Nurses are instrumental in the battle against lifestyle-related diseases, yet nurses may not be participating in their own health-promoting self-care. This study used qualitative content analysis of survey responses to explore nurses' perceptions regarding barriers and facilitators to health-promoting behaviors such as exercise, healthy eating, and participation in stress reduction activities. Seven themes emerged: lack of time/overwork, lack of resources/facilities, fatigue, outside commitments, “unhealthy” food culture, supportive versus unsupportive individuals, and positive versus negative role models. Institutional, interpersonal, and intrapersonal changes are needed to adequately address barriers to nurses' participation in health-promoting behaviors.

Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week "floating" in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians and CAM practitioners. Casey Health is incorporating clinical outcomes into their electronic medical record that can be used internally to assess comparable effectiveness and cost effectiveness of the different treatment modalities such as yoga therapy, providing evidence that eventually may lead to yoga therapy becoming an accepted treatment that is eligible for insurance reimbursement.

Yoga therapy may improve a variety of symptoms and health conditions, but little is known about how yoga therapy is being delivered in the real world. The purpose of this study was to describe the delivery of yoga therapy by yoga instructors across the U.S. In this cross-sectional survey, certified instructors were recruited from the Iyengar Yoga National Association, United States (IYNAUS) (n = 966) via an email that contained a link to an anonymous online survey that collected information on demographics, their delivery of yoga therapy, and the health conditions and symptoms seen and records kept by the instructors. A total of 487 instructors (50.4%) completed the survey. Instructors ranged from 28 to 82 years in age (m = 56.4 + 10.1 years) and had been teaching for 17.0 + 10.0 years. The majority (n = 384, 81.4%) reported teaching some form of therapeutic yoga either in groups (n = 261, 55%) and/or privately (n = 340, 73.4%). All instructors (100%) reported modifying poses in their regular yoga classes for students because of health conditions or symptoms. Other than attendance, the majority (n = 255, 57.3%) reported keeping no records on their sessions. Students came to instructors for help with over 54 health conditions, most commonly musculoskeletal conditions and injuries (n = 267, 62.8%), followed by pregnancy (n = 56, 13.2%) and hypertension (n = 22, 5.2%). Nearly all (n = 373, 85.6%) reported pain to be the symptom that brought students to yoga therapy most frequently. Whereas yoga in randomized controlled trials typically is delivered to individuals in large, homogenous groups, the instructors reported that most yoga therapy is being provided individually or in small, general therapeutic classes that include a variety of health conditions. Research is needed to examine the effectiveness of yoga therapy under such conditions. A clear set of guidelines for assessing and documenting the effectiveness of yoga therapy using standardized, valid, and reliable methods is needed, particularly for pain-related conditions.

Yoga therapy may improve a variety of symptoms and health conditions, but little is known about how yoga therapy is being delivered in the real world. The purpose of this study was to describe the delivery of yoga therapy by yoga instructors across the U.S. In this cross-sectional survey, certified instructors were recruited from the Iyengar Yoga National Association, United States (IYNAUS) (n = 966) via an email that contained a link to an anonymous online survey that collected information on demographics, their delivery of yoga therapy, and the health conditions and symptoms seen and records kept by the instructors. A total of 487 instructors (50.4%) completed the surve y. Instructors ranged from 28 to 82 years in age (m = 56.4 ± 10.1 years) and had been teaching for 17.0 ± 10.0 years. The majority (n = 384, 81.4%) reported teaching some form of therapeutic yoga either in groups (n = 261, 55%) and/or privately (n = 340, 73.4%). All instructors (100%) reported modifying poses in their regular yoga classes for students because of health conditions or symptoms. Other than attendance, the majority (n = 255, 57.3%) reported keeping no records on their sessions. Students came to instructors for help with over 54 health conditions, most commonly musculoskeletal conditions and injuries (n = 267, 62.8%), followed by pregnancy (n = 56, 13.2%) and hypertension (n = 22, 5.2%). Nearly all (n = 373, 85.6%) reported pain to be the symptom that brought students to yoga therapy most frequently. Whereas yoga in randomized controlled trials typically is delivered to individuals in large, homogenous groups, the instructors reported that most yoga therapy is being provided individually or in small, general therapeutic classes that include a variety of health conditions. Research is needed to examine the effectiveness of yoga therapy under such conditions. A clear set of guidelines for assessing and documenting the effectiveness of yoga therapy using standardized, valid, and reliable methods is needed, particularly for pain-related conditions.

Yoga therapists are interested in knowing whether their therapeutic interventions are helpful in improving health and wellbeing in their yoga therapy clients. However, few yoga therapists use standardized, reliable, and valid questionnaires to determine the therapeutic effectiveness of their treatments. Patient-reported outcome (PRO) measures are paper or web-based questionnaires used to assess an individual's perceptions of their symptoms and/or quality of life. In 2004, the National Institutes of Health (NIH) launched the PROMIS initiative to standardize and simplify the collection of PROs in research and in clinical practice. The PROMIS initiative launched a multicenter cooperative group that collected and reviewed thousands of PROs, then extensively tested them in over 20,000 research participants. The result was a web-based collection of item banks of the best questions or "items" within three domains of interest: physical, mental, and social health. These item banks are housed in the Assessment Center, a free online resource for collecting PROs. Incorporating PROMIS outcomes into yoga therapy streamlines and optimizes the collection of PROs by enabling access to reliable and valid questionnaires that are easy to read, simple to complete, and are available in multiple languages as well as in both adult and pediatric versions. The use of standardized PROs may improve yoga therapy implementation in healthcare and accelerate translation of clinical research by allowing yoga therapists to conduct indepth symptom assessments using tools that allow for comparisons to other therapeutic clinical and research interventions. The purpose of this paper is to summarize the development of the NIH PROMIS initiative and to provide suggestions for incorporating PRO collection into yoga therapy. Important considerations to consider when implementing PROs into yoga therapy are discussed, including the choice of questionnaires and method of delivery (paper or web-based), frequency of PRO administration, interpretation and management of PRO results, and the management of problematic issues that arise.