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Abstract

This report summarizes the current evidence on the effects of yoga interventions on various components of mental and physical health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the current literature. Nevertheless, there are some meta-analyses which indicate beneficial effects of yoga interventions, and there are several randomized clinical trials (RCT's) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health. Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2012, Article ID 165410, 7pages
doi:10.1155/2012/165410
Review Article
Effects of Yoga on Mental and Physical Health:
A Short Summary of Reviews
Arndt B ¨
ussing,1Andreas Michalsen,2Sat Bir S. Khalsa,3
Shirley Telles,4and Karen J. Sherman5
1Department Quality of Life, Spirituality and Coping, Center of Integrative Medicine, Faculty of Health,
Witten/Herdecke University, 58313 Herdecke, Germany
2Department of Internal and Complementary Medicine, Immanuel Hospital Berlin and Institute of Social Medicine,
Epidemiology & Health Economics, Charit´
e-University Medical Center, 14109 Berlin, Germany
3Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
4Director of Research, Patanjali Research Foundation, Haridwar 249405, India
5Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA
Correspondence should be addressed to Arndt B¨
ussing, arndt.buessing@uni-wh.de
Received 4 May 2012; Revised 4 July 2012; Accepted 18 July 2012
Academic Editor: Vernon A. Barnes
Copyright © 2012 Arndt B ¨
ussing et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This report summarizes the current evidence on the eects of yoga interventions on various components of mental and physical
health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga
may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity
among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the
current literature. Nevertheless, there are some meta-analyses which indicate beneficial eects of yoga interventions, and there are
several randomized clinical trials (RCT’s) of relatively high quality indicating beneficial eects of yoga for pain-associated disability
and mental health. Yoga may well be eective as a supportive adjunct to mitigate some medical conditions, but not yet a proven
stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control
interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct
treatment that is relatively cost-eective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long
behavioural skill, enhances self-ecacy and self-confidence and is often associated with additional positive side eects.
1. Introduction
The conceptual background of yoga has its origins in ancient
Indian philosophy. There are numerous modern schools
or types of yoga (i.e., Iyengar, Viniyoga, Sivananda, etc.),
each having its own distinct emphasis regarding the relative
content of physical postures and exercises (asanas), breathing
techniques (pranayama), deep relaxation, and meditation
practices that cultivate awareness and ultimately more pro-
found states of consciousness. The application of yoga as a
therapeutic intervention, which began early in the twentieth
century, takes advantage of the various psychophysiolog-
ical benefits of the component practices. The physical
exercises (asanas) may increase patient’s physical flexibility,
coordination, and strength, while the breathing practices
and meditation may calm and focus the mind to develop
greater awareness and diminish anxiety [1], and thus result
in higher quality of life. Other beneficial eects might involve
a reduction of distress, blood pressure, and improvements in
resilience, mood, and metabolic regulation [2].
Khalsa stated that a majority of the research on yoga as
a therapeutic intervention was conducted in India and a sig-
nificant fraction of these were published in Indian journals,
some of which are dicult to acquire for Western clinicians
and researchers [3]. In their bibliometric analysis from 2004,
they found that 48% of the enrolled studies were uncon-
trolled, while 40% were randomized clinical trials (RCT),
and 12% non-RCT (N-RCT). Main categories which were
2 Evidence-Based Complementary and Alternative Medicine
addressed were psychiatric, cardiovascular, and respiratory
disorders [3].
Despite a growing body of clinical research studies and
some systematic reviews on the therapeutic eects of yoga,
there is still a lack of solid evidence regarding its clinical rele-
vance for many symptoms and medical conditions. For many
specific indications and conditions, there is inconsistent
evidence with several studies reporting positive eects of
the yoga interventions, but other studies are less conclusive.
In some instances, these discrepancies may result from dif-
ferences between the study populations (e.g., age, gender,
and health status), the details of the yoga interventions, and
follow-up rates.
In this paper, we summarize the current evidence on the
clinical eects of yoga interventions on various components
of mental and physical health. In general, the respective
reviews (Tab le 1) and an Agency for Healthcare Research
and Quality Report (AHRQ) evidence report on “Meditation
Practices for Health,” which cites also studies on yoga [30],
include a heterogeneous set of studies with varying eect
sizes, heterogeneous diagnoses and outcome variables, often
limited methodological quality, small sample sizes, varying
control interventions, dierent yoga styles, and strongly
divergent duration of interventions.
2.YogaandMentalHealth
2.1. Depression. We found four relevant publications, includ-
ing two reviews on the eects of yoga on depression [4,5],
a description of studies on yogic breathing [6] for depres-
sion, and one “summary” [8]. The reviewing authors have
reported that the studies reviewed showed a large variety of
diagnoses ranging from “major depression or some other
type of diagnosed depression” to “elevated depressive symp-
toms” [5]. Although several randomized controlled trials
(RCTs) reported beneficial eects of yoga interventions for
treating depressive symptoms, the quality and quantity of
the data from these studies appear insucient to conclude
whether there is substantial clinical justification to consider
yoga as a treatment of depression. Compared to passive con-
trols, the yoga interventions seem to be eective; when com-
pared with active controls, not surprisingly, the eects are less
conclusive [5].Thestudyresultsaresofarnotsucient in
quantity and quality to determine whether studies with a
focus on the asanas are more eective as compared to stud-
ies with meditation-focussed or pranayama-focussed styles.
Thus, there is a strong need to conduct more conclusive
studies with high methodological quality and larger patient
samples. Whether motivation of depressed patients could be
a problem or not remains to be clarified. There has been an
attempt to explore mechanisms of action and to understand
the complete picture of the eects of yoga in depression look-
ing at electrophysiological markers of attention, and neu-
rotransmitters which were found to change with yoga [7,31].
2.2. Fatigue. We found one systematic review/meta-analysis
evaluating the eects of yoga on fatigue in a variety of med-
ical conditions. The review included 19 RCTs and included
Tab le 1: Systematic reviews for the dierent domains discussed.
Indications Studies on yoga interventions
Depression
2 reviews [4,5],
1 description of studies on
yogic breathing [6,7],
1 summary [8]
Fatigue 1 systematic review [9]
Anxiety and anxiety disorders
1systematicreview[1],
1 Cochrane review on
meditation therapy [10],
1 description of studies on
yogic breathing [6,7],
1 summary [8]
Stress 1systematicreview[11]
Posttraumatic stress disorder 1 review article [12]
Physical fitness 1 critical review [13]
Sympathetic/parasympathetic
activation 1systematicreview[14]
Cardiovascular endurance 1 review [15]
Blood pressure and hypertension 1 systematic review [14]
Pulmonary function 1 review [15]
Glucose regulation 3systematicreviews
[14,16,17]
Menopausal symptoms 1review[18],
1systematicreview[19]
Musculoskeletal functioning
and pain
3 systematic reviews [2022],
2 reviews [23,24]
Cancer 2 reviews [25,26],
2 meta-analyses [27,28]
Epilepsy 1 Cochrane review [29]
healthy persons as well as patients with cancer, multiple
sclerosis, dialysis, chronic pancreatitis, fibromyalgia, and
asthma [9]. Overall, a small positive eect with an SMD
of 0.28 [0.24–0.33] was found. This standardized mean
dierence (SMD) describes the dierence in the group mean
values divided by the respective standard deviation; a value
between 0.3 and 0.5 can be regarded as small, SMD between
0.5 and 0.8 as moderate, and SMD >0.8 as large. For those
studies that included cancer patients (n=10), the treatment
eect of yoga was 0.20 (0.15–0.24); for all other studies that
did not include cancer patients (n=9), the eect was
0.46 (0.24–0.67) [9]. Nevertheless, there are some studies on
cancer-related fatigue which indicate that treatment eects of
yoga could be improved in well-designed future studies.
2.3. Anxiety and Anxiety Disorders. There is one systematic
review examining the eects of yoga on anxiety and anxiety
disorders [1], a Cochrane review on meditation therapy for
anxiety disorders [10] (citing one yoga study [32]), a descrip-
tion of studies on yogic breathing (which are also addressed
in the systematic review) [6], and one summary [8].
Most studies described beneficial eects in favour of the
yoga interventions, particularly when compared with passive
controls (i.e., examination anxiety), but also compared with
active controls such as relaxation response or compared
Evidence-Based Complementary and Alternative Medicine 3
to standard drugs. However, there are currently no meta-
analyses available which would clearly dierentiate this
important issue. At least the AHRQ report stated that “yoga
was no better than Mindfulness-based Stress Reduction at
reducing anxiety in patients with cardiovascular diseases”
[30].
2.4. Stress. One systematic review describes the eects of
yoga on stress-associated symptoms. Chong et al. identified 8
controlled trials, 4 of which were randomized, which fulfilled
their selection criteria [11]. Most studies described beneficial
eects of yoga interventions. Although not all studies used
adequate and/or consistent instruments to measure stress,
they nevertheless indicate that yoga may reduce perceived
stress as eective as other active control interventions such
as relaxation, cognitive behavioural therapy, or dance.
Also the AHRQ report stated that “yoga helped reduce
stress” [30]. Here, the two included studies showed a signi-
ficant reduction of stress scores in favour of the yoga group
(SMD =1.10 [CI: 1.61 to 0.58].
Posttraumatic Stress Disorder. A single review article looked
at the existing research on yoga for posttraumatic stress
disorder (PTSD) [12]. Seven articles were reviewed which
included 8 studies on PTSD following exposure to natural
disasters such as a tsunami and a hurricane (1 RCT, 1 N-
RCT, 3 group study, 2 single-arm studies, 1 cross-sectional
study) and 2 studies on PTSD due to combat and terrorism
(1 RCT, 1 single-arm study). After a natural disaster, yoga
practice was reported to significantly reduce symptoms of
PTSD, self-rated symptoms of stress (fear, anxiety, disturbed
sleep, and sadness) and respiration rate. Similarly, yoga
interventions were able to improve the symptoms of PTSD in
persons with PTSD after exposure to combat and terrorism.
The interventions varied in duration from one week (when
interventions were given on the site) to six months. The
review suggested a possible role of yoga in managing PTSD,
though long-term studies conducted with greater rigor are
needed [12].
3.YogaandPhysicalFitness
3.1. Physical Fitness. Therewasonecriticalreviewwhich
evaluated whether yoga can engender fitness in older adults
[13]. Ten studies with 544 participants (mean age 69.9±6.3)
were included; 5 of these studies were RCTs, and 5 studies had
a single-arm pre/post-design. With respect to physical fitness
and function, the studies reported moderate eect sizes for
gait, balance, body flexibility, body strength, and weight loss
[13]. However, there is still a need for additional research
trials with adequate control interventions (active and spe-
cific) to verify these promising findings.
One may expect that retaining physical fitness and
improving physical functioning can have a positive eect on
functional abilities and self-autonomy in older adults. Fur-
ther studies should address whether or not individuals’ self-
esteem and self-confidence will increase during the courses,
and whether or not regular classes may also improve social
competence and involvement. A problem with studies
enrolling elderly subjects can be compliance with the study
protocol leading to low levels of study completion and long-
term follow-up data. Future studies should investigate the
most appropriate duration of yoga intervention and the most
suitable postures and yoga style for the elderly.
3.2. Sympathetic/Parasympathetic Activation. There were 42
studies on the yoga eects on sympathetic/parasympathetic
activation and cardiovagal function [14], that is, 9 RCTs, 16
non-RCTs, 15 uncontrolled trials, and 2 cross-sectional trials.
Most studies oered“someevidencethatyogapromotesa
reduction in sympathetic activation, enhancement of cardio-
vagal function, and a shift in autonomic nervous system bal-
ance from primarily sympathetic to parasympathetic” [14].
However, some of the studies included in the review showed
less clear-cut or even contrasting, eects. Because most of
these eects are short-term phenomena, more rigorous work
is needed.
Another lacuna is that there are very few studies which
have studied plasma catecholamine levels and most of them
are early studies [33,34].
3.3. Cardiovascular Endurance. Raub’s literature review, which
included 7 controlled studies, reported “significant improve-
ments in overall cardiovascular endurance of young subjects
who were given varying periods of yoga training (months
to years)” [15]. Outcome measures included oxygen con-
sumption, work output, anaerobic threshold, and blood
lactate during exercise testing. As expected, physical fitness
increased in adolescents or young adults (athletes and
untrained individuals) compared to other forms of exercise,
withalongerdurationofyogapracticeresultedinbetter
cardiopulmonary endurance.
4. Yoga and Cardiopulmonary Conditions
4.1. Blood Pressure and Hypertension. Innesetal.reportedon
37 studies investigating the eects of yoga on blood pressure
and hypertension, among them 12 RCTs, 12 nonrandomized
clinical trials, 11 uncontrolled studies, 1 cross-sectional
study, and 1 single yoga session examination. Most reported
a reduction of systolic and/or diastolic pressure. However,
there were several noted potential biases in the studies
reviewed (i.e., confounding by lifestyle or other factors) and
limitations in several of the studies which makes it “dicult
to detect an eect specific to yoga” [14].
Ospina et al.s AHRQ cites two studies which found
small, insignificant improvements of systolic (weighted mean
dierence =8.10; 95% CI, 16.94 to 0.74) and diastolic
blood pressure (weighted mean dierence =6.09; 95% CI,
16.83 to 4.64) in favour of yoga when compared to no
treatment [30]. When compared to health education, yoga
interventions resulted only in small and insignificant
improvements of systolic blood pressure (weighted mean
dierence =15.32; 95% CI, 38.77 to 8.14) and diastolic
blood pressure (weighted mean dierence =11.35; 95% CI,
30.17 to 7.47) [30].
4 Evidence-Based Complementary and Alternative Medicine
4.2. Pulmonary Function. In his descriptive literature review,
Raub also examined studies evaluating yoga’s eects on lung
function in healthy volunteers and patients with chronic
bronchitis and asthma [15]. In healthy volunteers practicing
yoga, there are reported improvements of various parameters
of lung function with breathing control techniques, specific
postures, and/or relaxation techniques [15]. However, these
improvements were “not consistent and depended upon
the length of yoga training, the type of yoga practice used
(e.g., breathing exercises and yoga postures), and the type
of subject” [15]. Raub also cited some studies on patients
with asthma describing improvements in peak expiratory
flow rate, medication use and asthma attack frequency. In a
double-blinded RCT with placebo-control, [35] there were
only a few small and insignificant improvements in lung
function variables. Thus, more rigorous trials are needed to
clarify the value of yoga breathing practices for patients with
asthma.
5. Yoga and Metabolic/Endocrine Conditions
5.1. Glucose Regulation. Three systematic reviews examined
the eects of yoga on risk indices associated with insulin
resistance syndrome [14], risk profiles in adults with type
2 diabetes mellitus [16], and the management of type 2
diabetes mellitus [17]. Innes et al. [14] identified several
studies on the eects of yoga on insulin resistance syndrome-
associated variables, that is, 2 RCTs, 2 non-RCTs, and 8
uncontrolled clinical trials. These studies reported postinter-
vention improvement in various indices in adults. However,
the results varied by population (healthy adults, adults at
cardiovascular disease risk, adults with type 2 diabetes, etc.)
and study design.
Another systematic review by Aljasir et al. [17] addressed
the management of type 2 diabetes mellitus and concluded
that the reviewed trials “suggest favourable eects of yoga on
short-term parameters related to diabetes but not necessarily
for the long-term outcomes.” However, the duration of
treatment in the reviewed studies was variable (ranging from
20 min. session per day to three to five 90min. sessions in
the review of Aljasir et al. [17];3-4hperdayfor8days,2
sessions per day (25–35 min) for 3 months to 40min per day
for 6 months, and 72 4 h sessions during 12 months in the
review by Innes and Vincent [16]).
The AHRQ cites two studies comparing yoga versus
medication which reported a large and significant reduction
of fasting glucose in individuals with type 2 diabetes in one
study, and a smaller but still significant improvement in the
other study [30]. The authors discussed dierences in the
study populations, and interventions as possible explanation
for the observed heterogeneity of results.
5.2. Menopausal Symptoms. A single review addressed
menopausal symptoms and analyzed 3 RCT, 1 N-RCT, and 3
uncontrolled clinical trials [18]. Although some studies
reported beneficial eects, “the evidence was insucient to
suggest that yoga is an eective intervention for menopause”
[18].
A recent systematic review included 5 RCTs, which
addressed eects of yoga on menopausal symptoms, partic-
ularly psychological symptoms, somatic symptoms, vasomo-
tor symptoms, and/or urogenital symptoms [19]. However,
yoga was associated with small eects on psychological
symptoms (SMD =0.37; 95% CI 0.67 to 0.07; P=
0.02), but no eects on “total menopausal symptoms, soma-
tic symptoms, vasomotor symptoms, or urogenital symp-
toms” [19].
6. Yoga and Musculoskeletal Conditions
6.1. Musculoskeletal Functioning and Pain. There were 3 sys-
tematic reviews [2022] and 2 other reviews on the eects of
yoga on musculoskeletal function, chronic pain conditions,
and pain-associated disability [23,24]. Two reviews specifi-
cally addressed low back pain [22,24] or arthritis [23], while
the other reviews summarized studies on various chronic
pain conditions, most with a focus on musculoskeletal
conditions and associated disability.
Posadzki et al. [21] included 11 RCTs with variable
methodological quality and found that 10 of 11 studies
reported significantly greater eects in favor of yoga when
compared to “standard care, self care, therapeutic exercises,
relaxing yoga, touch and manipulation, or no intervention.
A recent meta-analysis on pain intensity/frequency, and
pain-related disability included 5 RCTs with single blinding,
7 RCTs without blinding, and 4 non-RCTs [20]. Reviewed
studies included yoga for the treatment of back pain (6
studies), rheumatoid arthritis (2 studies), headache/migraine
(2 studies), and other indications (i.e., hemodialysis, irritable
bowel syndrome, labor pain, etc.). All of these studies
reported positive eects in favor of the yoga interventions.
There were moderate treatment eects with respect to 5 pain
(SMD =0.74 [CI: 0.97 to 0.52], P<0.0001), and pain-
related disability (SMD =0.79 [CI: 1.02 to 0.56], P<
0.0001). Despite some study limitations, there was evidence
that yoga may be useful for several pain-associated disorders.
Thus, well-designed larger scale studies with adequate con-
trols for confounding factors and more thorough statistical
analyses are needed to verify these promising findings.
With respect to chronic back pain, the studies indicate
that yoga was more eective than the control interventions
(including usual care or conventional therapeutic exercises),
albeit some studies showed no between group dierence
[22]. Two recent and properly powered trials of yoga for back
pain were published and reported clinically meaningful ben-
efits for yoga over usual medical care from 6- to 12-months
postrandomization [36,37], but not over an intensive
stretching intervention [36].
7. Yoga and Specific Diseases
7.1. Cancer. With respect to cancer, there are 2 reviews
[25,26] and 2 meta-analyses (one with 10 studies [27], and
one “letter to the editor” with 6 studies [28]). According to
the findings of the more comprehensive meta-analysis of Lin
et al., the yoga groups showed improvements in psycholog-
ical health when compared to waitlist or supportive therapy
Evidence-Based Complementary and Alternative Medicine 5
groups, that is, anxiety (8 studies: SMD =0.76 [1.34 to
0.19], P=0.009), depression (8 studies: SMD =0.95
[1.55 to 0.36], P=0.002), distress (2 studies: SMD =
0.4 [0.67 to 0.14], P=0.003), and stress (5 studies;
SMD =0.95 [1.63 to 0.27], P<0.006) [27]. With
respect to overall quality of life, there was just a trend towards
improvement (SMD =0.29 [0.58 to 0.001], P=0.06).
To explain the positive outcomes, Smith and Pukall suggested
that complex pathways which may involve relaxation, coping
strategies, acceptance, and self-ecacy [26]. Although Lin
et al. stated that the “findings are preliminary and limited
and should be confirmed through higher-quality, random-
ized controlled trials,” they nevertheless attested “potential
benefit of yoga for people with cancer in improvements of
psychological health” [27]. However, the outcome parame-
ters described in these cancer reviews were also addressed in
the symptom-specific reviews described above.
7.2. Epilepsy. To assess the potential eects of yoga in the
treatment of epilepsy, 1 Cochrane review analyzed 1 RCT and
1 N-RCT [29]. However, the authors were not able to draw
“reliable conclusions” whether yoga may be eective or not.
8. Discussion
These reviews suggest a number of areas where yoga may be
beneficial, but more research is required for virtually all of
them to more definitively establish benefits. However, this
is not surprising given that research studies on yoga as a
therapeutic intervention have been conducted only over the
past 4 decades and are relatively few in number. Typically,
individual studies on yoga for various conditions are small,
poor-quality trials with multiple instances for bias. In addi-
tion, there is substantial heterogeneity in the populations
studied, yoga interventions, duration and frequency of yoga
practice, comparison groups, and outcome measures for
many conditions (e.g., depression and pain). Disentangling
the eects of this heterogeneity to better understand the value
of yoga interventions under various circumstances is chal-
lenging. For many conditions, heterogeneity and poor qual-
ity of the original trials indicated that meta-analyses could
not be appropriately conducted. Nevertheless, some RCTs
of better quality found beneficial eects of yoga on mental
health (see Uebelacker et al.s critical review [5]). Further
investigations in this area are recommended, particularly
because of the plausibility of the underlying psychophysio-
logical rationale (including the ecacy of frequent physical
exercises, deep breathing practices, mental and physical
relaxation, healthy diet, etc.).
While it is not surprising that physical fitness can be
improved by training, using either yoga or conventional
exercises, it is of interest that in individuals with pain yoga
may have beneficial eects with overall moderate eects sizes.
However, these eects were strong particularly in healthy
individuals, but much weaker in patients with chronic pain
conditions. The beneficial eects might be explained by an
increased physical flexibility, by calming and focusing the
mind to develop greater awareness and diminish anxiety,
reduction of distress, improvement of mood, and so forth.
Because patients may recognize that they are able to be
physically active, even despite of persisting pain symptoms,
they may therefore experience higher self-competence and
self-awareness, which contributes to higher quality of life.
Conceivably, asanas particularly have a positive eect on
fitness and physical flexibility with a secondary eect on
the mental state, while the pranayama practices and relax-
ation/meditation techniques may result in greater awareness,
less stress, and higher well-being and quality of life. However,
this remains to be shown in well-performed future studies.
Because patients are engaged in the yoga practices as
a self-care behavioural treatment, yoga interventions might
well increase self-confidence and self-ecacy. On the other
hand, patients with psychological burdens and/or low moti-
vation (i.e., depression, anxiety, fatigue, etc.) might be less
willing to participate fully in intensive yoga interventions.
Some of these studies found relatively low participation and
high dropout rates in some of the analysed studies. Patient
compliance may be higher with the social support within
group interventions, while private regular practices at home
mightbemoredicult to perform consistently. These
factors need to be addressed in further studies. Innes et al.
[14] argued that most studies were from India where “yoga
is an integral part of a longstanding cultural and spiritual
tradition.” It is thus unclear whether adherence in Western
patients might be the same. Many of the Indian clinical trials,
which have been conducted in residential settings, not typ-
ically found outside India, include yoga class interventions
5 to 7 days per week, whereas such compliance would not
be possible with patient populations outside India. However,
such practices are unlikely to be continued, at least at such
intensity. If as believed by some yoga practitioners, the inten-
sity of the practice should be greater at the beginning of ther-
apy, such programs would be an excellent way to begin yoga
treatment. In India, there is a gradual shift in the attitude
towards yoga with most urban Indians under the age of 35
believing yoga is a way to keep fit rather than attaching the
same cultural importance to it, which earlier generations did.
For these reasons, cross-cultural studies (which are lacking)
using an identical intervention given to a population in India
and parallel conducted elsewhere would be very useful.
Motivation might be a crucial point. To overcome this,
shorter time interventions might be an option for some
specific indications (i.e., pain and depressive symptoms),
while the cardiovascular and fitness eects might require
long-term practices. In fact, some pain studies suggest that
short-term interventions might be more eective than longer
durations of practice [20]. This would indicate a putative
lack of motivation to be physically active. Indeed, a couple
of reviews noted that data on subject treatment compliance
was not routinely reported in most studies [4,30].
Clearly yoga intervention programs require an active
participation of the individuals as do all behavioral inter-
ventions, and thus adherence might be a crucial point that
limits potentially beneficial eectsofyoga.Itisapparentin
many life style diseases, that patients must change attitudes
and behaviour in order to successfully treat these diseases. A
positive feature of yoga interventions is that they may in fact
6 Evidence-Based Complementary and Alternative Medicine
Tab le 2: Level of action and observed eects of yoga interventions.
Specific eects Unspecific eects
Cognition Contemplative states; Mindfulness; Self-identity;
Self-ecacy; Beliefs; Expectations Control of attentional networks
Emotions Emotional control/regulation Quality of Life
Physiology Vaga l aerent activity; Heart rate/Respiratory; Relaxation
response/Stress reduction Social contacts
Physical body Physical flexibility, Fitness/Endurance Healthy life style
Specific and unspecific eects are often interconnected.
be very supportive for the execution and maintenance of such
lifestyle changes due to the experience of well-being from the
practices which can support regular practice, and from the
changes in mind/body awareness that occur over time with
continued yoga practice, which will in turn support a desire
to adopt and maintain healthy behaviours.
Thus, further studies should identify which patients may
benefit from the interventions, and which aspects of the yoga
interventions (i.e., physical activity and/or meditation and
subsequent life style modification) or which specific yoga
styles were more eective than others. Larger-scale and more
rigorous research is highly encouraged because yoga may
have potential to be implemented as a safe and beneficial
supportive/adjunct treatment that is relatively cost-eective,
may be practiced at least in part as a self-care behavioral
treatment, provides a life-long behavioural skill, enhances
self-ecacy and self-confidence, and is often associated with
additional positive side eects (Tabl e 2).
The degree to which yoga interventions are curative
treatments remains to be determined; currently it is safe to
suggest that yoga can be a beneficial supportive add-on or
adjunct treatment. Jayasinghe stated that one may “conclude
that yoga can be beneficial in the primary and secondary pre-
vention of cardiovascular disease and that it can play a pri-
mary or a complementary role in this regard” [38]. Because
of yoga’s low risk for side eects, when selecting appropriate
postures for the population, and potential for actual positive
side eects, it might be a promising candidate particularly
for cardiac rehabilitation, depending on the patients’ abilities
and willingness to adopt yoga practices with regularity. How-
ever, the meditative and self-reflective (cognitive) aspects
of yoga could be problematic especially for patients with
psychotic or personality disorders. Nevertheless, there is cur-
rently insucient data on contraindications or side eects
related to yoga practices in patients with psychological dis-
orders.
Taken together, while several reviews suggest positive
benefits of yoga, various methodological limitations (includ-
ing small sample sizes, heterogeneity of controls and inter-
ventions) limit the generalizability of these promising study
findings. It is quite likely that yoga may help to improve
patient self-ecacy, self-competence, physical fitness, and
group support, and may well be eective as a supportive
adjunct to mitigate medical conditions, but not yet as a
proven stand-alone, curative treatment. Confirmatory stud-
ies with higher methodological quality and adequate control
interventions are needed.
References
[1]G.Kirkwood,H.Rampes,V.Turey, J. Richardson, and K.
Pilkington, “Yoga for anxiety: a systematic review of the
research evidence,British Journal of Sports Medicine, vol. 39,
no. 12, pp. 884–891, 2005.
[2] K. Yang, “A review of yoga programs for four leading risk
factors of chronic diseases,Evidence-Based Complementary
and Alternative Medicine, vol. 4, no. 4, pp. 487–491, 2007.
[3] S. B. S. Khalsa, “Yoga as a therapeutic intervention: a biblio-
metric analysis of published research studies,Indian Journal
of Physiology and Pharmacology, vol. 48, no. 3, pp. 269–285,
2004.
[4] K. Pilkington, G. Kirkwood, H. Rampes, and J. Richardson,
“Yoga for depression: the research evidence,Journal of Aec-
tive Disorders, vol. 89, no. 1-3, pp. 13–24, 2005.
[5] L. A. Uebelacker, G. Epstein-Lubow, B. A. Gaudiano, G.
Tremont, C. L. Battle, and I. W. Miller, “Hatha yoga for
depression: critical review of the evidence for ecacy, plausi-
ble mechanisms of action, and directions for future research,
Journal of Psychiatric Practice, vol. 16, no. 1, pp. 22–33, 2010.
[6] R. P. Brown and P. L. Gerbarg, “Sudarshan Kriya Yogic breath-
ing in the treatment of stress, anxiety, and depression: part
II—clinical applications and guidelines,Journal of Alternative
and Complementary Medicine, vol. 11, no. 4, pp. 711–717,
2005.
[7] R.P.BrownandP.L.Gerbarg,“SudarshanKriyayogicbreath-
ing in the treatment of stress, anxiety, and depression: part
I—neurophysiologic model,Journal of Alternative and Com-
plementary Medicine, vol. 11, no. 1, pp. 189–201, 2005.
[8] S. A. Saeed, D. J. Antonacci, and R. M. Bloch, “Exercise,
yoga, and meditation for depressive and anxiety disorders,
American Family Physician, vol. 81, no. 8, pp. 981–987, 2010.
[9] K.Boehm,T.Ostermann,S.Milazzo,andA.B
¨
ussing, “Eects
of yoga interventions on fatigue: a meta-analysis,” in press.
[10] T. Krisanaprakornkit, W. Krisanaprakornkit, N. Piyavhat-
kul, and M. Laopaiboon, “Meditation therapy for anxiety
disorders,Cochrane Database of Systematic Reviews,Article
ID CD004998, 2006.
[11] C. S. Chong, M. Tsunaka, H. W. Tsang, E. P. Chan, and W.
M. Cheung, “Eects of yoga on stress management in healthy
adults: a systematic review,Alternative Therapies in Health
and Medicine, vol. 17, no. 1, pp. 32–38, 2011.
[12] S. Telles, N. Singh, and A. Balkrishna, “Managing mental
health disorders resulting from trauma through yoga: a
review,” Depression Research and Treatment, vol. 2012, Article
ID 401513, 9 pages, 2012.
[13] K. P. Roland, J. M. Jakobi, and G. R. Jones, “Does yoga engen-
der fitness in older adults? A critical review,JournalofAging
and Physical Activity, vol. 19, no. 1, pp. 62–79, 2011.
Evidence-Based Complementary and Alternative Medicine 7
[14] K. E. Innes, C. Bourguignon, and A. G. Taylor, “Risk indices
associated with the insulin resistance syndrome, cardiovascu-
lar disease, and possible protection with yoga: a systematic
review,” Journal of the American Board of Family Practice, vol.
18, no. 6, pp. 491–519, 2005.
[15] J. A. Raub, “Psychophysiologic eects of Hatha Yoga on
musculoskeletal and cardiopulmonary function: a literature
review,” Journal of Alternative and Complementary Medicine,
vol. 8, no. 6, pp. 797–812, 2002.
[16] K. E. Innes and H. K. Vincent, “The influence of yoga-based
programs on risk profiles in adults with type 2 diabetes melli-
tus: a systematic review,Evidence-Based Complementary and
Alternative Medicine, vol. 4, no. 4, pp. 469–486, 2007.
[17] B. Aljasir, M. Bryson, and B. Al-Shehri, “Yoga practice for the
management of type II diabetes mellitus in adults: a system-
atic review,Evidence-Based Complementary and Alternative
Medicine, vol. 7, no. 4, pp. 399–408, 2010.
[18] M. S. Lee, J. I. Kim, J. Y. Ha, K. Boddy, and E. Ernst, “Yoga for
menopausal symptoms: a systematic review,Menopause, vol.
16, no. 3, pp. 602–608, 2009.
[19] H. Cramer, R. Lauche, J. Langhorst, and G. Dobos, “Eective-
ness of yoga for menopausal symptoms - a systematic review
and meta-analysis of randomized controlled trials,Evidence-
Based Complementary and Alternative Medicine. In press.
[20] A. B¨
ussing, T. Ostermann, R. L¨
udtke, and A. Michalsen,
“Eects of yoga interventions on pain and pain-associated dis-
ability: a meta-analysis,” JournalofPain, vol. 13, no. 1, pp. 1–9,
2012.
[21] P. Posadzki, E. Ernst, R. Terry, and M. S. Lee, “Is yoga eective
for pain? A systematic review of randomized clinical trials,
Complementary Therapies in Medicine, vol. 19, no. 5, pp. 281–
287, 2011.
[22] P. Posadzki and E. Ernst, “Yoga for low back pain: a systematic
review of randomized clinical trials,Clinical Rheumatology,
vol. 30, no. 9, pp. 1257–1262, 2011.
[23] S. Haaz and S. J. Bartlett, “Yoga for arthritis: a scoping review,
Rheumatic Disease Clinics of North America,vol.37,no.1,pp.
33–46, 2011.
[24] Z. Kelly, “Is yoga an eective treatment for low back pain: a
research review,International Journal of Yoga Therapy, vol. 19,
pp. 103–112, 2009.
[25] J.E.Bower,A.Woolery,B.Sternlieb,andD.Garet,“Yogafor
cancer patients and survivors,Cancer Control, vol. 12, no. 3,
pp. 165–171, 2005.
[26] K. B. Smith and C. F. Pukall, “An evidence-based review of
yoga as a complementary intervention for patients with can-
cer,Psycho-Oncology, vol. 18, no. 5, pp. 465–475, 2009.
[27] J. Y. Tsauo, K. Y. Lin, Y. T. Hu, K. J. Chang, and H. F. Lin,
“Eects of yoga on psychological health, quality of life, and
physical health of patients with cancer: a meta-analysis,
Evidence-Based Complementary and Alternative Medicine, vol.
2011, Article ID 659876, 12 pages, 2011.
[28] H. Cramer, S. Lange, P. Klose, A. Paul, and G. Dobos, “Can
yoga improve fatigue in breast cancer patients? A systematic
review,” Acta Oncologica, vol. 51, no. 4, pp. 559–560, 2011.
[29] S. Ramaratnam and K. Sridharan, “Yoga for epilepsy,
Cochrane Database of Systematic Reviews,ArticleID
CD001524, 2000.
[30] M. B. Ospina, K. Bond, M. Karkhaneh et al., “Meditation
practices for health: state of the research,Evidence Report/
Technology Assessment, no. 155, 2007.
[31] P. J. Murthy, B. N. Gangadhar, N. Janakiramaiah, and D. K.
Subbakrishna, “Normalization of P300 amplitude following
treatment in dysthymia,Biological Psychiatry,vol.42,no.8,
pp. 740–743, 1997.
[32] D. S. Shannaho-Khalsa, L. E. Ray, S. Levine, C. C. Gallen, B.
J. Schwartz, and J. J. Sidorowich, “Randomized controlled trial
of yogic meditation techniques for patients with obsessive-
compulsive disorder,CNS Spectrums, vol. 4, no. 12, pp. 34–47,
1999.
[33] R. Lang, K. Dehof, K. A. Meurer, and W. Kaufmann, “Sympa-
thetic activity and transcendental meditation,Journal of
Neural Transmission, vol. 44, no. 1-2, pp. 117–135, 1979.
[34] K. N. Udupa, R. H. Singh, and R. M. Settiwar, “A comparative
study on the eect of some individual yogic practices in nor-
mal persons,Indian Journal of Medical Research, vol. 63, no.
8, pp. 1066–1071, 1975.
[35] V. Singh, A. Wisniewski, J. Britton, and A. Tattersfield, “Eect
of yoga breathing exercises (pranayama) on airway reactivity
in subjects with asthma,Lancet, vol. 335, no. 8702, pp. 1381–
1383, 1990.
[36] K. J. Sherman, D. C. Cherkin, R. D. Wellman et al., “A
randomized trial comparing yoga, stretching, and a self-care
book for chronic low back pain,Archives of Internal Medicine,
vol. 171, no. 22, pp. 2019–2026, 2011.
[37] H. E. Tilbrook, H. Cox, C. E. Hewitt et al., “Yoga for chronic
low back pain: a randomized trial,Annals of Internal Medi-
cine, vol. 155, no. 9, pp. 569–578, 2011.
[38] S. R. Jayasinghe, “Yoga in cardiac health (a review),European
Journal of Cardiovascular Prevention and Rehabilitation, vol.
11, no. 5, pp. 369–375, 2004.
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... The scale consists of 11 items which were scored as either 1 (the answer was "yes") or 0 (the answers were "no", "unclear", or "not applicable"). The studies were classified, using the total rating score (item 1 not scored), as having excellent (9-10), good (6)(7)(8), fair (4)(5), or poor (<4) quality [13]. In addition, to reduce the risk of bias in the assessment, two researchers (ZX and ZW) scored the quality of the included articles independently. ...
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Mind–body exercise has been proposed to confer both physical and mental health benefits. However, there is no clear consensus on the neural mechanisms underlying the improvements in health. Herein, we conducted a systematic review to reveal which brain region or network is regulated by mind–body exercise. PubMed, Web of Science, PsycINFO, SPORTDiscus, and China National Knowledge Infrastructure databases were systematically searched to identify cross-sectional and intervention studies using magnetic resonance imaging (MRI) to explore the effect of mind–body exercise on brain structure and function, from their inception to June 2020. The risk of bias for cross-sectional studies was assessed using the Joanna Briggs Institute (JBI) checklist, whereas that of interventional studies was analyzed using the Physiotherapy Evidence Database (PEDro) scale. A total of 15 studies met the inclusion criteria. Our analysis revealed that mind–body exercise modulated brain structure, brain neural activity, and functional connectivity, mainly in the prefrontal cortex, hippocampus/medial temporal lobe, lateral temporal lobe, insula, and the cingulate cortex, as well as the cognitive control and default mode networks, which might underlie the beneficial effects of such exercises on health. However, due to the heterogeneity of included studies, more randomized controlled trials with rigorous designs, similar measured outcomes, and whole-brain analyses are warranted.
... As evident by the results from EORTC-H&N-35, GHQ-12, and PSS, yoga intervention fails to cause improvement in the psychological distress among patients. However, previous studies highlighted that the general health had been improved [43,44] and stress levels had been decreased upon yoga intervention [45]. Besides stress, the anxiety level was found to be decreased significantly after yoga intervention in the present study which is consistent with the previous studies [1]. ...
... Besides stress, the anxiety level was found to be decreased significantly after yoga intervention in the present study which is consistent with the previous studies [1]. Moreover, overall mental wellbeing was also found to be enhanced after yoga intervention in the present study which is also consistent with previous yoga trials [43,32]. Blood pressure and pulse rate did not differ significantly when measured before and after the yoga session in the present study. ...
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Background Being a holistic approach, yoga is getting popular in the clinical scenario as alternate or integrative medicine. Aims: In the present work, we proposed that yoga could synergize the conventional treatment of oral cancer by reducing psychological distress, thus improving patients' quality of life. Methods Being a pilot study, we have recruited 26 patients with advanced stages of oral cancer. One group is taken as control which does not perform yoga, whereas patients in the experimental group performed yoga for 1 hour per day/5 days per week for 3 months. ResultsWe evaluated the quality of life between the control and experimental group using EORTC-QLQ-H&N-35 and found that certain domains of quality of life showed significant improvement.Conclusion The present study revealed that yoga, if administered along with conventional treatment in an integrative manner, can help in improving the patients’ quality of life. Further studies that could relate the yoga with symptoms scale, recurrence and disease-free survival could be proved of immense importance in the management of the disease.
... It is well known that yoga produces beneficial effects on individual at physical as well as emotional level. Yoga greatly enhance physical and respiratory function [18] , improve respiratory and cardiovascular function, reduce stress, anxiety, depression, improve sleep patterns [19] , improves autonomic functions [20] , provides a life-long behavioral skill, and enhances self-confidence [21] . Published literature support the utility of integrated yoga as a complementary intervention for populations at risk or already suffering from COVID19 [22] . ...
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The Coronavirus Disease 2019 (COVID19) outbreak is one of the biggest pandemics reported in the history. Widespread prevalence of COVID19 have not only caused the respiratory consequences, but also psychological effects because of its fear. Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the virus responsible for COVID19 and have been reported to cause impairment in mucociliary clearance (MCC) as a result of damage to the ciliary layer of respiratory epithelium. Because MCC is one of the important defense process of respiratory system, impairment of MCC could be one of the important mechanisms of progression of COVID19. Yoga is a multidimensional system of practices for physical, mental, and spiritual health popularly practiced all over the world for physical and mental well-being. This article summarizes various components of COVID19, effect on mucociliary clearance, role of nitric oxide and various mechanisms of beneficial effects of yoga asana, pranayama, mantra chanting and meditation for prevention and treatment of COVID19. International Research Journal of Ayurveda and Yoga, 4(4): 97-108. Full text available at, https://irjay.com/irjay/index.php/ijray/article/view/485
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This cross-sectional research aims to study the effect of yoga practice on the illness perception, and wellbeing of healthy adults during 4-10 weeks of lockdown due to COVID19 outbreak. A total of 668 adults (64.7% males, M = 28.12 years, SD = 9.09 years) participated in the online survey. The participants were grouped as; yoga practitioners, other spiritual practitioners, and non-practitioners based on their responses to daily practices that they follow. Yoga practitioners were further examined based on the duration of practice as; long-term, mid-term and beginners. Multivariate analysis indicates that yoga practitioners had significantly lower depression, anxiety, & stress (DASS), and higher general wellbeing (SWGB) as well as higher peace of mind (POMS) than the other two groups. The results further revealed that the yoga practitioners significantly differed in the perception of personal control, illness concern and emotional impact of COVID19. However, there was no significant difference found for the measure of resilience (BRS) in this study. Yoga practitioners also significantly differed in the cognitive reappraisal strategy for regulating their emotions than the other two groups. Interestingly, it was found that beginners -those who had started practicing yoga only during the lockdown period reported no significant difference for general wellbeing and peace of mind when compared to the mid- term practitioner. Evidence supports that yoga was found as an effective self- management strategy to cope with stress, anxiety and depression, and maintain wellbeing during COVID19 lockdown.
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Background: Previous studies indicate that yoga may be an effective treatment for chronic or recurrent low back pain. Objective: To compare the effectiveness of yoga and usual care for chronic or recurrent low back pain. Design: Parallel-group, randomized, controlled trial using computer-generated randomization conducted from April 2007 to March 2010. Outcomes were assessed by postal questionnaire. (International Standard Randomised Controlled Trial Number Register: ISRCTN 81079604) Setting: 13 non-National Health Service premises in the United Kingdom. Patients: 313 adults with chronic or recurrent low back pain. Intervention: Yoga (n = 156) or usual care (n = 157). All participants received a back pain education booklet. The intervention group was offered a 12-class, gradually progressing yoga program delivered by 12 teachers over 3 months. Measurements: Scores on the Roland-Morris Disability Questionnaire (RMDQ) at 3 (primary outcome), 6, and 12 (secondary outcomes) months; pain, pain self-efficacy, and general health measures at 3, 6, and 12 months (secondary outcomes). Results: 93 (60%) patients offered yoga attended at least 3 of the first 6 sessions and at least 3 other sessions. The yoga group had better back function at 3, 6, and 12 months than the usual care group. The adjusted mean RMDQ score was 2.17 points (95% CI, 1.03 to 3.31 points) lower in the yoga group at 3 months, 1.48 points (CI, 0.33 to 2.62 points) lower at 6 months, and 1.57 points (CI, 0.42 to 2.71 points) lower at 12 months. The yoga and usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher pain self-efficacy scores at 3 and 6 months but not at 12 months. Two of the 157 usual care participants and 12 of the 156 yoga participants reported adverse events, mostly increased pain. Limitation: There were missing data for the primary outcome (yoga group, n = 21; usual care group, n = 18) and differential missing data (more in the yoga group) for secondary outcomes. Conclusion: Offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care. Primary funding source: Arthritis Research UK.
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Objectives. To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms. Methods. Medline, Scopus, the Cochrane Library, and PsycINFO were screened through April 2012. Randomized controlled trials (RCTs) were included if they assessed the effect of yoga on major menopausal symptoms, namely, (1) psychological symptoms, (2) somatic symptoms, (3) vasomotor symptoms, and/or (4) urogenital symptoms. For each outcome, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Results. Five RCTs with 582 participants were included in the qualitative review, and 4 RCTs with 545 participants were included in the meta-analysis. There was moderate evidence for short-term effects on psychological symptoms (SMD = −0.37; 95% CI −0.67 to −0.07; P = 0.02). No evidence was found for total menopausal symptoms, somatic symptoms, vasomotor symptoms, or urogenital symptoms. Yoga was not associated with serious adverse events. Conclusion. This systematic review found moderate evidence for short-term effectiveness of yoga for psychological symptoms in menopausal women. While more rigorous research is needed to underpin these results, yoga can be preliminarily recommended as an additional intervention for women who suffer from psychological complaints associated with menopause.
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Background. Researchers aimed at systematically reviewing and meta-analyzing the effectiveness of yoga interventions for fatigue. Methods. PubMed/Medline was searched until January 2012 for controlled clinical studies. Two reviewers independently extracted the data. The methodological quality of the studies was assessed. A meta-analysis was performed. Results. Nineteen clinical studies (total n = 948) were included in this review. Investigated yoga styles included Hatha, Iyengar, Asanas, Patanjali, Sahaja, and Tibetan yoga. Participants were suffering from cancer, multiple sclerosis, dialysis, chronic pancreatitis, fibromyalgia, asthma, or were healthy. Yoga had a small positive effect on fatigue (SMD = 0.27, 59% CI = 0.23-0.31). Seven studies received 4 points on the Jadad score. There were baseline differences in at least 5 studies. Conclusion. Overall, the effects of yoga interventions on fatigue were only small, particularly in cancer patients. Although yoga is generally a safe therapeutic intervention and effective to attenuate other health-related symptoms, this meta-analysis was not able to define the powerful effect of yoga on patients suffering from fatigue. Treatment effects of yoga could be improved in well-designed future studies. According to the GRADE recommendations assessing the overall quality of evidence, there is a moderate effect of the confidence placed in the estimates of the effects discussed here.
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There are many and varied types of trauma. The extent to which trauma influences the mental health of an individual depends on the nature of trauma, as well as on the individual's coping capabilities. Often trauma is followed by depression, anxiety, and PTSD. As the pharmacological remedies for these conditions often have undesirable side-effects, nonpharmacological remedies are thought of as a possible add-on treatment. Yoga is one such mind-body intervention. This paper covers eleven studies indexed in PubMed, in which mental health disorders resulting from trauma were managed through yoga including meditation. The aim was to evaluate the use of yoga in managing trauma-related depression, anxiety, PTSD and physiological stress following exposure to natural calamities, war, interpersonal violence, and incarceration in a correctional facility. An attempt has also been made to explore possible mechanisms underlying benefits seen. As most of these studies were not done on persons exposed to trauma that had practiced yoga, this is a definite area for further research.
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Previous studies indicate that yoga may be an effective treatment for chronic or recurrent low back pain. To compare the effectiveness of yoga and usual care for chronic or recurrent low back pain. Parallel-group, randomized, controlled trial using computer-generated randomization conducted from April 2007 to March 2010. Outcomes were assessed by postal questionnaire. (International Standard Randomised Controlled Trial Number Register: ISRCTN 81079604) 13 non-National Health Service premises in the United Kingdom. 313 adults with chronic or recurrent low back pain. Yoga (n = 156) or usual care (n = 157). All participants received a back pain education booklet. The intervention group was offered a 12-class, gradually progressing yoga program delivered by 12 teachers over 3 months. Scores on the Roland-Morris Disability Questionnaire (RMDQ) at 3 (primary outcome), 6, and 12 (secondary outcomes) months; pain, pain self-efficacy, and general health measures at 3, 6, and 12 months (secondary outcomes). 93 (60%) patients offered yoga attended at least 3 of the first 6 sessions and at least 3 other sessions. The yoga group had better back function at 3, 6, and 12 months than the usual care group. The adjusted mean RMDQ score was 2.17 points (95% CI, 1.03 to 3.31 points) lower in the yoga group at 3 months, 1.48 points (CI, 0.33 to 2.62 points) lower at 6 months, and 1.57 points (CI, 0.42 to 2.71 points) lower at 12 months. The yoga and usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher pain self-efficacy scores at 3 and 6 months but not at 12 months. Two of the 157 usual care participants and 12 of the 156 yoga participants reported adverse events, mostly increased pain. There were missing data for the primary outcome (yoga group, n = 21; usual care group, n = 18) and differential missing data (more in the yoga group) for secondary outcomes. Offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care. Arthritis Research UK.
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Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Back-related functional status (modified Roland Disability Questionnaire, a 23-point scale) and bothersomeness of pain (an 11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12, and 26 weeks by interviewers unaware of treatment group. After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function, -2.5 [95% CI, -3.7 to -1.3]; P < .001; mean difference for symptoms, -1.1 [95% CI, -1.7 to -0.4]; P < .001). At 26 weeks, function for the yoga group remained superior (mean difference, -1.8 [95% CI, -3.1 to -0.5]; P < .001). Yoga was not superior to conventional stretching exercises at any time point. Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months. clinicaltrials.gov Identifier: NCT00447668.
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Low back pain is a significant health problem. Current conventional medical interventions seem largely ineffective and do not address the contributing issues of low back pain in a comprehensive or holistic manner. The holistic approach of Yoga makes it an ideal intervention for low back pain, as it addresses the multifactorial physical, psychological, and social factors associated with low back pain. The objectives of this research review were to (1) identify all relevant published studies that identify Yoga as an intervention for low back pain; (2) draw conclusions about whether Yoga is an effective treatment for low back pain and comparable to other interventions; and (3) summarize interventions used in studies to better inform practitioners, healthcare providers, and researchers about how Yoga may be used to treat low back pain. Seven studies were identified: five moderate- to high-quality randomized controlled trials (RCTs) and two case series. Participants of six out of the seven studies had chronic low back pain with a duration of greater than three months. The main outcome measures were disability questionnaires and pain. Styles of Yoga included Anusara, Iyengar, Viniyoga, a combined intervention of Yoga and Pilates, and Hatha Yoga, not further specified.The findings of this review suggest that Yoga has a positive effect on low back pain and function, with effects comparable to education combined with aerobic and strengthening exercise and more effective than education alone or no treatment. Yoga may provide an inexpensive and easily accessible way for those with low back pain to manage their symptoms. However, the small number of studies prevents definite conclusions from being drawn. This demonstrates a need to increase the evidence base through larger, well-designed RCTs in this area.
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Unlabelled: We searched databases for controlled clinical studies, and performed a meta-analysis on the effectiveness of yoga interventions on pain and associated disability. Five randomized studies reported single-blinding and had a higher methodological quality; 7 studies were randomized but not blinded and had moderate quality; and 4 nonrandomized studies had low quality. In 6 studies, yoga was used to treat patients with back pain; in 2 studies to treat rheumatoid arthritis; in 2 studies to treat patients with headache/migraine; and 6 studies enrolled individuals for other indications. All studies reported positive effects in favor of the yoga interventions. With respect to pain, a random effect meta-analysis estimated the overall treatment effect at SMD = -.74 (CI: -.97; -.52, P < .0001), and an overall treatment effect at SMD = -.79 (CI: -1.02; -.56, P < .0001) for pain-related disability. Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions. Perspective: This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.
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The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for any type of pain. Seven databases were searched from their inception to February 2011. Randomized clinical trials were considered if they investigated yoga in patients with any type of pain and if they assessed pain as a primary outcome measure. The 5-point Jadad scale was used to assess methodological quality of studies. The selection of studies, data extraction and quality assessment were performed independently by two reviewers. Ten randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale. Nine RCTs suggested that yoga leads to a significantly greater reduction in pain than various control interventions such as standard care, self care, therapeutic exercises, relaxing yoga, touch and manipulation, or no intervention. One RCT failed to provide between group differences in pain scores. It is concluded that yoga has the potential for alleviating pain. However, definitive judgments are not possible.