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Effects of Yoga versus walking on mood, anxiety, and brain GABA Levels: A Randomized Controlled MRS Study


Abstract and Figures

Yoga and exercise have beneficial effects on mood and anxiety. γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. The yoga subjects (n = 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n = 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
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Original Article
Effects of Yoga Versus Walking on Mood,
Anxiety, and Brain GABA Levels:
A Randomized Controlled MRS Study
Chris C. Streeter, MD,
Theodore H. Whitfield, ScD,
Liz Owen, BArch,
Tasha Rein, BA,
Surya K. Karri, MD, MPH,
Aleksandra Yakhkind, MS,
Ruth Perlmutter, MA,
Andrew Prescot, PhD,
Perry F. Renshaw, MD, PhD,
Domenic A. Ciraulo, MD,
and J. Eric Jensen, PhD
Objectives: Yoga and exercise have beneficial effects on mood and anxiety. g-Aminobutyric acid (GABA)-ergic
activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased
brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels
are specific to yoga or related to physical activity.
Methods: Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a
metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety
scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at
baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking inter-
vention, which was immediately followed by Scan 3.
Results: The yoga subjects (n¼19) reported greater improvement in mood and greater decreases in anxiety than
the walking group (n¼15). There were positive correlations between improved mood and decreased anxiety
and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and
changes in GABA levels.
Conclusions: The 12-week yoga intervention was associated with greater improvements in mood and anxiety
than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic
GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral
intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in
thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that
increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported
correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga
on mood and anxiety warrants further study.
Yoga has been used to reduce symptoms of depres-
sion, anxiety, and epilepsy.
Reduced activity in
g-aminobutyric acid (GABA) systems has been found in mood
disorders, anxiety disorders, and epilepsy.
All three of
these conditions respond to pharmacologic agents known to
increase GABA system activity, raising the possibility that
some of the therapeutic effect may be via increased GABA
In a previous study using magnetic resonance
spectroscopy (MRS) to obtain brain GABA levels, our group
demonstrated that experienced yoga practitioners had a sig-
nificant (27%) increase in whole-slab GABA levels after a 60-
minute session of yoga postures compared to no change in
Division of Psychiatry, Boston University School of Medicine, Boston, MA.
Division of Actuarial Science, Boston University, Boston, MA.
Liz Owen Yoga, Arlington, MA.
Department of Neurosurgery, Harvard University, Boston, MA.
Medicine/Hematology-Oncology, Children’s Hospital Boston, Boston, MA.
School of Medicine, University of Massachusetts, Boston, MA.
Departments of Radiology and
Psychiatry, University of Utah, Salt Lake City, UT.
Department of Psychiatry, Harvard University, Belmont, MA.
This article was previously presented as a poster at the American Psychiatric Association Annual Meeting, San Francisco, CA in 2008.
Volume 16, Number 11, 2010, pp. 1–8
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2010.0007
GABA levels in controls after a 60-minute reading session.
These findings raise the question of whether the associated
increase in GABA levels was specific to yoga or related to
physical activity in general.
There is a large body of research on the beneficial effects of
exercise on depression and anxiety.
The results of exer-
cise as a treatment for mild to moderate depression compare
favorably to psychotherapy and pharmacologic treatment,
supporting the contention that a behavioral intervention can
have an effect similar to a pharmacologic intervention on
This study extends the findings of self-reported mood
changes by exploring a possible mechanism: changes in
thalamic GABA levels measured on MRS. This study was
designed to correlate changes in mood, anxiety, and brain
GABA levels, and to determine whether such changes are
specific to a practice of yoga postures or whether they occur
in a metabolically matched walking intervention. We hy-
pothesize that improvement in mood scores correlate posi-
tively with GABA levels, while anxiety scores will correlate
negatively with GABA levels.
Materials and Methods
Subjects were recruited from the community by newspa-
per ads, flyers, and the Internet. Screening interviews and
written informed consent were obtained at Boston University
School of Medicine General Clinical Research Unit. Eligible
subjects were randomized in permuted blocks (n¼4) to a 12-
week intervention of either Iyengar yoga or walking for three
60-minute sessions per week, with a maximum of 36 ses-
sions. All subjects had three MRS scans: Scan 1 at baseline;
Scan 2 after their 12-week intervention; immediately after
Scan 2, all subjects completed a 60-minute yoga or walking
intervention, depending on group assignment, which was
immediately followed by Scan 3.
Participants were 18–45 years old with no current Axis I
diagnosis. Nonpsychoactive medications were allowed if the
subject had been on a stable dose for at least 1 month with no
anticipated changes during the study. The following items
were exclusionary: any yoga practice in the previous 3
months, or a lifetime history of one yoga session/week for
4 weeks; current participation in psychotherapy, prayer
groups, or any mind–body disciplines; a neurological dis-
order or medical condition that would compromise subject
safety or scan data; treatment within the previous 3 months
with medications that might affect the GABA system; use of
tobacco products (known to affect GABA levels)
; alcohol
consumption >4 drinks/day; and contraindication to mag-
netic resonance evaluation.
The following instruments were used for screening: the
Structured Clinical Interview for Diagnostic and Statistical
Manual of Mental Disorders IV to identify Axis I Disorders
and the Time Line Follow Back to assess alcohol consump-
Two (2) reliable and valid psychologic scales were
selected to monitor the effects of the interventions on mood
and anxiety over time. Mood was assessed with the Exercise-
Induced Feeling Inventory (EIFI), which has four subscales:
Positive Engagement, Revitalization, Tranquility, and Phy-
sical Exhaustion.
Anxiety was assessed with the State scale
of the Spielberger State–Trait Anxiety Inventory (STAI).
The EIFI and STAI-State were given before each scan, prior
to the first intervention session (week 0), and after comple-
tion of sessions at weeks 4, 8, and 12.
Metabolic equivalents (METs) are used to rate and com-
pare the physical demands of various activities.
American College of Sports Medicine list of metabolic
equivalents was consulted to match the 60-minute Iyengar
yoga intervention with a 60-minute walking intervention at
2.5 miles per hour (mph) on a flat surface rated at 3.0 METs.
During the intervention, the Physical Activity Recall (PAR), a
valid and widely used instrument, was used to convert each
subject’s weekly physical activity outside of the intervention
into a METs score.
For each group, the mean weekly PAR
METs scores was computed.
Certified Iyengar yoga instructors taught the yoga inter-
ventions, which were monitored by the Principal Investigator
to ensure consistency in presentation of weekly posture se-
quences. Written lists of the weekly sequences and pictures of
the postures were given to the subjects.
After 4 weeks of
instruction, subjects were encouraged to practice at home. The
intrascan yoga sequence was taught in class and monitored by
research staff during Imaging Session II. The structure of the
walking intervention was designed to be similar to that of the
yoga intervention, with weekly group sessions in which
subjects walked around the gym perimeter at 2.5 mph for
60 minutes. The intrascan walking session was done on a
treadmill set to 2.5 mph with 0 incline. This design controlled
for group effects and interaction time with research staff.
Subjects were scanned on a 4-Tesla full-body MR scanner
(Varian/UnityInova, Varian Inc., Palo Alto, CA) at Mclean
Hospital in Belmont, MA. Scout images confirmed optimal
positioning. After global shimming on unsuppressed water,
T1-weighted anatomical images were taken in sagittal and
axial planes [echo time (TE)/repetition time (TR) ¼6.2 sec-
onds/11.4 milliseconds, field-of-view ¼22228 cm (sagittal)
and 222216 cm (axial), readout duration ¼4 ms, receive
bandwidth ¼32 kHz, in-plane matrix size ¼12825616
(sagittal) and 25625664 (axial), in-plane resolution ¼
0.941.9 mm (sagittal) and 0.940.94 mm (axial), readout
points ¼512, slice-thickness ¼2.5 mm, flip-angle ¼118].
In our previous study, a post-hoc regional analysis that
used multivoxel spectroscopic imaging showed that the
greatest increase in GABA levels after the yoga intervention
was in the thalamus.
The selection of the left thalamus was
based on evidence that the left side has greater parasympa-
thetic innervations and that GABA levels are lower in the left
thalamus in post-traumatic stress disorder subjects.
this study, an algorithm was developed to position a 223-
cm voxel over the left thalamus. Proton spectroscopy
implemented a MEGAPRESS [MEscher-GArwood Point-
Resolved Echo Spectroscopy Sequence] difference-editing
sequence specifically tuned for GABA.
Manual voxel
shimming yielded global water-line widths ranging from 8 to
15 Hz. The MEGAPRESS sequence collected 68-millisecond
echo-time spectra in an interleaved fashion where the GABA
editing pulse was applied on every second transient. Addi-
tional MEGAPRESS acquisition parameters were: TR¼2sec-
onds, spectral-bandwidth ¼2 kHz, readout-duration ¼512
milliseconds, Number of Excitations (NEX) ¼384, and total
scan duration ¼13 minutes.
FIG. 1. Flow chart of subject recruitment through completion. GABA, g-aminobutyric acid.
In order to quantify GABA, the difference-edited spectra
were processed and then fitted with LCModel using basis sets
acquired at 4 T. A separate LCModel template was used to fit
the unedited 68-milisecond subspectrum to obtain creatine
(Cr). All fitted metabolite areas were normalized to the fitted
Cr resonance from the 68-millisecond subspectrum. One (1)
spectrum from the MEGAPRESS acquisition in the thalamus
was excluded from analysis due to low signal-to-noise.
GABA/Cr ratios are referred to as GABA levels. In order to
ascertain the gray and white matter contribution to each
voxel, the axial T
-weighted images were segmented into gray
matter, white matter, and cerebrospinal fluid compartments
using the commercial software package FSL 4.1 (FMRIB
Software Library; Analysis Group, FMRIB; Oxford, UK).
Statistical analysis
The primary outcome variables were mood scores, anxiety
scores, and thalamic GABA levels. Continuous measures
were summarized by means standard deviations; within-
group comparisons were performed using paired t-tests,
while between-group comparisons were performed using
two-sample t-tests. Discrete measures were summarized by
raw counts for numerators and denominators, as well as the
associated percentages, and were compared by Fisher’s exact
test due to the limited sample size. Linear regression analysis
was used to quantify the association between the primary
outcome variables and potential predictor variables. In order
to take into account within-subject correlations arising from
repeated longitudinal measurements, generalized estimated
equations (GEEs) were used to analyze within-group trends
in mood and anxiety scores, as well as to perform between-
group analyses.
All hypothesis tests were two-tailed and
conducted at the a¼0.05 significance level. Confidence in-
tervals were two-sided and were constructed with 95% con-
fidence. Stata 10.0 (College Station, TX) was used for analysis.
Demographics and study participation
Thirty-four (34) subjects completed the study: 19 in the
yoga group and 15 in the walking group (Fig. 1). There was
no significant difference between groups for demographic or
descriptive variables except for height, which although sta-
tistically significant due to a relatively small standard devi-
ation was clinically not significant. There was no difference
in demographics between study completers and dropouts,
Table 1. Demographics and Study Participation
Yoga group
Walking group
Factor Mean SD Mean SD tdfp
Age 23.9 3.0 25.6 4.9 1.25 32 0.22
Female 11 (58%) 11 (73%) 0.48
Single 18 (95%) 12 (80%) 0.30
Years of education 16.4 1.1 16.7 1.4 0.74 32 0.46
Possible drinking days 91.6 6.9 89.3 15.8 0.56 32 0.58
Actual drinking days 14.8 15.5 8.7 7.4 1.41 32 0.17
Heavy drinking days 0.4 0.6 0.4 0.7 0.09 32 0.93
Very heavy drinking days 0.0 0.0 0.0 0.0 32 –
Total drinks 23.8 22.4 13.9 11.3 1.57 32 0.13
Average drinks/possible drinking days 0.3 0.2 0.2 0.1 1.41 32 0.17
Height (m) 1.7 0.1 1.7 0.1 2.43 32 0.02
Weight (kg) 68.2 12.5 65.6 10.9 0.64 32 0.53
Body–mass index 22.5 2.9 23.8 2.7 1.33 32 0.19
PARs (during 12-week intervention) 11.3 10.6 24.8 22.90 2.35 32 0.02
PARs week prior to scan 2 8.5 16.1 19.5 24.9 1.57 32 0.13
Attendance (of 36) 23.4 7.5 24.8 6.2 0.59 32 0.56
Home yoga sessions/week 0.9 1.0 
SD, standard deviation; df, degrees of freedom; PAR, Physical Activity Recall.
Table 2. Generalized Estimated Equations Analysis of Mood and Anxiety Scales During Interventions
Yoga group Walking group Difference
beta zpbeta zpbeta zp
EIFI-Positive Engagement 0.792 2.50 0.01 0.450 0.93 0.35 1.424 2.58 0.01
EIFI-Revitalization 3.069 4.46 <0.001 1.771 2.01 0.04 2.359 2.15 0.03
EIFI-Tranquility 1.923 3.10 0.002 0.226 0.28 0.78 2.394 2.42 0.02
EIFI-Physical Exhaustion 1.343 1.86 0.06 0.931 0.99 0.32 2.275 1.95 0.05
STAI-State 4.517 2.11 0.04 2.415 1.05 0.30 6.088 1.93 0.05
EIFI, Exercise-Induced Feeling Inventory; STAI, State–Trait Anxiety Inventory.
Table 3. Tonic and Acute Changes in Thalamic Gamma-Aminobutyric Acid Levels
Tonic Scan 1 Scan 2 (Scan 2–Scan 1) tdfp
Yoga group 0.065 0.020 0.061 0.021 0.004 0.017 1.01 18 0.33
Walking group 0.059 0.023 0.060 0.014 0.000 0.020 0.04 14 0.97
Acute Scan 2 Scan 3 (Scan 3–Scan 2) tdfp
Yoga group 0.058 0.018 0.067 0.019 0.009 0.020 1.80 17 0.09
Walking group 0.060 0.014 0.059 0.019 0.000 0.017 0.10 14 0.92
df, degrees of freedom.
FIG. 2. Spectral data show-
ing an increase in the area of
the edited g-aminobutyric acid
(GABA) resonance doublet at
3.00 parts per million (ppm)
from scan 2 to scan 3 for the
left thalamic voxel in the yoga
group. Glx, glutamate and
glutamine complex; MRS,
magnetic resonance spectros-
copy; NAA, N-acetylaspartate;
MM, macromolecules.
Table 4. Significant Correlations of Thalamic Gamma-Aminobutyric Acid Levels with Mood and Anxiety Scores
Scan(s) rho tdfp
Correlation of thalamic GABA levels with mood and anxiety scores
Whole group
Revitalization 1 0.38 2.32 32 0.03
Tranquility 1 0.50 3.27 32 0.003
Tranquility 2 0.47 3.01 32 0.005
STAI-S 2 0.35 2.11 32 0.04
STAI-S 3 0.41 2.46 30 0.01
Correlation of changes in thalamic GABA levels with changes in mood and anxiety scores
Yoga group
Revitalization 2-1 0.78 5.14 17 0.001
Tranquility 2-1 0.50 2.38 17 0.03
STAI-S 2-1 0.50 2.38 17 0.03
Tranquility 3-2 0.56 2.70 16 0.01
GABA, g-aminobutyric acid; df, degrees of freedom; STAI, State–Trait Anxiety, Inventory.
with dropouts equally divided between interventions (Table 1).
The means for the weekly PAR METs during the 12-week
intervention showed the walking group to have a signifi-
cantly greater level of activity outside the intervention than
the yoga group ( p¼0.02); however, there was no difference
between groups in activity levels on the week before Imaging
Session II. Out of 36 sessions, each group attended about two
thirds, with the yoga group reporting about one session a
week at home.
Analysis of mood and anxiety scales and GABA levels
The following analyses were done with statistically sig-
nificant findings reported in the tables: (1) a GEE model for
changes in mood and anxiety scores for each group at weeks
0, 4, 8, and 12; (2) tonic changes in GABA levels were as-
sessed over the course of the intervention by subtracting
Scan 1 from Scan 2 values, while acute changes associated
with the intrascan session were assessed by subtracting Scan
2 from Scan 3 values; (3) tonic and acute changes in GABA
levels; (4) correlations of mood and anxiety scores with
GABA levels for each scan; (5) correlations of tonic (Scan 2–1)
and acute (Scan 3–2) changes in mood and anxiety scores
with tonic and acute changes in GABA levels.
In the three ‘‘positive’’ subscales of EIFI (Positive En-
gagement, Revitalization, and Tranquility), an increase in
score indicates improved mood. In the two ‘‘negative’’ scales,
the STAI-State and EIFI-Physical Exhaustion, an increase in
score indicates increased anxiety and physical exhaustion,
respectively. Inverse associations (-beta), with the negative
scales, indicate decreased anxiety in the within-group anal-
ysis and greater decrease in anxiety for the yoga group in the
between-group analysis.
In the GEE analysis, the yoga group showed increased
scores over the course of the intervention in the three positive
EIFI subscales (Positive Engagement, Revitalization, and
Tranquility), while the walking group showed an increase in
the EIFI-Revitalization subscale. The yoga group showed a
decrease in the STAI-State score, indicating decreased anxi-
ety. The between-group analysis showed the yoga group to
have greater increases in all positive scales and greater de-
creases in all negative scales compared with the walking
group, indicating improved mood, decreased anxiety and
decreased exhaustion (Table 2).
Tonic changes in mean mood scores showed significant
increases in the yoga group for Revitalization (1.8 2.5,
t¼3.21, df ¼18, p¼0.005). Acute changes in mean scores
indicated significant increases in the yoga group for Re-
vitalization (2.5 2.7, t¼4.12, df ¼18, p<0.001) and Tran-
quility (2.0 1.8, t¼4.77, df ¼18, p<0.001), and significant
decrease in the STAI-State (5.2 5.5, t¼4.05, df ¼17,
p<0.001). There were no significant tonic or acute changes
detected in the walking group.
Analysis of the gray matter/white matter ratio in the
thalamic voxel was done for each of the three scans. There
was no difference in the average gray matter/white matter
ratio among the three scans for the thalamus (F¼0.11, df ¼2,
p¼0.90), indicating consistent repositioning of the voxel
over the same anatomical region for each scan. There was no
difference between the yoga and walking group in baseline
GABA levels (t¼0.73, df ¼32, p¼0.47). There were no sig-
nificant changes in tonic GABA levels in either group. There
was a nearly significant increase in acute thalamic GABA
levels in the yoga group (0.009 0.019, t¼1.80, df ¼17,
p¼0.09) (Fig. 2 and Table 3).
Whether thalamic GABA levels correlate with improved
mood or decreased anxiety is a general question, indepen-
dent of group assignment. Therefore, the correlation of mood
and anxiety scores with GABA levels was done for the whole
group. There were significant positive correlations of GABA
levels with Revitalization and Tranquility scores and a neg-
ative correlation with the STAI-State scores (Table 4).
In the yoga group, for the tonic condition, there were
positive correlations of changes in mood and anxiety scores
with changes in mean GABA levels for Revitalization and
Tranquility scores and a negative correlation with the STAI-
State, while in the acute condition there were positive cor-
relations with Tranquility scores (Table 4).
Women (n¼22) used an approved method of birth control
and had negative urine pregnancy tests prior to each imag-
ing session. Because decreases in GABA levels occur during
the follicular phase, women were scheduled for scanning in
the nonluteal stage defined by a serum progesterone
<3.0 ng/mL.
All women, except 1 using hormonal con-
traception and assumed to be in the nonluteal stage, had
progesterone levels drawn before each imaging session.
Serum progesterone levels were <2.0 ng/mL for all but four
samples. Two (2) women had levels <5.2 ng/mL for imaging
session I. For imaging session II, serum progesterone levels
were 20.2 ng/mL for 1 subject in the walking group, and
17.3 ng/mL for one subject in the yoga group, consistent
with the luteal phase that is associated with higher GABA
levels. Increases in GABA levels due to the luteal phase
during imaging session II would have made tonic increases
easier to detect, yet there was no significant increase in tonic
GABA levels for either group. In the previous study, in the
yoga group, menstrual stage did not affect increases in
GABA levels. Accordingly, the luteal levels of progesterone
for imaging session II should not have affected the detection
of acute changes.
In this study, the yoga intervention was associated with
greater improvements in mood and decreases in anxiety in
the tonic, acute and intervention analyses compared to the
metabolically matched walking intervention, suggesting that
the effect of yoga on mood and anxiety is not solely due to
the metabolic demands of the activity. In our prior study,
significant acute increases in brain GABA levels immediately
after a yoga session were recorded. The current study found
near-significant acute increases, but stable tonic levels during
the 12-week yoga intervention. These observations are con-
sistent with a time-limited effect of the yoga intervention on
thalamic GABA levels. The lack of tonic changes in this
study, and the lack of baseline differences between the ex-
perienced yoga practitioners and controls in the prior study,
suggest that tonic GABA levels are stable in subjects
screened to exclude low GABA states.
The whole group analysis of the correlations between
mood and anxiety scales taken before each scan and the
GABA levels obtained from those scans demonstrated sig-
nificant positive correlations with the positive scales of
Tranquility and Revitalization and a negative correlation
with the STAI-State. To our knowledge, this is the first study
to report a positive correlation between thalamic GABA levels
and improved mood or decreased anxiety. The correlations
between group changes in mood and anxiety scores and
changes in GABA levels in the tonic and acute conditions
suggestthatincreasesinthalamic GABA levels are associated
with improved mood and decreased anxiety. This is the first
study to show that a behavioral intervention (i.e., yoga) is as-
sociated with a positive correlation between changes in tha-
lamic GABA levels and improvements in mood and anxiety.
The use of METs controlled for metabolic demands of each
intervention and allowed the activity level of the 2 groups
(outside of the intervention) to be compared. The signifi-
cantly greater level of physical activity outside the inter-
vention in the walking group compared to the yoga group
was not expected. The higher level of outside activity in the
walking group could have contributed to the finding of
smaller changes in mood and anxiety in the walking group,
as the intervention may not have been a great enough
physical challenge given the greater level of outside activity.
The small sample size in the yoga group where only a
nearly significant increase in thalamic GABA levels was de-
tected was a limitation, which was offset by the findings of
significant correlations between GABA levels and mood and
anxiety scores. In our previous study, the acute increase in
whole-slab GABA levels in experienced yoga practitioners
was 27% (published) and a 26% increase in thalamic GABA
levels (unpublished), compared to a 13% thalamic increase
seen in the current study of yoga-naı
¨ve subjects who were
trained for 12 weeks.
This suggests that while subjects can
be trained to practice yoga in a relatively short time with a
measurable effect, the associated change in GABA levels may
increase with experience.
be due to the ability of yoga practices to increase para-
sympathetic nervous system (PNS) activity.
In a study
comparing Iyengar yoga to a walking control, the Iyengar
yoga group showed greater increases in PNS activity.
Yoga techniques and vagal nerve stimulation (VNS) in-
crease PNS tone by stimulating vagal afferents.
suggest that the antiepileptic effects of VNS are largely
mediated by widespread release of GABA.
the practice of yoga through stimulation of vagal afferents
may result in the increase of brain GABA levels as seen
in the yoga group.
The 12-week yoga intervention was associated with
greater improvements in mood and anxiety than a meta-
bolically matched walking exercise. This is the first study to
demonstrate that increased thalamic GABA levels are asso-
ciated improved mood and decreased anxiety. It is also the
first time that yoga postures have been associated with a
positive correlation between acute increases in thalamic
GABA levels and improvements in mean scores on mood
and anxiety scales. Given that pharmacologic agents that
increase the activity of the GABA system are prescribed to
improve mood and decrease anxiety, the reported correla-
tions are in the expected direction.
The possible role of
GABA in mediating the beneficial effects of yoga on mood
and anxiety warrants further study.
We acknowledge the certified Iyengar yoga teachers with-
out whom this project would not have been possible: Marysia
Gensler, Annie Hoffman, Nancy Turnquist, and Lynnae Le-
Blanc. Funding for this study was provided through NIH
grants: 1R21AT004015 (CCS), DAO15116 (PFR), R01 1AA
015923 (DAC), M01RR00533 and Ul1RR025771 (General
Clinical Research Unit at Boston University Medical Center).
Disclosure Statement
Dr. Renshaw is a consultant for Novartis, Roche and Kyowa
Hakko and received research support from GlaxoSmithKline
and Roche. Dr. Ciraulo is a consultant for Novo Nordisk and
received research support from Merck and Catalyst.
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Address correspondence to:
Chris C. Streeter, MD
Division of Psychiatry
Boston University School of Medicine
85 East Newton Street, M912-E
Boston, MA 02118
... Another major central mechanism through which yoga produces a calming and relaxing effect is by enhancing the levels of the neurotransmitter γ-aminobutyric acid (GABA). Studies have also found that Iyengar yoga intervention, varying from a single session to 12 weeks, can increase thalamic GABA levels in healthy individuals (Streeter 2007;Streeter 2010). Similar findings have also been observed with 12 weeks of yoga practice in patients with major depressive disorder (Streeter 2020). ...
Yoga was developed primarily as a tool for selfmastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.
... Multiple neurotransmitters in the brain are altered by regular yoga practice. In a study, yoga practice for one hour boosted GABA levels in the brain [123]. BDNF has neuroprotective and neurotrophic properties [122,124]. ...
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Pain is an unpleasant and upsetting experience. Persistent pain has an impact on an individual’s quality of life which causes stress and mood disorders. There are currently no pain-relieving techniques available that can eliminate pain and offer relief without causing any adverse effects. These factors draw attention to traditional treatments like yoga and meditation, which can reduce biological stress and hence increase immunity, as well as alleviate the psychological and emotional suffering produced by pain. Yoga reduces the stress response and the pain cascade via the downregulation of the hypothalamus-pituitary-adrenal (HPA) axis and vagal stimulation. Yoga is a cost-effective growing health practice that, unlike pharmaceuticals, has no side effects and can help patients stay in remission for longer periods of time with fewer relapses. Yoga not only reduces stress and depression severity but also improves functional status and reduces pain perception. This article highlights the impact of yoga on pain management and on a malfunctioning immune system, which leads to improved health, pain reduction, disease management, and improvement in overall quality of life.
... Low arousal (Deactivation) The advantage of the two-dimensional approach is that it can assess affective changes as they unfold over time. For example, positive affect after a single bout of exercise has been reported for many forms of exercise activities, like dance aerobics (Rokka et al., 2010), Nordic walking (Stark et al., 2011), running (Hoffman & Hoffman, 2008;Szabo, 2003), swimming (Valentine & Evans, 2001), shadowboxing (Li & Yin, 2008), taekwondo (Toskovic, 2001), tai chi (Wang et al., 2010), walking (DaSilva et al., 2011), yoga (Streeter et al., 2010), Bikram yoga (Szabo et al., 2017), Pilates (Tolnai et al., 2016), spinning (Szabo et al., 2015), and many more. However, these investigations usually adopted a pre-post assessment of affect. ...
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The affective experience during and after exercise helps determine motivation, commitment, and adherence to sports. Choice reaction time (RT) is critical in decision-making and sports performance. In this within-subjects laboratory experiment, we scrutinized core affect and choice RT in 18 male adolescent basketball players during exercise sessions performed to voluntary exhaustion and during a control condition. The adolescents performed choice RT tasks in one of two exercise conditions and in the control session. Participants’ feeling states differed between exercise and control sessions and decreased slightly even after moderate exercise intensity. Core affect also declined as the workload increased, but it remained pleasant-activated in all conditions. The RT errors increased at the peak exercise intensity. These results suggest that while high-intensity training might negatively affect young athletes’ feeling states and impair their decision-making, their core affect remained positive, with large inter-individual variability. We discuss the practical implications of these results in adolescents’ sports.
Background: Yoga-based treatments, which are recognized by the National Institutes of Health's National Center for Complementary and Integrative Health as a form of complementary and alternative medicine, have proven to be beneficial for people with various psychiatric disorders, including depression, anxiety, posttraumatic stress disorder, and attention deficit-hyperactivity disorder, as well as schizophrenia and other psychotic disorders. Purpose: The purpose of this evidence-based practice (EBP) project was to offer structured yoga sessions as a means of providing stress relief, promoting relaxation, reducing anxiety, and improving quality of care among male and female adult patients (ages 18 years and older) hospitalized in a locked medical-psychiatric unit within an academic medical center for treatment of both acute medical and acute psychiatric conditions. Practice change and implementation: The Iowa Model and Implementation Strategies for EBP provided the guiding framework for this pilot project. Patients were offered once weekly, 30-to-60-minute yoga sessions for 12 weeks and were screened for their ability to participate by the nurse-yoga instructor and the interprofessional team. Using a Precision Implementation Approach, a data-driven selection of strategies from the implementation framework promoted the adoption and sustainability of the practice change, which were further advanced through interprofessional reinforcement of yoga practice and internal reporting. Results: Patient feedback was sought before and after yoga sessions. Thirty-nine patients responded to the pre-yoga questionnaire and 38 patients responded to the post-yoga questionnaire. Patients reported improved mood after yoga, with 23% (nine of 39) reporting feelings of calm and relaxation pre-yoga compared with 76% (29 of 38) post-yoga, and 41% (16 of 39) reporting feelings of anxiety pre-yoga compared with just 5% (two of 38) post-yoga. Conclusion: Yoga sessions provided by a nurse certified in yoga instruction improved patients' mood and sense of well-being. Instructional materials and videos were created to promote sustained use. The EBP of providing yoga sessions grew from a pilot program to a sustained change with more widespread use. In addition to patients hospitalized on medical-psychiatric units, the health system expanded the sessions to include inpatients on behavioral health units.
This systematic integrative review aims to summarize the protective effect of PA on children and adolescents, with special reference to the immune system. Periods of prolonged inactivity in children and adolescents are rare and due to exceptional events, such as illness or environmental circumstances, e.g., natural disasters, wars, or epidemics. The recent COVID-19 pandemic forced billions of children in developmental ages into inactivity. This exceptional event was the reason for studying the compensational behavioral strategies adopted by children and adolescents to counteract physical inactivity. Several studies showed the rise of spontaneous physical activity (PA) among children and adolescents to compensate for sedentarism. However, for some children, sedentarism could in turn foster other sedentarism. With the restart of “normal daily life” worldwide, a question is posed on both how to resume PA without causing damage and how to improve the immune response. Some key points emerged from the literature. Children must resume PA gradually using different methods, considering age, sex, health status, and the presence of overweight conditions. Immunity can be stimulated with PA by aerobic exercise, resistance training, flexibility exercise, relaxation, and coordinative exercises.
Arterial hypertension is a major cause of premature death worldwide. It is also the most important risk factor for cardiovascular diseases. The reactivity of the cardiovascular system to stressors is associated with the development of arterial hypertension. Yoga and meditative practices, including mindfulness-based interventions, provide the tools to manage this cardiovascular reactivity through restoration of psycho-physiological balance. Due to its holistic approach to the individual, the practice of yoga emphasizes cultivation of healthy habits and ways of living. Yoga and meditative practices also focus on the development of conscious awareness of the present moment, allowing perception of experiences in the most objective way, overcoming identification with the ever-changing external and internal environment, thereby reducing reactivity, improving acceptance, and restoring the body-mind equilibrium. With research evidence questioning antihypertensive drug treatment in mild hypertension, the time is ripe to implement evidence-based yoga practices accompanied with yoga’s holistic approach in mainstream healthcare. Keywords: Arterial hypertension, Blood pressure, Yoga and hypertension, Meditation, Mindfulness-based interventions, Hypertensive patients, Cardiovascular risk factors, Non-communicable diseases.
The experience of stroke can significantly impact the physical health, psychosocial wellbeing of an individual. These consequences make the patients vulnerable to develop mental illnesses, ranging from dysthymia to as serious as severe depression with suicidal tendencies. There is a need for holistic therapies such as yoga-based lifestyle, which aim at improving quality of life on both physical and psychosocial domains. There is growing evidence indicating the potential use of yoga in improving an individual’s functional status post-stroke. This chapter aimed at reviewing the evidence for the effects of yoga in the prevention of stroke and its post-stroke rehabilitative potential. The literature suggests the need for integration of yoga therapy with the conventional treatment to curb the morbidity and mortality associated with stroke and its co-morbidities.
Integrative medicine is an emerging field with many possible applications in Neurology. Patients living with neurological disease have been hungry for more guidance and study in this area. There is huge interest in wellness and helping patients make better lifestyle choices to influence the outcomes of their disease and to improve quality of life. We review the definitions, current literature and discuss limitations and identify questions for further research.
Yoga has been demonstrated to improve well-being and mental health in diverse populations; however, understanding of the mechanisms of action is still developing. This chapter explores the impact of yoga-based interventions on psychological and/or biological mechanisms related to mental health. This chapter highlights that yoga-based interventions decrease stress reactivity, influence physiological markers of stress reactivity, resulting in overall improved health and well-being, in diverse populations of adults. Yoga-based interventions influence psychological processes important in the regulation of mood and emotion, including dispositional mindfulness, self-compassion, rumination, attention, metacognition, and memory. Finally, yoga-based interventions result in structural and functional changes in several brain regions. Yoga-based interventions impact several processes relevant to mental health and maybe a useful complementary intervention for a number of mental health concerns.
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Governments and societies need to be prepared to confront population aging. Such preparation includes policies that can improve quality of life, functional capacity, and health of the general population, encouraging a more active and healthier lifestyle. Normal aging is associated with changes in brain structure and function, which may cause behavioral and cognitive impairments. It is important to understand which changes make some individuals healthier than others. Yoga has been associated with improved quality of life, cognition, and physical health as well as brain functional and structural changes.
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more than two decades ago, the timeline was developed as a procedure to aid recall of past drinking / that method, first referred to as the gathering of daily drinking disposition data and later labeled as the timeline follow-back (TLFB) method, is the focus of this chapter / TLFB appears to provide a relatively accurate portrayal of drinking and has both clinical and research utility administration of the TLFB technique / psychometric properties / test–retest reliability / subject-collateral comparisons / concurrent validity (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper proposes an extension of generalized linear models to the analysis of longitudinal data. We introduce a class of estimating equations that give consistent estimates of the regression parameters and of their variance under mild assumptions about the time dependence. The estimating equations are derived without specifying the joint distribution of a subject's observations yet they reduce to the score equations for niultivariate Gaussian outcomes. Asymptotic theory is presented for the general class of estimators. Specific cases in which we assume independence, m-dependence and exchangeable correlation structures from each subject are discussed. Efficiency of the pioposecl estimators in two simple situations is considered. The approach is closely related to quasi-likelihood.
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The effect of exercise on negative affect has been examined in hundreds of studies. However, the effect of exercise on diagnosed clinical depression has received far less attention. Furthermore, poor methodological techniques predominate and results have been conflicting. A meta-analysis was conducted to investigate the effect of exercise on clinical depression and depression resulting from mental illness. The 37 chosen studies (since 1996) examined the effect of a chronic exercise paradigm (independent variable) on depression (dependent variable). Each study's variables were coded: design, subjects, exercise, and dependent measure characteristics that could moderate the effect of exercise on depression. Moderator variables were analyzed using ANOVA. Results showed an overall mean effect of –.72. Therefore, individuals who exercised were –.72 of a standard deviation less depressed than individuals who did not exercise. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes the development and validation of a measure designed to assess feeling states that occur in conjunction with acute bouts of physical activity, the Exercise-Induced Feeling Inventory (EFI). The EFI consists of 12 items that capture 4 distinct feeling states: revitalization, tranquility, positive engagement, and physical exhaustion. The multidimensional structure of the EFI is supported by confirmatory factor analysis. The subscales have good internal consistency, share expected variance with related constructs, are sensitive to exercise interventions, and appear responsive to the different social contexts in which activity may occur. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Activity Counseling Trial: rationale, design, and methods. Med. Sci. Sports Exerc., Vol. 30, No. 7, pp. 1097-1106, 1998. The Activity Counseling Trial (ACT) is a multicenter, randomized controlled trial to evaluate the effectiveness of interventions to promote physical activity in the primary health care setting. ACT has recruited, evaluated, and randomized 874 men and women 35-75 yr of age who are patients of primary care physicians. Participants were assigned to one of three educational interventions that differ in amount of interpersonal contact and resources required: standard care control, staff-assisted intervention, or staff-counseling intervention. The study is designed to provide 90% power in both men and women to detect a 1.1 kcal·kg-1·day-1 difference in total daily energy expenditure between any two treatment groups, and over 90% power to detect a 7% increase in maximal oxygen uptake, the two primary outcomes. Primary analyses will compare study groups on mean outcome measures at 24 months post-randomization, be adjusted for the baseline value of the outcome measure and for multiple comparisons, and be conducted separately for men and women. Secondary outcomes include comparisons between interventions at 24 months of factors related to cardiovascular disease (blood lipids/lipoproteins, blood pressure, body composition, plasma insulin, fibrinogen, dietary intake, smoking, heart rate variability), psychosocial effects, and cost-effectiveness, and at 6 months for primary outcome measures. ACT is the first large-scale behavioral intervention study of physical activity counseling in a clinical setting, includes a generalizable sample of adult men and women and of clinical settings, and examines long-term (24 months) effects. ACT has the potential to make substantial contributions to the understanding of how to promote physical activity in the primary health care setting.
Immunocytochemical studies have identified alterations in GABA neurons in several models of seizure disorders. However, the changes have varied among different epilepsy models, and these variations presumably reflect the diversity of mechanisms that can lead to seizure disorders. In models of cortical focal epilepsy, there is strong evidence for decreases in the number of GABAergic elements, and the changes closely parallel the time course of seizure development. By contrast, in some genetic models of epilepsy, increases in the number of immunocytochemically-detectable neurons have been observed in selected brain regions. In several models of temporal lobe epilepsy, there presently is little immunocytochemical evidence for alterations of GABA neurons within the hippocampal formation despite physiological demonstrations of decreased GABA-mediated inhibition in this region. However, it remains possible that certain types of GABA neurons could be differentially affected in some seizure disorders while other types are preserved. Thus, distinguishing between different classes of GABA neurons and determining their functional roles represent major challenges for future studies of GABA neurons in seizure disorders.