Article

Iyengar Yoga for Treating Symptoms of Osteoarthritis of the Knees: A Pilot Study

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Abstract

The American College of Rheumatology (ACR) Guidelines for the medical management of osteoarthritis (OA) emphasize the use of nonpharmacologic interventions including exercise. Implementation of an exercise program can be difficult for patients, and little is known about the benefits of alternative therapies such as yoga. The aim of this pilot study was to assess the feasibility of using yoga in the tradition of B.K.S. Iyengar to treat the symptoms of osteoarthritis of the knee. Participants were instructed in modified Iyengar yoga postures during 90-minute classes once weekly for 8 weeks. Participants met ACR criteria for osteoarthritis of the knee and completed a medical history and physical examination, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Arthritis Impact Measurement Scale 2 (AIMS2), Patient Global Assessment (GA) by Visual Analog Scale (VAS), Physician GA by VAS, and 50-foot Walk Time before and following an 8-week course of yoga instruction. Eleven (11) subjects enrolled, nine completed at least one session and seven (six of whom were obese) had data from pre- and post-course time points available for analysis. Statistically significant reductions in WOMAC Pain, WOMAC Physical Function, and AIMS2 Affect were observed when participants' status were compared to their pre-course status. WOMAC Stiffness, AIMS2 Symptoms, Social and Role, Physician GA, and Patient GA measured trends in improvement of symptoms. No adverse events from treatment were reported. This pilot study suggests that yoga may provide a feasible treatment option for previously yoga-naive, obese patients >50 years of age and offers potential reductions in pain and disability caused by knee OA. Future studies should compare yoga to other nonpharmacologic interventions for knee OA, such as patient education or quadriceps-strengthening exercises.

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... [14] Similarly, Kolasinski et al. found that the practice of Iyengar Yoga postures during a 90-min class once a week for eight subsequent weeks lead to significant improvements in pain, physical functions, stiffness, and affect. [15] The existing evidence (although limited) suggests that yoga programs can be feasibly given to adults with OA that they are safe and have beneficial short-term effects. The effects of yoga relative to other complementary treatments (e.g. ...
... These results are consistent with findings of Garfinkel et al. who found similar result in patients with hand OA, i.e. improvement in finger's range of motion and pain. [25] The current study shows similar positive findings with yoga therapy as found by Ebnezar et al. [14] and Kolasinski et al. [15] and that too within 1-week duration of yoga therapy. The results of the current study strengthen the understanding that yoga has a beneficial effect on knee OA. ...
... Previous studies [14,15,25] have shown significant results with yoga therapy for OA but none of them have done a comparative study with ayurveda and naturopathy treatments. This study was a first attempt to compare between different treatment modalities and to find out whether complimentary alternative therapies have an additional treatment effect to yoga therapy in the treatment of knee OA. ...
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Background: Recent studies have shown beneficial effects of complementary and alternative therapies such as Yoga, Ayurveda, and Naturopathy on osteoarthritis (OA), but combining these therapies will have any synergistic effect and will be feasible and safe or not is not known. Aim: This study aimed at assessing feasibility and compare the effect of Ayurveda and Naturopathy as an add‑on to Yoga in individuals with knee OA. Materials and Methods: This study involved forty seven individuals (21 males and 26 females) in the age range of 45.19 ± 3.39, suffering from knee OA since 3.37 years admitted in a residential holistic therapy hospital. They were allocated into one of the three treatment programs based on their preference and clinician’s advice: (a) Yoga (n = 16), (b) Yoga + Ayurveda (n = 21), and (c) Yoga + Naturopathy (n = 10). Assessments were done at baseline and after 1 week of respective treatment program using knee injury and OA outcome score (KOOS), perceived stress scale, visual analog scale for pain intensity, and stiffness index. Furthermore, physiological and anthropometric measures were assessed. Data were analyzed using paired t‑tests and one‑way ANOVA for within and between groups comparison, respectively, using SPSS version 10.0. Results: No side effects were reported by the individuals in any of the groups. Within‑group comparisons showed significant improvement in all the variables except blood pressure in all the three groups and body mass index, heart rate (HR), and respiratory rate in Yoga + Naturopathy group. Between‑group comparison showed significant improvement in Yoga group as compared to Yoga + Naturopathy group for KOOS subscale ‑ sports function (P = 0.049; F = 3.24) and for HR (P = 0.025, F = 4.014) in Yoga group as compared to Yoga + Ayurveda group. Conclusion: Although addition of Ayurveda and naturopathy to yoga therapy for short term did not yield significant results, it was found to be feasible and safe. Current study also suggests yoga as monotherapy to be as effective as other CAM therapies in the treatment of OA in a short‑term residential setup. Seven days yoga therapy improved clinical symptoms, anthropometric measures, and psychological states of individuals with knee OA.
... Finally, 9 articles (6 studies) were selected in this review ( Figure 1). Six articles (three RCTs) [16-19, 22, 23], one quasi-RCT [24], and two single group pre-post studies [20,21] were included. ...
... The mean age of subjects varied from 51 to 71 years. The subjects gender of four studies was all females [19][20][21]24]; in one study, the number of males was about half of the females [16], and in other studies the number of males was almost equal to that of females [23]. ...
... In another study, both groups were treated with EMG biofeedback, knee muscle strengthening exercises, and Transcutaneous Electrical Nerve Stimulation (TENS), and the yoga group received additionally Iyengar yoga [23]. Two other studies did not have control group [20,21]. ...
Article
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Objective. To systematically assess the effects of yoga on pain, mobility, and quality of life in patients with knee osteoarthritis. Methods. Pubmed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), and other sources were searched systematically in this study. Two reviewers identified eligible studies and extracted data independently. Downs and Black’s Quality Index were used to evaluate the methodological quality of the included studies. Results. A total of 9 articles (6 studies) involving 372 patients with knee osteoarthritis met the inclusion criteria. The most common yoga protocol is 40∼90 minutes/session, lasting for at least 8 weeks. The effect of yoga on pain relief and function improvement could be seen after two-week intervention. Conclusion. This systematic review showed that yoga might have positive effects in relieving pain and mobility on patients with KOA, but the effects on quality of life (QOL) are unclear. Besides, more outcome measure related to mental health of yoga effects on people with KOA should be conducted
... The use of anti-inflammatory drugs is common, 5 but the American College of Rheumatology Guidelines emphasizes exercise over pharmacological interventions. 6 In the past thirty years, a consensus has developed on the importance of self-managed exercise in controlling the pain and stiffness of osteoarthritis. Movement of the joints distributes synovial fluid, which lubricates and nourishes cartilage. ...
... In 2005, Garfinkel and associates designed another Yoga intervention, this time to treat the symptoms of osteoarthritis of the knee. 6 Eleven participants enrolled in an eight-week course of Yoga classes. Seven of them, six of whom were obese, completed pre-and post-course physical assessments. ...
... Indeed, allowance for individual variation is explicitly acknowledged in the arthritis trials by Garfinkel and associates. 6,[11][12] Further, such flex-ibility in pose modification is essential to be able to teach seniors effectively and safely. ...
Article
To examine whether Yoga classes can relieve arthritis symptoms in older adults, Yoga classes were offered once a week for six weeks to 23 older adults (mean age 71; 19 of the 23 were diagnosed with arthritis) in four different senior institutions in East Harlem, New York. Most participants were of Puerto Rican or Spanish-speaking origins, and all had low incomes and little knowledge of or prior exposure to Yoga. Self-reported levels of pain, stiffness and sleeplessness were collected at the beginning and end of the six-week Yoga program. Statistical analyses revealed significant improvements in pain and stiffness, with large effect sizes. The classes had no significant effect on sleeplessness. Twenty-two of the 23 participants also reported home practice of breathing and poses. The results of this pilot study provide promising evidence that group Yoga classes can reduce pain and stiffness among seniors with arthritis. The study also demonstrates the feasibility of this type of intervention: a group format delivered to seniors where they already live or seek resources and that accommodates a diverse range of abilities and health conditions.
... These measurements will allow for a correlation to obesity and BMI. It is recommended that strength training of the hip abductors and the musculature supporting the knee joint commence early in adult life to avoid valgus collapse and shearing at the knee joint [22][23][24][25][26]. Several strengthening techniques have been suggested in the clinical literature such as clinic-based physical therapy programs, homebased physical therapy programs, yoga and pilates [22][23][24][25][26]. ...
... These measurements will allow for a correlation to obesity and BMI. It is recommended that strength training of the hip abductors and the musculature supporting the knee joint commence early in adult life to avoid valgus collapse and shearing at the knee joint [22][23][24][25][26]. Several strengthening techniques have been suggested in the clinical literature such as clinic-based physical therapy programs, homebased physical therapy programs, yoga and pilates [22][23][24][25][26]. The purpose of this manuscript is not to determine the best mode of strengthening exercise for at-risk populations but rather to highlight the importance of initiating strength training in early adulthood for individuals that may be predisposed to OA based on occupational and clinical backgrounds. ...
... Indeed, in yoga, 16/44 (36%) improved one category or more on the SF36 self-rating of health. We noted a trend toward improved physical function with yoga at week 8, as have some (37,(40)(41)(42), though not all (43). When we pooled data from all yoga completers, there were significant improvements in all HRQL scales except Role Emotional which was already close to population norms at baseline. ...
... Some (37,41,42,44,46) though not all (42,43,49) have reported similar results. Yoga was associated with positive affect and fewer depressive symptoms, findings also reported by some (37,40,44) though not all (42,50). In contrast to Evans et al. (37), self-efficacy was not significantly different between groups, perhaps because both groups improved. ...
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Objective—To evaluate the impact of Integral-based hatha yoga in sedentary people with arthritis.Methods—75 sedentary adults aged 18+ with rheumatoid arthritis (RA) or knee osteoarthritis (OA) were randomly assigned to 8 weeks of yoga (2 60 min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health (SF36 Physical Component Summary [PCS]) adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF36 health-related quality of life (HRQL) and RA disease activity. In everyone completing yoga, we explored long-term effects at 9 months.Results—Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 (12). Average disease duration was 9 (9) yrs. and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5; 95% CI: 2.0,10.7), walking capacity (125 m; 95% CI:15,235), positive affect (5.2; 95% CI:1.4,8.9) and lower CES-D (−3.0; 95% CI: −4.8,−1.3). Significant (p<.05) improvements were evident in SF36 Role Physical, Pain, General Health, Vitality and Mental Health scales. Balance, grip strength, and flexibility were similar between groups. 22/28 on waitlist completed yoga. Among all yoga participants, significant (p<.05) improvements were observed in mean PCS, flexibility, 6-min walk, all psychological and most HRQL domains at 8 weeks with most still evident 9 months later. Of seven adverse events, none were associated with yoga.Conclusions—Preliminary evidence suggests yoga classes may help sedentary individuals with arthritis safely increase physical activity and improve physical and psychological health, and HRQL.Key Indexing
... Observed improvements in OA pain and function in this study were also comparable or superior to those reported in studies of other nonpharmacologic therapies for knee OA, including acupuncture [101,102], massage [103], yoga [40,[104][105][106][107][108], t' ai chi [109][110][111], and other forms of exercise [102,112]. Notably, effect sizes for knee pain and function in the MM group were large (range 0.7-1.6), ...
... Participants assigned to MM also demonstrated greater improvements than the ML group in certain domains of knee-related function/QOL, as well as in mood, sleep, QOL-MH, and fear of movement, outcomes of clear relevance to OA management. In addition, observed effect sizes in the MM group were comparable to or superior to those reported in RCTs of both nonpharmacologic [40,41,[101][102][103][104][105][106][107][108][109][110][111][112] and pharmacologic interventions [113][114][115]. ...
Article
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Objective Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA. Methods Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program. Results Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09). Conclusions Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.
... The objective of the present review was to verify the effects of yoga on the QOL of patients with RD. After the analysis of the 23 studies found, a total 1430 patients with RD were evaluated, and most of the studies were conducted in patients with OA, 24,25,32,[46][47][48][49][50][51][52][53][54] followed by studies with RA patients, 30,31,55,56 and FM (17.4%). [57][58][59][60] The RD with the lowest number of studies was CFS, 61 and no studies were found in patients with SLE. ...
... 46 The other studies that did not enter the meta-analysis, reported finding significant differences in the QOL of the participants after interventions with yoga. 31,47,49,50,52,59 ...
Article
Aim To analyze the effects of yoga on the quality of life of patients with rheumatic diseases through a systematic review with meta-analysis. Methods This systematic review with meta-analysis was conducted following the recommendations of the Declaration of PRISMA. The searches were carried out on the databases PubMed, Web of Science, EBSCO, Scopus, and Cochrane until August 2018. Experimental studies evaluating the effect of yoga on the quality of life in patients with rheumatic diseases were included. Results After data searches, 483 studies were found, 23 of which were included in our analysis. We found that yoga improves the overall quality of life (d= −0.64; 95% CI: −0.91 to 0.038) of patients with rheumatic diseases, as well as the following domains: functional capacity (d = 16.43; 95% CI: 13.37–19.49), physical aspects (d = 27.11; 95% CI: 19.40–34.83), emotional aspects (d = 26.00; 95% CI: 18.87–33.13), general health (d = 16.61; 95% CI: 12.66–20.55), and social aspects (d = 7.01 ; 95% CI: 5.57–9.45). Conclusion Evidence suggests weak recommendations can be made for the use of yoga in the management of RD patients.
... (4) 20.95% for psychological distress (P = .103), and (5) 16.44% for fatigue (P < .001). The group also showed significant decreases in 3 variables: (1) 3.51% for self-esteem (P < .001), ...
... Regular practice of yoga can help in many health-related conditions, such as asthma, diabetes, hypertension, osteoarthritis, 14 and fatigue. 14 It also has been shown to have a positive influence on several mental health conditions such as anxiety disorder, schizophrenia, depression, etc. 15 It is a well-known stress buster, 16 and it also can alleviate the effects of stress on health. 17 Research has shown that yoga can improve sleep, 18 increase self-esteem, 19 enhance cognitive function, 20 and encourage mindfulness. ...
Article
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Context • Several studies have revealed a high rate of physical and psychological problems from stress among schoolteachers. Yoga is one of the mind-body interventions known to alleviate stress and effects. The mind sound resonance technique (MSRT), a yoga-based, mindfulness relaxation is recognized as having a positive influence on physical and psychological health. Objectives • The study intended to examine the effects of an MSRT intervention for 1 mo on perceived stress, quality of sleep, cognitive function, state and trait anxiety, psychological distress, and fatigue among female teachers. Design • The study was a randomized, controlled trial. Setting • The study occurred at 2 primary schools in Bangalore City, India. Participants • Sixty female teachers, aged between 30 and 55 y, from the 2 schools were enrolled in the study. Intervention • The participants were randomly divided into an MSRT group (n = 30) and a control group (n = 30). Participants in the MSRT group participated in MSRT for 30 min/d, 5 d/wk, for the duration of 1 mo. The participants in the control group followed their normal daily routines. Outcome measures • Perceived stress, sleep quality, cognitive function, anxiety, psychological distress, fatigue, and self-esteem were assessed using standardized assessment tools at baseline and after 1 mo of the intervention. Results • In the MSRT group, a significant reduction occurred for 5 variables: (1) 47.01% for perceived stress (P < .001), (2) 28.76% for state anxiety (P < .001), (3) 13.35% for trait anxiety (P < .001), (4) 32.90% for psychological distress (P < .001), and (5) 44.79% for fatigue (P < .001). A significant improvement occurred for that group for 2 variables: (1) 44.94% for quality of sleep (P < .001), and (2) 12.12% for self-esteem (P < .001). An 11.88% increase occurred for the group for cognitive function, but the change was not significant (P = .111). On the other hand, the control group showed significant increases in 5 variables: (1) 55.56% for perceived stress (P < .001), (2) 13.32% for state anxiety (P < .001), (3) 21.28% for trait anxiety (P < .001), (4) 20.95% for psychological distress (P = .103), and (5) 16.44% for fatigue (P < .001). The group also showed significant decreases in 3 variables: (1) 3.51% for self-esteem (P < .001), (2) 21.39% for quality of sleep (P = .003), and (3) 17.60% for cognitive function (P = .002). A comparison between the 2 groups showed significant differences in 7 variables: (1) perceived stress (P < .001), (2) quality of sleep (P < .001), (3) state anxiety (P < .001), (4) trait anxiety (P < .001), (5) psychological distress (P = .006), (6) fatigue (P = .005), and (7) self-esteem (P < .001). No significant differences existed between the groups in cognitive function (P = .083). Conclusions • In the current study, the practice of MSRT facilitated a reduction in the levels of stress, anxiety, fatigue, and psychological distress. The relaxation technique also enhanced the levels of self-esteem and quality of sleep among female teachers working in primary schools.
... Different schools of yoga (such as Iyengar yoga, IAYT, hatha yoga, etc.) developed a therapeutical intervention for knee OA. A pilot study was conducted on nine participants, using modified Iyengar yoga postures (90-min classes once in a week for 8 weeks) as a treatment modality and showed potential reductions in pain and disability caused by knee OA (20). Few other studies compared yoga therapy with different interventions such as traditional stretching and strengthening exercises or no structured group exercise for 6 weeks and showed functional changes and improvement in the quality of life in traditional practice and yoga-based approach (21). ...
... The physical posture (hatha yoga) practice also helps to reduce pain and symptoms of OA and increase scores of daily activities, sports, spare-time activities, and quality of life (17). The practice of yoga effects on knee OA reported positive outcomes on symptoms including pain, flexibility, functional disability, anxiety, and quality of life (20). Earlier studies indicated subsided pain intensity in walking scale and improvement in WOMAC and quality of life after yoga practice. ...
Article
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Objective: To investigate the effect of integrated approach of yoga therapy (IAYT) intervention in individual with knee Osteoarthritis. Design: Randomized controlled clincial trail. Participants: Sixty-six individual prediagnosed with knee osteoarthritis aged between 30 and 75 years were randomized into two groups, i.e., Yoga (n = 31) and Control (n = 35). Yoga group received IAYT intervention for 1 week at yoga center of S-VYASA whereas Control group maintained their normal lifestyle. Outcome measures: The Falls Efficacy Scale (FES), Handgrip Strength test (left hand LHGS and right hand RHGS), Timed Up and Go Test (TUG), Sit-to-Stand (STS), and right & left extension and flexion were measured on day 1 and day 7. Results: There were a significant reduction in TUG (p < 0.001), Right (p < 0.001), and Left Flexion (p < 0.001) whereas significant improvements in LHGS (p < 0.01), and right extension (p < 0.05) & left extension (p < 0.001) from baseline in Yoga group. Conclusion: IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility. CTRI Registration Number: http://ctri.nic.in/Clinicaltrials, identifier CTRI/2017/10/010141.
... There is a limited amount of research that highlights yoga's potential physical benefits, some of which include increasing strength and flexibility (3); improving grip strength and reducing pain in patients with carpal tunnel syndrome (6); and reduction in pain and disability of patients with osteoarthritis of the knee (12). Despite a lack of controlled trials to support their position, International Journal of Exercise Science http://www.intjexersci.com ...
... A year-long randomized controlled trial with adult male and female Crohn's patients evaluated a low-impact exercise program carried out at home and found that increases in BMD were significantly associated with exercise session compliance. Moreover, BMD increases at the greater trochanter in the exercise group were statistically significant (12). Finally, a year-long intervention comparing lowimpact and high-impact exercise programs showed that BMD of the lumbar spine was maintained in both groups of early postmenopausal women (7). ...
Article
Adherents claim many benefits from the practice of yoga, including promotion of bone health and prevention of osteoporosis. However, no known studies have investigated whether yoga enhances bone mineral density. Furthermore, none have estimated reaction forces applied by yoga practitioners. The purpose of this study was to collect ground reaction force (GRF) data on a variety of hatha yoga postures that would commonly be practiced in fitness centers or private studios. Twelve female and eight male volunteers performed a sequence of 28 hatha yoga postures while GRF data were collected with an AMTI strain-gauge force platform. The sequence was repeated six times by each study subject. Four dependent variables were studied: peak vertical GRF, mean vertical GRF, peak resultant GRF, and mean resultant GRF. Univariate analysis was used to identify mean values and standard deviations for the dependent variables. Peak vertical and resultant values of each posture were similar for all subjects, and standard deviations were small. Similarly, mean vertical and resultant values were similar for all subjects. This 28 posture yoga sequence produced low impact GRF applied to upper and lower extremities. Further research is warranted to determine whether these forces are sufficient to promote osteogenesis or maintain current bone health in yoga practitioners.
... (4) 20.95% for psychological distress (P = .103), and (5) 16.44% for fatigue (P < .001). The group also showed significant decreases in 3 variables: (1) 3.51% for self-esteem (P < .001), ...
... Regular practice of yoga can help in many health-related conditions, such as asthma, diabetes, hypertension, osteoarthritis, 14 and fatigue. 14 It also has been shown to have a positive influence on several mental health conditions such as anxiety disorder, schizophrenia, depression, etc. 15 It is a well-known stress buster, 16 and it also can alleviate the effects of stress on health. 17 Research has shown that yoga can improve sleep, 18 increase self-esteem, 19 enhance cognitive function, 20 and encourage mindfulness. ...
Article
Full-text available
Context • Several studies have revealed a high rate of physical and psychological problems from stress among schoolteachers. Yoga is one of the mind-body interventions known to alleviate stress and effects. The mind sound resonance technique (MSRT), a yoga-based, mindfulness relaxation is recognized as having a positive influence on physical and psychological health. Objectives • The study intended to examine the effects of an MSRT intervention for 1 mo on perceived stress, quality of sleep, cognitive function, state and trait anxiety, psychological distress, and fatigue among female teachers. Design • The study was a randomized, controlled trial. Setting • The study occurred at 2 primary schools in Bangalore City, India. Participants • Sixty female teachers, aged between 30 and 55 y, from the 2 schools were enrolled in the study. Intervention • The Participants were randomly divided into an MSRT group (n = 30) and a control group (n = 30). Participants in the MSRT group participated in MSRT for 30 min/d, 5 d/wk, for the duration of 1 mo. The participants in the control group followed their normal daily routines.Outcome measures • Perceived stress, sleep quality, cognitive function, anxiety, psychological distress, fatigue, and self-esteem were assessed using standardized assessment tools at baseline and after 1 mo of the intervention. Results • In the MSRT group, a significant reduction occurred for 5 variables: (1) 47.01% for perceived stress (P < .001), (2) 28.76% for state anxiety (P < .001), (3) 13.35% for trait anxiety (P < .001), (4) 32.90% for psychological distress (P < .001), and (5) 44.79% for fatigue (P < .001). A significant improvement occurred for that group for 2 variables: (1) 44.94% for quality of sleep (P < .001), and (2) 12.12% for self-esteem (P < .001). An 11.88% increase occurred for the group for cognitive function, but the change was not significant (P = .111). On the other hand, the control group showed significant increases in 5 variables: (1) 55.56% for perceived stress (P < .001), (2) 13.32% for state anxiety (P < .001), (3) 21.28% for trait anxiety (P < .001), (4) 20.95% for psychological distress (P = .103), and (5) 16.44% for fatigue (P < .001). The group also showed significant decreases in 3 variables: (1) 3.51% for self-esteem (P < .001), (2) 21.39% for quality of sleep (P = .003), and (3) 17.60% for cognitive function (P = .002). A comparison between the 2 groups showed significant differences in 7 variables: (1) perceived stress (P < .001), (2) quality of sleep (P < .001), (3) state anxiety (P < .001), (4) trait anxiety (P < .001), (5) psychological distress (P = .006), (6) fatigue (P = .005), and (7) self-esteem (P < .001). No significant differences existed between the groups in cognitive function (P = .083). Conclusions • In the current study, the practice of MSRT facilitated a reduction in the levels of stress, anxiety, fatigue, and psychological distress. The relaxation technique also enhanced the levels of self-esteem and quality of sleep among female teachers working in primary schools.
... Stress may play a role in worsening symptoms of OA, and contribute to flare-ups of inflammation in RA [15]. There is promising evidence that yoga therapy may help both osteoarthritis and rheumatoid arthritis [25,44,66676869707172737475 . The most important limitations of the existing research regarding the impact of yoga are: lack of minority representation, inadequate sample size, overly broad age range, lack of specification regarding the tradition of yoga utilized, and lack of a theoretical model to inform treatment implementation and assessment of outcomes [76]. ...
Article
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Background While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. Methods/design In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. Discussion There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. Trial registration ClinicalTrials.gov: NCT01617421
... A systematic review of six RCTs investigating the effect of tai chi suggested that this exercise controlled pain and improved physical function for knee OA patients [29]. A pilot study of an eight-week yoga course was done at the University of Pennsylvania Medical Center that showed reduction in pain and disability in obese patients over 50 years of age [30]. Although limited studies have been reported to date, the results for yoga and tai chi have been encouraging for OA knee patients. ...
Article
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Knee osteoarthritis (OA) is the most common form of arthritis worldwide. The incidence of this disease is rising and its treatment poses an economic burden. Two early targets of knee OA treatment include the predominant symptom of pain, and cartilage damage in the knee joint. Current treatments have been beneficial in treating the disease but none is as effective as total knee arthroplasty (TKA). However, while TKA is an end-stage solution of the disease, it is an invasive and expensive procedure. Therefore, innovative regenerative engineering strategies should be established as these could defer or annul the need for a TKA. Several biomaterial and cell-based therapies are currently in development and have shown early promise in both preclinical and clinical studies. The use of advanced biomaterials and stem cells independently or in conjunction to treat knee OA could potentially reduce pain and regenerate focal articular cartilage damage. In this review, we discuss the pathogenesis of pain and cartilage damage in knee OA and explore novel treatment options currently being studied, along with some of their limitations.
... As we know that a mean reduction in VAS of 30.0mm represents a clinically important difference in pain severity that matches with patients' perception of adequate pain control. Sharon L. 20 reported statistically significant reductions in WOMAC Pain, WOMAC Physical Function, in OA knee patients using yoga interventions. But in the present study, there was no clinically significant difference found at post 2 weeks and 4 weeks of intervention for the between-group comparison of WOMAC outcome, because it is understood that in therapeutic intervention, the effects larger than 12% of baseline score (6% of maximal score) can be detected as MCID for the WOMAC. ...
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Background: The purpose of this study was to check the effectiveness of 4 weeks of yoga asanas exercises on patients with OA knee in comparison with physiotherapy interventions. Methods: Fifty‒Eight subjects between 40‒55 years of age diagnosed with Osteoarthritis of Knee (OA Knee) was randomly allocated into two groups. Group A received Yoga Program for 4 weeks and Group B received Conventional Physiotherapy for 4 weeks. The outcomes assessed in terms of Visual Analog Scale (VAS), WOMAC, 30Second Chair Stand Test and the knee range of Motion (ROM) at baseline, at end of week 2, and at the end of week 4. Results: Findings showed that all the outcome measures were significantly improved in both the groups. However, there was no significant clinical difference in between‒ group comparisons at the end of week 2, and at the end of week 4. Conclusion: This study concludes that the yoga program is more effective in improving the functionality and mobility outcome measures of the OA knee patients than a conventional physiotherapy program. Keywords: sosteoarthritis of knee, conventional physiotherapy, yoga asanas, 30second chair stand test, WOMAC
... Yoga is a popular form of exercise that promotes overall health and wellbeing. Some endorse yoga as an effective alternative exercise strategy for patients with physically limiting orthopaedic conditions [1,2]. Despite its promise as a restorative element of a total body wellness program, yoga may cause discomfort at the hip in some individuals [3][4][5]. ...
Article
Objective: Yoga is a popular form of exercise that promotes mind-body wellness and has recently been touted as a modality that may be well tolerated by patients with orthopaedic conditions. Paradoxically, yoga may exacerbate pain and dysfunction in certain populations, as poses often require prolonged activation of periarticular hip musculature to optimize stability, balance, and posture. The purpose of this study was to evaluate muscular activation patterns in subjects with hip pain during select yoga poses, hypothesizing that yoga participants with hip pain demonstrate poor ability to maintain muscular contractility necessary for pelvic stability. Methods: Women with and without hip pain, who regularly participate in yoga, were evaluated using surface electromyography (SEMG) while performing common yoga poses. Each participant performed 30 s holds of three poses. To introduce the element of fatigue, the three poses were repeated in the original order, immediately following 20 repetitions of side-lying hip abduction. Results: Subjects with hip pain demonstrated decreased muscular activation of the Gluteus Medius (p=0.0008), Gluteus Maximus (p<0.0001), Adductor Longus (p=0.0003) and External Obliques (p<0.0001). In healthy subjects, EMG activity of these muscles during yoga did not change (p=0.6387, 0.9954, 0.9740, 0.4878 respectively). Baseline amplitudes between groups were not significantly different (p=0.1725), although the Gluteus Medius amplitude was suggestive of a difference as it approached significance (p=0.0707). Conclusion: Patients with hip pain undergo more rapid periarticular muscular fatigue than control subjects. They demonstrate increased muscular dysfunction when performing weight bearing yoga poses, therefore, should be appropriately counselled regarding the potential risk of symptomatic exacerbation and possible counterproductive effects of participation.
... Original Research GYNECOLOGY ajog.org its potential therapeutic applications, that has been used successfully in studies of yoga for other indications, 18,20,[40][41][42][43][44][45][46] and that differs from other yoga styles in ways expected to maximize both efficacy and safety. These included: 1) emphasis on precise anatomical alignment and awareness of specific bodily structures during practice of yoga postures; 2) incorporation of yoga props to minimize risk of injury and to accommodate individuals with less strength or flexibility; and 3) emphasis on mindful awareness during practice of postures rather than rapid cycling through postures. ...
Article
Background: Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. Objective: To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. Materials and methods: Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. Results: Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. Conclusion: Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.
... Recently, a systematic review concluded that traditional Chinese herbal patches may improve effectiveness for OA [20]. Early pilot work on yoga use for OA shows possible reduction in pain and functional disability [21], and more recent research has provided encouraging evidence that some CAM (mind-body therapies such as Tai Chi) may confer benefits to people with chronic rheumatic conditions [6]. Nevertheless, further prospective trials are needed, and current evidence regarding efficacy of various CAM modalities for arthritis remains highly limited and inconsistent [22]. ...
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A critical review of complementary and alternative medicine (CAM) use among people with arthritis was conducted focusing upon prevalence and profile of CAM users as well as their motivation, decision-making, perceived benefits and communication with healthcare providers. A comprehensive search of peer-reviewed literature published from 2008 to 2015 was undertaken via CINAHL, Medline and AMED databases. The initial search identified 4331 articles, of which 49 articles met selection criteria. The review shows a high prevalence of CAM use (often multiple types and concurrent to conventional medical care) among those with arthritis which is not restricted to any particular geographic or social-economic status. A large proportion of arthritis sufferers using CAM consider these medicines to be somewhat or very effective but almost half do not inform their healthcare provider about their CAM use. It is suggested that rheumatologists and others providing health care for patients with arthritis should be cognizant of the high prevalence of CAM use and the challenges associated with possible concurrent use of CAM and conventional medicine among their patients.
... Medications typically used are NSAIDs [12], steroids and antidepressants [13]. Therapy of osteoarthritis comprises physical therapy, occupational therapy, tai chi and yoga [14][15][16][17]. Additional methods include the use of cortisone injections, lubricating injections [18], and joint realignment surgery [19]. ...
... Currently, no studies have directly reported that yoga can reduce pain in older adults; however, some conditions like low back pain and osteoarthritis, which are commonly found in the elderly, have been relieved by yoga (Kolasinski et al., 2005;Saper et al., 2009). ...
Article
Introduction Mindful yoga combines yoga techniques with the mindfulness‐based stress reduction approach. Previous studies on mindful yoga have reported improvements in depression for working‐age adults, but no studies have been conducted with older people. Aims To explore the experiences of older adults with depression participating in a mindful yoga group to establish if the approach has potential as a future intervention for this client group. Method This study adopted a qualitative descriptive method and used inductive content analysis. Eighteen in‐depth individual interviews were conducted with nine participants (each participant had one interview following the program and another four weeks later). Results Six main themes emerged: “improved physical status,” “actively involved in the community,” “positive psychological effects,” “perceived therapeutic ingredients”, “facilitators of practicing mindful yoga,” and “barriers to practicing mindful yoga. Discussion: Most participants reported benefitting from the program. Two male participants expressed that exercises were too challenging and more suited to women, suggesting single‐sex groups may be more acceptable. Implications for practice Mindful yoga may be an acceptable/useful intervention for older adults with depression, but future studies are required to establish its feasibility and potential efficacy. This article is protected by copyright. All rights reserved.
... In a yoga group received IAYT intervention for 1 week at yoga center, right and left handgrip strength showed improvement after 1 week IAYT intervention [311]. The practice of yoga effects on knee OA reported positive outcomes on symptoms including pain, flexibility, functional disability, anxiety, and quality of life [312]. IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility [311]. ...
Article
Aristotle (4th century B.C.) defined pain as emotion, being the opposite of pleasure. Whereas, Buddha stated "Pain is the outcome of sin", as evidence that an individual was possessed by demons. In some religions it is the cost of attachment. Spiritual counseling thus may be more of a preference than medical management. Many non-physiologic factors (psychological, familial and societal attitudes, life stressors, and cultural or spiritual) contributing to the experience of and response to pain. Emotional stress, for example, anxiety and depression assume a key job in understanding of agony. Endless agony is related with expanded dimensions of burdensome side effects, anxiety, and insomnia paying little heed to disability status. it has both modifiable factors (mental health, co-morbidities, smoking, alcohol, obesity, physical activity/exercise, sleep, nutrition, economic status and occupational) and non-modifiable factors (age, sex, cultural and socioeconomic background, history of trauma/ injury/ interpersonal violence, heritage). The relationship between increased BMI and chronic pain in adults seems intuitive and may be related, in part, to increased weight-bearing on joints, reduced physical activity and deconditioning. Patient with physical disabilities may have co-occurring chronic pain, but the prevalence and specific associated factors are unknown. Neuropathic pain (NeP) can be the result of a variety of conditions, including metabolic disease, infection, malignancy, trauma, medications, and toxins; estimates of 60% among those with chronic pain. Chronic pain affects 20% of the European population and is commoner in women, older people, and with relative deprivation. Its administration in the network remains commonly unacceptable, somewhat as a result of absence of proof for successful intercessions. Additionally, family and guardians' convictions and demeanors towards torment, either decidedly and contrarily to endure and express torment are imperative. Hazard factors incorporate socio-demographic, clinical, psychological, and biological factors. Pain increases depression risk 3-5-fold. Pain, rather than chronic disease, is associated with the recurrence of depressive and anxiety disorders; 50-80% of chronic pain patients report insomnia of a severity that warrants clinical attention. It is estimated that approximately one in five of the adult population in Europe suffers chronic pain, which is therefore more prevalent than asthma or diabetes. Chronic pain has long-term biological, psychological and social causes and consequences that are important in prevention and management.
... These observations indicate that Yoga, Naturopathy, Physiotherapy and Diet control when used combindly and adopted as a way of life is safe and efficient in reducing pain, improving functional status. Previous studies also support our results (42,43). Recent evidence suggests that massage therapy may be helpful in the treatment of symptomatic Knee OA (44). ...
Article
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Osteoarthritis of Knees (OA Knees) also known as degenerative arthritis or degenerative joint disease is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. The aim of the study focuses on reduction of symptoms and increase in functional activities of elderly patients with osteoarthritis of knees before and after modalities of yoga, naturopathy and physiotherapy. A total 43 patients were recruited and divided into two Groups. Group I (control group) were on allopathic medicines (called once in a month for one year follow-up) and Group II (intervention group) (called 64 times for one year follow-up) were on Yoga, Naturopathy, Physiotherapy and diet control. The study parameters were assessed at baseline and at 12 th month follow-up. Results found in this study shows an improvement in pain, 50 foot walk test, morning stiffness, swelling, SF-12, Vitamin D3 level, MMT and ROM after taking one year of allopathic medicines in group I and Yoga, Naturopathy and Physiotherapy treatment with diet control in group II. In conclusion, a combined package of Yoga, Naturopathy and Physiotherapy with diet control is found to be effective in reducing pain, facilitating improvement in functional status of elderly people suffering from Osteoarthritis of Knees.
... Studies on yoga for CLBP have shown that while yoga can reduce pain, there was no significant improvement in QOL or functioning (Teut et al., 2016). In addition, some other trials (Bellamy et al., 1988;Garfinkel et al., 1994;Kolasinski et al., 2005) have also shown that yoga can significantly improve the pain of knee, hip, and hand arthritis in older adults and also presented compelling evidence that yoga is safe. ...
Article
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Background Aging is a significant risk factor in chronic pain development with extensive disability and greater health care costs. Mind-body exercise (MBE) has been scientifically proven to affect the pain intensity and physical health. Objectives To assess the effects of MBE modes (Tai Chi, yoga, and qigong) for treating chronic pain among middle-aged and old people, compared with nonactive and active treatment, as well as function, quality of life, and adverse events. Methods We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Scientific Journals Full-Text Database (VIP) till March 2022. No restrictions were chartered within the year and language of publication. We included randomized controlled trials of MBE treatment in middle-aged and elderly people with chronic pain. The overall certainty of evidence was evaluated by using the GRADE approach. Results A total of 17 studies ( n = 1,332) were included in this review. There was low-certainty evidence indicating that MBE had a moderate effect on reducing pain compared with the nonactive and active control group (standard mean difference (SMD): −0.64, 95% confidence interval (CI): −0.86 to −0.42, P < 0.001). Very-low-certainty evidence showed that the pooled SMD for the functional improvement was −0.75 (95% CI: −1.13 to −0.37, P < 0.001). Low-certainty evidence presented that no influence was observed in physical component summary (SMD: 0.23, 95% CI: −0.16 to 0.62, P = 0.24) and mental component summary (SMD: −0.01, 95% CI −0.39 to 0.36, P = 0.95). Conclusion Our results indicated that MBE was an effective treatment for reducing symptoms of middle-aged and elderly people with chronic pain compared with nonactive and active control groups. TC and qigong had obvious benefits for knee osteoarthritis in self-reported function, but the efficacy of chronic low back pain was uncertain. No significant benefit of MBE on quality of life in older adults with chronic pain was found. More high-quality RCTs should be conducted to explore the efficacy and mechanism of MBE on chronic pain in middle-aged and elderly people from various dimensions, such as affective and cognitive dimensions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316591 , identifier CRD42022316591.
... In a yoga group received IAYT intervention for 1 week at yoga center, right and left handgrip strength showed improvement after 1-week IAYT intervention [279]. The practice of yoga effects on knee OA reported positive outcomes on symptoms including pain, flexibility, functional disability, anxiety, and quality of life [280]. IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility [279]. ...
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Toxicity of traditional pain modulation with pain killers are well reported and toxic effects and potential dependence of synthetic opioids are not completely understood yet. Famous celebrities like Bruce Lee, Chris Penn, Elvis Presley, Heath Ledger, Anna Nicole Smith died from opioid overdose. Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. In France, work productivity loss contributed almost 90% of the total costs incurred by patients with fibromyalgia. The US spent 17.8% of it ‘ s GDP on healthcare in 2015, expected to increase to 20% or higher by 2025. Approximately 70 to 85% of the western population will develop low back pain at least once during their lifetime. Of the people that consult their general practitioner for low back pain, one year later about 60% still report pain. Asia, Africa, and Latin America are collectively home to more than 50% of cancer patients; with more than half of global cancer-related mortality occurring in Asia alone. Migraine is now ranked as the second most disabling disorder worldwide reported by the Global Burden of Disease Study 2016.
... Par exemple, la yoga-thérapie peut être prescrite pour la prise en charge de l'arthrose du genou ou encore l'arthrose des mains. En effet, certains exercices de yoga servent à améliorer l'amplitude des mouvements et à réduire la douleur, l'infl ammation, ainsi que l'handicap global chez les personnes souffrant d'arthrose des mains [7] ou de gonarthrose [8]. Les exercices de Yoga seraient également plus effi caces que la contention du poignet dans le traitement du syndrome du canal carpien, soulageant Focus sur... ainsi plusieurs symptômes, notamment la douleur et améliorant la force de préhension [9]. ...
... Unavoidably, cardiovascular boundaries change as one age, yet these age-related decays in cardiovascular capacities are slower in people who practice yoga consistently as yoga professionals had lower pulse just as lower systolic and diastolic circulatory strain than coordinated with controls (Bharshankar et al., 2003). Various investigations show that asana, reflection, or a mix of the two can diminish agony and incapacity while further developing adaptability and practical portability in individuals with various conditions causing ongoing torment (McCall, 2007;Desikachar et al., 2005;Kolasinski et al., 2005;Gatantino et al., 2004;Garfinkel et al., 1998;Williams et al., 2005). Furthermore, at times, the utilization of agony prescription was decreased or killed totally. ...
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Quickly rising in the Western world as a discipline for incorporating the psyche and body into association and amicability, when embraced as a lifestyle, yoga works on physical, mental, scholarly, and otherworldly wellbeing. Yoga offers a powerful technique for overseeing and diminishing pressure, tension, and melancholy and various investigations exhibit the adequacy of yoga on disposition-related issues. The discoveries of the previously mentioned consider analysing the mental and actual results of yoga demonstrate hard, to sum up and make substantial inferences because of variety in the examination plans, contrasts in the length and recurrence of yoga classes, and contrasts in the particular yoga projects and populaces being contemplated. Regardless, results for the included investigations exhibit a large number of the various restorative impacts, benefits, and significant mending force of yoga.
... These practices are growing in popularity worldwide, and according to a recent national health survey, 14% of the adult United States population used yoga or meditation within the previous year (2). Several studies have demonstrated multiple health benefits from such methods (3,4), including reduced stress (5)(6)(7)(8), anxiety (5,7,9,10), fatigue (5,11), depression (5,9,12), chronic pain (13)(14)(15), and disease severity for inflammatory bowel disease (16,17) and cardiovascular disease (6,18,19). However, the mechanisms responsible for these improvements are poorly understood. ...
Article
The positive impact of meditation on human well-being is well documented, yet its molecular mechanisms are incompletely understood. We applied a comprehensive systems biology approach starting with whole-blood gene expression profiling combined with multilevel bioinformatic analyses to characterize the coexpression, transcriptional, and protein–protein interaction networks to identify a meditation-specific core network after an advanced 8-d Inner Engineering retreat program. We found the response to oxidative stress, detoxification, and cell cycle regulation pathways were down-regulated after meditation. Strikingly, 220 genes directly associated with immune response, including 68 genes related to interferon signaling, were up-regulated, with no significant expression changes in the inflammatory genes. This robust meditation-specific immune response network is significantly dysregulated in multiple sclerosis and severe COVID-19 patients. The work provides a foundation for understanding the effect of meditation and suggests that meditation as a behavioral intervention can voluntarily and nonpharmacologically improve the immune response for treating various conditions associated with excessive or persistent inflammation with a dampened immune system profile.
... The therapeutic yoga program was designed to provide instruction and practice in selected yoga postures and techniques chosen for their potential to improve bladder control in older women as well as promote safety and feasibility in this population. The program was based in Iyengar yoga, a form of Hatha yoga that is known for its potential therapeutic applications, has been employed successfully in other studies of yoga for other indications, [19][20][21][22][23][24] and differs from other yoga styles in ways that were thought likely to maximize both efficacy, safety and accessibility. These included: 1) emphasis on precise anatomical alignment and awareness of specific bodily structures during practice of yoga postures; 2) incorporation of props to minimize risk of injury, accommodate those with decreased strength or flexibility, and increase comfort and duration of postures; and 3) emphasis on mindful awareness rather than rapid cycling through postures. ...
Article
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Background: Most clinical investigations involving yoga lack adequate description of the specific yoga elements, including physical postures. Few studies have measured self-efficacy regarding the performance of yoga postures or assessed observed success in performing postures. Methods: We developed and piloted several tools to evaluate self-efficacy and observed success in practicing yoga in the context of a randomized feasibility trial of an Iyengar-based yoga intervention for urinary incontinence in ambulatory women ≥50 years. At the end of the 12-week yoga intervention involving twice weekly group yoga classes and once weekly home practice, participants rated their self-efficacy in performing each of the included 15 yoga postures on a 5-point Likert scale. During the 12th week, an expert yoga consultant observed participants and rated their competency in performing postures on a 5-point scale. Participants completed a questionnaire about self-efficacy in adhering to home yoga practice. We examined the distribution of and correlations between scores on the above measures. Results: Among 27 participants (mean age 65 years), the range of means for self-efficacy ratings for individual postures was 3.6 to 4.5. The range of means for observed competency ratings for individual postures was 3.3 to 5.0. Mean self-efficacy rating for confidence in adhering to the assigned once-weekly home yoga practice was 2.8 (range 1 to 5). Posture self-efficacy was inversely correlated with participant age (p = 0.01) and positively correlated with self-reported physical function (p = 0.03) and mobility (p = 0.01). No significant correlations were found between posture self-efficacy scale scores and expert-observed yoga competency ratings or practice adherence self-efficacy scores. Conclusions: These measures hold promise for advancing yoga research and practice by describing methods to: 1) measure self-efficacy in performing specific yoga postures; 2) use an expert observer to assess participants' competence in performing yoga postures; and 3) measure self-efficacy in adhering to home practice. These proposed measures can be used to describe specific components of yoga interventions, to assess whether study participants are able to learn to practice physical aspects of yoga and/or maintain this practice over time, as well as to investigate relationships between self-efficacy and competency in performing yoga postures to achieve specific health outcomes. Trial registration: ClinicalTrials.gov, NCT02342678, January 21, 2015.
... Yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life. 1,2 Relaxation response involves a profound sensation of calmness achieved through means such as yoga, prayer or breathing exercises (Benson, Corliss, and cowley, 2004). 3 Yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. ...
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Regular practice of yoga promotes strength, endurance, flexibility and facilitates characteristics of friendliness, compassion & self-control. So this study was conducted to find out the effect of yoga on anxiety. This study was conducted on 200 anxiety cases having age range of 18 to 55 years. Hamilton anxiety scale was used to measure the anxiety. These cases were divide into two group randomly i.e. study group and control group. Study group was given certain set of yogic exercise. Both the groups were followed and results were compared where independent variables yoga and dependent variable Anxiety was used. Chi-square, independent t test, was used for data analysis. It was observed that Anxiety was significantly decreased after the yogic intervention (P=0.042S). So it can be concluded that yoga can reduce perceived stress improve well-being even more significantly so its recommend to do yoga regularly.
... [13][14][15][16][17][18][19] Despite the increased relevance of spirituality as a topic of research in the West, and the efforts of many vocal Yoga practitioners to maintain the spiritual practices implicit in Yoga, the discipline frequently remains thought of, and researched as, the physical practices of Yoga alone. [20][21][22] "Thinning of the Sacred" is a phrase borrowed from author P. Vrajaprana's article, "Contemporary Spirituality and the Thinning of the Sacred: A Hindu Perspective," published in Cross Currents in 2000. 23 Vrajaprana's article mirrors sentiments expressed in A.K. Malhotra's 1999 book Instant Nirvana: Americanization of Mysticism and Meditation. ...
Article
With acceptance of Yoga in the West come challenges to Western understanding of what healing is, and how healing happens. The principles of spirituality and holistic living, which form the basis of Yoga, are largely being edited out of Yoga practice in America in an attempt to hold on to cultural perceptions about the nature of healing. This deletion has been a concern for many contemporary Yoga practitioners. This article explores Western cultural values as a backdrop for understanding the tendency to edit "practices" from other "traditions." Suggestions are made for how contemporary Yoga therapists can actively promote the traditional practices of Yoga through the language used to discuss Yoga, scientific studies, and reflection on Western preconceptions about health and healing. Yoga need not be divested of its spiritual heritage to live alongside biomedical approaches to health. By holding multiple theories of health and wellness as correct and useful within their own specific contexts, we will have more to offer those who are suffering with physical or mental illness.
... Numerous studies have shown that asana, meditation or a combination of the two decreased pains in people with arthritis, carpel tunnel syndrome, back pain and other chronic conditions. [32,33,40,[41][42][43] Yoga also increases proprioception and improves balance. Yoga enhances blood flow and levels of hemoglobin and red blood cells, allowing more oxygen to enter the body cells and improving their function. ...
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The amount of exercise a person performs is directly related to the individual's well-being, it has been shown that physical activity improves physical and mental health, decreases stress, enhances mood and helps prevent obesity. Most people in India suffer from obesity, anxiety, depression, and other disorders of health, partially due to their lack of exercise. On 23 March 2020 India's government took all necessary measures to avoid COVID-19 pandemic. Health and family welfare ministry gave advice to take precautions in this pandemic. WHO Director Tedros Adhanom welcomed India's lockdown decision at a very early stage, and vowed to take care, live well and be safe in days of lockdown. The WHO also suggests that all healthy adults perform physical exercises every day for 30 minutes, and that children be physically active for 1 hour. Exercising at home will allow us to maintain our heart health, muscle strength, endurance, healthy mind and balanced mind better. This article reviews that exercise plays a great role in reducing health risk, and it should be must to be physically active during lockdown.
... Therefore, it's imperative to realize that to realize of yoga under current circumstances. yogic practices enhance muscular strength and body flexibility, promote and improve metabolic process and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life (Collins C, 1998 [27] . ...
Article
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COVID-19 is a driblet transmitted probably fatal corona virus pandemic that affecting the world in 2020. The world Health Organization suggested that social distancing and human to human contact was discouraged to regulate the transmission of viruses. The Covid-19 had an unexampled impact on not only physical but also mental health. The disease collapsed healthy systems everywhere the world. To live through this lockdown & pandemic period, yoga is that the best thing to adopt as a lifestyle habit. It helps to build a strong physical, mental and spiritual health system. When combined with breathing and meditation, it acts care of our mind, body and soul also. There are different styles of yoga that may help us to stay physically strong and mentally balanced throughout lockdown. Yogic practices enhance muscular strength and body flexibility, promote and improve metabolism and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns and enhance overall well-being and quality of life during lockdown.
... The yoga protocol for this trial emphasized breathwork (pranayama) to engage the parasympathetic nervous system and modifiable postures (asanas) to improve musculoskeletal flexibility, strength, and balance (21,(26)(27)(28)(29)(30). Similar to other yogaand exercise-based CIPN and fall interventions, the selected asanas focused on increasing parasympathetic activation, circulation and aerobic capacity, joint strength and mobility, spinal flexibility and tone, core strength, balance, and proprioception (21,25,26,(31)(32)(33)(34)(35)(36)(37). ...
Article
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BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect that worsens quality of life and increases the risk of falls in cancer survivors. Evidence of yoga’s safety and efficacy in treating CIPN is lacking. METHODS In a randomized controlled study, we assigned breast and gynecological cancer survivors with persistent moderate-to-severe CIPN pain, numbness, or tingling ≥4 (0-10 Numeric Rating Scale (NRS)) for ≥3 months after chemotherapy to eight weeks of usual care or yoga focused on breathwork and musculoskeletal conditioning. Primary endpoint was treatment arm differences for NRS, and secondary endpoints were Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale (FACT/GOG-Ntx), and Functional Reach test after week eight. We tested treatment arm differences for each outcome measure using linear mixed models with treatment-by-time interactions. All statistical tests were two-sided. RESULTS We randomized 41 participants into yoga (N = 21) or usual care (N = 20). At week eight, mean NRS pain decreased by 1.95 points (95% Confidence Interval [CI]= -3.20 to -0.70) in yoga vs. 0.65 (95% CI = -1.81 to 0.51) in usual care (P = .14). FACT/GOG-Ntx improved by 4.25 (95% CI = 2.29 to 6.20) in yoga vs. 1.36 (95% CI = -0.47 to 3.19) in usual care (P = .035). Functional Reach, an objective functional measure predicting the risk of falls, improved by 7.14 cm (95% CI = 3.68 to 10.59) in yoga and decreased by 1.65 cm (95% CI = -5.00 to 1.72) in usual care (P = .001). Four grade 1 adverse events were observed in the yoga arm. CONCLUSION Among breast and gynecological cancer survivors with moderate-to-severe CIPN, yoga was safe and showed promising efficacy in improving CIPN symptoms.
... In a yoga group received IAYT intervention for 1 week at yoga center, right and left handgrip strength showed improvement after 1 week IAYT intervention [311]. The practice of yoga effects on knee OA reported positive outcomes on symptoms including pain, flexibility, functional disability, anxiety, and quality of life [312]. IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility [311]. ...
Article
Many non-physiologic factors (psychological, familial and societal attitudes, life stressors, and cultural or spiritual) contributing to the experience of and response to pain. Emotional stress, for example, anxiety and depression assume a key job in understanding of agony. Endless agony is related with expanded dimensions of burdensome side effects, anxiety, and insomnia paying little heed to disability status. it has both modifiable factors (mental health, co-morbidities, smoking, alcohol, obesity, physical activity/exercise, sleep, nutrition, economic status and occupational) and non-modifiable factors (age, sex, cultural and socioeconomic background, history of trauma/ injury/ interpersonal violence, heritage). The relationship between increased BMI and chronic pain in adults seems intuitive and may be related, in part, to increased weight-bearing on joints, reduced physical activity and deconditioning. Patient with physical disabilities may have co-occurring chronic pain, but the prevalence and specific associated factors are unknown. Neuropathic pain (NeP) can be the result of a variety of conditions, including metabolic disease, infection, malignancy, trauma, medications, and toxins; estimates of 60% among those with chronic pain. Chronic pain affects 20% of the European population and is commoner in women, older people, and with relative deprivation. Its administration in the network remains commonly unacceptable, somewhat as a result of absence of proof for successful intercessions. Additionally, family and guardians' convictions and demeanors towards torment, either decidedly and contrarily to endure and express torment are imperative. Hazard factors incorporate socio-demographic, clinical, psychological, and biological factors. Pain increases depression risk 3-5-fold. Pain, rather than chronic disease, is associated with the recurrence of depressive and anxiety disorders; 50–80% of chronic pain patients report insomnia of a severity that warrants clinical attention. It is estimated that approximately one in five of the adult population in Europe suffers chronic pain, which is therefore more prevalent than asthma or diabetes. Chronic pain has long-term biological, psychological and social causes and consequences that are important in prevention and management.
... 24,33 Daily or almost daily home-based exercise for a longer time period can provide sustained pain reduction, increased physical functioning, and improved emotional well-being. 46,53,54 This suggests that TQY exercises should be practiced as a regular exercise routine to maintain the positive effective of the exercise. ...
Article
Background: Clear and complete reporting of the components of complex interventions is required in clinical trials to ensure that research can be reliably replicated and successfully translated into clinical practice. Movement-based mind-body exercises, such as Tai Chi, qigong, and Yoga (TQY), are considered complex interventions and recommended for individuals with osteoarthritis in the latest guidelines of the American College of Rheumatology. This review analyzes the intervention reporting of randomized controlled trials of TQY to guide the implementation in osteoarthritis exercise programs. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and EMBASE for TQY exercise trials in osteoarthritis between 2000 and 2020. Pairs of researchers independently screened the records, extracted study characteristics, and assessed 19 items on the Consensus on Exercise Reporting Template (CERT) checklist. For each of these items, the numbers of studies that clearly reported the item were calculated. We then identified the items in the studies that are key to delivering home-based exercises for further analysis. Results: We included 27 publications reporting 22 TQY interventions in the analysis. None of the studies reported sufficient details on all the 19 CERT items. The median completeness of reporting score was 11 and ranged from 6 to 15 of 19. The most frequently incompletely reported items (number reporting and percentage of studies) were "starting level rule" (n = 1, 5%) and "progression rule" (n = 1, 5%). Other incompletely reported items included "fidelity or adherence (planned)" (n = 9, 41%), "motivations" (n = 9, 41%), and "progression description" (n = 5, 23%). Conclusions: The content analysis highlights motivational strategies for long-term adherence to home-based exercises, which may help clinicians develop interventions for their patients. Details of TQY exercises interventions for osteoarthritis are incompletely reported in the included studies. The study suggests that improvements in content reporting are especially needed on items related to exercise intensity and program progression decisions, and motivational strategies in future implementation.
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Z E T Yoga, binlerce yıl önce Hindistan'da ortaya çıkan, bireyin fiziksel, zihinsel, duygusal ve spirütüel boyutlarına denge ve sağlık getirmek için tasarlanan eski bir disiplindir. Son yıllarda sağlık için yoga uygulaması dünya çapında popüler hale gelmiştir. Esnekliği artırmak, genel kondisyonu, genel sağlığı, fiziksel uygunluğu iyileştirmek ve stresi azaltmak yogaya başlamak için en çok bildirilen nedenlerdir. Yoga yararlı etkilerinden dolayı alternatif bir terapatik yaklaşım olarak bilinir. Klinik yoga, hastalığı önlemek, iyileştirmek ve/veya düzeltmek için geleneksel yoga uygulamalarının kullanımını içerir. Romatizmal hastalıklar eklemlerde ağrı, şişlik, sertlik ve fonksiyon kaybına neden olarak bireylerin yaşam kalitesinde azalma ve engelliliğe neden olabilir. Artrit hastalarının yönetiminde ilaç ve cerrahi müdahalenin yanı sıra öz-yönetim, fizik tedavi, ergoterapi, kilo kaybı gibi farmakolojik olmayan yaklaşımlar önerilmektedir. Öz yönetimin ve fiziksel aktivitenin artmasının rolü, artritin tedavisinde büyük önem taşır. Terapatik etkilerinden dolayı yoga romatizmal hastalığı olanlar için alternatif bir yaklaşım olarak düşünülebilir. Son yıllarda romatoid artrit, osteoartrit ve fibromyalji gibi romatizmal hastalıklarda yoganın etkinliğinin araştırıldığı çalışmalar artmaktadır. Mekanizması tam olarak açıklanamasa da yoganın özellikle ağrı üzerine olumlu etkileri olduğu bildirilmiştir. Ayrıca hastalık semptomları, fonksiyon, psikolojik durum, uyku ve yaşam kalitesinde iyileşmeler bildirilmiştir. Fiziksel duruşlar, nefes çalışmaları, meditasyon ve yoga felsefesi birlikte uygulandığında daha etkili sonuçlar gözlenmiştir. Fakat çalışmalardaki randomizasyon eksiklikleri, küçük örneklem büyüklükleri, yoga müdahalelerinin standardizasyonunun olmaması ve müdahalelerin değişen dozajları nedeniyle çalışma sonuçlarının dikkatli yorumlanması gereklidir. Çalışmaların tüm bu sınırlamalarına rağmen, yoga artrit için umut verici bir yöntemdir. Yoga, romatoid atrit, osteoartrit, fibromyalji sendromu olan hastalar için yardımcı bir tedavi olarak düşünülebilir. A B S T R A C T Yoga is an ancient discipline that emerged in India thousandans of years ago, designed to bring balance and health to the physical, mental, emotional and spiritual dimensions of the individual. Yoga practice for health has become popular worldwide in recent years. Increasing flexibility, improving overall condition, overall health, physical fitness, and reducing stress are the most reported reasons for starting yoga. Yoga is known as an alternative therapeutic approach due to its beneficial effects. Clinical yoga involves the use of traditional yoga practices to prevent, cure and / or ameliorate disease. Rheumatic diseases can cause pain, swelling, stiffness and loss of function in the joints, leading to decreased quality of life and disability. In the management of arthritis patients, non-pharmacological approaches such as self-management, physical therapy, ergotherapy, weight loss, as well as drug and surgical intervention are recommended. The role of self-management and increased physical activity is of great importance in the treatment of arthritis. Due to its therapeutic effects, yoga can be considered as an alternative approach for those with rheumatic disease. In recent years, studies investigating the effectiveness of yoga in rheumatic diseases such as rheumatoid arthritis, osteoarthritis and fibromyalgia have been increasing. Although the mechanism is not fully explained, yoga has been reported to have positive effects especially on pain. In addition, improvements in disease symptoms, function, psychological state, sleep and quality of life have been reported. More effective results were observed when physical postures, breathing exercises, meditation and yoga philosophy were applied together. However, due to lack of randomization in studies, small sample sizes, lack of standardization of yoga interventions and changing dosages of interventions, study results should be interpreted with caution. Despite all these limitations of studies, yoga is a promising method for arthritis. Yoga can be considered as an adjunct therapy for patients with rheumatoid atritis, osteoarthritis, fibromyalgia syndrome.
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The objective of this study is to assess the findings of selected articles regarding the therapeutic effects of yoga and to provide a comprehensive review of the benefits of regular yoga practice. As participation rates in mind-body fitness programs such as yoga continue to increase, it is impor tant for health care professionals to be informed about the nature of yoga and the evidence of its many therapeutic effects. Thus, this manuscript provides information regarding the therapeutic effects of yoga as it has been studied in various populations concerning a multitude of different ailments and conditions. Therapeutic yoga is defined as the application of yoga postures and practice to the treatment of health conditions and involves instruction in yogic practices and teachings to prevent reduce or alleviate structural, physiological, emotional and spiritual pain, suffering or limitations. Results from this study show that yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of ad diction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.
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Recent literature proves a distinct correlation between sporting activity and the development of osteoarthritis (OA). In a disease affecting millions of people worldwide this is an important and ever growing field of interest. Sports has the potential to be a positive but also negative impact factor in OA development, depending on the intensity and the level of professionalism of sporting activity. Due to the importance of muscular stability in the development of OA this is also a reasonable approach for the treatment of already established OA in the elderly. In many different types of sports, professional athletes show higher rates of radiographic OA signs, however, clinically these patients complain of not more, sometimes even less pain than the average population with similar signs of OA. Concerning foot and ankle some sports lead to premature OA like soccer, rock climbing and beach volleyball. Joint involving trauma is an important risk factor, especially in professional athletes. In contrast to the development of OA trough sports, in the elderly with established OA some kind of sports seem to have at least short time positive effects on pain and function. In conclusion, sports can either influence the development of OA (depending on the intensity and the kind of sports) or show positive clinical effects in cases with present OA. Sports must consequently be subdivided into different categories and carefully analyzed to determine if positive of negative effects exist regarding OA.
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WHO stated that there is a high risk of COVID-19 spreading to other countries around the world. In March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic. WHO and public health authorities around the world are acting to contain the COVID-19 outbreak, so the need for effective population mental health promotion approaches is urgent as mental health concerns are escalating provided treatment regimens are insufficient to bring people towards the state of Emotional or Psychological well-being. People are turning to yoga and go with WHO guidelines for improving mental health status because of preferences for: self-treatment as opposed to clinical intervention; perceived greater efficacy than medication. Keywords: yoga, psychological well-being, WHO.
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The purpose of the current study was to test the feasibility and efficacy of a shared yoga (SY) program for sleep disturbance in older adults with osteoarthritis (OA). Participants (ages 50 to 72) with insomnia related to OA were randomized to 12 weeks of SY (n = 9) or individual yoga (IY; n = 7). The sample was 53% male and 41% self-identified as a race other than White/Caucasian. The groups did not significantly differ in class attendance, home practice, or change scores on efficacy outcomes. Pre-post comparisons in all participants showed statistically significant improvements on the Insomnia Severity Index and Patient-Reported Outcomes Measurement System sleep disturbance scale. Findings support the overall feasibility of the program, both in the shared and individual formats. Efficacy data suggest that this yoga program may improve sleep, but given the study limitations, further research is needed to draw conclusions. [Journal of Gerontological Nursing, xx(x), xx-xx.].
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Objective: The aim of the present study was to determine the feasibility of a relaxation‐based yoga intervention for rheumatoid arthritis, designed and reported in accordance with Delphi recommendations for yoga interventions for musculoskeletal conditions. Methods: Participants were recruited from a hospital database, and randomized to either eight weekly 75‐min yoga classes or a usual care control. Feasibility was determined by recruitment rates, retention, protocol adherence, participant satisfaction and adverse events. Secondary physical and psychosocial outcomes were assessed using self‐reported questionnaires at baseline (week 0), week 9 (primary time point) and week 12 (follow‐up). Results: Over a 3‐month period, 26 participants with mild pain, mild to moderate functional disability and moderate disease activity were recruited into the study (25% recruitment rate). Retention rates were 100% for yoga participants and 92% for usual care participants at both weeks 9 and 12. Protocol adherence and participant satisfaction were high. Yoga participants attended a median of seven classes; additionally, seven of the yoga participants (54%) reported continuing yoga at home during the follow‐up period. No serious adverse events were related to the study. Secondary outcomes showed no group effects of yoga compared with usual care. Conclusions: A relaxation‐based yoga programme was found to be feasible and safe for participants with rheumatoid arthritis‐related pain and functional disability. Adverse events were minor, and not unexpected from an intervention including physical components. This pilot provides a framework for larger intervention studies, and supports further exploration of yoga as a complex intervention to assist with the management of rheumatoid arthritis. KEYWORDS complementary medicine, RCT, rheumatoid arthritis, yoga
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Various case histories of turbo-machinery problems are discussed in this chapter.
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Objective: Osteoarthritis (OA) literature makes minimal suggestion regarding age of disease onset or preventative strategies to reduce risk for onset in various populations. In 2005, the Centers for Disease Control and Prevention estimated that 33.6% of Americans 65+ years old were affected by OA; this cadaveric analysis suggests this is largely underestimated. The objective of this assessment is to identify at-risk populations for OA in the knee joint and make recommendations to prevent or delay disease onset. Design: Morphometric analyses of the articular cartilage of the tibial plateau were performed on cadaver specimens using Image Pro software on 3 age populations and surface area measurements for articular cartilage degradation were compared with donors' reported ages, clinical histories, and occupations. Results: Data showed that by the seventh decade of life, when patients are in their 60s, articular cartilage degeneration on the tibial plateau had commenced in 100% of specimen. All "homemakers" displayed above-average medial tibial plateau degeneration (32.33% ± 24.85%) for their age group while simultaneously reporting pathologies in their clinical history that encourage a sedentary lifestyle. Conclusions: This assessment identifies an occupational class with a propensity to develop disease and also identifies a more realistic time frame than previous advisory committees have produced regarding age of disease onset and initiation of preventative measures. It is recommended that strengthening of the hip abductors and the musculature supporting the knee commence early in adult life to avoid valgus collapse and shearing at the knee joint.
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Contrary to expectations, assistive technology (AT) usage by the elderly has not increased in proportion to availability and ease of access. This is despite a belief that technology can contribute significantly towards improving their quality-of-life. Our Rehabilitation Mechatronics research group at NTU Singapore is developing a “unified neuro-physio platform”, taking a cue from Eastern philosophies which emphasize that the “internal environment” of the users strongly affects how they interact with the “external environment.” This chapter highlights the need to bridge these two environments meaningfully through “sensitive” technologies which address the mindsets and learning mechanisms of users. The technology platform we propose helps the elderly to understand and enhance their internal environment in order to interact at various levels with AT in their external environment. It provides a fresh approach to understanding and minimizing the persistent “digital divide” between the elderly and high technology.
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Background: Limited information is available to understand the muscular demands of composite yogasanas such as Surya Namaskar, which is essential to guide prescription of Surya Namaskar in management of commonly prevalent musculoskeletal disorders such as back and knee pain. Aim: Therefore, muscle activation pattern in prime accessible muscles of the trunk and lower extremity, namely lower trapezius, latissimus dorsi, erector spinae, rectus abdominis, gluteus maximus, vastus lateralis, and gastrocnemius, was explored during the traditional 12-pose sequence of Surya Namaskar. Methodology: Muscle activity of 8 healthy trained yoga practitioners (5 females and 3 males) was recorded using wireless, eight-channel surface electromyography (sEMG) system at a sampling rate of 2000 Hz and bandwidth of 20-450 Hz. Data were processed using EMGworks analysis software, and root mean square values were normalized against muscle activity during maximal voluntary contraction (MVC). Results: The 12-pose sequence of Surya Namaskar activated muscles of the trunk, upper and lower extremities to a varying extent, in each pose. During sustenance, erector spinae demonstrated the highest muscle activation in Hastapadasana (64.7% MVC in Pose 3and 64.3% MVC in Pose 11), lower trapezius during Hastapadasana (41.9% MVC in Pose 3and 39.2% in Pose 11); latissimus dorsi during Bhujangasana (37.4% MVC), Ashtangasana (34.9% MVC), and Parvatasana (34.6% MVC in Pose 8,); gluteus maximus in Ashwa Sanchalanasana (38.5% MVC in Poses 9 and 4); and vastus lateralis in Ashwa Sanchalanasana (34.9% MVC). Rectus abdominis demonstrated low activation throughout Surya Namaskar, presenting the highest activation during Parvatasana (22.8% MVC). All recorded muscles demonstrated greater activation during transition compared to sustenance of pose. Conclusion: Surya Namaskar elicited high-to-moderate muscle activation of major postural muscles of the trunk and lower extremity during alternating flexion-extension movements of the spine, supporting its prescription in prevention and management of mechanical low back pain among vulnerable groups of people.
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Regarding the cultural elements related to India (such as Yoga), they are surrounded by a number of different phenomena: India has undergone one of the largest Diaspora in the world, and its emigrants carry their cultural heritage wherever they go, spreading it in its diversity all over the societies that receive them. This is also found in the propagation of different beliefs, fortified by the context of globalization and strengthened even further by the mass media, as well as by the dynamism of the different places, which involves the market of symbolic property imposed by these movements, thus giving way to a phenomenon known as the New Age, characterized by authors such as Campbell (1997, quoted in Silva da Silveira 2005) within an “orientalization of the Western World”. Thus, yoga practice began to expand from India and has extended all over the world. The access of yoga in Argentina as pointed out by Saizar (2006), took place in the early twentieth century as a practice involving a spiritual pursuit directed to urban sectors of high educational levels and high incomes, who would invite yogis to their homes in order to profit by their teachings on the basic principles and discipline of oriental philosophy. Some of these specialists remained in Argentina and passed on their knowledge to other specialists thus producing, so to speak, a cultural synthesis between the cosmovisions of the East and the West. Nowadays, yoga practice has extended to people of different educational and economic levels. This work shows some of the results obtained from a research project on the matter in consideration, which seeks to contribute relevant data for the labor field and a deeper understanding of the cultural elements of different contexts and their effect on the people’s quality of life at a local level.
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The effect of pranayama a controlled breathing practice, on exercise tests was studied in athletes in two phases; sub-maximal and maximal exercise tests. At the end of phase I (one year) both the groups (control and experimental) achieved significantly higher work rate and reduction in oxygen consumption per unit work. There was a significant reduction in blood lactate and an increase in P/L ratio in the experimental group, at rest. At the end of phase II (two years), the oxygen consumption per unit work was found to be significantly reduced and the work rate significantly increased in the experimental group. Blood lactate decreased significantly at rest in the experimental group only. Pyruvate and pyruvate-lactate ratio increased significantly in both the groups after exercise and at rest in the experimental group. The results in both phases showed that the subjects who practised pranayama could achieve higher work rates with reduced oxygen consumption per unit work and without increase in blood lactate levels. The blood lactate levels were significantly low at rest.
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The present study was conducted to determine whether breathing through a particular nostril has a lateralized effect on hand grip strength. 130 right hand dominant, school children between 11 and 18 yrs of age were randomly assigned to 5 groups. Each group had a specific yoga practice in addition to the regular program for a 10 day yoga camp. The practices were: (1) right-, (2) left-, (3) alternate- nostril breathing (4), breath awareness and (5) practice of mudras. Hand grip strength of both hands was assessed initially and at the end of 10 days for all 5 groups. The right-, left- and alternate-nostril breathing groups had a significant increase in grip strength of both hands, ranging from 4.1% to 6.5%, at the end of the camp though without any lateralization effect. The breath awareness and mudra groups showed no change. Hence the present results suggest that yoga breathing through a particular nostril, or through alternate nostrils increases hand grip strength of both hands without lateralization.
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The short-term effects of 4 weeks of intensive yoga practice on physiological responses in six healthy adult female volunteers were measured using the maximal exercise treadmill test. Yoga practice involved daily morning and evening sessions of 90 minutes each. Pre- and post-yoga exercise performance was compared. Maximal work output (Wmax) for the group increased by 21%, with a significantly reduced level of oxygen consumption per unit work but without a concomitant significant change in heart rate. After intensive yoga training, at 154 Wmin(-1) (corresponding to Wmax of the pre-yoga maximal exercise test) participants could exercise more comfortably, with a significantly lower heart rate (p < 0.05), reduced minute ventilation (p < 0.05), reduced oxygen consumption per unit work (p < 0.05), and a significantly lower respiratory quotient (p < 0.05). The implications for the effect of intensive yoga on cardiorespiratory efficiency are discussed, with the suggestion that yoga has some transparently different quantifiable physiological effects to other exercises.
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To determine to what extent articular, kinesiological, and psychological factors each contribute to pain and disability in patients with osteoarthritis (OA), after controlling for other factors. Cross sectional study among 200 patients with OA of the hip or knee. Dependent variables include pain (visual analog scale), self-reported disability (questionnaire), and observed disability (performance of standardized tasks). Independent variables include joint degeneration (radiographs), muscle strength (dynamometer), range of joint motion (goniometer), pain coping (behavioral and cognitive strategies), and psychological well being (depression, anxiety, cheerfulness). Multiple regression analysis was used. Pain was found to be associated with muscle weakness and pain coping (p < 0.05). Disability was associated with muscle weakness, range of joint motion, pain, pain coping, and psychological well being (all p < 0.05). Both pain and disability were most strongly associated with kinesiological characteristics and pain coping. After controlling for the other characteristics, kinesiological and psychological characteristics in patients with OA are each associated with disability. The association with pain is less clear. Future research on mechanisms underlying these associations is warranted.
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Quadriceps sensorimotor dysfunction may be important in the pathogenesis of knee osteoarthritis (OA) and a determinant of disability. Exercise regimes can increase quadriceps strength, but whether this improves proprioception and reduces disability is uncertain. Moreover, research regimes involve protracted treatment which is clinically impracticable. We compared quadriceps sensorimotor function and disability in 60 patients with knee OA, before and after an exercise regime, with a control group (n = 37) who did not exercise. Exercise improved quadriceps strength (mean change, 95% CI; 73 N, 26-19 N), voluntary activation (14%, 5-20%), knee joint position sense (0.6 degrees, 0.1-1.8 degrees), and reduced the Lequesne Index (3.5, 0.5-4) and aggregate time of four activities of daily living (8.4 s, 0.2-16.7 s). At 6 month follow-up, these improvements were maintained. The parameters of the control group were unchanged. These results substantiate the association between quadriceps sensorimotor dysfunction and disability, emphasizing the importance of quadriceps exercise in the management of knee OA. The regimen is relatively brief and clinically practicable, but could be adapted to make it more cost effective.
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The Western Ontario MacMaster (WOMAC) is a validated instrument designed specifically for the assessment of lower extremity pain and function in osteoarthritis (OA) of the knee or hip. In the clinic, however, we have noted that OA patients frequently have other musculoskeletal and non-musculoskeletal problems that might contribute to the total level of pain and functional abnormality that is measured by the WOMAC. In this report, we investigated back pain and non-articular factors that might explain WOMAC scores in patients with OA, rheumatoid arthritis (RA) and fibromyalgia (FM) in order to understand the specificity of this instrument. RA, OA and FM patients participating in long-term outcomes studies completed the WOMAC and were assessed for low back pain, fatigue, depression and rheumatic disease symptoms by mailed questionnaires. Regardless of diagnosis, WOMAC functional and pain scores were very much higher (abnormal) among those complaining of back pain. On average, WOMAC scores for back pain (+) patients exceeded those of back pain (-) patients by approximately 65%,, and 52% of OA patients reported back pain. In regression analyses, study symptom variables explained 42, 44 and 38% of the variance in WOMAC function, pain and stiffness scores, respectively. In the subset of OA patients, radiographic scores added little to the explained variance. The strongest predictor of WOMAC abnormality in bivariate and multivariate analyses was the fatigue score, with correlations of 0.58, 0.60 and 0.53 with WOMAC function, pain and stiffness, respectively. The WOMAC performed well in RA and FM, and correlated strongly with the Health Assessment Questionnaire (HAQ) disability scale and a visual analogue scale (VAS) pain scale. The WOMAC captures more than just knee or hip pain and dysfunction, and is clearly influenced by the presence of fatigue, symptom counts, depression and low back pain. WOMAC scores also appear to reflect psychological and constitutional status. These observations suggest the need for care in interpreting WOMAC scores as just a measure of function, pain or stiffness, and indicate the considerable importance of psychological factors in rheumatic disease and rheumatic disease assessments.
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A multidimensional index that measures the health status of individuals with arthritis has been developed. The Arthritis Impact Measurement Scales (AIMS) are a combination of previously studies and newly created health status scales which assess physical, emotional, and social well-being. The self-administered AIMS questionnaire has been pilot tested in a mixed arthritis population. Results indicate that the instrument is practical and that it generates scalable, reliable, and valid measures of both aggregated and disaggregated health status. The AIMS approach to health status measurement should prove useful for evaluating the outcomes of arthritis treatments and programs.
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For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
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The civilization of India has produced a great variety of systems of spiritual beliefs and practices. Ancient seers used yoga as a means to explore the exterior and interior world and, perhaps, ultimately to achieve wisdom and knowledge of the sacred Indian texts: the Vedas, Upanishads, and Shastras.6 These great teachers, or gurus, did not equate yoga with religion but more as an art of living at the highest level in attunement with the larger life–reality. The emphasis in yoga was on personal verification rather than on belief. The practice of yoga was a way to inner joy and outer harmony.The Sanskrit word “yoga” comes from the root yug (to join), or yoke (to bind together or to concentrate). Essentially, however, the word “yoga” has come to describe a means of uniting or a method of discipline: to join the body to the mind and together join to the self (soul), or the union between the individual self and the transcendental self. Yoga comes from an oral tradition in which teaching was transmitted from teacher to student. The Indian sage Patanjali, called “The Father of Yoga, ” collated this oral tradition in his classic work The Yoga Sutras, a 2000-year-old treatise on yogic philosophy. He defines yoga as “that which restrains the thought process and makes the mind serene.” Patanjali suggests that ethics (yama and niyama) is the way to cleanse the mind, body, and spirit. He emphasizes a more psychological approach to healing and self-realization. The body's organs and systems are to be cleansed first through asanas (postures) and pranayama (controlling the breath).13 The Sutras provide guidance on how to gain mastery over the mind and emotions and how to achieve spiritual growth. The code of conduct includes the practice of the highest human virtues like ahimsa (noninjury) and satya (truth), and the promotion of the noblest feelings like amity and compassion.2Initially, the discipline of hatha yoga used in the studies described later was developed as a means for meditation: preparing the body and the nervous system for stillness. Physical strength and stamina developed by asanas and pranayama allowed the mind to remain calm. The word “hatha” can be divided into two words: ha (sun) and tha (moon). The common interpretation of hatha yoga is a union of the pairs of opposites. Hatha yoga, the yoga of activity, addresses the body and mind and requires discipline and effort. It is through hatha yoga that most Westerners are introduced to the philosophy. Many people believe that this is yoga and are unaware of the totality of yoga as a philosophy of life.Along with meditation, yoga asanas and pranyama have become popular in the West, and yoga has become “westernized.” Postures are taught as ends in themselves merely to heal an illness, reduce stress, or look better. The fact that these postures are a foundation for self-realization is generally ignored. Yoga is often thought of as calisthenics, epitomized by the headstand, the lotus posture, or another pretzel-like pose. Many think of yoga as a system of meditation or religion. Yoga, however, is meant to be practiced in the larger context of conscious spiritual discipline. The Hatha Yoga Pradipika is considered to be the classic manual on hatha yoga. The first chapter reminds the student that hatha yoga is used as a vehicle in self-realization.25 This goal should be kept in sight. Yoga is proposed to be a preventive as well as curative system of the body, mind, and spirit.14Recently, large numbers of Americans are practicing yoga for its proposed health benefits. Some health professionals are referring their patients to yoga teachers for help in managing a variety of stress-related ailments. Yoga is regarded as a holistic approach to health that not only increases flexibility, strength, and stamina but also fosters self-awareness, emotional stability, and peace of mind. Yoga has become a household word in the West. Millions of men and women read books about yoga, attend classes or seminars, and do the physical exercises for which yoga is famous. Many have tried meditation or some other form of yoga on a regular basis. Clearly, yoga is alive in Western society today.There are various styles of hatha yoga, and each has specific characteristics that reflect a particular approach to the yoga asanas such as Iyengar, Kundalini, Kripalu, and Sivananda. Iyengar, a popular style in the West, is based on the teachings of living yoga master named B.K.S. Iyengar. The method is orderly and progressive. Postures are adjusted to meet the needs and physical conditions of the student. There are specific anatomic guidelines in the execution of the asanas and pranayama.12 As a therapy, yoga is a system designed to refine human physiology. Asanas, or postures, if done properly, are believed to affect every gland and organ in the body. Postures have to be adjusted so that the various organs, joints, and bones are properly positioned so that physiologic changes may occur. Distribution of body weight has to be even on the joints and muscles so that there is no injury. Therapeutic yoga is the performance of postures for treating medical disorders. A key development in this application of yoga is Iyengar's use of props (e.g., chairs, belts, blankets, blocks) to assist the patient in assuming the posture without strain. It is said that each posture has a specific shape to which the body must be adapted and not the asana to the body.23In a disease like osteoarthritis (OA) of the finger joints, asanas are proposed to realign the skeletal structure and loosen stiff joints. Effects may be the result of the geometry of the asana. Many musculoskeletal problems may be mechanical and have to be mechanically considered. Realignment of muscles is proposed to remove the altered stresses and strains and to re-establish anatomic relationships.8
Article
Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
Article
For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
Article
The Arthritis Impact Measurement Scales (AIMS) have been developed to assess the health status of arthritis patients. In this study, the self-administered AIMS questionnaire, which includes scales designed to measure the physical, psychologic, and social aspects of health status, was completed by 625 patients with various forms of arthritis. A comprehensive battery of analytic techniques was used to investigate the performance of these scales in this large sample. The results confirmed the reliability and validity of the AIMS instrument. They also showed that AIMS performs well in at least 4 major types of arthritis, in a range of sociodemographic groups, and across time. These findings emphasize the strengths of the AIMS approach and suggest that the instrument will prove useful as a tool to assess arthritis outcome in a wide variety of clinical settings.
Article
Yoga and relaxation techniques have traditionally been used by nonmedical practitioners to help alleviate musculoskeletal symptoms. The objective of this study was to collect controlled observations of the effect of yoga on the hands of patients with osteoarthritis (OA). Patients with OA of the hands were randomly assigned to receive either the yoga program or no therapy. Yoga techniques were supervised by one instructor once/week for 8 weeks. Variables assessed were pain, strength, motion, joint circumference, tenderness, and hand function using the Stanford Hand Assessment questionnaire. The yoga treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. Other trends also favored the yoga program. This yoga derived program was effective in providing relief in hand OA. Further studies are needed to compare this with other treatments and to examine longterm effects.
Article
It is unclear whether the age-associated reduction in baroreflex sensitivity is modifiable by exercise training. The effects of aerobic exercise training and yoga, a non-aerobic control intervention, on the baroreflex of elderly persons was determined. Baroreflex sensitivity was quantified by the alpha-index, at high frequency (HF; 0.15-0.35 Hz, reflecting parasympathetic activity) and mid-frequency (MF; 0.05-0.15 Hz, reflecting sympathetic activity as well), derived from spectral and cross-spectral analysis of spontaneous fluctuations in heart rate and blood pressure. Twenty-six (10 women) sedentary, healthy, normotensive elderly (mean 68 years, range 62-81 years) subjects were studied. Fourteen (4 women) of the sedentary elderly subjects completed 6 weeks of aerobic training, while the other 12 (6 women) subjects completed 6 weeks of yoga. Heart rate decreased following yoga (69 +/- 8 vs. 61 +/- 7 min-1, P < 0.05) but not aerobic training (66 +/- 8 vs. 63 +/- 9 min-1, P = 0.29). VO2 max increased by 11% following yoga (P < 0.01) and by 24% following aerobic training (P < 0.01). No significant change in alpha MF (6.5 +/- 3.5 vs. 6.2 +/- 3.0 ms mmHg-1, P = 0.69) or alpha HF (8.5 +/- 4.7 vs. 8.9 +/- 3.5 ms mmHg-1, P = 0.65) occurred after aerobic training. Following yoga, alpha HF (8.0 +/- 3.6 vs. 11.5 +/- 5.2 ms mmHg-1, P < 0.01) but not alpha MF (6.5 +/- 3.0 vs. 7.6 +/- 2.8 ms mmHg-1, P = 0.29) increased. Short-duration aerobic training does not modify the alpha-index at alpha MF or alpha HF in healthy normotensive elderly subjects. alpha HF but not alpha MF increased following yoga, suggesting that these parameters are measuring distinct aspects of the baroreflex that are separately modifiable.
Article
Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity. To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome. Randomized, single-blind, controlled trial. A geriatric center and an industrial site in 1994-1995. Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years). Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment. Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time. Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time. In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.
Article
To review the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee. A computerized literature search of Medline, Embase, and Cinahl was carried out. Randomized clinical trials on exercise therapy for OA of the hip or knee were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The validity of trials was systematically assessed by independent reviewers. Effect sizes and power estimates were calculated. A best evidence synthesis was conducted, weighting the studies with respect to their validity and power. Six of the 11 assessed trials satisfied at least 50% of the validity criteria. Two trials had sufficient power to detect medium-sized effects. Effect sizes indicated small-to-moderate beneficial effects of exercise therapy on pain, small beneficial effects on both disability outcome measures, and moderate-to-great beneficial effects according to patient's global assessment of effect. There is evidence of beneficial effects of exercise therapy in patients with OA of the hip or knee. However, the small number of good studies restricts drawing firm conclusions.
Article
To evaluate the effects of isokinetic exercise versus a program of patient education on pain and function in older persons with knee osteoarthritis. A randomized, comparative clinical trial, with interventions lasting 8 weeks and evaluations of 12 weeks. An outpatient Veterans Affairs Medical Center clinic and an affiliated university hospital. One hundred thirteen men and women between 50 and 80 years old with diagnosed osteoarthritis of the knee; 98 completed the entire assigned treatment. Patients received either a regimen of isokinetic exercise of the quadriceps muscle three times weekly over 8 weeks or a series of 4 discussions and lectures led by health care professionals. Variables studied for change were isokinetic and isometric quadriceps strength, pain and function determined by categorical and visual analog scales, and overall status using physician and patient global evaluations by the Arthritis Impact Scale, version 2, Western Ontario McMaster's Arthritis Index, and Medical Outcome Study Short Form 36. Both treatment groups showed significant strength gains (p < .05), which occurred over a wider velocity spectrum for the exercise group. Exercised patients also had improved pain scores for more of the variables measured than those receiving education. Both groups had positive functional outcomes and slightly improved measures of overall status. Isokinetic exercise is an effective and well-tolerated treatment for knee osteoarthritis, but a much less costly education program also showed some benefits.
Article
Few investigations include both subjective and objective measurements of the effectiveness of treatments for osteoarthritis of the knee. Beneficial interventions may decrease the disability associated with osteoarthritis and the need for more invasive treatments. To evaluate the effectiveness of physical therapy for osteoarthritis of the knee, applied by experienced physical therapists with formal training in manual therapy. Randomized, controlled clinical trial. Outpatient physical therapy department of a large military medical center. 83 patients with osteoarthritis of the knee who were randomly assigned to receive treatment (n = 42; 15 men and 27 women [mean age, 60 +/- 11 years]) or placebo (n = 41; 19 men and 22 women [mean age, 62 +/- 10 years]). The treatment group received manual therapy, applied to the knee as well as to the lumbar spine, hip, and ankle as required, and performed a standardized knee exercise program in the clinic and at home. The placebo group had subtherapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10% pulsed mode. Both groups were treated at the clinic twice weekly for 4 weeks. Distance walked in 6 minutes and sum of the function, pain, and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A tester who was blinded to group assignment made group comparisons at the initial visit (before initiation of treatment), 4 weeks, 8 weeks, and 1 year. Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group. By 8 weeks, average 6-minute walk distances had improved by 13.1% and WOMAC scores had improved by 55.8% over baseline values in the treatment group (P < 0.05). After controlling for potential confounding variables, the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m (95% CI, 71 to 270 m) more than that in the placebo group and the average WOMAC scores were 599 mm higher (95% CI, 197 to 1002 mm). At 1 year, patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance; 20% of patients in the placebo group and 5% of patients in the treatment group had undergone knee arthroplasty. A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
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Division of Rheumatology University of Pennsylvania School of Medicine 504 Maloney Building 36th and Spruce Streets Philadelphia
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Address reprint requests to: Sharon L. Kolasinski, M.D. Division of Rheumatology University of Pennsylvania School of Medicine 504 Maloney Building 36th and Spruce Streets Philadelphia, PA 19104
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Systematic Review of the Efficacy of Meditation Techniques as Treatments for Medical Illness
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Albert J. Arias, Karen Steinberg, Alok Banga, Robert L. Trestman. 2006. Systematic Review of the Efficacy of Meditation Techniques as Treatments for Medical Illness. The Journal of Alternative and Complementary Medicine 12:8, 817-832. [Abstract] [PDF] [PDF Plus]