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ORIGINAL RESEARCH
Impact of daily yoga-based exercise on pain,
catastrophizing, and sleep amongst individuals
with fibromyalgia
This article was published in the following Dove Press journal:
Journal of Pain Research
Asimina Lazaridou
1
Alexandra Koulouris
1
Jaime K Devine
2
Monika Haack
2
Robert N Jamison
1
Robert R Edwards
1
Kristin L Schreiber
1
1
Department of Anesthesiology,
Perioperative, and Pain Medicine,
Brigham and Women’s Hospital, Harvard
Medical School, Chestnut Hill, MA 02467,
USA;
2
Department of Neurology,
Harvard Medical School, Beth Israel
Deaconess Medical Center, Boston, MA
02215, USA
Background: Fibromyalgia (FM) is a chronic widespread pain disorder characterized by
negative affect, sleep disturbance, and fatigue. This uncontrolled pilot study investigated the
efficacy of daily yoga-based exercise to improve FM symptoms and explored baseline
phenotypic characteristics associated with the greatest benefit.
Methods: FM patients (n=46, with 36 completers) reported psychosocial functioning and a
range of FM symptoms using validated instruments before and after participation in
Satyananda yoga, which included weekly in-person pain-tailored group classes for 6 weeks
and daily home yoga video practice.
Results: Changes in FM symptoms from pre- to post-yoga were variable amongst partici-
pants. Group means for pain decreased, as reported by average daily diary and Brief Pain
Inventory, with greater home practice minutes associated with a greater decrease in pain.
Average daily ratings of sleep and fatigue improved. Pain catastrophizing was decreased
overall, with greater change correlated to a decrease in FM symptoms. We did not observe
any group mean changes in actigraphy sleep efficiency, Patient-Reported Outcomes
Measurement Information System-anxiety and the Revised Fibromyalgia Impact
Questionnaire. Multilevel Modeling analysis revealed a significant interaction between
anxiety and catastrophizing for end-study sleep efficiency, fatigue, and pain, such that
patients with higher baseline catastrophizing and lower baseline anxiety reported less pain
and fatigue, and higher sleep efficiency after the sixth week of yoga practice.
Conclusion: This pilot study suggests that yoga may reduce pain and catastrophizing, as
well as improve sleep, but these changes were modest across study participants. Greater
uptake of home yoga practice as well as a phenotype of higher baseline catastrophizing
combined with lower baseline anxiety were associated with greater impact. Future rando-
mized, controlled trials comparing different types of yoga or exercise will allow determina-
tion of the most effective treatments for FM and allow closer targeting to the patients who
will benefit most from them.
Keywords: yoga, pain, fibromyalgia, sleep, catastrophizing
Introduction
Fibromyalgia (FM), characterized by persistent, widespread pain, myofascial tender-
ness, negative affect, and dysregulated sleep, affects an estimated 5 million adults in the
US (2% prevalence in 2005), though recent population-based surveys have estimated
higher rates.
1,2
FM involves a complex and diverse set of symptoms and proposed
biopsychosocial mechanisms including 1) alterations in central pain-modulatory pro-
cesses in the spinal cord and brain, 2) a prominent role of negative affective factors in
Correspondence: Kristin L Schreiber
Department of Anesthesiology,
Perioperative, and Pain Medicine, Brigham
and Women’s Hospital, Harvard Medical
School, 75 Francis Street, Boston, MA
02115, USA
Tel +1 617 732 8218
Email klschreiber@bwh.harvard.edu
Journal of Pain Research Dovepress
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Open Access Full Text Article
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http://doi.org/10.2147/JPR.S210653
maintaining pain and disability, 3) disrupted sleep and circa-
dian rhythms and related fatigue, and 4) a relative lack of
efficacy of many pharmacologic treatments.
2
Psychosocial functioning plays a key role in shap-
ing individual differences in pain. Negative affect and
catastrophizing amplify pain sensitivity and influence
pain modulation in many chronic pain conditions,
including FM, as well as low back pain, osteoarthritis,
and rheumatoid arthritis.
3,4
Interestingly, exercise has
been shown to impact a broad array of FM symptoms,
5
with collective evidence suggesting that moderately
intense, relatively frequent (at least 3×/week) and sus-
tained (4–6 weeks) exercise may reduce not only pain
and fatigue, but also depression symptoms.
6
However,
finding an exercise routine that is 1) gentle enough not
to trigger the new onset of pain, soreness, and thereby,
catastrophizing about pain, 2) adaptable to the indivi-
dual, and 3) habitually sustainable over the long term,
is a substantial challenge. Yoga, with its holistic
approach, may be well-adapted to meet these criteria,
and has shown promise in reducing pain and functional
outcomes in both low back and FM pain.
1,7–14
Most
patients with FM also suffer from significant distur-
bances initiating or maintaining sleep,
15
and robust
relationships are observed between pain severity and
sleep disturbance in FM patients,
16
suggesting this to
be an important aim for treatment strategy success.
The aim of this uncontrolled pilot study was to assess
the effectiveness daily yoga-based exercise, consisting of a
specially designed gentle 6-week program to reduce FM
symptoms, including pain and sleep disturbance, and with
a focus on the role of negative cognitions about pain such
as catastrophizing.
Materials and methods
Setting, participants, and study design
The Partners Institutional Review Board approved this
study, which was a pilot uncontrolled trial without a
control comparison group. Participants were recruited
using physical flyers and a centralized clinical data reg-
istry. Inclusion criteria included; 1) 18–75 years of age,
2) chronic pain with a diagnosis of FM (Wolfe et al 2011
criteria) for>6 months’duration, 3) stable medications
prior to entering the study, 4) average pain score ≥4/10,
5) sleep disturbance, defined as Pittsburgh Sleep Quality
Index (PSQI) score ≥5, 6) able to speak and understand
English, 7) access to a computer/tablet/smartphone at
home, 8) and willing and physically able to participate
in yoga-based exercise. Exclusion criteria included; 1)
ongoing cancer treatment, 2) acute osteomyelitis/bone
disease, 3) chronic systemic inflammatory disease, 4)
schizophrenia, delusional disorder, psychotic disorder, or
dissociative disorder judged to interfere with study parti-
cipation, 5) pregnancy, 6) unstable systemic illness or
injury requiring urgent surgery or treatment, 7) active
addiction disorder, 8) current rigorous daily exercise rou-
tine (>20 mins/day and >5×/week), and 9) current regular
meditative practice (e.g tai-chi, meditative form of yoga
or contemplative prayer) for >20 min/week. Informed
consent procedures were performed in accordance with
the Declaration of Helsinki for all participants. Patients
who dropped out before week 6 or attended <4/6 weekly
yoga classes were not included in the analysis.
Yoga study procedures
Participants underwent initial telephone screening, and eligi-
ble participants who gave consent were invited for a baseline
research visit followed by a 6-week yoga program. Once a
sufficient number of participants to fill a class were enrolled
(group sizes of n~10), time of day and day of the week for
classes was determined based on participants’and instruc-
tor’s collective schedules. The study included 5 separate
consecutive yoga cycles/groups, with 6–10 participants com-
pleting the yoga program per cycle, which took place at a
satellite outpatient clinical and research center connected to a
large tertiary referral academic hospital.
Satyananda Yoga program
Subjects participated in a yoga program specifically adjusted
for chronic pain patients, led by a certified yoga instructor and
doctoral-level psychologist. Each week, there was an in-per-
son session that lasted 1.5 hrs and included asanas, meditation,
and other mindfulness-based practices (see Appendix).
Satyananda Yoga is a traditional form of yoga which includes
asanas (physical exercises), pranayama (breathing exercises),
pratyahara (mind focusing practices), and meditation (breath-
ing awareness, awareness of senses, awareness of thoughts,
and yoga nidra); it is gentle and may be adapted to be less
physically demanding,
17,18
integrating development of physi-
cal, mental, emotional, psychic, and spiritual aspects of one’s
being. In order to encourage the integration of these practices
into everyday life, participants were also instructed to follow a
daily 30-min yoga video while at home in between in-person
classes with the instructor. These videos featured the same
instructor as in-person and consisted of a condensed
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combination of meditation, breathing exercises, and asanas,
which had been introduced in the class that week (i.e., 6
different videos sent throughout the program, a new one for
each week).
Sociodemographic data and psychosocial
characteristics
Sociodemographic information was collected including age,
race, education, and current occupational status. Only female
participants responded to study advertisements. Data were
collected during the baseline assessment week and the 6th
week of yoga intervention (end of study intervention), via the
secure REDCap survey system email link.
Pain Catastrophizing
The Pain Catastrophizing Scale (PCS),
19
which has been
widely used in chronic pain patients and controls,
20,21
was
used to measure catastrophic thinking (rumination, magni-
fication, and helplessness) about pain.
Emotional Distress-Anxiety and Depression
The Patient-Reported Outcomes Measurement Information
System (PROMIS) anxiety (7 items) and depression
(8 items) short forms, which are widely used and exten-
sively validated,
22,23
were used.
Fibromyalgia symptoms
In order to measure general FM symptomatology, the
Revised Fibromyalgia Impact Questionnaire (FIQR),
24
a
21-item assessment of functioning and overall impact of
FM symptoms, was completed.
Self-Reported Sleep Assessment
The Pittsburgh Sleep Quality Inventory (PSQI), which
includes questions regarding sleep quality, latency, dura-
tion, disturbances, habitual sleep efficiency, daytime func-
tionality due to sleep, and the use of sleep medications,
25
was used, with score ≥5 considered “poor sleep quality”.
Sleep Actigraphy
A wrist actigraph (Actiwatch 2) was worn by participants
during the baseline assessment week and during the 6th
week of the yoga program in order to estimate sleep effi-
ciency. Activity count data was downloaded and habitual
sleep parameters determined using Philips Actiware default
settings for sleep–wake determination. Average sleep effi-
ciency for a week was calculated as: (sleep time/in bed
time)×100, averaged over 6 nights.
Pain
Participants completed the Brief Pain Inventory (BPI),
26
including 4 pain intensity questions (pain now, average
pain, worst pain, least pain) rated on a 0 to 10 scale.
Ecological momentary assessment (daily diaries)
During the baseline assessment week and the 6th week of
yoga intervention, patients completed 7 days of electronic
diary entries at home, sent via the secure REDCAP survey
system email link each morning and evening. This
included pain ratings, anxiety, fatigue, stress, and subjec-
tive sleep quality.
Yoga practice
At the end of each week of the yoga program (i.e., on the day
before each yoga class), participants completed a “weekly
check-in”survey, reporting the number of days and amount
of time/number of days that they practiced yoga at home
since the last yoga class (over a 5-day period).
Data analysis
A total of 46 participants were enrolled, with 36 participants
completing the study (Appendix-studyflow diagram). Those
who dropped out before week 6 or attended <4/6 weekly
yoga classes were not included in the analysis. All analyses
were conducted using IBM-SPSS v.25. Individual changes in
pain and other symptoms were assessed using Students’
paired samples t-test or Wilcoxon signed-ranks tests and
Pearson or Spearman correlations were calculated to assess
relationships between variables, as appropriate. In the group
of participants who completed the study, the amount of
missing data was relatively low for daily diary collection
(5%), with no missing preintervention and postintervention
assessment data. Multilevel modeling was used in order to
assess patient characteristics that were associated with better
outcomes at the end of the yoga program (sixth week).
Baseline to post-treatment percentage change was calculated
as follows: {[Post/Pre×100]–100}. Repeated measures of
daily pain, fatigue, and sleep efficiency (Level 1 units)
were nested within participants, and related to patients’base-
line psychosocial characteristics (Level 2 units), including
baseline anxiety (PROMIS-anxiety short form) and catastro-
phizing (PCS). Given that multilevel modeling can account
for an unbalanced data structure and/or random missing
data,
27,28
no data imputation procedure was used. Two-way
(e.g., Level 2 baseline catastrophizing × Level 2 baseline
PROMIS-anxiety) interaction terms were also specified and
included in the model, and baseline sleep efficiency, fatigue,
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and pain were included as covariates. We examined the
amount of missing data for each of the main outcome vari-
ables (e.g. pain catastrophizing, pain intensity, daily fatigue,
daily pain, FM symptoms, sleep quality). For the primary
variables sleep quality, daily fatigue, pain severity, pain cat-
astrophizing, and FM symptoms, there were no missing data.
Non-completers were not included in the analysis, due to a
lack of endpoint comparator for pre-post comparisons, and
lack of 6-week data for multilevel modeling.
Results
Forty-six participants initially enrolled, and 36 participants
completed the study. Participants who dropped out of the
study (n=10; 5 at week 1, 1 at week 2, 1 at week 4, and 3 at
week 5) (see flow diagram, Appendix), most commonly cited
lack of time to attend classes as the reason for noncontinuance.
Demographic and baseline characteristics
of sample (Table 1)
The average age of participants was 48.5±13.9, all parti-
cipants were women, and 83% were identified as
Caucasian. The reported average pain severity, sleep dis-
turbance, and psychosocial variables were similar to pre-
vious studies among patients with FM.
29–31
Of those who
initially agreed to participate, 74% (N=36) participated to
a meaningful extent (attending 4–6 classes and reporting
minutes of at home practice/day).
Changes in pain
Pain, as measured by the BPI, decreased from baseline to 6
weeks amongst the participants (5.0±2.1 vs 4.5±2.3,
p=0.041) and the highest reported daily pain (measured
by daily diaries during baseline and week 6) decreased as
well (67±16 vs 60±18, p=0.007) although substantial
variability in pain scores was reported across participants
(Figure 1A). Similarly, participants reported a variable
amount of daily home practice, with more average home
practice time associated with reduction in average pain
(Spearman Rho: −0.428, p=0.009, Figure 1B). The great-
est benefit was observed in those who practiced 25 mins/
day or more (28% of subjects), compared to those who
practiced less than 25 mins/day (p=0.023).
Changes in FM symptoms: FIQR, fatigue,
and sleep efficiency
In contrast to the decrease in BPI, we did not observe a
decrease in Revised FIQR group means (57.20±20.52 vs
53.18±18.12, p=0.44; 7% change). Because sleep disturbance
is a prominent facet of FM symptomatology, we examined
whether yoga-based exercise impacted sleep. Similar to pain,
we observed a small overall decrease in sleep disturbance
groupmeanonthePSQI(Figure 2A, 11.3±4.5 vs 10.0±4.40
p=0.027, 12% change) as well as fatigue (Figure 2B,60.7
±17.5 vs 54.0±17.8, p=0.003; 11% change), although this was
quite variable between individuals. No significant change in
sleep efficiency was detected as measured by actigraphy
(Figure 2C, 87.1±7.6 vs 85.5±9.9, p=0.59, Wilcoxon signed
rank), again with variability between individuals. However, a
higher sleep efficiency at the end of the study (week 6 average
sleep efficiency) was correlated with greater decreases in sleep
disturbance over the course of the study (PSQI) (Rho: –0.40,
p=0.03), greater decreases in fatigue (rho: –0.395, p=0.034),
and greater increases in overall self-reported physical activity
(Rho: 0.395, p=0.034).
Table 1 Demographics and baseline clinical characteristics
Age 48.5±13.9
BMI 28.2±7.1
Race
Caucasian 83%
African American 8%
Education
Non-college graduate 26%
College graduate 49%
Master's degree 20%
Doctoral degree 6%
Employment
Full-time 15%
Part-time 18%
Homemaker 23%
Retired 15%
Daily average pain (0–100) 51.6±18.1
Fybromyalgia symptoms (FIQR) 57.2±20.5
Pain (BPI) 5.0±2.1
Sleep disturbance (Pittsburgh Sleep Quality Index) 11.3±4.5
Daily fatigue (0–100) 60.7±17.5
Catastrophizing (PCS) 21.5±14.0
Anxiety (PROMIS t-score) 59.4±8.7
Abbreviations: BMI, body mass index; FIQR, Fibromyalgia Impact Questionnaire;
BPI, Brief Pain Inventory; PCS, Pain Catastrophizing Scale; PROMIS, patient-
reported outcomes measurement system.
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Changes in pyschosocial functioning: pain
catastrophizing
Changes in pain catastrophizing were also variable
amongst participants, with an overall decrease over the
course of the program (21.5±14 vs 18.1±15, p=0.039,
16% change Wilcoxon signed rank; Figure 3A). On the
other hand, general anxiety, as measured by the PROMIS-
anxiety short form, did not change (59.38±8.7 vs 60.19
±10.14 p<0.001).
Interestingly, those who showed a greater decrease in pain
catastrophizing over the course of the program also reported a
greater decrease in FM symptoms (FIQR) (Rho: 0.450,
p=0.006, Figure 3B) as well as lower reported daily “worst”
pain (Rho: 0.351, p=0.036). There was a trend toward a
negative correlation between decreased catastrophizing and
improved sleep efficiency (Rho: –0.31, p=0.102), but not
between decreased anxiety and improved sleep efficiency
(Rho: 0.09, p=0.649).
Baseline characteristics predicting
symptoms at the end of yoga intervention
In order to understand whether individual differences in
psychosocial characteristics, such as catastrophizing and
anxiety, could help explain variation in the degree of
yoga’s effect between individuals, we conducted multi-
level modeling (MLM) analysis of pain and sleep.
Figure 1 Changes in pain: association with amount of yoga practiced. (A) Pain intensity scores as measured using the brief pain inventory, either at baseline before (left) or
after (right) yoga program; (B) correlation of decrease in average daily pain from baseline to 6th week of program with average reported minutes of home yoga practice over
a 5-day period.
Figure 2 Changes in sleep and fatigue. (A) Sleep quality as measured by the pittsburgh sleep quality index, either at baseline before (left) or after (right) yoga program; (B)
average fatigue (0–100) measured by daily diaries, either at baseline (left) or during the 6th week of the yoga program (right); (C) sleep efficiency as measured using
actigraphy, at baseline (left), and at end (right) of yoga program.
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Specifically, we used this method to investigate the influ-
ence of baseline catastrophizing and anxiety on the daily
diary-rated pain and fatigue, as well as on actigraphy-
measured sleep efficiency, during the final week of the
yoga program, because FM symptoms (such as pain and
sleep disturbance) vary considerably from day to day.
The results from the MLM analyses did not reveal a
significant main effect of baseline pain catastrophizing score
(PCS) on sleep efficiency (B=0.041 SE=0.16, p=0.80), fatigue
(B=0.059 SE=0.28, p=0.83), or pain (B=−0.17 SE=0.29,
p=0.55). Similarly, there was no significant main effect of
PROMIS-anxiety scores on sleep efficiency (B=−0.077
SE=0.26, p=0.77), fatigue (B=0.41, SE=0.43, p=0.34), or
pain (B=0.399, SE=0.40, p=0.33). However, we observed a
significant interaction between baseline PROMIS-anxiety and
catastrophizing on post-study sleep efficiency (B=−0.40,
Figure 3 Changes in pain catastrophizing: association with changes in fibromyalgia symptoms. (A) Pain catastrophizing scores as measured using the pain catastrophizing
scale (PCS), either at baseline before (left) or after (right) yoga program. (B) Correlation of decrease in fibromyalgia symptoms, as measured by change in pre- and post-
scores on the Revised Fibromyalgia Impact Questionnaire (FIQR), with decrease in pain catastrophizing.
Figure 4 Pain, fatigue, and sleep efficiency at study end: association with baseline psychosocial characteristics. (A) Daily diary pain severity, (B) daily diary fatigue, and (C)
nightly sleep efficiency (actigraphy) during the last week of yoga (week 6) was investigated using multilevel modeling to understand the impact of patients’baseline
psychosocial characteristics. An interaction between baseline anxiety, as measured using PROMIS-anxiety, and baseline catastrophizing, as measured using the pain
catastrophizing scale, was observed for all three outcomes.
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SE=0.01, p=0.016), fatigue (B=0.06 SE=0.022, p=0.011), and
pain (B=0.055 SE=0.02, p=0.011), such that patients who
scored high in catastrophizing and low in anxiety demon-
strated significantly less fatigue, and pain, and higher sleep
efficiency (Figure 4), after controlling for baseline fatigue,
sleep efficiency and pain severity. In addition, sensitivity
analyses indicated that the interaction was not moderated by
any other demographic (i.e., age, sex, ethnicity) or psycholo-
gical (i.e., anxiety, depression) variables (all p’s>0.05).
Discussion
This pilot study in FM patients suggests that an exercise-
based Satyananda yoga intervention may modulate some
of the core symptoms of FM, including pain, sleep dis-
turbance, and catastrophizing, but that this benefit is quite
variable amongst individuals, resulting in meaningful ben-
efit only to some. Exploratory analysis demonstrated that
benefit was more pronounced for individuals who prac-
ticed more consistently, and who reported higher baseline
catastrophizing, but low anxiety, in terms of sleep effi-
ciency, fatigue, and pain at the end of the program.
The present finding that pain modestly decreased from
baseline to postintervention for the overall group parallels
results from previous yoga and meditation-based research
interventions in chronic pain populations.
9,32,33
These stu-
dies have shown a modest effect on reducing pain and
disability, pain catastrophizing and acceptance, as well as
cortisol, proinflammatory cytokines, and endorphin
levels.
1,7–14,34–36
Further analysis revealed the degree of benefittobe
unequally distributed among participants, with some parti-
cipants reporting more marked pain reduction.
Specifically, pain reduction was inversely correlated with
a greater amount of home practice, and most pronounced
in those reporting greater than 25 mins of home practice
on average. This suggests that greater engagement and
participation may yield benefits in terms of pain reduction,
which is in agreement with prior studies.
37
Use of daily
yoga videos at home, which featured the same instructor,
may have assisted with practice adherence and engage-
ment, but further investigation is required to determine
barriers and facilitators to self-practice.
Laboratory-based, clinical, and epidemiological studies
have suggested that sleep duration and quality influence
subsequent pain report. Sleep deprivation in healthy sub-
jects results in enhanced pain, and poor sleep is correlated
with elevated pain severity and disability in individuals
with chronic pain.
11,38
Patients with sleep disturbance are
more likely to develop chronic pain, and degree of sleep
disturbance predicts severity of FM symptoms.
12,13
Epidemiologic surveys consistently report that the vast
majority of patients with FM suffer from significant dis-
turbances initiating or maintaining sleep,
15
and robust
relationships are observed between pain severity and
sleep disturbance in FM patients.
16
Our study indicated
beneficial effects of yoga practice on sleep quality and
subjective fatigue in patients with FM, similar to earlier
studies.
8,39–41
Yoga appears to decrease autonomic reac-
tivity, suggesting a fundamental normalization of physical
processes,
42
which may favor a transition to more normal
sleep. More efficient sleep at the end of the study (based
on wrist actigraphy) mirrored subjective sleep quality
improvement and was associated with greater physical
activity.
Patients with high catastrophizing and low anxiety at
the beginning of the study had the most favorable sleep
efficiency, reported better sleep, and less pain during the
final week of Satyananda yoga. This interaction between
catastrophizing and anxiety with respect to pain and sleep
quality may indicate that participants who engage in nega-
tive thinking about symptoms (i.e. catastrophizing) might
stand the most to gain from both the physical exercises and
meditative practices inherent in yoga, but only if they have
relatively low generalized anxiety. Previous studies have
indicated that yoga allows patients to overcome the fear of
movement,
43
which is similar conceptually to catastrophiz-
ing about pain. Catastrophizing, which is higher amongst
individuals with FM, was modestly decreased overall in
the group during this study. Interestingly, we did also
observe that decreases in reported FM symptoms (FIQR)
during the course of the yoga program were associated
with decreases in catastrophizing, perhaps indicating that
FM symptom reduction may be connected to decreased
catastrophizing in FM patients.
3,44
However, a higher level
of general anxiety might preclude effective engagement
with yoga practice. Although prior studies have demon-
strated that yoga helps decrease anxiety, this might be only
the case in individuals with mild-moderate levels of anxi-
ety at preintervention.
45
The most important limitation of this pilot study was a
relatively small sample size without a control group, mak-
ing the generalizability of positive findings, as well as the
definitiveness of negative findings, unclear. While we
observed trends toward change in many variables, some
did not reach statistical significance, raising the possibility
that the study was underpowered for these outcomes.
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Second, as is apparent in the figures, the between subject
variability was high, also limiting statistical power. We
were able to partially mitigate the impact of variability
by using paired tests and MLM analysis of daily diary and
actigraphy data. However, it is likely that the degree of
variation between individuals reflects a true variability in
the experience of symptoms between individuals with FM,
with some people gaining more benefit (or less) from the
practice of yoga. Third, because of the voluntary nature of
the intervention, substantial selection bias may exist, limit-
ing the application of findings to individuals who are
willing and able to engage in yoga. Fourth, approximately
a quarter of initially interested individuals dropped out of
meaningful participation, suggesting that this type of inter-
vention may be too cumbersome for a significant subset of
FM patients, and precluding our ability to assess its benefit
to FM patients more generally. Fifth, this particular yoga
intervention included gentle postures, anchored by a short
meditation, and included daily at home video-led practice.
It is unclear which of these elements was helpful/not help-
ful, and to what degree this may generalize to other yoga,
exercise, or meditation practices. Further evaluation in a
larger sample of patients, with a time-and-attention
matched control would allow confirmation of the efficacy
and tolerability of group-based yoga therapy for this chal-
lenging condition. The selection of meaningful active and
passive control conditions will be important to understand
whether and for whom yoga may be more useful.
Conclusion
This pilot study suggests that yoga-based exercise can be
effective in decreasing pain, catastrophizing, and sleep
disturbance in some FM patients, particularly those who
are willing to engage in a more consistent home self-paced
practice. As uptake of Satyananda yoga in FM can be
variable, future research should potentially explore the
efficacy of other yoga styles and protocols. Additionally,
individual phenotypic characteristics that may predict the
better clinical effect of yoga on fatigue, sleep efficiency,
and pain include high catastrophizing, but relatively low
general anxiety, although this should be investigated in a
larger sample before being applied to clinical recommen-
dation. Overall, yoga, as a safe, gentle, and adaptable
exercise option, could be a beneficial tool to complement
the conventional therapies currently used to manage FM
symptoms.
Acknowledgment
The authors would like to sincerely thank all the partici-
pants who gave their time and energy to making this study
possible. This study was supported by a grant to KLS from
the Osher Center for Integrative Medicine/Harvard Medical
School.
Disclosure
The authors report no conflicts of interest in this work.
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