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Gender Differences in Motivations and Perceived Effects of Mind-Body Therapy Practice Among Acute Coronary Syndrome Patients: Why DO Women Use Mbt?

Gender Differences in Motivations and Perceived Effects of Mind-Body Therapy Practice Among Acute Coronary Syndrome Patients: Why DO Women Use Mbt?
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  See discussions, stats, and author profiles for this publication at: Gender differences in motivations andperceived effects of Mind-Body Therapy (MBT)practice and views on integrative...  Article   in  Complementary therapies in medicine · January 2009 DOI: 10.1016/j.ctim.2008.04.009 · Source: PubMed CITATIONS 7 READS 52 4 authors , including:Yvonne W LeungUniversity Health Network 29   PUBLICATIONS   345   CITATIONS   SEE PROFILE Sherry L GraceYork University 256   PUBLICATIONS   4,408   CITATIONS   SEE PROFILE All content following this page was uploaded by Yvonne W Leung on 10 January 2017. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the srcinal documentand are linked to publications on ResearchGate, letting you access and read them immediately.  Genderdifferences in motivations and perceivedeffectsofMind-BodyTherapy  MBT practice and views on integrativecardiacrehabilitation among acutecoronary syndrome patients: Why do women use MBT? Yvonne W. Leunga   Keerat  rew l a Donna E. Stewartb C Sherry L. Gracea b c a KinesiologyandHealthScience York University 222BBethuneCollege 4700KeeleStreet Toronto ON M3J1P3 Canada b University of HealthNetwork Canada C University of Toronto Canada Summary Background: Overone-third of cardiacpatientspracticeMind-BodyTherapy  MBT , particularlywomen.Consideringwomenare less likely to engageinconventionalphysicalactivity,fewstudieshaveexaminedwhy MBT iswell-acceptedbywomen. Objectives: To qualitativelyexploregenderdifferencesinthemotivationsfor, and perceivedeffects of MBT, and theinter-relationshipsamongalternative and conventionalphysicalactivities and secondarypreventionprograms. Methods: ArandomsUbsample of 16 participants  8 female)whoreportedpracticing MBT inalargerstudy of 661 cardiacpatients was interviewed until themesaturation was achieved.AUdiotapesweretranscribed and coded basedon interpretive-descriptivetechniquewithinNvivo-7software. An audit trail and secondcoderwereutilized to ensurethetransparency and validity of results. After mainthemesemerged,thedataweresplitbygender to identify differences for eachtheme. Results: Fivethemesemerged:(1)promotespositivewell-being,(2)physicalhealthbenefits,(3)intrinsic and extrinsicmotivations,(4)proactivehealthorientation, and (5) MBT as apreferredcomplementary and/or alternativephysicalactivity. Men moreoftenexpressedpreference for MBT forincreasedpositivemood and cardiac-specificbenefits,whereaswomenemphasizedstressreduction,increasingself-efficacy, and physicalactivity, and wereeager to seeMBT offeredincardiacrehabilitation  CR . Conclusions: Bothmale and femaleusersperceivedsubstantialpsychosocial and physicalbenefits of MBT practice. MBT addresses some of women scommonbarriers to CR. * Correspondingauthor.Tel.:  1 416736 2100x20575; fax:  1 4167365774.  Y.W. Leung .  Introduction Mind-BodyTherapies  MBTs aredefined as  techniquesdesignedtoenhancethemind scapacitytoaffectbodilyfunction and symptoms .1Therearetwomaintypes of MBT: relaxationtechniqueswhichincludemeditation and deepbreathing, and somatictechniques(Le.,exercisewithrelaxation) such as Yoga and TaiChL2 Empiricalevidence suggests thatsomaticforms of MBT inparticular may ease theburden of cardiovascular diseaseby improvingphysiologicalfunction and reducingemotionaldistress. 3- 5 MBTs have been commonlypracticed by bothhealthy and patientpopulations,particularlywomen. 6-9 Apreviousstudyreportedthat 36 of cardiacpatients used complementary and alternativemedicine, among which 17 used MBTs.lo Epidemiologicevidence shows increased MBT participation among patientpopulations,includingcardiacpatients, 8 11-13 however,thesestudies do notexplainthemotivationsthesecardiacpatientsheldortheperceivedeffectsassociated with MBT use. Ourpreviousworkexaminedtheprevalence and correlates of MBT practice among 465 acutecoronarysyndrome  ACS patients.? Results showed that one-third of participantsself-reported using MBTs. Adjustedanalysesrevealed that femaleswhoare less likely to participateincardiacrehabilitation  CR 14,15 weremorelikely to use MBTs. The currentstudy was undertaken to investigate: (1) genderdifferencesinthemotivations and perceivedeffects of MBT practice among ACS patients, and (2) theinter-relationship among alternative and conventionalphysicalactivities and cardiovascularsecondaryprevention. Methods Participants Thiscurrentqualitativestudy was conductedwithinalargerprospective study. Ethicsapproval was obtainedfromallparticipatinginstitutions.Asample of 661 ACS in-patients was recruitedfrom3hospitalsinOntario.Asurvey was mailed to participants 18 monthspost-discharge and included ques tionsregarding MBT practice. As outlinedinaprevious paper,? 165  34 ) ACS patientsself-reported using MBTs intheirlifetime, and overhalfreported using morethan one type of MBT. Using arandomnumbertable,a subsample of 60 current and former MBT users werecontactedwitha letter and aconsentformrequestingtheirparticipationin an in-depthpersonalinterview.Twenty-one  9 females)patientsagreedtoparticipate;however,only 16 interviewswereconducted.Interviewscontinueduntildatageneratedfailedtonotablycontributetotheemergentcategories and themes.Interviewswereconductedconsecutively,withthegender of theparticipantalternatedwherepossible. Procedure The researcherconductedsemi-structuredtelephoneinterviewswithparticipants,lastingapproximately 45 min. The open-endedquestionsweredesignedwithafocus on perceivedbenefits,motivations for practice,opinions on conventionalhealthcare, and theincorporation of MBTs into CR programs.Interviewswereaudio-taped and transcribedverbatim. Data wereimportedinto NVivo 7softwareforcoding. 16 Data transcription and analysiswereconcurrentwithdatacollection,whichfacilitatedgeneration of newquestionsforsubsequentparticipants, and thereforeinterview ques tionswererevised and re-evaluated as datacollectionprogressedy,16Forinstance,additionalquestionsand/orprobeswereintroduced to interviewswhen issues of importance arose inpreviousinterviews.Additionally, ques tionsnotunderstood by respondentswerereworded, and questions that didnotgeneraterelevant discussion wereeliminatedforlaterinterviews. Analysis The interviewtranscriptswereanalyzed basedon theinterpretive-descriptivemethod 18  19 toenablethedevelopment of generalthemes. Main themes of thecollecteddataemergedfromaconstantcomparativemethod of dataanalysis. 2o Aftermainthemeswereidentified, each theme was reviewed by gendertoinvestigatedifferences.Afterinterviews and analyses werecompleted,thefirst andsecond authors  Y.L. and K.G.)re-examined and dis cussed thedatabycodeuntil consensus was reached. To ensuretheobjectivity and validity of theresults, an audittrail was used, incorporatingthetechniques of memoing and overall checks of therepresentativeness of thecodingandcategories.   Results Sixteenpatientswhopracticed MBTs 8 females)wereinterviewed. Table 1 displaysthedescriptivecharacteristics of participants. Females weregenerallyolder, and had alowerfamilyincome and educationlevelthan males. Throughqualitativeanalysis of transcripts,fivethemeswereidentified: (1) MBTs promotepositivewell-being, (2) physicalhealthbenefits,  3 intrinsic and extrinsicmotivations, (4) proactivehealthorientation, and (5) MBT as apreferredcomplementaryand/oralternativephysicalactivity. Each maintheme is outlinedbelow. Theme 1: promotespositivewell-being Respondents felt that practicing MBTs resultedinpositive mood and promotedpositiveself-image. For instance,manypatientsmentionedthey  feel good after MBT practice. Subthemes identified by participantsincludedpromotinga sense of belonging,improvedself-image and personalcontroloveremotions,increasedself-efficacy, stress reduction and relaxation, and quietingone smind. 197 M: In thelongrun, it [MBT practice] givesyou amorepositivelookin life. It gives you morerelaxedstate .... Malesdiscussed that MBTs increasedpositive moodand self-image,whilefemalesmentioned MBTs ledtoincreasedself-efficacy.Moreover,onlyfemalesmentionedthat MBTs ledtoincreasedproductivity and sense of achievement.  1197 F: I am sort of proud of thefactthatI am doing these things, go to yoga, go to Curves, practice my little exercise at home.Nota lot of women do these, none of my acquaintancesdoaround my age. They don t doany thingabout it [healthcondition], so Isort of feelsmarterthatIdo. Stress reductionandrelaxationAlmostallrespondentsstatedthat MBT was used as atoolforreducingstress,negativeemotions and anxiety. Femalesexpressed thattheyexperienced stress and anxietywhere males tendedtoreport using MBT as aself-regulatingtoolwhichhelpedcontrolanger and keptoneselfcalmer. 516 F: Itriedto be as relaxed as Ican.But when I run intoasituationthat is morestressful,I will tryto focus on my deepbreathexerciseto try tocalmmyself down and thenI can do moreotherexercise. Theme2:physicalhealthbenefits This themeincludedparticipantdescriptionsaboutperceivedphysical and cognitivebenefitsfromtheir MBT practiceincludingmusclerelaxation,decreased muscle and joint pain,improvedbloodcirculation,weight loss, increasedstamina and exercisecapacity, and improvedsleep,thoughtclarity,abilitytoconcentrate and othercardiac-specificbenefits.Withregardtothelatter, many respondentsreportedthat MBT was aself-regulatingtooltocontrolcardiacsymptoms such as shortness of breath, angina pain, and rapidheartrate. Several respondentsviewed MBT as atooltohelpthembecomestronger so thattheycouldparticipate and enjoyotherphysicalactivities. In terms of genderdifferences,femalesreportedthat MBTs helped decrease joint and musclepain andsore ness, weight loss, and improvedcirculation. Wheremales reportedcardiac-specificbenefits, such as ability to control and enhanced awareness of theircardiacsymptoms. 1235 M: Iplaygolf and what have you.Itend to push myselfa little further and gettootired and thenI have an anginaattack, and that is whenI have to do it [MBT] ... I am not going to spend therest of my life sitting in theemergency roomand I have tofindsomethingtohelpthat and this [MBT]is what came about. Many females expressed that MBTs ledtoincreasedstaminato engage inexercise and otherphysicalactivities.Theyperceived MBT as alow-impactactivitywhich made themphysicallystronger.Therefore,they felt more com fortabletryingotherphysicalactivities such as walking and lightweighttraining. 157 F: It [MBT]is away of making you feel goodand keep yourstamina up ... it helps me exercisemore because it keepsyou morelimber and you arenot sorewhen youdo exercise, when you are not sore,you attemptto do a little bit more. Theme3:intrinsicandextrinsicmotivation Thisthemeincorporated sources of intrinsicmotivationtowardpracticing MBTs includingpersonalinterest, posi tiveexpectation, andneed forself-care,self-motivation and self-discipline, and need forlow-impactactivity. For instance, many respondentslearnedthat MBTs were good  fortheelderly and health, and mentionedpersonalinterest, such that they felt themovementswerebeautiful and enjoyable. Both men and womenexpressedtheneedtoparticipateinalow-impactphysicalactivityduetotheirphysicalcomorbidities such as arthritis,shortness of breath on exertion, andweakness inthe kneesand legs. 331 M: AllI cansay is whenI do it [MBT],  t does help. It strengthens my resolve by doing it .... I have 3 massive heartattacks and I didn t evenknowI had them.IthoughtI had indigestion .... My doctor was surprised that Icouldsurviveany of them.That is whenIthoughtthatmeditationmust have helped.That is whyIkeepdoingthemeditation. Some patientsmentionedthat MBTs wereself-taughtfromreadingsorself-discovery.Interestingly,amajority of femalesexpressedinterestinlearningotherforms of MBT. 817 M: Igot some TaiChi tapesfromthe Mississauga library and I havebeen reading books about Tai Chiand martialarts.Ifoundoutabout Tai Chi whichisslowmoving and smoothmotion and Ifound that is betterforseniors to do. ExtrinsicmotivationExtrinsicmotivatorsarticulatedincludedsupportsfromfam ily and friends as well as physicians. The majority of respondents expressed thattheirfamily and friendswereverysupportiveabouttheir MBT use. However,femalesdidnotmentionsupportfromtheirfamily and friends as didtheirmalecounterparts. 128 M: My wife is veryencouragingto try toget me to do as muchexercise as Icould. She likes me todomore. Many malestoldtheirphysicianabouttheir MBT practice, and their physiciansencouragedthem. 157 M: Ididtell my cardiologist and familydoctorabout it, especially my familydoctorwhoencouraged me to do a lotof walking, hesaid   youdo that you areableto do a little bit more.They said  t was excellent. Theme4:proactivehealthorientation MBT practice was oftenregarded as part of respondents overallproactivehealthorientationformanagingtheirheartproblems.Thistheme was interwovenwithpersonalitytraits such as inclinationto engage inconventionalexercise,beinghealthconscious,thedesiretokeephealthy and active, pos itiveattitudestowardsthehealthcaretheyreceived, and informingtheirphysiciansabouttheir MBT practice. The majority of respondentsconcurrently engaged inconventionalforms of exercise and regardedexercise as an importantpart of theirlifestyle, even thoughhalf of theserespondentsdidnotattend CR programs.They engaged innotonly MBTs but also commonexercise such as golfing and swimming.Afewrespondentsraisedtheneed for aroutine,creatingchallenge, and pushingthemselves. 365 F: Istill do walking,linedancing,swimming and gardeninginthe summer,and Ihelplooking after my grandchildren. Theme 5:MBT as apreferredcomplementaryand/oralternativephysical activity Thisthemefocused on logistical issuessuch as greater access, lowercost and fewerbarriersto MBT practicethanconventionalexercise.Almostallrespondents expressed thattherewerefewhealthbarrierstopracticing MBTs because of theirsimple,non-strenuous, and they fit flexiblywithinone sschedule.Moreover, MBTs could be performedsociallyorprivately. Respondents whopracticedsomatic MBTs foundtheywerecomparabletootherconventionalexercisesinterms of exerciseintensity and relaxingquality. 765 F: The mostbeneficialthing is that  t doesn tcostanything. You can do  t when you arelying down and relaxing. In terms of genderdifferences,females saw MBT as agreatexercisealternative.First,femaleswere pleased aboutthelowcosttoparticipatein MBTs. Second, theyfoundthat MBTs werealow-impact and non-strenuous phys icalactivity.Third,theyexpressedthattherewere no healthbarriersorsideeffectsto MBT practice.Finally,theyreportedthat MBT practice was enjoyablewhichinvolvedsocialinteractionswithothers.Offering MBTs mayincrease interest in cardiacrehabilitation This subthemeincludedreferences to integrating MBTs intoconventionaltreatment and secondaryprevention such as CR programs. Respondents perceivedthatagreaternumber of cardiacpatientsshould be exposedto MBTs. Mostrespon dentsagreedthatintroducing MBTs into CR programswouldincreaseinterest of cardiacpatients. Females wantedto seeMBT incorporatedintoconventional CR programs. 1197 F: Yes, Iwouldprobablydomorethan myshare [if MBT was introducedto CR]. Ithink it [CR]was a 4 monthprogram that wedid, and Iwould have lovedto do another4months. Discussion Thisstudy was designedtoqualitativelyexplorethemotivations and perceivedeffects of MBT practice among male and female ACS patients, and toexaminegenderdifferencesintheseperceptions.Essentially,ourfindings show thatbothfemale and malerespondentsperceivedsubstantial phys ical and psychosocialbenefitsfrom MBT practice,citingimprovementsinanginasymptoms,breathing,relaxation and positivemood,whichconsequentlyfosteragreater sense of controlduringrecovery.While some respondents used MBT as amechanism to reducenegativeemotions,manyweremotivatedtodiscover ways to improvetheirheartcondition by keepingthemselves fit and beingactive. Psychosocialeffects of MBT practice Confirmingpreviousresearch,ourfindingsrevealthatrespondents used MBT as away to increasetheirselfefficacy.Similarly, an epidemiologicalstudy shows thatbreastcancerpatients used MBTs to improvequality of life,
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