Clinical Outcome in Covid 19 with Yoga and Naturopathy Intervention: A Systematic Review

Abstract

Exploring traditional Indian systems of medicine, such as Naturopathy and Yoga, can provide potential benefits in improving host immunity and mitigating the severity of the infection. Naturopathic medicine therapies focus on correcting underlying imbalances caused by sedentary lifestyles and require a comprehensive care plan to support long-term sustainable health and enhance immune function. This review aims to thoroughly investigate the recent scientific literature regarding the clinical efficacy of yoga and naturopathy in treating COVID-19 and to explore the proposed mechanisms underlying their ability to improve the host immune system. To gather relevant references, comprehensive searches were conducted in PubMed Central, Research Gate, Science Direct, Google Scholar, Scopus and MEDLINE databases from 2018 to 2023, using the keywords Naturopathy, Yoga, Covid-19 and India. The initial search yielded a total of 693 records. After applying specific inclusion and exclusion criteria, seven articles were selected for synthesis, comprising two case studies, one pilot study, three randomized controlled trials and one cohort study. The integration of naturopathy and yoga in conjunction with conventional modalities has shown promising results in effectively managing the severity of Covid-19. These findings highlight the potential benefits of incorporating these holistic approaches into treating Covid-19 patients.

Full text

| ISSN: 1993-6095 | Volume 17 | Number 4 |
548
| 2023 |
Research Journal of
Medical Science
Research Article
doi: 10.59218/makrjms.2023.548.554
OPEN ACCESS
Key Words
Covid 19, naturopathy, yoga, clinical
outcome
Corresponding Author
Shrikanth Muralidharan
Department of Research, National
Institute of Naturopathy, Ministry of
Ayush, Pune 411001, India
Received: 2 July 2023
Accepted: 14 July 2023
Published: 16 July 2023
Citation: Abitone Valsakumar,
Satyalakshmi Komarraju, Yuvaraj
Paul, D. Sathyanath and Shrikanth
Muralidharan, 2023. Clinical
Outcome in Covid 19 with Yoga
and Naturopathy Intervention: A
Systematic Review. Res. J. Med. Sci.,
17: 548-554, doi: 10.59218/
makrjms.2023.548.554
Copy Right: MAK HILL Publications
Clinical Outcome in COVID 19 with Yoga and
Naturopathy Intervention: A Systematic Review
1Abitone Valsakumar, 2Satyalakshmi Komarraju,
2Yuvaraj
Paul, 2D. Sathyanath and 3Shrikanth Muralidharan
1Department of Clinical Naturopathy, National Institute of Naturopathy,
Ministry of Ayush, Pune 411001, India
2
National Institute of Naturopathy, Ministry of Ayush, Pune 411001, India
3Department of Research, National Institute of Naturopathy, Ministry of
Ayush, Pune 411001, India
ABSTRACT
Exploring traditional Indian systems of medicine, such as Naturopathy and
Yoga, can provide potential benefits in improving host immunity and
mitigating the severity of the infection. Naturopathic medicine therapies
focus on correcting underlying imbalances caused by sedentary lifestyles
and require a comprehensive care plan to support long-term sustainable
health and enhance immune function. This review aims to thoroughly
investigate the recent scientific literature regarding the clinical efficacy
of yoga and naturopathy in treating COVID-19 and to explore the
proposed mechanisms underlying their ability to improve the host
immune system. To gather relevant references, comprehensive searches
were conducted in PubMed Central, Research Gate, Science Direct,
Google Scholar, Scopus and MEDLINE databases from 2018 to 2023, using
the keywords Naturopathy, Yoga, Covid-19 and India. The initial search
yielded a total of 693 records. After applying specific inclusion and
exclusion criteria, seven articles were selected for synthesis, comprising
two case studies, one pilot study, three randomized controlled trials and
one cohort study. The integration of naturopathy and yoga in conjunction
with conventional modalities has shown promising results in effectively
managing the severity of Covid-19. These findings highlight the potential
benefits of incorporating these holistic approaches into treating Covid-19
patients.

Res. J. Med. Sci., 17 (4): 548-554, 2023
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549
| 2023 |
INTRODUCTION
The Coronavirus emerged as a global pandemic,
officially as per the World Health Organization on
March 11, 2020[1,2]. Belonging to the Coronaviridae
family, this virus causes respiratory infections such as
severe pneumonia, which can be particularly fatal for
immunocompromised and elderly individuals. Although
it affects individuals of all ages, those with weak
immunity and underlying health conditions tend to
experience milder to moderate symptoms. The virus
spreads through respiratory droplets expelled by
infected individuals[3-7]. Implementing healthcare
strategies that primarily focus on immune surveillance
and resilience can significantly reduce the severity of
the disease. These strategies aim to decrease
inflammatory markers, enhance the activity of specific
immune cells involved in COVID-19's pathogenesis and
mitigate inflammatory responses[8]. While vaccination
can induce specific immunity, strengthening overall
host immunity remains crucial in preventing the spread
of infection and reducing the potency of SARS-CoV.
Exploring traditional Indian systems of medicine, such
as Naturopathy and Yoga, can provide potential
benefits in improving host immunity and mitigating the
severity of the infection. Naturopathy is a subset of
primary care medicine that combines ancient healing
practices with contemporary research, emphasizing
the body's inherent healing power, disease prevention
and individual responsibility for optimal health. Its
therapeutic techniques include diet and clinical
nutrition, yoga, acupuncture, behavioural modification,
hydrotherapy, physical medicine, medicines and minor
surgery[9]. Naturopathic medicine therapies focus on
correcting underlying imbalances caused by sedentary
lifestyles and require a comprehensive care plan to
support long-term sustainable health and enhance
immune function
[10,11]
. This review aims to consolidate
existing literature on Yoga and Naturopathy for
COVID-19, demonstrating the efficacy and consistency
of this treatment strategy in fighting the pandemic by
improving the host immune system.
MATERIALS AND METHODS
Study strategy and design
Literature search: A comprehensive search of
literature published from 2021 to 2023 was conducted
to identify relevant studies. The search was performed
using keywords such as: “Yoga,” “Naturopathy,”
“COVID-19,” “India,” “therapeutic effect” and
“efficacy” and their synonyms. The following databases
were searched: PubMed Central, Research Gate,
Science Direct, Google Scholar, Scopus, Medline and
Cochrane. No restrictions were placed on the type of
study (Fig. 1).
Fig. 1: PRISMA flow chart and screening of studies
Studies included in review
(n = 7)
Case study (n = 2)
RCT (n = 2)
Pilot study (n = 1)
Cohort study (n = 1)
Identification of stu dies via database and registers
Records identified from:
MEDLINE/PubMed
central (n = 31),
research gate (n = 31),
scopus+sci ence direct ( n =39),
Google scolar (n = 592)
Database (n = 693)
Record s screened (n = 261)
Record s removed b efore
screenin g (n = 432)
Record s excluded = k eywords
Post Covid, non-Indian,
Ayurveda (n = 222)
Reports assessed for
eligibility (n = 12)
Reports sought for
retrieval (n = 39)
Reports excluded:
Protocol (n = 2)
Letter to editor (n = 2)
Reports not retrieved
(n = 27)
Screening
Included
Identification

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Inclusion and exclusion criteria
Exclusion criteria:
C Letters to the editor and study procedures were
excluded
C Animal trials and in vitro studies were not
considered
After applying these criteria, five studies were
selected for review.
Study population and intervention: The selected
studies included a population ranging from 18-70 years
of age
[12]
, consisting of individuals previously diagnosed
with COVID-19. All study subjects were found to have
average higher mental functions. The selected studies
focused on managing COVID-19 and its manifestations
through naturopathy and yoga interventions. The
interventions employed in these studies included
Balneotherapy, Diet therapy and yoga therapy.
RESULTS
A total of 693 records were identified using the
keywords “Yoga,” “Naturopathy” and “COVID-19”.
Seven articles were included in this study after
applying the inclusion and exclusion criteria. The
selected articles comprised a range of study designs,
including 2 case study, one pilot study, three
randomized controlled trials and 1 cohort study.
Table 1 and 2 presents the quality assessment, details
of each article, including the source, keywords, study
design, intervention used, parameters assessed and
conclusions.
DISCUSSIONS
To the best of our knowledge, this study is the first
to examine the effect of naturopathy and yoga on
improving the host immune system in COVID-19
patients. The COVID-19 pandemic has significantly
impacted mental health, particularly among vulnerable
groups[13]. Psychological symptoms of stress, anxiety
and depression can impair immunological function and
increase vulnerability to viral upper respiratory tract
infections
[14,15]
. Therefore, investigating the relationship
between psychological distress and the immune
response to COVID-19 infection is crucial. A close
connection between the neurological, endocrine and
immunological systems explains how mental health
issues can influence the immune response to
infection
[16]
. Naturopathy addresses underlying causes
rather than symptoms, while yoga effectively manages
psychosomatic and lifestyle disorders
[17]
. Naturopathic
interventions such as balneotherapy stimulate the
body's inherent healing mechanisms by improving
blood and lymph circulation. Yoga supports weakened
or damaged systems and physical medicine techniques,
including massage and manual manipulation, correct
structural disintegration. Naturopathy also employs
Table
1:
Quality
assessment
of
the
included
studies
Sampling
method
not
specified
Comparison
group
Not
present
Random
allocation
Not
done
Calibration
of investigator
Not
mentioned
Scales used
for measurement
HADS,
CAS
scale
Long-term
follow-up of cases
Not
done
Author
(year)
Jerrin
et
al
.
[31]
(n
=
130)
Blinding
Not
done
Limitations
C
No control group and
C
Being a non-randomized trial
C
Limited sample size
Not
applicable
C
Small sample size, single center,
C
Short evaluation period
C
Lack of control group
Not
applicable
C
Smaller sample size
C
Unequal gender distribution
C Smaller sample size
C
Non-randomization
C
Small
sample
size
C
Blinding
of
patients
was
not
possible
due to study design
Mooventhan et al.[35]
Jagadeesan
et
al
.
[32]
(n
=
42)
Not
applicable
not
specified
Not
present
Not
present
Not
done
Not
done
Not
done
Not
done
Not
mentioned
Not
mentioned
Symptom
score
DASS-21,
PSQI,
WHOQOL-BREF
Not
done
Not
done
Aruchunan et al.[24]
Sharma
et
al
.
[33]
(n
=
62)
Not
applicable
Simple
random
Not
present
present
Not
done
Not
done
Not
done
Done
Not
mentioned
Mentioned
DASS-21
HADS,
PHQ-9,
GAD-7,
PSS-10
Not
done
Not
done
Pradeep[36]
(n
=
112)
Non-Randomized
Present
Not
done
Not
done
Not
mentioned
DASS-21
and
WHO
QoL
Not
done
Dua
et
al
.
[26]
(n
=
20)
Simple
random
Present
Outcome
assessor
and
statistician
Done
Mentioned
QOL,
SGRQ,
PHQ-9,
GAD-7
scale
and
FSS
Not
done

Table 2: Outcome measures of the included studies
Study Design Inclusion criteria Intervention Outcome measures Findings
Jerrin et al.[31] (n = 130) Pilot study Covid-19-positive patients Yoga and Naturopathic intervention HADS (Hospital anxiety depression After the intervention, there was a
of both sex were given for 60 min a day for scale) and CAS (Corona anxiety scale) score significant reduction in HADS-anxiety
two weeks scores (p<0.05), HADS-depression
scores (p<0.04) and CAS scores (p<0.01),
indicating a decrease in anxiety, depression
and COVID-19- related stress
Mooventhan et al.[35] Case report COVID-19 Positive Conventional medicine+yoga and Number of hospital stay and symptom score The length of hospital stay was 11 days.
naturopathy for 11 days Which is less than the median hospital
stay observed in previous studies and the
symptom score reduced from 6 (day 1)
to 0 (day 6)
Jagadeesan et al.[32] (n = 42) Quasi-experimental study Who satisfied COVID-19 Bhramari Pranayama (Bhr.P) Depression anxiety and stress scale-21 The mean scores of depression, anxiety,
diagnostic criteria and for 15 days [DASS-21], sleep quality (Pittsburgh
stress and total DASS-21 showed a significant
asymptomatic home-isolated Sleep Quality Index-PSQI) and overall reduction (p < 0.001) after the intervention,
patients All adult patients quality of life (WHOQOL-BREF)
suggesting an overall improvement in mental
from18 to 60 years of age health
Aruchunan et al.[24] Case report COVID-19 positive Conventional medicine+yoga Systolic blood pressure (SBP), diastolic blood Post-test assessments compared to
and naturopathy pressure (DBP) and pulse rate (PR) were baseline assessments showed a conversion
measured with the digital BP apparatus. of positive to negative RT-PCR results for
Assessments such as pulse pressure (PP), COVID-19, improvements in cardiovascular
mean arterial pressure (MAP), rate pressure parameters (SBP, DBP, PR, MAP, RPP and
product (RPP) and double product (Do-P) Do P) and psychological parameters
Depression anxiety and stress scale (DASS)-21 (depression, anxiety and stress)
Sharma et al. (n = 62)[33] Quasi-randomized controlled study COVID-affected patients 50 min of yoga+conventional Standardized Hospital Anxiety and Depression The add-on yoga intervention led to a
medical treatment Scale, Generalized Anxiety Disorder-7 Item, significant decrease in stress, anxiety
Patient Health Questionnaire-9 and and depression. Furthermore, patients
Perceived Stress Scale practising yoga significantly improved
oxygen saturation and heart rate levels
Pradeep[36] (n = 112) Nonrandomized controlled study COVID-19 Positive patients
C
Yoga and naturopathy intervention
Depression anxiety stress scale YNI group had shown significant
(yoga therapy, naturopathic diet, steam (DASS-21), World Health Organization improvement in DASS-21 scores
inhalation, self-acupressure) (WHO) QoL and Symptom scores and the QoL domains as compared with
C
Simple-sectional breathing through
the controls. The severity of cough was
a telemedicine mode for 14 days+ significantly reduced in the study group
conventional medical treatment compared with the controls
Dua et al. (n = 20)[26] Parallel-group prospective COVID-19 patients with moderate One hour yoga session that included High-sensitivity C-reactive protein (hs-CR, The Intervention Group showed a more
randomized controlled trial (RCT) pneumonia, (iii) having a pranayama and Gayatri mantra (GM) interleukin 6 (IL6), ferritin, D-dimer, significant decline in high-sensitivity C-
smartphone with internet chant for up to 14 days erythrocyte sedimentation rate (ESR), reactive protein (hs-CRP) levels than the
facility, (iv) needing oxygen neutrophil-lymphocyte ratio (NLR), control group, indicating reduced
supplementation and (v) serum chest x-ray (CXR) scores, health-related inflammation.
procalcitonin <0.5 ng mLG1 quality of life (QOL) by St George Both intervention groups demonstrated a
Moderate pneumonia was Respiratory Questionnaire (SGRQ), decline in quality of life (QOL), depression,
defined as hypoxia with a Patient Health Questionnaire (PHQ)-9 anxiety and fatigue severity scale (FSS)
saturation of 90-94% on room and Generalized Anxiety Disorder (GAD)-7 scores, with a significant decline observed
air/dyspnea/respiratory scale, and fatigue assessment by Fatigue in FSS scores in the Intervention Group.
rate >24 breaths minG1 per Severity Scale (FSS) The median chest X-ray scores were also
Indian Council of Medical Research reduced in the intervention group,
(ICMR) guidelines indicating potential improvements in
lung health
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Med.
Sci.,
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548-554,
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specific natural substances, dietary supplements and
fasting therapy to manage bodily pathology[18]. These
natural therapies promote the body's natural immune
system homeostasis to counter pathogens. For
instance, a naturopathic elimination diet and yoga
have been shown to reduce inflammatory biomarkers
and ameliorate clinical signs of inflammation[19,20].
Compounds like naringenin and hesperidin found in
citrus fruits and grains indirectly affect insulin
resistance through various pathways, such as
promoting the growth of gut microorganisms and
altering gene expression related to glucose
homeostasis and insulin sensitivity[21-24]. Major
micronutrients especially Vitamin E,Vitamin C and
Vitamin D helps in reducing viral load by reducing
reactive oxygen species, modulating immune
function and promoting humoral response. And
hydro modalities such as warm turmeric salt
gargling,jalaneti,steam inhalation or local steam
application helps in supporting mucociliary clearance
and bronchodilator effect that ease upper respiratory
tract infection(URTI)[25]. In the present review, various
yoga and naturopathy interventions for COVID-19
patients have shown improvements in both systolic
and diagnostic blood pressure, pulse rate (PR), pulse
pressure (PP), mean arterial pressure (MAP), rate
pressure product (RPP), double product (Do P) and the
potential immunomodulatory effects of hydrotherapy
treatments[26,27].
Additionally, a significant reduction in
inflammatory markers, such as high-sensitivity
C-
reactive protein, was observed in COVID-19 patients
after a 14 day diet and 1 hr yoga intervention[28].
Stress and depression are psychiatric conditions
associated with the dysregulation of glucocorticoids
released by the autonomic nervous system and the
hypothalamic-pituitary-adrenal (HPA) axis, leading to
inflammation[29,30]. Recent meta-analysis studies have
also demonstrated that acute psychological stress
can alter circulating levels of inflammation and pro-
inflammatory cytokines, contributing to a “cytokine
storm,” which is implicated in COVID-19
pathogenesis
[31,32]
. Naturopathy and yoga interventions
positively modulate the host immune system by
reducing stress hormones, depression and anxiety
and improving sleep. In this analysis, significant
improvements were observed in HADS (Hospital
Anxiety Depression Scale), PSQI (Pittsburgh Sleep
Quality Index) and CAS (Corona Anxiety Scale) scores of
COVID-19 patients after naturopathy and yoga
interventions[33,34]. The subjective improvement in
COVID-19 patients' symptoms can be attributed to the
psychoneuroimmunology (PNI) effect of autonomic
nervous system modulation and reduction of
systemic inflammation through naturopathy and yoga
interventions. Therefore, this review demonstrates
the benefits of integrating naturopathy and yoga
management with conventional interventions to
enhance natural immunity in COVID-19 individuals.
CONCLUSION
This study reviewed seven Indian articles that
examined the integration of naturopathy and yoga
management alongside conventional approaches,
demonstrating improvements in host immune
function, quality of life, sleep and a reduction in
depression, stress and inflammatory markers. The
findings indicate that naturopathy and yoga
interventions can improve overall functional symptoms
in COVID-19 patients.
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