Effect of Yoga Training on Cardiovascular and Mental Health Parameters in Hypertensive Patients

Quality of life will be assessed using the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) (EUROQOL, 2025; VAN ROTTERDAM, HENSLEY, HAZELTON, 2021). This questionnaire was introduced by the EuroQol Group in 2009. This questionnaire assessed quality of life and health perception, consisting of a page with an objective questionnaire and another page with a visual analog scale. The objective questionnaire is divided into five aspects: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each aspect has five levels ranging from "no problem" (1) to "extreme problem" (5), thus, higher scores denote a worse quality of life. The scale allows participants to record their overall health perception on a vertical scale, from 0 (worst health) to 100 (best health) (BAGATTINI, 2015).

Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA) questionnaire, which comprises eight domains. The maximum score is 30 points, corresponding to the best cognitive ability (HOBSON, 2015).

Sleep quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI-BR) (BERTOLAZI et al., 2011; BUYSSE, 1989). It consists of a questionnaire composed of 19 self-administered questions, followed by five questions to be answered by the bed partner, if available. This questionnaire is composed of seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction (BERTOLAZI et al., 2011). Minimum: 0 points → excellent sleep and Maximum: 21 points → very poor sleep.

Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9) (APA, 2000; SANTOS et al., 2013), containing nine questions that assess the presence of symptoms of a major depressive episode, described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): depressed mood, anhedonia, problems with sleep, fatigue or lack of energy, changes in appetite or weight, feelings of guilt or worthlessness, trouble concentrating, feeling sluggish or restless, and suicidal thoughts (APA, 2000). The PHQ9 assesses the frequency of symptoms in the past two weeks, assessed on a scale with the possible responses of "none of the time," "several days," "more than half the days," and "almost every day" (SANTOS et al., 2013). Values can range from 0 to 27, with higher values indicating a greater presence of depressive symptoms.

Perceived stress will be assessed using the Perceived Stress Scale-10 (PSS-10) (SIQUEIRA REIS, FERREIRA HINO \& RODRIGUEZ AÑEZ, 2010). It is an instrument that assesses the level of stress perceived by the person in recent weeks, that is, how they interpret and feel life situations as stressful. There are 10 items, each with answers from 0 to 4 points. Minimum possible: 0 points → no perceived stress and Maximum possible: 40 points → very high perceived stress. Higher values = greater perception of stress

The Stroop Test will assess attention and inhibitory response capacity, calculating response time and accuracy. Better results are associated with shorter response times and fewer errors. By comparing congruent and incongruent conditions, cognitive interference and inhibitory control will be assessed (STROOP, 1935). Shorter reaction time and fewer errors → better cognitive performance and Longer reaction time and more errors → worse performance (may reflect attention difficulties, but not necessarily anxiety). There is no single universal minimum and maximum value.

The Short Form Health Survey - 36 items (SF-36) It is a questionnaire that measures health-related quality of life in a broad way, covering physical, emotional and social aspects. Assesses 8 domains: Functional capacity, Physical aspects, Pain, General health, Vitality, Social aspects, Emotional aspects and Mental health. The SF-36 has a scoring system in which higher values indicate better, not worse, quality of life. Score for each domain: ranges from 0 to 100 0 → worst possible state 100 → best possible state Summary scores (physical and mental components) are also typically converted to this 0-100 scale (Ware; Sherboune, 1992).

Hospital Anxiety and Depression Scale (HAD) is an instrument used to assess symptoms of anxiety and depression in patients. HAD-A → Anxiety Subscale (7 items) and HAD-D → Depression Subscale (7 items). Each item is scored from 0 to 3. Subscale score: Minimum: 0 points (no symptoms) and Maximum: 21 points (very severe symptoms). Higher values indicate more symptoms of anxiety or depression, depending on the subscale.