Paper Title
Efficacy of Controlled Diaphragmatic Breathing Exercise on Mental Health of Family Caregivers of Post Stroke Patients

Abstract
Families are often the primary source of home care and support. It is therefore essential to ensure that they are in best of their health while carrying out their responsibilities. Clinical observation and early empirical research showed that assuming a caregiving role are stressful and burdensome. Mental health issues such as depression, anxiety, lack of sleep is highly likely to be expected in them. Stroke is a very common cause of adult disability often leaving stroke survivors dependent on others. Much of this support comes from informal carers. Among stroke caregivers, mental health and social functioning have repeatedly been found to be the most severely compromised health-related quality of life domains. Past researches indicates that caring for a stroke survivors, especially the ones with disabling condition, places an undue strain on caregivers. Studies have found earlier that exercise has both physical and psychological effects. However, the heterogeneous nature of the exercise intervention trials makes determining the appropriate program variables (frequency, intensity, duration and type of exercise) difficult. Most studies explored the benefit of aerobic exercise in depression and anxiety and included running, brisk walking, treadmill or stationary bicycle. Also most of these aerobic activities might not be possible to be carried out in home by all and difficult to be supervised. Diaphragmatic breathing have been shown to have a relaxing and stabilizing effect on the autonomic nervous system. So, its role in mental health as a physical therapy intervention is an area that needs to be further explored. Several studies indicate that breath controls used in various combinations could have beneficial effects on mental health and well-being of an individual. Whether they really play a significant positive role in regulating mental health or are more placebo in nature is something that needs to be seen. The Objective of the study was to find out the efficacy of controlled diaphragmatic breathing exercise as a simple and easy to practice mean in addressing the mental health issues of family caregivers of post stroke patients who probably suffers from and are susceptible to develop more advance mental health complications. A total of 200 subjects were recruited based on inclusion and exclusion criteria from family members serving as caregivers to post stroke patients residing in Kolkata and undergoing rehabilitation upon due recommendations. They were allotted in two groups (100 each) alternately. The intervention group underwent a supervised controlled diaphragmatic breathing exercise program at thrice a week for eight weeks. The control group has undergone baseline measurements and were allowed to carry on their normal life without any recommendations. At the end of 8 weeks outcome measures were further evaluated for every subject and analyzed statistically. Outcome measures included Karolinska Sleepiness Scale for sleep, Beck Depression inventory for depression, Beck Anxiety inventory for anxiety, Positive and negative affect schedule (PANAS) to measure both positive and negative affect. Abbreviated Profile of mood state (POMS) to assess the mood. The intervention group showed significant difference (p<0.01) in the outcomemeasures in comparison to their baseline values whereas there were no significant differences in the outcome measures of control group in comparison to baseline. This study shows that controlled diaphragmatic breathing has significant positive and beneficial effects on the mental health of family caregivers of post stroke patients. Keywords - Family Caregiver, Mental Health, Breathing Exercise, Stroke Survivors