then on the other hand, what drew me to be interested in using yoga ... there's a few of us now, I've got colleagues in Melbourne as well who are really interested in doing more study, is of course yoga is ubiquitous. It's everywhere. It's on every street corner, practically. And some of our stroke survivors are telling us, "I don't want to go to some fancy clinic. It's expensive." They feel like it just reminds them they've got a stroke. So I guess my kind of long-term vision is that people with stroke can go to any yoga class.

You know, if yoga teachers generally can feel confident working with people who've got some physical or cognitive difficulties, impairments, then this is a great normalising thing. It's something that you can walk to your local corner gym and do yoga, whether you've got a stroke or not. I think that's something that we're really keen to look at.

And then I've got a colleague here in Adelaide, Saran Chamberlain, who's a young stroke survivor, and we want to do exactly that. We want to work with yoga centres or Pilates centres or whatever, and almost give them the tick of approval that they're stroke-friendly, because we're never going to get enough stroke services, are we? We have to be honest about that.

But how marvellous it would be if people with stroke could feel that they could just jump into a mainstream class.

Chris: [27:28] Right. So it's really a way to get that activity and community involvement that is recommended by rehabilitation guidelines.

Susan: [27:37] Yes. Yeah, absolutely. It ticks all the boxes. It keeps people engaged. They're weight-bearing, they're stretching, getting into different postures, stimulating muscles, and what was really nice for us to find out, they're stimulating their minds as well. It is the whole package, and the cardiovascular system.

We're really pleased with the studies. It'd be nice to get more funding to do the definitive trials so that we can be really confident. But I think in the meantime, what I would suggest to stroke survivors is, talk to their therapist about finding a class, maybe asking their therapist to be an advocate for them in a class, to work with the teacher, look at some of the poses, how they can adapt them, what they can do, how they can challenge themselves. Because that's the other thing that people really liked. They liked the very gentle challenge in a very supportive environment. But you know, they didn't want to play it safe necessarily. They wanted to take a few little mini-risks. Go from there. Give it a try.

Chris: [28:45] Great! Well, thank you very much Susan and I do hope that you get to continue this research and get the larger trials that you're you're aiming for.

Susan: [28:55] Great. Thanks Chris.

Chris: [28:56] Thanks for joining us. That was researcher Professor Susan Hillier.

Announcer: [28:59] Setting goals is crucial to stroke recovery. Goals can be as simple as walking to the letterbox to check the mail, or bigger goals like getting back to work. EnableMe has a unique tool where you and your carer or family can plan what you want to achieve, track how you are progressing and celebrate your successes. You can also connect with other people who set goals similar to yours, and challenge or inspire each other. You can even set up a blog to write down how you are feeling and share your own story. And don't forget our professionals from StrokeLine can help with personalised and confidential advice to help you grow stronger after stroke. Visit enableme.org.au.

Chris: [29:39] Now to finish off, Jude and Simone, I'd like to talk to you about your advice for people who are wanting to into yoga or to get back into it, as the case may be. Simone, I thought I might start with you. What should stroke survivors consider physically when taking up yoga?

Simone: [29:54] I would always say, and I think Susan's touched on this, but having a conversation with your doctor to start with, just to get that medical clearance, is important. And if there is a therapy team involved, like a physiotherapist or an occupational therapist, to have a chat to them about where to start. And then really, I don't know, Jude, I think, has got some great tips around thinking about how to find a studio. Obviously, access is something that you want to check in on if that's something that is going to be a consideration for you. So a lot of studios can sometimes be on first floors or upstairs. So if stairs are a problem for you, or if access is a problem, that's something to also consider if you're going to start your practice in a studio.

But did you want to talk a bit more, Jude, about how to find a studio?

Jude: [30:39] Sure. So you definitely had a lot of options. As Susan's mentioned, there is a yoga school pretty much on every street corner these days, which is a really big change over the last couple of decades in Australia.

So you've got your yoga schools, and a lot of those will advertise a lot and they'll be really present in the community and online. You've also got classes at community and neighbourhood houses. So it's worth checking out what's available through your local council as well, just checking their website. They often have information on accessible exercise options.

Once you get online to have a look, you'll find that websites and class descriptions, they help you, but they're not always easy to understand, as a newbie in particular. So, Simone and I have been talking about Yin, and Sue talked about Chill, and there's a lot of different words and descriptions that get bandied around.

So do your research online, ask anyone you can think of for a recommendation, but then when you're narrowing in on a yoga school, send an email or phone and outline what you're looking for and what you might need, and I think it's helpful to have that conversation before you front up. It's sometimes helpful too, to speak to the founder or the owner of the school. They're often a good point of call really to get those questions answered and answered well.

When you go to your first class, go early and have some time to speak to the teacher, and I think that's a really important part of it as well. I would say that there are as many types of yoga as there are schools and teachers, and it's a bit like buying a house. It might take you a bit of time to find your yoga home. You might need to visit a few different places. Then, if the first few places you visit aren't for you, then just like finding a home, keep looking.

You're not just looking for a good school, but you're often looking for a good teacher at that school as well. So yeah, shop around.

Chris: [32:35] Okay.

Simone: [32:36] And a good community, I think getting that vibe. I think Sue talked about the vibe, I think it is looking around and going, "Yeah, I feel like I belong here." I think that's really important. If you're someone that is perhaps feeling a little bit fearful of going to a class, you're probably not going to front up to a class where there's lots of really young, fit, beautiful people in the room. You may not feel at home there. So it's really about knowing who you are, knowing where you feel like you belong, and finding that community, and that's different for everybody.

I think too, if you're thinking about starting a home practice, then that's really where I would talk a lot more with your therapy team, if you have a therapy team, around what your abilities are, and around any recommendations around where to start and whether a particular DVD or class for home practice might be good, looking at equipment, that kind of thing. And having a set-up.

I know some stroke survivors, certainly I've practised with stroke survivors in my class before, and have seen them progress. Things like thinking about, "Do I need to stand near a wall to start with, just for security and for my balance," and then progressing that over time.

So there's lots of different considerations, but if you find a good teacher or if you've got therapists involved, if you're doing a home practice, then that can be really helpful and ensure that you're feeling like you're well-equipped and that you have a safe practice as well, I think. Yeah.

Chris: [33:58] Are there any other things that might be specific to stroke survivors? You talked about sometimes accessibility, in terms of stairs and those sorts of things, might be something to look out for. But what about, I think something we touched on earlier, was the idea that having a teacher who is able to help you and give you feedback. Is there something about having a smaller class, or having that sort of slower approach?

Simone: [34:22] Yeah, yeah. I definitely think having a smaller class can be helpful. If you're new to yoga or coming back to yoga after a stroke, I actually often recommend people that call StrokeLine to consider one-on-one classes to start with. So you get one-on-one attention. The teacher gets a really good understanding of your abilities, and particularly if there's anything else like spasticity or sensory changes after your stroke, or perhaps there's balance issues, vision issues or something else. So I think having a one-on-one is also a good option, if that's available for you. That can be a really good way to start.

But often, yes, smaller classes. Sometimes finding out too from the teacher what's the best class, what's the smallest class, they'll be able to say to you, "Look, come on a Wednesday at lunchtime. The class is quite small. You'll get more attention."
The teacher maybe has a background in working with other people with disability, or there are many teachers now that may have a background in health, so occupational therapists, physiotherapists and other health practitioners that also are now looking at teaching yoga.

So you know, really just finding out, asking those questions, and something that some people don't realise, but often the studios will have a little note on your file as well. So when you sign into the class, it might bring up that you've got a history or an injury, and so you can, if you consent, you can elect to have that information available to the teacher. So if there's a new teacher or a fill-in teacher, then they get a quick notification when you sign into that class that there may be something they need to have a chat to you about.

That's also a good way to make sure that the teacher knows about your history as well. And really that open communication with the teacher, I think Jude said, the Yin classes can be good because the teachers get a lot more time to actually work with you and to see what feels good. You know, we obviously don't want people to be practising yoga and putting themselves through pain, and pain can be an issue for stroke survivors. So really allowing that space to communicate with the teacher as well, around making sure that you're not crossing that point of pain.

Chris: [36:20] Okay. Jude, do you concur?

Jude: [36:22] I do. I think it's really helpful to think about a quick script before you arrive as well. You're going into a new environment, it's different, it can be a bit overwhelming. So just think about what are the three things you want a teacher to know about you, and sort of script it for yourself. So it becomes really regular. You do it every time with a new teacher and it doesn't feel embarrassing or difficult to do.

I think it can really help the teacher to give you some tips to start with. So that thing about, "Yeah, maybe grab a spot near the wall if your balance is not good," and what to do if you're feeling tired or need to rest, but also too it will flag for them, "Oh, you might find this pose is not accessible to you, so I need to start thinking now about what I might come over and suggest for you instead."
So yeah, have a script.

Chris: [37:10] Yep. Now, Simone also talked about how people can ask some questions on StrokeLine. What other help can StrokeLine provide?

Simone: [37:17] Yeah look, I think we can really have a chat to you about where you're at and sort of what your level of ability is, whether you've practised yoga before. We can find out a bit about your history and maybe what you've tried before. We can find out a little bit more about what your intention is. I think we've all touched on when you're thinking about practising, or getting back to yoga, what's the intention behind it? Is it to build strength or balance, or is it for the community aspect, or perhaps it's for an emotional, a spiritual aspect, but getting a bit of information from the person who calls us around what the intention is.

You know, we can obviously have a chat about the different types of yoga. We can go through some of the things we've covered on the podcast around good questions to ask, how to find a studio, or thinking about a home practice. There's lots of different things that we can cover.

I think something that does come up on StrokeLine with stroke survivors is around the fears as well, around, "Oh, I'm feeling a bit scared to go to a class. What will people think?" So we can actually help work through some of those blocks or barriers or reasons that might be holding someone back as well.

So yeah, there's a whole range of things that we can do, but really tailored advice to get you in the right direction and to give it a go. You know, there's lots of myths around, like you need to be flexible to go to yoga. Well, it's just not true. You don't have to be flexible, you don't have to be able to touch your toes. So there is really something for everybody.

Chris: [38:37] Great. And Jude, do you have any other final advice that you would give stroke survivors?

Jude: [38:41] I'm just laughing because we do actually call StrokeLine the Yogi Hotline some days, because we get so many questions, and most people on StrokeLine do practise yoga. So yeah, call the Yogi Hotline.

Look, my last thing would just be to say that you're looking for a yoga school and a teacher that will be welcoming and inclusive, but think also too about how you will include yourself and how you'll treat yourself as someone that can practise yoga and deserves to practise yoga and deserves to be in the room.

There are definitely moments in your yoga practice when it's too hard, you're too different to other people and you get really out of your depth, and it's very easy to freak out. And I know for me there's often a point where I just panic because I don't actually know what I'm meant to be doing and I'm on the left and everyone else is on the right, all that kind of thing. But if you drop that feeling of not being good enough, if you include yourself, don't worry about feeling like you stand out. That's not a bad thing. It can be amazing how liberating that is.

You don't have to be perfect. We always say in yoga that it's all about just showing up on your mat. So switch the focus from what hurts, what you can't do, what feels bad, to what feels good and really concentrate on not, "I'm trying to do this post perfectly," but, "I'm actually trying to make myself feel good." And that's a very simple thing and it feels really empowering.

Chris: [40:04] Great.

Simone: [40:05] And there's always child's pose.

And there's a saying that goes around, "I regret going to yoga today or practising yoga today, said no one." And that really rings true for me too. I think that one of the big things I've learned about yoga is that, keep your eyes on the four corners of your own mat. You know, it's really teaching you about your own self-awareness, and yeah, really stay focused on what's going on for you on your mat.

Just go along with that open mind, and as Jude said, everything will be okay.

Chris: [40:37] Fantastic. I love the enthusiasm there.

Now, if you want to speak to a health professional about yoga or any other topic, you can call StrokeLine on 1800 787 653 or 1800 STROKE, or you can go onto EnableMe and ask a question and get a response from health professionals and other stroke survivors.

If you like what you've heard today, please give us a good rating and review on iTunes or Apple Podcasts or whatever other app you can, as that helps lift us up in the search ranking so that other people can find our podcast.

Thanks once again to our guests, Sue Bowden, Susan Hillier, Simone Russell and Jude Czerenkowski.

Announcer: That's all for today's EnableMe podcast. You can find out more on this topic and continue the conversation or listen to other podcasts in the series at enableme.org.au. It's free to sign up, and you can talk with thousands of other stroke survivors, carers, and supporters. You can also suggest a topic or provide feedback on this podcast.

EnableMe has qualified health professionals from StrokeLine who can answer your questions and give evidence-based advice. The advice given here is general in nature, and you should discuss your own personal needs and circumstances with your healthcare professionals.

The music in this podcast is "Signs" by stroke survivor Antonio Iannella and his band The Lion Tamers. It's recorded at Antonio's studio, which you can find out more about at facebook.com/studiofour99. This EnableMe podcast series is produced by the Stroke Foundation in Australia, working to prevent, treat and beat stroke. See strokefoundation.org.au.