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A yoga intervention for type 2 diabetes risk reduction: A pilot randomized controlled trial

Authors:
  • Central Council for Research in Yoga and Naturopathy

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Type 2 diabetes is a major health problem in many countries including India. Yoga may be an effective type 2 diabetes prevention strategy in India, particularly given its cultural familiarity. This was a parallel, randomized controlled pilot study to collect feasibility and preliminary efficacy data on yoga for diabetes risk factors among people at high risk of diabetes. Primary outcomes included: changes in BMI, waist circumference, fasting blood glucose, postprandial blood glucose, insulin, insulin resistance, blood pressure, and cholesterol. We also looked at measures of psychological well-being including changes in depression, anxiety, positive and negative affect and perceived stress. Forty-one participants with elevated fasting blood glucose in Bangalore, India were randomized to either yoga (n = 21) or a walking control (n = 20). Participants were asked to either attend yoga classes or complete monitored walking 3–6 days per week for eight weeks. Randomization and allocation was performed using computer-generated random numbers and group assignments delivered in sealed, opaque envelopes generated by off-site study staff. Data were analyzed based on intention to treat. This study was feasible in terms of recruitment, retention and adherence. In addition, yoga participants had significantly greater reductions in weight, waist circumference and BMI versus control (weight −0.8 ± 2.1 vs. 1.4 ± 3.6, p = 0.02; waist circumference −4.2 ± 4.8 vs. 0.7 ± 4.2, p < 0.01; BMI −0.2 ± 0.8 vs. 0.6 ± 1.6, p = 0.05). There were no between group differences in fasting blood glucose, postprandial blood glucose, insulin resistance or any other factors related to diabetes risk or psychological well-being. There were significant reductions in systolic and diastolic blood pressure, total cholesterol, anxiety, depression, negative affect and perceived stress in both the yoga intervention and walking control over the course of the study. Among Indians with elevated fasting blood glucose, we found that participation in an 8-week yoga intervention was feasible and resulted in greater weight loss and reduction in waist circumference when compared to a walking control. Yoga offers a promising lifestyle intervention for decreasing weight-related type 2 diabetes risk factors and potentially increasing psychological well-being. Trial registration ClinicalTrials.gov Identified NCT00090506.
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... Regarding body weight and body mass index (BMI), a randomized controlled pilot study (28) investigated adults with high risk of diabetes. According to the outcomes, the yoga group showed reduced body weight and BMI at the end of the 8-week long (3-6 days/week, 75 min/session) intervention compared to the monitored walking group (28). ...
... Regarding body weight and body mass index (BMI), a randomized controlled pilot study (28) investigated adults with high risk of diabetes. According to the outcomes, the yoga group showed reduced body weight and BMI at the end of the 8-week long (3-6 days/week, 75 min/session) intervention compared to the monitored walking group (28). Similarly, another study investigating healthy adults (29) reported a significant decrease in BMI after a 1-month long daily (1 h) yoga training compared to the control group which received no intervention. ...
... Studies which investigated BMI previously and reported a decrease in the outcomes involved a more frequent yoga training, e.g., daily yoga for 1 month (29), or 3-6 times/week training for 8 weeks (28). Average BMI of the participants in these two studies belonged to the overweight category (26.4 ± 2.5 and 28.4 ± 5.3, respectively). ...
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Beneficial physical and physiological health outcomes of yoga practice are well-supported by empirical data. However, whether weekly frequency of training is sufficient to evoke positive changes, is still an open question. The present intervention study investigated the effects of 10 weekly sessions of beginner level hatha yoga with respect to indicators of physical fitness and physiological markers. 82 young women (mean age of 22.0 ± 3.83 years) participated in the study. The yoga group (N = 49) attended a yoga course consisting of 10 sessions (1.5 h each) on a weekly basis. The control group (N = 33) did not receive any intervention. BMI, body fat percentage, balance (one-leg-stand test with open and closed eyes, functional reach test), flexibility (side bend test, modified sit and reach test) core muscle strength (plank test) as well as resting heart rate (HR), and heart rate variability (HRV) were assessed 1 week before and after the course. Both frequentist and Bayesian analysis showed an improvement in flexibility and balance in the yoga group compared to the control group. The yoga group showed also increased core muscle strength. No changes with respect to BMI, body fat percentage, resting HR and HRV were found. Ninety minute beginner level hatha yoga classes were characterized by 93.39 HR and 195 kcal energy consumption on average. The present findings suggest that weekly setting of a 10-session long hatha yoga training leads to improvements in balance, flexibility and core muscle strength among healthy young women. However, for changes in BMI, body fat percentage, resting HR and HRV longer, and/or more intense interventions are needed.
... Figure 1 showed the flow diagram of the study. Total 17 studies were included qualitative analysis (systematic review) [11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and 15 were considered for quantitative analysis (meta-analysis) as data for mean ± SD was not available for two studies. [17,20] ...
... 6 months and 9 months of yoga protocol were given in one study each. [28,30] have given sham yoga to the control group. Only two studies [11,20] have taken follow-up of the participants. ...
... Two studies have not provided the mean ± SD. [17,20] The insignificant improvement was found only in two studies. [20,30] Rest of the studies has shown significant improvement in at least one of the outcome measure. ...
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Type 2 diabetes mellitus (T2DM) is a fastest evolving metabolic disorder and India houses second highest number of patients with diabetes after China. Cardiovascular diseases are the major cause of mortality among patients with T2DM. Yoga is an ancient Indian practice that proves to be effective for patients with diabetes. The present systematic review and meta-analysis has been conducted to see the benefits of yoga on blood pressure, lipid profile, and anthropometric measures among patients with T2DM. The articles were extracted from three databases - PubMed, The Cochrane library, and Google scholar. Only English language articles, with PEDro score≥6, were included in the current study. The duplicates were removed using Mendeley. Fourteen randomized controlled trials (RCTs) and three 3 non-RCTs were included in the analysis. The meta-analysis was done using Review Manager 5.3. The results reveal that yoga is effect in improving blood pressure (P<0.01), lipid profile (P<0.01) except HDL (P=0.06), and anthropometric measures (P<0.01) except waist-hip ratio (P=0.79). Heterogeneity was also high for most of the variables. It may be concluded from the results that the yoga is effective in improving of blood pressure, lipid profile, and anthropometric measures. However, high heterogeneity sought the need of more high quality RCTs to affirm these findings.
... Yoga plays a promising role in minimizing the risk of Diabetes for high-risk individuals with prediabetes [5,6]. It reduces body weight, glucose, and lipid levels, though, most of these studies comply with the guidelines of randomized controlled trials adhered to the CONSORT statements [7][8][9][10][11] whereas majority of studies have not reported as per CONSORT statements [12][13][14][15]. ...
... Sample size estimation for the main Pan India study was focused for prediabetes subjects [23]. However, for the present pilot scale study we calculated sample size assuming a small effect size 0.3 [5] of DYP vs waitlist control 0.25, α = 0.80 as 180 (n = 90:90). Further, assuming an attrition rate of 20%, the final sample size was n = 220. ...
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Purpose To study the effectiveness of diabetic yoga protocol (DYP) against management of cardiovascular risk profile in a high-risk community for diabetes, from Chandigarh, India. Methods The study was a randomized controlled trial, conducted as a sub study of the Pan India trial Niyantrita Madhumeha Bharath (NMB) . The cohort was identified through the Indian Diabetes Risk Scoring (IDRS) (≥ 60) and a total of 184 individuals were randomized into intervention (n = 91) and control groups (n = 93). The DYP group underwent the specific DYP training whereas the control group followed their daily regimen. The study outcomes included changes in glycemic and lipid profile. Analysis was done under intent-to-treat principle. Results The 3 months DYP practice showed diverse results showing glycemic and lipid profile of the high risk individuals. Three months of DYP intervention was found to significantly reduce the levels of post-prandial glucose levels (p = 0.035) and LDL-c levels (p = 0.014) and waist circumference (P = 0.001). Conclusion The findings indicate that the DYP intervention could improve the metabolic status of the high-diabetes-risk individuals with respect to their glucose tolerance and lipid levels, partially explained by the reduction in abdominal obesity. The study highlights the potential role of yoga intervention in real time improvement of cardiovascular profile in a high diabetes risk cohort. Trial registration: CTRI, CTRI/2018/03/012804. Registered 01 March 2018—Retrospectively registered, http://www.ctri.nic.in/ CTRI/2018/03/012804.
... Significant levels of heterogeneity were observed for most pooled estimates of the secondary outcomes (>75%), except for fasting insulin with moderate levels (27%, p = 0¢24) and waist-to-hip ratio for which no heterogeneity was observed, although based on only four estimates. No sensitivity analyses for secondary outcomes were considered needed as the univariate and multivariate meta-regressions of pre-specified potential sources of heterogeneity revealed no significant explanatory variables (appendix pp [42][43][44][45][46][47]. ...
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Background As lifestyle modification offers a unique strategy to prevent diabetes, we evaluated the effectiveness of lifestyle interventions in the prevention of type 2 diabetes and gestational diabetes in low- and middle-income countries (LMICs). Methods We did a systematic literature review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and Cochrane Library for randomised controlled trials published in English, Spanish, French, and Portuguese between 1 January 2000 and 15 June 2022, evaluating multi-target and multi-component lifestyle interventions in at-risk populations conducted in LMICs. The main outcomes were incidence of type 2 diabetes and gestational diabetes, and indicators of glycaemic control. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. Inverse-variance random-effects meta-analyses estimated the overall effect sizes. Sources of heterogeneity and study bias were evaluated. The study protocol was registered in PROSPERO (CRD42021279174). Findings From 14 330 abstracts, 48 (0·3%) studies with 50 interventions were eligible of which 56% were conducted in lower-middle-income countries, 44% in upper-middle, and none in low-income. 54% of the studies were assessed as moderate risk of bias and 14% as high risk. A median of 246 (IQR 137-511) individuals participated in the interventions with a median duration of 6 (3-12) months. Lifestyle interventions decreased the incidence risk ratio of type 2 diabetes by 25% (0·75 [95% CI 0·61 to 0·91]), and reduced the levels of HbA1c by 0·15% [−0·25 to −0·05], fasting plasma glucose by 3·44 mg/dL [−4·72 to −2·17], and 2-hr glucose tolerance by 4·18 mg/dL [−7·35 to −1·02]. No publication bias was suggested for these outcomes. High levels of heterogeneity (I²≥ 81%) were found in most meta-analyses. Exploration using meta-regressions could not identify any explanatory variable, except for fasting glucose for which the quality score of the articles seems to be an effect modifier decreasing slightly the heterogeneity (72%) in the low risk of bias pooled estimate. The effect on gestational diabetes could not be evaluated due to the scarcity of available studies. Interpretation Comprehensive lifestyle interventions are effective strategies to prevent type 2 diabetes among at-risk populations in LMICs. The heterogeneity identified in our results should be considered when using these interventions to address the onset of type 2 diabetes. Funding None.
... These findings are concordant with the findings reported in previous studies [14,[16][17][18] whereas in contrast to some other studies. [19] Studies in countries outside India give mixed reports with some reporting a significant improvement in HbA1c and fasting blood glucose profiles, whereas another exploratory study in the UK showed only a marginal decline in HbA1c. [20,21] However, the exact cause of the reduction in HbA1c is not known. ...
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Context: In view of the rising burden of type 2 diabetes mellitus (DM) cases in India, there is an urgent need for an effective, low‑cost, sustainable intervention controlling diabetes thus preventing complications. Aims: This study aimed to assess the effect of structured yoga programs on diabetes. Subjects and Methods: This was a community‑based interventional study that was conducted in an urban resettlement colony of Delhi, India. Known diabetes patients with glycated hemoglobin (Hb1Ac) ≥6.5% were enrolled from 12 randomly selected blocks of the community with a sample size of 192 in each intervention and wait‑listed control arm. The intervention was structured yoga of 50 min daily, 2 consecutive weeks in a nearby park and health center followed by twice a week home practice up to the 3rd month. The primary outcome measure was HbA1c% and secondary outcome measures were lipid profile and fasting blood glucose. Statistical Analysis Used: A per‑protocol analysis was done. Mean, standard deviation (SD), and 95% confidence interval were estimated. The level of significance was considered for 0.05. Results: There was a significant decrease of Hb1Ac (0.5%, SD = 1.5, P = 0.02), total cholesterol (11.7 mg/dl, SD = 40.5, P < 0.01), and low‑density lipoprotein (3.2 mg/dl, SD = 37.4, P < 0.01) from baseline to end line in the intervention group. These changes in intervention group were also significantly different from the change in the wait‑listed control group. The other variables did not change significantly. Conclusions: It revealed that structured yoga program improved glycemic outcome and lipid profile of individuals in a community‑based setting. Yoga can be a feasible strategy to control hyperglycemia, lipid levels, and can help better control type 2 DM.
... Specific yoga practices are known to modulate the physiological functions [14][15][16] as well as the psychological states [17]. In view of complexities in the treatment plans for control of T2DM, yoga could be considered as cost-effective and safe adjuvant therapy [18]. Previous studies have found yoga to be beneficial in the management of T2DM. ...
Article
Objectives Type 2 Diabetes Mellitus (T2DM) is a major burden on global health and economy. Various Yogic techniques are found to be beneficial in the management of T2DM. Mind Sound Resonance Technique (MSRT) is one of the yoga-based meditation techniques observed to be effective in clinical settings. Methods Thirty-two patients with T2DM were randomized to either MSRT or supine rest (SR) sessions on two separate days separated by a washout period of one day. Fasting blood glucose levels were measured before and immediately after the sessions. State anxiety and subjective feeling of relaxation were assessed using Spielberg’s state anxiety inventory (STAI) and Visual Analogue Scale (VAS) respectively. Results There were significant differences between MSRT and SR groups in fasting blood glucose (p=0.019), STAI scores (p<0.001) and subjective relaxation (p<0.001). Within group analyses revealed significant reductions (p<0.001) in fasting blood glucose and STAI scores, along with an increase in subjective relaxation following the practice of MSRT, whereas, non-significant changes were found following the SR session. Conclusions A single session of MSRT was found to reduce blood glucose levels and state anxiety along with enhanced relaxation when compared to SR.
... Diyabetli ve sağlıklı bireylerle yapılan bir çalışmada 6 aylık yoga terapi sonrasında hem tip II diyabetlilerde hem de sağlıklı bireylerde açlık ve tokluk kan şekerinin anlamlı bir şekilde azaldığı bildirilmiştir 32 . Başka bir çalışmada ise yoga terapinin sekiz hafta gibi erken bir zamanda bile açlık ve tokluk kan şekerinde bir düşüşe yol açtığını göstermiştir 33 . Bir sistematik bir incelemeye 25 RKÇ ile 2170 katılımcı dahil edilmiş, analiz sonucunda yoga terapinin diyabetli bireylerde iyileştirilmiş glisemik kontrol, lipid seviyeleri, oksidatif stres, kan basıncı, pulmoner ve otonomik fonksiyon sağladığı bildirilmiştir. ...
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GIRIŞ Yoga, Hindistan'da ortaya çıkan fiziksel ve zihinsel uygulamaların bir bütünü olup, nihai amacı zihin ve ruhta huzur elde etmektir. Yoga kelimesi "birlik" anla-mına gelir ve kozmik bilincin kişinin kendi kişisel bilinciyle birleşmesine yani, bir kişinin "Ben"den "Biz"e, ben-merkezli olmaktan küresel bir insana dönüşmesine yardımcı olur 1. Bu birlik hali aynı zamanda düşünce ve eylemin birleşmesi olduğu kadar, hastalık ve sağlık alanlarında terapötik değere sahip olabilecek bütünsel bir zihin ve bedene doğru ilerlemektir 2. Yogadaki bütünsel yönelimin yararları zihinsel ve ruhsal varlığa kadar uzanmakta, sağlıklı yaşamın devamı, hastalıkların önlenmesi, hastalıkların tedavisi ve yaşam kalitesinin artmasına katkı sağlayarak popülerliği artmaktadır 3. Son yıllarda bazı hastalıklarda yoganın tamamlayıcı bir tedavi olarak kullanıl-dığı ve bu yönde bilimsel çalışmaların yapıldığı görülmektedir 4. Yoga terapinin kardiyovasküler hastalıklar, hipertansiyon, artrit, ağrı sendromları, astım, tip II diyabet, multipl skleroz, HIV, meme kanseri, parkinson, doğum öncesi ve doğum sonrası depresyon, stres, TSSB, anksiyete ve obezite gibi hastalıklarda pek çok fay-dası tanımlanmıştır 4,5. Yoga kolay uygulanabilen, invaziv olmayan, rekabet içer-meyen, maliyeti düşük, bilimsel kanıtları olan bir uygulama olması ve getirdiği bütünsel iyilik hali ile hem fiziksel hem de ruhsal hastalıklar için umut vadetmek-tedir 2. Bu nedenle bu bölümde yoga terapinin iyileştirici boyutuna yönelik bilgi sunulmuş, yoganın felsefesi, faydaları, bedensel ve ruhsal hastalıklarda kullanımı ve yapılan bilimsel çalışmalar detaylı bir şekilde paylaşılmıştır.
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Objectives: Yoga is a mind-body stress-relieving exercise that increases mental and physical health, which may have a role in the improvement of metabolic disorders. The present study has reviewed the effect of yoga on lipid profiles as a systematic review and meta-analysis. Methods: We evaluated the available randomized controlled trials on the effects of yoga-based programs, and lipid profiles by searching PubMed/Medline, Scopus, Web of Science, and the Cochrane central register of control trials up to January 2022. Both fixed and random effect analyses were used to find the relationships. Subgroup analysis was performed based on the continent, duration of the included studies, gender, and health condition of participants to discover the sources of heterogeneity. Result: Fifty-three studies were included in the current systematic review and meta-analysis with a total sample size of 13,191. There was a striking association between yoga and total cholesterol (-10.31 mg/dl; 95% CI: -14.16, -6.45; I 2 = 82.5%, P < 0.001), low-density lipoprotein cholesterol (-8.64 mg/dl; 95% CI: -12.03, -5.25; I 2 = 75.0%, P < 0.001), high-density lipoprotein cholesterol (1.98 mg/dl; 95% CI: 0.81, 3.14; I 2 = 91.6%, P < 0.001), triglycerides (-13.50 mg/dl; 95% CI: -20.09, -6.92; I 2 = 90.7%, P < 0.001) and very low-density lipoprotein (-3.94 mg/dl; 95%CI: -6.31, -1.56; I 2 = 72.2%, P < 0.001). Conclusion: It seems yoga interventions had a substantial effect on lipid profiles, however, more qualified trials or cohort studies are needed to conclude exactly.
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BACKGROUND: The increasing of diabetes mellitus cases in Indonesia may be due to changes in people’s lifestyles, which is lack of exercise. Factors that may contribute to the high prevalence of diabetes mellitus sufferers other than genetics are exacerbated by environmental factors. Exercise interventions have been effective in counterbalancing diabetes complications. Yoga exerts a beneficial effect on insulin kinetics and the resulting lipid profile. Yoga helps redistribute body fat and reduces obesity which may lead to insulin resistance. In addition, other types of physical activity that can be done by diabetes mellitus patients are adequate morning walking while having scenery leisure for 30 min or more. AIM: This study was conducted to determine the effect of yoga therapy and walking therapy on diabetes mellitus patients in the community. METHODS: Quantitative research using randomized control trial, conducted in Gedongan Village, Baki Subdistrict, Sukoharjo Regency, involving 54 samples divided into three groups. Inclusion criteria: Patients with type 2 diabetes mellitus, fasting glucose levels of 126 mg/dl, no complication, and no insulin therapy or diabetes medication. The outcome measured was fasting blood sugar levels. The intervention group performed therapy for 12 weeks with a duration of 3 times a week. RESULTS: The average fasting sugar levels in the yoga group pre (217.00) post (187.72) p (0.001), the walking group averaged pre (209.89) post (193.83) p (0.001), and the control group averaged pre (221.50) post (225.17) p (0.067). CONCLUSION: There was an effect of yoga therapy and walking therapy on reducing fasting glucose levels.
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Several studies have documented the beneficial short term effects of yoga in type 2 diabetics. In this prospective two-armed interventional randomized control study, 277 type 2 diabetics of both genders aged above 28 years who satisfied the study criteria were recruited from 5 zones in and around Bengaluru, India. They were allocated to a yoga-based life style modification program or exercise-based life style modification program. Integrated yoga special technique for diabetes included yogasanas, pranayama, meditation and lectures on yogic life style. Control intervention included physical exercises and life style education. Medication score, blood glucose, HbA1c and lipid profile were assessed at baseline and after 9 months. Intention to treat analysis showed better reduction (P < 0.05, Mann-Whitney test) in the dose of oral hypoglycemic medication required (Yoga - 12.8 %) (Yoga-12.3 %) and increase in HDL (Yoga-7 %) in Yoga as compared to the control group; FBG reduced (7.2 %, P = 0.016) only in the Yoga group. There was significant reduction within groups (P < 0.01) in PPBG (Yoga-14.6 %, Control-9 %), HbA1c (Yoga-14.1 %, Control-0.5 %), Triglycerides (Yoga-15.4 %, Control-16.3 %), VLDL (Yoga-21.5 %, Control-5.2 %) and total cholesterol (Yoga-11.3 %, Control-8.6 %). Thus, Yoga based life style modification program is similar to exercise-based life style modification in reducing blood glucose, HbA1c, triglycerides, total cholesterol and VLDL. Yoga is better than exercise in decreasing oral hypoglycemic medication requirement and LDL; and increasing HDL in type 2 diabetics.
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Context Exercise is widely perceived to be beneficial for glycemic control and weight loss in patients with type 2 diabetes. However, clinical trials on the effects of exercise in patients with type 2 diabetes have had small sample sizes and conflicting results.Objective To systematically review and quantify the effect of exercise on glycosylated hemoglobin (HbA1c) and body mass in patients with type 2 diabetes.Data Sources Database searches of MEDLINE, EMBASE, Sport Discuss, Health Star, Dissertation Abstracts, and the Cochrane Controlled Trials Register for the period up to and including December 2000. Additional data sources included bibliographies of textbooks and articles identified by the database searches.Study Selection We selected studies that evaluated the effects of exercise interventions (duration ≥8 weeks) in adults with type 2 diabetes. Fourteen (11 randomized and 3 nonrandomized) controlled trials were included. Studies that included drug cointerventions were excluded.Data Extraction Two reviewers independently extracted baseline and postintervention means and SDs for the intervention and control groups. The characteristics of the exercise interventions and the methodological quality of the trials were also extracted.Data Synthesis Twelve aerobic training studies (mean [SD], 3.4 [0.9] times/week for 18 [15] weeks) and 2 resistance training studies (mean [SD], 10 [0.7] exercises, 2.5 [0.7] sets, 13 [0.7] repetitions, 2.5 [0.4] times/week for 15 [10] weeks) were included in the analyses. The weighted mean postintervention HbA1c was lower in the exercise groups compared with the control groups (7.65% vs 8.31%; weighted mean difference, −0.66%; P<.001). The difference in postintervention body mass between exercise groups and control groups was not significant (83.02 kg vs 82.48 kg; weighted mean difference, 0.54; P = .76).Conclusion Exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications, but no significantly greater change in body mass was found when exercise groups were compared with control groups.
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Aims Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. Methods In 2009–2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-minute group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-hour glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. Results 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (− 0.35 mmol/L vs. -0.03 mmol/L; p = 0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. Conclusions Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors.
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Diabetes mellitus and metabolic syndrome have reached global pandemic proportions with India being desig- nated 'diabetes capital' of the world. Epidemiological studies over the last three decades have shown five- fold increase in the prevalence of diabetes in India, while prevalence rates of >30% have been reported recently for metabolic syndrome. Primary prevention studies have shown significant reduction in relative risk of development of diabetes using lifestyle modifi- cations as well as drugs like metformin, acarbose and rosiglitazone among others. Use of such strategies adapted to suit the local culture along with use of tra- ditional approaches like yoga and ayurveda would go a long way in responding to the challenges posed by these chronic disorders to the country.