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2013 SYR Accepted Poster Abstracts

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Abstract

SYR 2013 Accepted Poster abstracts.
Effectiveness of yoga for hypertension: Systematic review and meta-analysis
Effectiveness of yoga for hypertension: Systematic review and meta-analysis
Marshall Hagins, PT, PhD
Marshall Hagins, PT, PhD1
1, Rebecca States, PhD
, Rebecca States, PhD1
1, Terry Selfe, DC, PhD
, Terry Selfe, DC, PhD2,3
2,3, Kim Innes, MSPH, PhD
, Kim Innes, MSPH, PhD2,3,4
2,3,4
Introduction
Introduction
Presented at the IAYT 2013 Symposium on Yoga Research Boston, MA
*References:
See Handout or published article for complete References: Effectiveness of Yoga for Hypertension: Systematic Review and
Meta-Analysis: Marshall Hagins,!Rebecca States,!Terry Selfe,!and!Kim Innes in Evidence-Based Complementary and
Alternative Medicine; Volume!2013!(2013), Article ID!649836, 13 pages;http://dx.doi.org/10.1155/2013/649836
Conclusions
Conclusions
Results
Results
Methodology
Methodology
$ $ $ Effect size (confidence interval), mmHg
$
Subgroup Category$
Number of
trials
!Number of
participants
!
Systolic
!
!Diastolic
$
Type of Yoga Intervention*
! ! ! !
[1] P, M, B 11 431 -8.17 (-12.75, -3.89) -6.14 (-9.39, -2.89)
[2] 2 or less of PMB 8403 0.19 (-1.70, 2.07) 0.38 (-1.55, 2.32)
[3] (+/-P+/-M+/-B) + other intervention 3109 -11.87 (-26.43, 2.70) -7.35 (-16.20, 1.50)
$
Type of Comparison Group*
!
!
! !
[1] no intervention or usual care, 13 656 -7.96 (-10.65, -5.27) -5.52 (-7.92, -3.11)
[2] exercise or exercise + additional intervention 397 2.87 (1.42, 4.31) -0.30 (-1.47, 0.87)
[3] non-exercise intervention 6190 1.14 (-3.37, 5.66) -0.35(-3.56, 2.86)
$
Length of Yoga Intervention
! ! ! !
[1] ≤ mean (58.9 hours) 16 728 -3.11 (-5.49, -0.73) -2.55 (-2.95, 2.15)
[2] > mean (58.9 hours) 6215 -9.73 (-17.66, -1.79) -1.83 (3.59, --0.07)
Types of Yoga intervention: P = postures; B = breathing; M = meditation; 1 = P+M+B, 2 = any 2 of these or less; 3 = (P+/-M+/-B) + Other intervention.
Several reviews regarding the potential benefits of yoga for reducing blood pressure and other
cardiovascular disease risk factors have been published* with most stating that yoga has a
significant effect on blood pressure.
However, the quality of most studies is generally poor and few reviews have specifically focused on
blood pressure control, and meta-analyses are lacking.
Thus, the degree to which yoga may decrease blood pressure as well as the potential modifying
effects of type of yoga intervention and type of comparison group remain unclear.
Purpose: This study is a systematic review and meta-analysis of controlled
studies examining the effects of yoga practice on systolic and diastolic blood
pressure in individuals with prehypertension or hypertension, as well as an
assessment of the modifying influences of type and length of yoga
intervention and type of comparison group.
Data bases examined: Academic Search Premier, AltHealthWatch, Biosis/Biological Abstracts,
CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, PsycARTICLES, Natural Standard,
and Web of Science
Search terms: yoga or yogi* or yama or niyama or pratyaharaor dharana or dhyana or samadhi or
asana combined with “blood pressure” or hypertension or hypertensive or systolic or diastolic.
Types of Studies: Peer reviewed, English language, controlled studies (either a randomized
controlled trial (RCT) or a non-RCT) published between January 1966 and March 2013 were
included. Cross sectional studies, case series, dissertations, and abstracts/posters were not
included.
Participants: Adults (mean age ≥18 years) with prehypertension or hypertension.
Interventions: Only papers that explicitly labeled the intervention as “yoga” were examined. we
excluded studies only examining immediate changes following a single yoga session.
Outcome measures: Blood pressure (mmHg) was the only outcome of interest (systolic and
diastolic). Studies which did not provide blood pressure data (effect size and/or variability
estimates) were excluded.
Data Analysis/Assessment : Reference Manager (RevMan) Version 5.1 from the Cochrane
Collaboration [20] was used to analyze all data.
Subgroup Analysis : Subgroup analyses were performed based on duration of the yoga
intervention and on yoga practice components included in the intervention
Type of yoga intervention: 1) those that incorporated postures, meditation, and breathing (“3-
element yoga”); 2) those that included fewer than the 3 yoga practices just described; 3) yoga
using any combination of the three elements plus one or more additional intervention(s).
Total time of yoga practice
Type of comparison group: 1) usual care, no treatment, or wait list; 2) exercise; and 3) attention
control or active, non-exercise comparator.
See Figure 1 for results of the search strategy.
22 trials within the 17 eligible studies were identified
for analysis.
Ten (58.8%) of the 22 studies incorporated three
elements of yoga (postures, meditation, and breathing)
with no additional interventions, while 4 (23.5%) used
two or fewer of the elements, and 3 (17.6%) used
various elements of yoga in combination with additional
interventions.
Three categories of comparison groups were
identified: 13 (59%) no treatment or usual care; 3
(13.6%) exercise; 5 (22.7%) various types of non-yoga,
non-exercise interventions.
The mean length of time used for yoga practice was
58.9 (+/- 56.1) hours.
Risk of Bias: Categorization of the risk of bias at the
individual study level is presented in Figure 2. No
studies achieved a low risk of bias as all had an
unclear or high risk of bias within at least one major
domain.
Figure 3. Systolic
Figure 4. Diastolic
Figure 2. Risk of Bias
Figure 1. Flow diagram
of article selection
Effects of Yoga on Blood Pressure:(Figs. 3 and 4)
Yoga had a modest but significant effect on both
systolic and diastolic BP.
systolic : -4.17 mmHg
diastolic : -3.26 mmHg
There was substantial heterogeneity present across
the included studies: Tau2=17.34; Chi2= 241.03, df=21,
(P<0.00001), I2=91% for systolic and Tau2=11.17;
Chi2=234.96, df=21, (P<0.00001), I2=91% for diastolic.
Subgroup Analysis: (Table 1).
Incorporating three elements of practice was
associated with significant reductions in blood pressure
whereas yoga interventions using two or fewer
elements of yoga practice or that combine yoga
practice with additional interventions are not.
Yoga had a significant effect on blood pressure
compared to no treatment but not when compared to
exercise or other types of treatment
There was no significant differences due to length of
time of yoga practice
Table 1. Results of Subgroup analysis
The current study is the first meta-analysis to examine the effects of yoga on blood
pressure among individuals with pre-hypertension or hypertension.
Overall, yoga was associated with a modest but significant
reduction in blood pressure (≈ 4 mmHg, systolic and diastolic) in
this population.
Subgroup analyses demonstrated larger, more clinically
significant reductions in blood pressure for:
1) interventions incorporating 3 basic elements of yoga
practice (postures, meditation, and breathing) (≈ 8 mmHg,
systolic; ≈6 mmHg, diastolic) but not for more limited yoga
interventions;
2) yoga compared to no treatment (≈8 mmHg, systolic; 6
mmHg, diastolic) but not compared to exercise.
These reductions are of clear clinical significance, and suggest that yoga may
offer an effective intervention for reducing blood pressure among people with pre-
hypertension or hypertension.
As none of the included studies had methodologies with low risk of bias in primary
domains additional rigorous controlled trials are warranted to further investigate
the potential benefits of yoga for improving blood pressure in these populations,
and to determine optimal yoga program design and dosing.
!This work was funded by the National Institute of General Medical Sciences:1SC3GM088049-01A1
1. Department of Physical Therapy, Long Island University, Brooklyn Campus, Brooklyn, New York, 10021; 2. Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV 26506-9190; 3. Center for the Study of Complementary
and Alternative Therapies, University of Virginia Health System, Charlottesville, Virginia 22908-0782. 4. Dept. Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia 22908-0782
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