Objectives: to explore patients' experiences of an individualised yoga therapy intervention for rheumatoid arthritis (RA), specifically in terms of its acceptability and impact on patientreported outcomes.Design: Ten patients took part in a 16 week yoga therapy intervention in a hospital setting, consisting of 10 one-to-one consultations with a yoga therapist followed by two group review sessions. Changes in health (EQ-5D, HADS) were assessed pre-and post-intervention and at 12-month follow-up. In-depth interviews were conducted post-intervention and analysed using thematic analysis.Results: Attendance of the 1-to-1 sessions was high (98%) and all participants reported strong commitment to their personalised home practice. There were significant improvements in measures of depression, anxiety, pain, quality of life and general health at post-intervention and 12-months (p<0.05). In interviews, all but one participant reported positive changes to their symptoms and several reported reductions in their medication and broader benefits such as improved sleep, mood and energy, enabling re-engagement with life. The personally tailored nature of the practice and perceived benefits were key motivational factors. Particular value was placed on the therapeutic function of the consultation and provision of tools to manage stress and build resilience. Conclusion:This yoga therapy intervention was positively received by patients with RA, with high levels of adherence to both the treatments and tailored home practice. The findings suggest that yoga therapy has potential as an adjunct therapy to improve RA symptoms, increase self-care behaviours and manage stress and negative affect such as anxiety. A larger multi-centre study is therefore warranted.

Low levels of physical activity and high levels of sedentary behaviour London Borough of Ealing are primary drivers of high levels of preventable chronic conditions. In the last two decades, the government has invested heavily to increase PA levels. However, these initiatives have not reached target groups such as low income and ethnic minorities. Children from this group face number of social, environmental and cultural barriers to engaging in PA. The article presents a health improvement intervention plan to improve PA of children aged 8-12 years from ethnic minorities and lower SEC living in the London Borough of Ealing using Socioecological Theory.Theory-Based Solution: Let's Get Fit Ealing is underpinned in a socio-ecological approach focusing on multi-level factors that can provide a comprehensive solution to increased PA in ethnic minorities children from deprived parts of Ealing. It is a sixweek school-based intervention to influence children's behaviour to engage in national guidelines of daily 60 minutes of MVPA. Components are 30 minutes policy of MVPA during otherwise sedentary times in school hours such as recess.Discussion: Low SEC ethnic children who have limited access to PA facilities and environmental factors outside of school deters them from engaging in PA. Additionally, low SEC in London finds neighbourhood constraints as one barrier for children to engage in PA. However, the solution uses school and its after school component as a setting for the delivery of the health-promoting intervention for children as it has an advantage due to its universal attendance, a significant amount of time spent in school and access to PA facilities and PE staff. The additional component includes providing information to parents about national guidelines and health benefits about PA to support their children in the most common languages used in Ealing. Conclusions:The socio-ecological framework offers a comprehensive approach to increasing levels of PA in children from ethnic and low SEC backgrounds of Ealing because it addresses not only the individual characteristics but also social and environmental influences. With many inactive children residing in this borough and high levels of preventable chronic conditions such as childhood obesity, the solution presents an excellent opportunity to increase PA in children based on previous successful school-based research.

BackgroundRheumatoid Arthritis (RA) is associated with mood disorders and poor quality of life (QOL) Chorus et al., 2003 Yoga therapy (Y-T) has been used in several Long Term Conditions. Khalsa et al, 2016.ObjectivesThis study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 adult-onset RA patients, b) acceptability and experiences of the intervention.MethodsTen adult RA patients (Ages: 29–71 Y; RA duration: 1–15 years) consented to 10 individual Y-T sessions (weekly ×4; biweekly ×6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centred physical yoga postures, breathing and visualisation techniques, mantras and meditation, and Lifestyle/behavioural strategies. All participants completed measures to assess changes in health pre- and post-intervention (EQ-5D and HADS) and took part in a semi-structured interview in a mixed methods design. Thematic analysis was applied to interview data.Results98/100 sessions were attended by participants.Abstract AB1440HPR – Table 1Pre-Post 10 sessions Y-T metricsPre-Post Y-T Change:PREPOSTCHANGE Mean Depression6.702.30- 65%Mean Anxiety9.404.80- 48%Mean HAQ1.100.85*−23%Mean Pain Score (HAQ)5.662.40−58%Mean Health Score (HAQ)5.101.72−66.3%Mean health Utility (EQ-5D)6.018.40**+39.6%*8/10 HAQ reduced >0.35 =/>MID (minimal important difference);**6/10 participants achieved EQ5D maximum score=1Qualitative findings indicated that considerable value was placed on the therapeutic function of the consultation, of being listened to and receiving advice on concerns. Therapeutic mechanisms appeared to reflect tailored physical practices alongside psychosocial techniques which promoted psychological wellbeing and increased perceptions of control and self-efficacy. Several reported reductions in their medication and broader benefits such as improved sleep, mood and energy. All but one participant reported positive changes to their RA symptoms, including pain reduction, greater mobility and joint flexibility.ConclusionsThis novel pilot YT intervention was positively received by patients with RA, with high levels of adherence to both the course of treatments and the tailored home practice. The results suggest that yoga therapy has potential as an adjunct therapy to improve RA symptoms, increase self-care behaviours and address negative mood. Whilst promising, a larger multi-centre study is required to evaluate the therapeutic and cost-effectiveness of Y-T.References[1] Chorus AM, Miedema HS, Boonen A, Van Der Linden S. (2003). Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis. 62(12):1178–1184.[2] Khalsa, SB, Cohen, L, McCall, T & Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing.AcknowledgementsLNWH Trust Fund, CMH Rheumatology Patient Support Group,University of Westminster Department of Health Psychology.Disclosure of InterestV. Sadana Gra...

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Background:Psoriatic Arthritis and Psoriasis have a major impact on QOL with associated mood disorders and Cardiovascular disease and Cancer as inter-related co-morbidities1. Yoga therapy (Y-T) has been used in several Long Term Conditions2and we have reported Rapid improvement in Proms in RA (RCP 2018) and so compared results of a PsA cohort offered the same Y-T intervention.Objectives:This first in UK PsA study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 PsA patients, b) acceptability and experiences of the intervention. We present results in comparison to a previously reported RA cohort n=10.Methods:Ten adult PsA patients (2 M 8 F Age 32-67 Avg: 53.7 Y; PsA diagnosis: 6.45 yrs:1 Juvenile onset) consented to 10 individual Y-T sessions (weekly x 4; biweekly x 6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centered physical yoga postures, breathing and visualization techniques, mantras and meditation, with supportive Lifestyle/behavioural strategies. All participants completed measures pre- and post-intervention (EQ-5D HAQ HADS PGIC) to assess change in health status.Results:A 10 session course of Y-T over 16 weeks was completed with 92/100 PsA YT sessions. Note 1 patient had unrelated Trauma and withdrew after 2 sessions. This confirms acceptability of delivery in a clinic setting and all participants reported strong adherence to practices (0-1) and strong belief (0-2) in impact of yoga. (Likert 5 point 0-4 scale).Further data on only 9 PsA participants will be presented in comparison to the previous RA cohort of 10.PsA patients n=9: Pain reduced 25 % HADs Depression reduced 39% Anxiety reduced 25%HAQ health score improvement was significant at P<0.04 (ANOVA).EQol 5d(3L) improved 24% but overall QOL remained below 50% max calculated TTO.RA patients had recorded stable overall TTO at a higher level 0.63 pre and post Y-T.PGIC record of positive change is recorded as a reduction on VAS from 5/5 to 2.4/5.We will add 12 month FU data set in PsA to compare with 24 month data in the RA cohort.Conclusion:Yoga-Therapy is deliverable and acceptable in a NHS clinic setting for PsA. Improved PROMS begs further larger studies of mechanisms of bio-psychosocial intervention in long term inflammatory conditions. The outcomes support the Poly Vagal Theory3as an effector model, via the bio-mechanistic neuro-inflammatory reflex4.We propose further Health Economic analysis of this 2500 yr old Yoga model for long term conditions to examine any long term cost benefit to the NHS.References:[1]Coates LC et al Rheumatology 2018;57:1321-1331 Remission in psoriatic arthritis-where are we now?[2]Khalsa, SB, Cohen, L, McCall, T & Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing.[3]Sullivan M B Porges SW et alFront. Hum. Neurosci., 2018 Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience[4]Pavlov V Tracey K Nat Rev Endocrinol. 2012 Dec; 8(12): 743–754. The vagus nerve and the inflammatory reflex—linking immunity and metabolismTable 1.PsA vs RA post Yoga Therapy PROMs at 4 mth.PsA n=9 prePsA 4 mPsA 4 m %RA n=10 PreRA4m FURA 4m %HADS m Depression6.333.88-396.72.3- 65HADS m Anxiety8.566.44-259.44.8- 48Mean HAQ0.790.75- 20.780.48- 26M Pain Score (HAQ)6045.00-255724- 58M Health Score (HAQ)6042.7-29 p<0.045117.2- 66M H Utility TTO (EQol5d)0.410.5+240.630.630PGIC52.4Acknowledgments:CMH Rheumatology Support GroupDisclosure of Interests:C Bernard Colaco Grant/research support from: Travel Support for Conference attendance, Speakers bureau: Menarini, Vidhi Sadana: None declared, Kofi Anie: None declared