Laugh Out Loud Hemodialysis (LOL-HD): Improving the Dialysis Experience at Satellite Healthcare
Laughing as a group while you are on dialysis sounds a little strange. How can you pretend to laugh? How can you laugh when you have pain, are tired and stuck to a machine for 4 hours? Maybe we want to turn the question around and ask ourselves “Why not laugh?”
Dialysis staff will say to me “we have a laugh at work and we try to make the patients happy” and patients say to me “the staff are very friendly and some of them are very funny”. This is brilliant and reflects a great center culture. In saying that Laugh Out Loud Hemodialysis (LOL-HD) takes this even further.
LOL-HD is based on Laughter Yoga, which combines deep breathing, stretching exercises, and laughter exercises. LOL-HD is intentional group laughter led by laughter therapists. The sessions go for approximately 30 minutes while patients are sitting undergoing hemodialysis. Trained laughter therapists lead staff and patients through about 12 to 15 exercises that encourages intentional laughter. Describing it in text is pretty much impossible so if you want to know what this looks like click on this link https://www.youtube.com/watch?v=BcpWHXqiqQQ
We all feel better when we laugh—but there is also science behind laughter. Let’s start with the most obvious benefit: an improvement in mood. Laughter can increase the production of the happy hormones “dopamine, endorphin, oxytocin and serotonin” resulting in decreased long term heart rate and blood pressure all the way to a euphoric state. This improved mood and decreased anxiety has even been demonstrated in dialysis.1
Furthermore, increases in endorphin has resulted in improvement in pain threshold. We also know this from studies in childbirth where mothers can deal with incredible pain levels because of increased endorphin production. Therefore, people who laugh more can decrease their chronic pain levels2 which is highly important in a country like the US where 60% of all dialysis patients have at least one opioid prescription for pain per year.3
There are breathing and lung benefits. Nature has provided us with muscles of breathing in (inhalation via the diaphragm & intercostal muscles), but there are no muscles of breathing out (exhalation) which is passive. Our lungs are elastic organs and they expand with deep inhalation. Exhalation on the other hand takes place by the elastic recoil of the lungs, which brings them to the normal resting position. Therefore, to force exhale the respiratory reserve (and clear the lungs), we need to use the abdominal muscles to squeeze out the residual air from the lungs. Laughter encourages people to exhale double the amount of air than they inhale. This is where laughter exercises really help, as it is a great way of expelling the expiratory reserve air from the lungs. Prolonged laughter is like forced exhalation and as we now can help remove lung secretions.4 Most of us have laughed and coughed – this is what laughing does. Therefore, we ask people to laugh as long as possible.
Science also tells us that laughter can improve blood vessel and heart function through increased heart volume output5, decreased blood vessel stiffness6, lower rates of heart attack7 and improved blood lipid and cholesterol profiles.8
Really interestingly, when we laugh for long periods of time, we can increase our immune response by increasing the production of what we call “Natural Killer” cells.9 These natural killer cells are like in-body surveyors who continually roam around our bodies looking for invading bacteria, abnormal viral cells and tumor cells.
What does this have to do with home dialysis? Let’s just start with the point that the most success has been seen with group laughter, such as a dialysis center. In saying that, we can feel isolated at home with many people unaware of the challenges we face in doing home dialysis. That is why it is even more important to look after ourselves, which includes as much laughter as possible. For those wanting to know more, simply google “Laughter Club” or “Laughter Yoga” in your area. Laughter clubs are everywhere in the world and they can change our way of thinking about laughter as a therapeutic tool.
LOL-HD is a full laughter workout, both physically and mentally!
1. Bennett PN, Parsons T, Ben-Moshe Rea. Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study. . BMC complementary and alternative medicine. 2015;15(1):176.↩
2. Dunbar RIM, Baron R, Frangou A, et al. Social laughter is correlated with an elevated pain threshold. Proceedings of the Royal Society B: Biological Sciences. 2012;279(1731):1161-1167.↩
3. Kimmel PL, Fwu C-W, Abbott KC, Eggers AW, Kline PP, Eggers PW. Opioid prescription, morbidity, and mortality in United States dialysis patients. Journal of the American Society of Nephrology. 2017;28(12):3658-3670.↩
4. Leibovitz Z. Humour and dialysis. EDTNA ERCA J. 1998;24(4):17-18.↩
5. Boone T, Hansen S, Erlandson A. Cardiovascular responses to laughter: a pilot project. Applied Nursing Research. 2000;13(4):204-208.↩
6. Xaplanteris P, Vlachopoulos C, Baou K, et al. Divergent effects of laughter and mental stress on aortic stiffness and wave reflections. Paper presented at: EUROPEAN HEART JOURNAL2007.↩
7. Berk LS, Tan SA, Berk D. Cortisol and Catecholamine stress hormone decrease is associated with the behavior of perceptual anticipation of mirthful laughter. In: Federation of American Societies for Experimental Biology; 2008.↩
8. Sharma V. Beneficial effect of laughter yoga and clapping exercise in coronary heart disease (CHD) patients in south Delhi metro population. Atherosclerosis. 2018;275.↩
9. Bennett M, Zeller J, Rosenberg L, McCann J. The effect of mirthful laughter on stress and natural killer cell activity. Alternative therapies in health and medicine. 2003;9(2):38-45.↩