Plain English Summary
Background and study aims
Multimorbidity is common in older adults, and associated with high levels of illness burden and healthcare expenditure. The evidence base for how best to manage older adults with multimorbidity is weak. Yoga might be a useful intervention, because it is low cost, simple, and can address several health conditions simultaneously. Gentle Years Yoga (GYY) is a yoga programme that was developed for older adults with chronic conditions. A pilot trial of GYY demonstrated feasibility and encouraging preliminary data. The current full-scale trial aims to answer the following research question: What is the clinical and cost effectiveness of the GYY programme plus usual care versus usual care only in community-dwelling older adults with multimorbidity?
Who can participate?
Eligible participants will be aged 65 or over, community-dwelling, and with multimorbidity, defined as having two or more chronic conditions from a predefined list.
What does the study involve?
We will conduct a multi-site, two-arm, parallel-group, individually-randomised controlled trial with an internal pilot phase and nested process and economic evaluations. We aim to recruit 586 participants primarily via mail-out from general practices. Eligible participants will be aged 65 years or over, community-dwelling, and have multimorbidity, defined as having two or more chronic conditions from a predefined list. Participants will be randomly allocated to receive usual care and the offer of a 12-week Gentle Years Yoga (GYY) programme (n=293) or usual care alone (n=293). The GYY programme will involve weekly group-based sessions and self-managed yoga practice on most days. The group=based sessions will be delivered in non-medical community-based facilities in at least 12 areas across England, Wales and Scotland.
Outcome data will be collected at baseline, and 3, 6 and 12 months post-randomisation using postal questionnaires. If a participant is unable to complete the questionnaire or there are missing data, this may be collected by a researcher over the phone. The primary effectiveness endpoint will be the overall difference in quality of life over 12 months measured using the EQ-5D-5L. Secondary outcome measures will include depression, anxiety, health-related quality of life, falls incidence, loneliness, adverse events, and healthcare resource use. Socio-demographic data will be collected at screening and baseline. Preferences and beliefs for the yoga programme and usual care will be collected at baseline and at 12 months. Intervention adherence will be assessed using class registers. A subset of participants and yoga teachers will be interviewed to inform intervention implementation.
What are the possible benefits and risks of participating?
Previous studies have shown that yoga programmes can benefit many different aspects of physical, mental and social wellbeing. However, as this is the first detailed investigation of the GYY programme in older people with multimorbidity, we cannot guarantee any specific treatment benefits. If enough people take part in this study, the information we get should help clarify the role of yoga as a routine treatment for this patient group.
The yoga exercises carry a very small risk of injury (for example, mild muscle strain), but this risk will be minimised by participants being carefully monitored by experienced yoga teachers who have been trained to teach the programme.
Where is the study run from?
Northumbria University is the Sponsor for this study based in the United Kingdom. The Chief Investigator is based at Northumbria University, and the process evaluation will be lead from here. Northumbria University has delegated responsibilities for the day-to-day management of the study to York Trials Unit at the University of York.
Potential participants will be identified primarily via GP database screening at GP practices located close to where the yoga classes are due to be held. The yoga classes will typically be delivered in non-medical community-based facilities (e.g. yoga centre, community hall, leisure centre).
We plan to run classes in 12 parts of the UK, with one Scottish site, two Welsh sites, and nine English sites. The following CRN regions will be involved:
- NHS Research Scotland Primary Care Network
- Health and Care Research Wales
- NIHR CRN: Thames Valley and South Midlands
- NIHR CRN: East Midlands
- NIHR CRN: West Midlands
- NIHR CRN: Eastern
- NIHR CRN: Yorkshire and Humber
- NIHR CRN: North West Coast
- NIHR CRN: North Thames
When is the study starting and how long is it expected to run for?
August 2019 to August 2021
Who is funding the study?
National Institute for Health Research, Health Technology Assessment Programme, ref 17/94/36
Who is the main contact?
Dr. Garry Tew, garry.tew@northumbria.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Dr Garry Tew
ORCID ID
http://orcid.org/0000-0002-8610-0613
Contact details
Department of Sport
Exercise and Rehabilitation
Northumbria University
Northumberland Building
Northumberland Road
Newcastle-upon-Tyne
NE1 8ST
United Kingdom
0191 243 7556
garry.tew@northumbria.ac.uk
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
40392
Study information
Scientific title
Individually randomised controlled multi-centre trial to determine the clinical and cost effectiveness of an adapted yoga programme for older adults with multimorbidity, including an embedded process evaluation
Acronym
Study hypothesis
The Gentle Years Yoga programme plus usual care will improve the health-related quality of life of community-dwelling older adults with multimorbidity relative to usual care only
Ethics approval
Pending approval, North East - York Research Ethics Committee (NHSBT Newcastle Blood Donor Centre, Holland Drive, Newcastle upon Tyne, NE2 4NQ; nrescommittee.northeast-york@nhs.net; 0207 1048091), ref: 19/NE/0072
Study design
Interventional randomised controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Community
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Condition
Two or more chronic health conditions in people aged over 65 years
Intervention
After baseline assessment, participants will be randomly allocated to receive either usual care and the offer of a 12-week British Wheel of Yoga Gentle Years Yoga (GYY) programme or usual care alone. The GYY programme will involve weekly group-based, supervised yoga sessions and self-managed yoga practice on most days. Usual care will comprise unrestricted care from primary, secondary, community and social services. After randomisation, all participants will be followed-up for 12 months.
Details of the randomisation process: Participants will have indicated (in the screening questionnaire) their preference and availability for a particular course of Gentle Years Yoga. Once a sufficient number (ideally ≥20) of recruited participants have stated their availability for a particular class they will be randomised collectively using a bespoke randomisation database, which will be managed by York Trial Unit. Varying allocation ratios will be used to ensure that (no more than) 15 participants are allocated to the intervention group in any one randomisation wave. Ideally, 30 participants will be randomised 1:1 in each wave (15 to the intervention group, and 15 to control). Classes for which fewer than 30 participants express availability will have an allocation ratio favouring the intervention group; conversely, classes for which more than 30 participants express availability will have an allocation ratio favouring the control group.
Intervention type
Behavioural
Phase
Drug names
Primary outcome measure
Health-related quality of life as measured by the EQ-5D-5L utility score assessed at baseline, and 3, 6 and 12 months after randomisation, and the primary endpoint will be the overall difference over the 12 months.
Secondary outcome measures
1. Health-related quality of life measured using the EQ-5D-5L utility score at each of the individual time points (3, 6, and 12 months)
2. Depression measured using the PHQ-8 at 3, 6, 12 months and overall
3. Anxiety measured using the GAD-7 at 3, 6, 12 months and overall
4. Health-related quality of life measured using the PROMIS-29 at 3, 6, 12 months and overall
5. Loneliness measured using the UCLA 3-Item Loneliness Scale and a direct loneliness question from the English Longitudinal Study of Ageing at 3, 6, 12 months and overall
6. Incidence of falls over the 12 months of follow-up, assessed using a question on the number of falls experienced at 3, 6 and 12 months
7. Incidence of adverse events over the 12 months of follow-up
8. Healthcare resource use (including prescriptions) over the 12 months of follow-up, assessed via self-report questionnaire at 3, 6 and 12 months
Overall trial start date
01/01/2019
Overall trial end date
31/12/2022
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Aged 65 years and over (on date of invitation to participate)
2. Community-dwelling (including sheltered living with support),
3. Have two or more chronic conditions from the following list:
3.1 Arthritis: including osteoarthritis, rheumatoid arthritis, and history of shoulder, hip or knee arthroplasty for arthritis
3.2 Asthma or chronic obstructive pulmonary disease (COPD)
3.3 Atrial fibrillation
3.4 A diagnosis of cancer within the last 5 years
3.5 Cardiovascular disease: including coronary heart disease (includes angina or history of heart attack, bypass surgery or angioplasty), hypertension, heart failure, peripheral arterial disease
3.5 Chronic kidney disease
3.6 Dementia (only if capacity to provide written informed consent)
3.7 Depression or anxiety
3.8 Diabetes
3.9 Epilepsy
3.10 Fibromyalgia
3.11 Multiple sclerosis
3.12 Osteoporosis or osteopenia
3.13 Parkinson’s disease
3.14 Sensory conditions: including hearing loss, macular degeneration, glaucoma
3.15 Stroke
3.16 Bowel conditions: including IBS, diverticulitis, inflammatory bowel disease
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
Planned Sample Size: 586; UK Sample Size: 586
Participant exclusion criteria
1. Baseline questionnaire not returned
2. Inability to attend one of the yoga courses on offer
3. Performance of yoga in the previous 6 months (defined as twice per month or more)
4. Contraindication to participation (as identified by the patient’s GP)
5. Severe mental health problem (Schizophrenia, bipolar affective disorder or other psychotic illness)
6. Learning disability
7. Unable to read or speak English
8. Unable to provide written informed consent
9. Currently enrolled in another clinical trial where concurrent participation is deemed inappropriate
10. No more than one participant per household may take part
Recruitment start date
01/07/2019
Recruitment end date
01/07/2021
Locations
Countries of recruitment
United Kingdom
Trial participating centre
University of York
York Trials Unit
Heslington
York
YO10 5DD
United Kingdom
Sponsor information
Organisation
Northumbria University Newcastle
Sponsor details
Sutherland Building
Newcastle-upon-Tyne
NE1 8ST
United Kingdom
01912437108
samantha.king@northumbria.ac.uk
Sponsor type
University/education
Website
Funders
Funder type
Government
Funder name
Health Technology Assessment Programme
Alternative name(s)
NIHR Health Technology Assessment Programme, HTA
Funding Body Type
government organisation
Funding Body Subtype
Federal/National Government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
The research findings will be written up in journal publications and evidence briefings, and presented at various forums and conferences.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. When there is a request to use the GYY Trial data from external researchers this will be notified to the Trial Management Group and the Sponsor. The external request must include the provision of a pre-defined protocol that specifies what data are required and how it will be used and describe how the data will be securely stored. The external researchers should also sign a confidentiality agreement that will include: 1) the data are used only for the reasons specified in the request; 2) they will not share the data with any other third party not included in the request; 3) declare the intent to publish the findings in a relevant peer-reviewed journal; and 4) agree to notify the Chief Investigator of any pending publications so that both the GYY Trial Team are aware of this and the output can be notified to the NIHR. When the Trial Management Group agrees to an external request for data the approval for this will be confirmed with the NIHR Programme Manager. The release of any data will be provided in an anonymised format and securely transferred to the requester. Finally, external data requests will only be considered once the main results paper has been published.
Intention to publish date
31/12/2023
Participant level data
Available on request
Basic results (scientific)
Publication list