Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review

A phase I feasibility study of yoga on the physical health and coping of informal caregivers

Family and friends who provide unpaid care to an individual with a disease or disability (known as informal caregivers) experience numerous threats to their physical health as a result of providing care. In spite of evidence that participation in physical and leisure activities can be health promoting, informal caregivers have reported diminished or completely absent leisure participation. Hatha yoga has documented therapeutic benefits, including reduced anxiety, as well as improved muscle strength and endurance and flexibility. The purpose of this study was to determine the feasibility of conducting an 8-week yoga program with informal caregivers, and to gather pilot data on the effects of yoga on the physical fitness and coping of informal caregivers. Caregivers were randomized into a yoga intervention (n = 8) or control group (n = 9). The yoga sessions were 2.5 hours/week for 8 weeks and consisted of a variety of pranayama (breathing) and asana (postures) activities and were led by a certified yoga instructor. Four caregivers (two in each group) dropped out of the study. After the conclusion of the 8-week yoga program, lower body strength increased significantly for those in the yoga group and other notable trends occurred in terms of coping, upper body strength and aerobic endurance. Caregivers in the control group experienced an unexpected increase in lower body flexibility. These findings indicate that caregivers in a yoga program may receive some benefits. Future studies are encouraged to test the efficacy of yoga as an intervention for caregivers.

Yoga as a complementary treatment of depression: effects of traits and moods on treatment outcome

Preliminary findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission. The purpose of this article is to present further data on the intervention, focusing on individual differences in psychological, emotional and biological processes affecting treatment outcome. Twenty-seven women and 10 men were enrolled in the study, of whom 17 completed the intervention and pre- and post-intervention assessment data. The intervention consisted of 20 classes led by senior Iyengar yoga teachers, in three courses of 20 yoga classes each. All participants were diagnosed with unipolar major depression in partial remission. Psychological and biological characteristics were assessed pre- and post-intervention, and participants rated their mood states before and after each class. Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability in the 17 completers. Eleven out of these completers achieved remission levels post-intervention. Participants who remitted differed from the non-remitters at intake on several traits and on physiological measures indicative of a greater capacity for emotional regulation. Moods improved from before to after the yoga classes. Yoga appears to be a promising intervention for depression; it is cost-effective and easy to implement. It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study. The physiological methods are especially useful as they provide objective markers of the processes and effectiveness of treatment. These observations may help guide further clinical application of yoga in depression and other mental health disorders, and future research on the processes and mechanisms.

Frequency of yoga practice predicts health: results of a national survey of yoga practitioners

Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits.

Complementary and alternative medicine for rheumatic diseases

Complementary and alternative medicine includes a heterogeneous spectrum of approaches to health and wellness, in addition to disease treatment, which span ancient to new-age modalities. Over the last 5 years, there has been a substantial increase in the use of specific complementary and alternative medicine therapies, particularly mind–body interventions. Patients with rheumatic diseases and musculoskeletal conditions such as osteoarthritis, fibromyalgia and rheumatoid arthritis may suffer not only from the physical manifestations of illness, but also from the nutritional, emotional, social and spiritual context in which their illness arises. The majority of these patients seek adjunctive care outside the medical mainstream. This article provides an evidence-based assessment of the therapeutic benefits of some mind–body interventions for several of these disorders.

Effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal women

OBJECTIVE

Regular and continuous yoga exercise is one of the most important nonpharmacological methods of improving serum lipid concentrations, adipose tissue, and metabolic syndrome factors. The purpose of this study was to analyze the effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal Korean women.

METHODS

Sixteen healthy postmenopausal women aged 54.50 ± 2.75 years with more than 36% body fat were randomly assigned to either a yoga exercise group (n = 8) or to a "no exercise" control group (n = 8). The variables of body composition, visceral fat, serum adiponectin, and metabolic syndrome factors were measured in all the participants before and after the 16-week study.

RESULTS

Body weight, percentage of body fat, lean body mass, body mass index, waist circumference, and visceral fat area had significantly decreased. High-density lipoprotein cholesterol and adiponectin had significantly increased, but total cholesterol, triglyceride, low-density lipoprotein cholesterol, blood pressure, insulin, glucose, and homoeostasis model assessment-insulin resistance had significantly decreased. Serum adiponectin concentrations were significantly correlated with waist circumference, high-density lipoprotein cholesterol, diastolic blood pressure, and homoeostasis model assessment-insulin resistance in the postyoga exercise group.

CONCLUSIONS

Our findings indicate that yoga exercise improves adiponectin level, serum lipids, and metabolic syndrome risk factors in obese postmenopausal women. Consequently, yoga exercise will be effective in preventing cardiovascular disease caused by obesity in obese postmenopausal Korean women.

Investigating the perceived feasibility of integrative medicine in a conventional oncology setting: yoga therapy as a treatment for breast cancer survivors

BACKGROUND

A majority of cancer survivors experience debilitating effect(s) related to their cancer diagnosis and treatments across physical, psychological, social, and spiritual domains. Timely and innovative solutions are needed to address the adverse treatment-related effects and often disjointed services that breast cancer patients face. Recent studies suggest that the majority of breast cancer survivors are using complementary and alternative medicine at some point along their cancer trajectory. In recent years, scientists and clinicians have examined the effects of yoga therapy among cancer patients and survivors. The current study examined the perceived feasibility of implementing yoga therapy as a treatment service for breast cancer patients at a large urban cancer center in Canada.

METHODS

A mixed-methods approach that included focus groups and self-reported surveys with health care providers (HCPs) and breast cancer patients was used in this research.

RESULTS

Overall, results indicated that breast cancer patients and HCPs were supportive and eager for the implementation of a yoga therapy program. Six themes emerged from the analysis of the focus group and the survey data: (1) the availability of resources and accessibility of yoga therapy, (2) the credibility and transparency of yoga therapy, (3) the understanding of yoga therapy, (4) an educational component, (5) the therapeutic context, and (6) the integration of yoga therapy. Specific facilitators and barriers became evident within these themes.

CONCLUSIONS

Although enthusiasm for the implementation of an integrative yoga therapy program was apparent among both breast cancer survivors and HCPs, barriers were also identified. The findings of this study are currently being used to inform a large-scale program of research aimed at developing integrative treatment services for breast cancer patients, beginning with yoga therapy.

A qualitative exploration of the impact of yoga on breast cancer survivors with aromatase inhibitor-associated arthralgias

RESEARCH QUESTION

Arthralgia affects postmenopausal breast cancer survivors (BCS) receiving aromatase inhibitors (AI), which may result in reduced function and long-term well-being. This is an exploratory, qualitative investigation of BCS who participated in a yoga-based program to understand impact on joint pain and various aspects of quality of life (QOL) through a yoga program.

THEORETICAL FRAMEWORK

Social cognitive theory was used and provided the foundation for developing a yoga intervention through sources of efficacy information: (1) performance accomplishment, (2) structured experience, (3) verbal support from instructor and group, and (4) physical feedback.

METHODOLOGY

Ten postmenopausal women with stage I-III breast cancer and AI associated arthralgia (AIAA) received yoga twice a week for eight weeks for 90 minutes and were instructed to continue in a home-based yoga program. We used social cognitive theory (SCT) to structure a yoga intervention as an ongoing physical activity to manage joint pain and function. Participants completed journal reflections on their experience and received weekly phone calls.

ANALYSIS

Data was collected and analyzed using qualitative methods. Member checks were completed and emergent themes were explored and agreed upon by the research team to ensure reliability and validity of data. Several emergent themes were discovered: Empowerment: Importance of Camaraderie, Community, and Sharing; Pain Relief; Increased Physical Fitness (Energy, Flexibility, and Function); Relieved Stress/Anxiety and Transferability of Yoga through Breathing. These themes were identified through instructor observation, participant observation, and weekly phone call documentation.

INTERPRETATION

Participants experienced an eight-week yoga intervention as an effective physical activity and support group that fostered various improvements in quality of life (QOL) and reduction in AIAA. Participants were highly motivated to improve physical fitness levels and reduce pain. This study revealed benefits from alternative forms of exercise such as yoga to provide a structure, which is transferable in other situations. Information, structured physical guidance in yoga postures, support, and feedback are necessary to foster physical activity for BCS experiencing pain.

IMPLICATIONS FOR CANCER SURVIVORS

Results of this qualitative analysis indicate that interventions to support BCS with AIAA are warranted. Yoga appears to positively impact these side effects of hormonal therapies. Additional research would aid in the development of other interventions.

Patterns of yoga practice and physical activity following a yoga intervention for adults with or at risk for type 2 diabetes

BACKGROUND

The current study described patterns of yoga practice and examined differences in physical activity over time between individuals with or at risk for type 2 diabetes who completed an 8-week yoga intervention compared with controls.

METHODS

A longitudinal comparative design measured the effect of a yoga intervention on yoga practice and physical activity, using data at baseline and postintervention months 3, 6, and 15.

RESULTS

Disparate patterns of yoga practice occurred between intervention and control participants over time, but the subjective definition of yoga practice limits interpretation. Multilevel model estimates indicated that treatment group did not have a significant influence in the rate of change in physical activity over the study period. While age and education were not significant individual predictors, the inclusion of these variables in the model did improve fit.

CONCLUSIONS

Findings indicate that an 8-week yoga intervention had little effect on physical activity over time. Further research is necessary to explore the influence of yoga on behavioral health outcomes among individuals with or at risk for type 2 diabetes.

Effects of yoga interventions on pain and pain-associated disability: a meta-analysis

We searched databases for controlled clinical studies, and performed a meta-analysis on the effectiveness of yoga interventions on pain and associated disability. Five randomized studies reported single-blinding and had a higher methodological quality; 7 studies were randomized but not blinded and had moderate quality; and 4 nonrandomized studies had low quality. In 6 studies, yoga was used to treat patients with back pain; in 2 studies to treat rheumatoid arthritis; in 2 studies to treat patients with headache/migraine; and 6 studies enrolled individuals for other indications. All studies reported positive effects in favor of the yoga interventions. With respect to pain, a random effect meta-analysis estimated the overall treatment effect at SMD = -.74 (CI: -.97; -.52, P < .0001), and an overall treatment effect at SMD = -.79 (CI: -1.02; -.56, P < .0001) for pain-related disability. Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions.

PERSPECTIVE

This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.

Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery

Context:

Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes.

Aims:

The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, quality of life and immune outcomes in breast cancer patients undergoing surgery.

Settings and Design:

Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative outcomes following surgery.

Materials and Methods:

Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins (IgG, IgA and IgM).

Statistical Analysis Used:

We used analysis of covariance to compare interventions postoperatively.

Results:

Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest a significant decrease in the state (P = 0.04) and trait (P = 0.004) of anxiety, depression (P = 0.01), symptom severity (P = 0.01), distress (P < 0.01) and improvement in quality of life (P = 0.01) in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% (P = 0.02) and lower levels of serum IgA (P = 0.001) in the yoga group as compared to controls following surgery.

Conclusions:

The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery.

Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

CONTEXT

Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery.

OBJECTIVE

The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.

METHODS

Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes.

RESULTS

Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels.

CONCLUSION

The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

Exploring the therapeutic effects of yoga and its ability to increase quality of life

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 important 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 addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.

Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: a randomized clinical trial

OBJECTIVE

We have evaluated the clinical efficacy of yoga for primary dysmenorrhea. Primary dysmenorrhea occurs in 50% of female adolescents and is a common problem in women of reproductive age. We have assessed whether three yoga poses (Cobra, Cat, and Fish Poses) are able to reduce severity and duration of primary dysmenorrhea.

METHODS

To determine the effectiveness of yoga in adolescents with primary dysmenorrhea, 92 girl students,18-22 years old, were randomly assigned to an experimental group (n = 50) and a control group (n = 42). The Visual Analog Scale for Pain was used to assess intensity of pain and the pain duration was calculated in terms of hours. Each group was evaluated for three menstrual cycles. At first cycle no method was presented; the participants only were asked to complete the questionnaire of menstrual characteristics during their menstrual. Then the participants were asked by the experimental group to do yoga poses at luteal phase, and also to complete the menstrual characteristics questionnaire in during of menstruation. The control group did not receive any intervention except to complete menstrual characteristics questionnaire in during of menstruation.

RESULTS

There was a significant difference in the pain intensity and pain duration in the post-tests compared with the pretest in yoga group (P < 0.05). The results showed that compared with the Control group, there was a significant difference in the pain intensity and pain duration in the experimental group (P < 0.05).

CONCLUSION

Yoga reduced the severity and duration of primary dysmenorrhea. The findings suggest that yoga poses are safe and simple treatment for primary dysmenorrhea.

An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia

Objectives:

Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, depression, and hypocortisolism. To date, published studies have not investigated the effects of yoga on cortisol in FM. This pilot study used a time series design to evaluate pain, psychological variables, mindfulness, and cortisol in women with FM before and after a yoga intervention.

Methods:

Participants (n = 22) were recruited from the community to participate in a 75 minute yoga class twice weekly for 8 weeks. Questionnaires concerning pain (intensity, unpleasantness, quality, sum of local areas of pain, catastrophizing, acceptance, disability), anxiety, depression, and mindfulness were administered pre-, mid- and post-intervention. Salivary cortisol samples were collected three times a day for each of two days, pre- and post-intervention.

Results:

Repeated measures analysis of variance (ANOVA) revealed that mean ± standard deviation (SD) scores improved significantly (p < 0.05) from pre- to post-intervention for continuous pain (pre: 5.18 ± 1.72; post: 4.44 ± 2.03), pain catastrophizing (pre: 25.33 ± 14.77; post: 20.40 ± 17.01), pain acceptance (pre: 60.47 ± 23.43; post: 65.50 ± 22.93), and mindfulness (pre: 120.21 ± 21.80; post: 130.63 ± 20.82). Intention-to-treat analysis showed that median AUC for post-intervention cortisol (263.69) was significantly higher (p < 0.05) than median AUC for pre-intervention levels (189.46). Mediation analysis revealed that mid-intervention mindfulness scores significantly (p < 0.05) mediated the relationship between pre- and post-intervention pain catastrophizing scores.

Discussion:

The results suggest that a yoga intervention may reduce pain and catastrophizing, increase acceptance and mindfulness, and alter total cortisol levels in women with FM. The changes in mindfulness and cortisol levels may provide preliminary evidence for mechanisms of a yoga program for women with FM. Future studies should use an RCT design with a larger sample size.

Cardiovascular and metabolic effects of intensive Hatha Yoga training in middle-aged and older women from northern Mexico

Background:

Hatha Yoga (HY) can be an alternative to improve physical activity in middle-aged and older women. However, conventional HY (CHY) exercising may not result in enough training stimulus to improve cardiovascular fitness. The purpose of this study was to evaluate the effect of an intensive HY intervention (IHY) on cardiovascular risk factors in middle-aged and older women from Northern Mexico.

Materials and Methods:

In this prospective quasiexperimental design, four middle-aged and nine older CHY practicing females (yoginis) were enrolled into an 11-week IHY program consisting of 5 sessions/week for 90 min (55 sessions). The program adherence, asana performance, and work intensity were assessed along the intervention. Anthropometric [body mass index (BMI), % body fat and Σ skin folds], cardiovascular fitness [maximal expired air volume (VE_max), maximal O₂ consumption (VO_2max), maximal heart rate (HR_max), systolic (BPs) and diastolic blood pressure (BPd)], biochemical [glucose, triacylglycerols (TAG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)], and dietary parameters were evaluated before and after IHY.

Results:

Daily caloric intake (~1,916 kcal/day), program adherence (~85%), and exercising skills (asana performance) were similar in both middle-aged and older women. The IHY program did not modify any anthropometric measurements. However, it increased VO_2max and VE_max and HDL-C while TAG and LDL-C remained stable in both middle-aged and older groups (P < 0.01).

Conclusions:

The proposed IHY program improves different cardiovascular risk factors (namely VO_2max and HDL-C) in middle-aged and older women.

Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias

Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving aromatase inhibitors (AIs). This study aims to establish the feasibility of studying the impact of yoga on objective functional outcomes, pain, and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA). Postmenopausal women with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial. A yoga program was provided twice a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were secondary outcomes. Paired t tests were used for analysis, and 90% provided data for assessment at the end of the intervention. Participants experienced significant improvement in balance, as measured by FR, and flexibility, as measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by FACT-B also improved; both P < .05. The score for the Pain Severity subscale of the BPI reduced. No adverse events nor development or worsening of lymphedema was observed. In all, 80% of participants adhered to the home program. Preliminary data suggest that yoga may reduce pain and improve balance and flexibility in BCSs with AIAA. A randomized controlled trial is needed to establish the definitive efficacy of yoga for objective functional improvement in BCSs related to AIAA.

Pilot evaluation of an Iyengar yoga program for breast cancer survivors

BACKGROUND

With continual improvements in screening uptake and adjuvant cancer treatments, the number of Canadian women surviving breast cancer continues to grow. Preliminary findings suggest yoga can improve quality of life (QoL) in breast cancer survivors, but few studies have focused on Iyengar yoga (IY).

OBJECTIVE

The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors.

METHODS

Breast cancer survivors (N = 24) participating in IY classes completed a questionnaire measuring generic and disease-specific QoL and psychosocial functioning, before and after the 12-week classes.

RESULTS

Postprogram questionnaires were completed by 17 participants (71%) who attended an average of 78.9% of the IY sessions. Several indicators of generic QoL improved significantly, including mental health (mean change, +4.2; P = .045), vitality (mean change, +4.9; P = .033), role-emotional (mean change, +6.4; P = .010), and bodily pain (mean change, +4.4; P = .024). Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant. Findings were further substantiated by participant's evaluation of the program's benefits and motivational value.

CONCLUSION

In this pilot study of breast cancer survivors participating in IY, we found improvements in QoL and psychosocial functioning. Moreover, positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors. Randomized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted.

IMPLICATIONS FOR PRACTICE

Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning.

Hatha yoga practices: energy expenditure, respiratory changes and intensity of exercise

The aim of this study was to critically observe the energy expenditure, exercise intensity and respiratory changes during a full yoga practice session. Oxygen consumption ([Formula: see text]), carbon dioxide output ([Formula: see text]), pulmonary ventilation ([Formula: see text]E), respiratory rate (Fr) and tidal volume (VT), were measured in 16 physical posture (asanas), five yoga breathing maneuvers (BM) and two types of meditation. Twenty male (age 27.3 ± 3.5 years, height 166.6 ± 5.4 cm and body weight 58.8 ± 9.6 kg) yoga instructors were studied. Their maximal oxygen consumption ([Formula: see text]) was recorded. The exercise intensity in asanas was expressed in percentage [Formula: see text] . In asanas, exercise intensity varied from 9.9 to 26.5% of [Formula: see text] . Highest energy cost was 3.02 kcal min(-1). In BM highest [Formula: see text]E was 53.7 ± 15.5 l min(-1). VT was 0.97 ± 0.59, 1.41 ± 1.27 and 1.28 ± l/breath with corresponding Fr of 14.0 ± 5.3, 10.0 ± 6.35, 10.0 ± 5.8 breaths/min. Average energy expenditure in asanas, BM and meditation were 2.29, 1.91 and 1.37 kcal min(-1), respectively. Metabolic rate was generally in the range of 1-2 metabolic equivalents (MET) except in three asanas where it was >2 MET. [Formula: see text] was 0.27 ± 0.05 and 0.24 ± 0.04 l min(-1) in meditation and Shavasana, respectively. Although yogic practices are low intensity exercises within lactate threshold, physical performance improvement is possible owing to both better economy of breathing by BM and also by improvement in cardiovascular reserve. Other factors such as psycho-physiological and better relaxation may contribute to it.

Does yoga engender fitness in older adults? A critical review

Interest in yoga is growing, especially among older adults. This review critically summarizes the current literature to investigate whether physical fitness and function benefits are engendered through the practice of yoga in older adults. A comprehensive search yielded 507 studies; 10 studies with 544 participants (69.6 ± 6.3 yr, 71% female) were included. Large variability in yoga styles and measurement outcomes make it challenging to interpret results across studies. Studies reported moderate improvements for gait (ES = 0.54, 0.80), balance (ES = 0.25-1.61), upper/lower body flexibility (ES = 0.25, 0.70), lower body strength (ES = 0.51), and weight loss (ES = 0.73, 0.99).Yoga may engender improvements in some components of fitness in older adults. However, more evidence is needed to determine its effectiveness as an alternative exercise to promote fitness in older adults. Further investigation into yoga as an exercise activity for older adults is warranted.

A randomized controlled trial examining Iyengar yoga for young adults with rheumatoid arthritis: a study protocol

Background

Rheumatoid arthritis is a chronic, disabling disease that can compromise mobility, daily functioning, and health-related quality of life, especially in older adolescents and young adults. In this project, we will compare a standardized Iyengar yoga program for young people with rheumatoid arthritis to a standard care wait-list control condition.

Methods/Design

Seventy rheumatoid arthritis patients aged 16-35 years will be randomized into either the 6-week Iyengar yoga program (12 - 1.5 hour sessions twice weekly) or the 6-week wait-list control condition. A 20% attrition rate is anticipated. The wait-list group will receive the yoga program following completion of the first arm of the study. We will collect data quantitatively, using questionnaires and markers of disease activity, and qualitatively using semi-structured interviews. Assessments include standardized measures of general and arthritis-specific function, pain, mood, and health-related quality of life, as well as qualitative interviews, blood pressure/resting heart rate measurements, a medical exam and the assessment of pro-inflammatory cytokines. Data will be collected three times: before treatment, post-treatment, and two months following the treatment.

Discussion

Results from this study will provide critical data on non-pharmacologic methods for enhancing function in rheumatoid arthritis patients. In particular, results will shed light on the feasibility and potential efficacy of a novel intervention for rheumatoid arthritis symptoms, paving the way for a larger clinical trial.

Trial Registration

ClinicalTrials.gov NCT01096823

Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome

Introduction

Irritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements.

Methods/Design

Sixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol.

Trial registration

ClinicalTrials.gov NCT01107977.

Yoga for persistent fatigue in breast cancer survivors: results of a pilot study

Approximately one-third of breast cancer survivors experiences persistent fatigue for months or years after successful treatment completion. There is a lack of evidence-based treatments for cancer-related fatigue, particularly among cancer survivors. This single-arm pilot study evaluated the feasibility and preliminary efficacy of a yoga intervention for fatigued breast cancer survivors based on the Iyengar tradition. Iyengar yoga prescribes specific poses for individuals with specific medical problems and conditions; this trial emphasized postures believed to be effective for reducing fatigue among breast cancer survivors, including inversions and backbends performed with the support of props. Twelve women were enrolled in the trial, and 11 completed the full 12-week course of treatment. There was a significant improvement in fatigue scores from pre- to post-intervention that was maintained at the 3-month post-intervention followup. Significant improvements were also observed in measures of physical function, depressed mood, and quality of life. These results support the acceptability of this intervention and suggest that it may have beneficial effects on persistent post-treatment fatigue. However, results require replication in a larger randomized controlled trial.

Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners

The aim of this study was to assess the levels of flexibility, functional autonomy and QoL in elderly yoga practitioners. The subjects were divided into a yoga group (YG; n = 52; age = 66.79 ± 3.30 years; BMI = 24.77 ± 3.18) and control group (CG; n = 31; age = 69.33 ± 4.84 years; BMI = 24.32 ± 3.71) and submitted to flexibility tests through goniometry, the LADEG autonomy protocol and QoL, using the WHOQOL-Old questionnaire. Repeated measures ANOVA showed increases in articular range of motion in shoulder abduction (Δ%SA = 14.11%; p = 0.0001), horizontal shoulder extension (Δ%HSE = 33.90%; p = 0.0001), lumbar spine flexion (Δ%LSF = 50.74%; p = 0.0001), hip flexion (Δ%HF = 35.75%; p = 0.0001), hip extension (Δ%HE = 10.93%; p = 0.021) and knee flexion (Δ%KF = 3.90%; p = 0.001) and in the GDLAM autonomy index (Δ%AI = -13.67%; p = 0.0001) in the YG compared to the CG. The Mann-Whitney test revealed increases in QoL scores in Facet 1 (Δ%Fac1 = 9.04%; p=0.043), Facet 5 (Δ%Fac5 = 51.06%; p = 0.0001) and in overall QoL (Δ%OqoL = 8.13%; p = 0.046) in the YG compared to the CG. The remaining variables showed no significant intergroup modifications. Thus, the study suggests that the regular practice of yoga may lead to improved range of motion in the performance of activities of daily living in elderly women.

Osteopathy and (hatha) yoga

Differences and points of contact between osteopathy and yoga as regards their history and practical application are outlined. Both seek to promote healing. Yoga seeks the attainment of consciousness; osteopathy aims for providing support to health. One fundamental difference is the personal involvement of the individual in yoga. Teacher and student alike are challenged to re-examine the attitudes of mind they have adopted toward their lives. Osteopathy generally involves a relatively passive patient while the osteopath is active in providing treatment. Practical examples are used to highlight points of contact between yoga and osteopathy. The text includes a discussion of the importance of physicality and a description of ways of using it in healing processes. Furthermore, processes of attaining consciousness are outlined. Possible reductionist misconceptions in yoga and osteopathy are also pointed out. Fundamental attitudes and focus that complement each other are presented, taking the concept of stillness as a particular example.

A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia

A mounting body of literature recommends that treatment for fibromyalgia (FM) encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping. A sample of 53 female FM patients were randomized to the 8-week Yoga of Awareness program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat. At post-treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies. This pilot study provides promising support for the potential benefits of a yoga program for women with FM.

Peaceful Play Yoga: Serenity and Balance for Children With Cancer and Their Parents

Children with a cancer diagnosis experience symptom distress, including anxiety, because of the disease and its treatment. Parents experience stress and anxiety because of the uncertainty of the disease as well as the suffering of their children. Yoga is a complementary intervention that has physiological and psychological benefits in healthy children and healthy and chronically ill adults. On an inpatient hematology/oncology unit, 11 children aged 6 to 12 years, 5 adolescents aged 13 to 18 years, and 33 parents participated in a single yoga session tailored to the needs and abilities of the patients and parents. Sense of well-being pre- and postclass was measured with the Spielberger State Anxiety Scale. Children had normal anxiety scores preclass that did not change. Adolescents and parents experienced significant decreases in anxiety scores, and all cohorts gave positive feedback about the experience. The authors conclude that yoga is a feasible intervention for this population and is beneficial to adolescents and parents.

Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors

OBJECTIVE

People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV-infected adults relative to standard of care treatment in a matched control group.

METHODS

Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were: 2-h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T-cell count and plasma HIV RNA, and the Medical Outcomes Study Short Form (SF)-36 health-related QOL inventory.

RESULTS

Resting systolic and diastolic blood pressures improved more (P=0.04) in the yoga group (-5 +/- 2 and -3 +/- 1 mmHg, respectively) than in the standard of care group (+1 +/- 2 and+2 +/- 2 mmHg, respectively). However, there was no greater reduction in body weight, fat mass or proatherogenic lipids, or improvements in glucose tolerance or overall QOL after yoga. Immune and virological status was not adversely affected.

CONCLUSION

Among traditional lifestyle modifications, yoga is a low-cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors.

The health benefits of yoga and exercise: a review of comparison studies

OBJECTIVES

Exercise is considered an acceptable method for improving and maintaining physical and emotional health. A growing body of evidence supports the belief that yoga benefits physical and mental health via down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). The purpose of this article is to provide a scholarly review of the literature regarding research studies comparing the effects of yoga and exercise on a variety of health outcomes and health conditions.

METHODS

Using PubMed((R)) and the key word "yoga," a comprehensive search of the research literature from core scientific and nursing journals yielded 81 studies that met inclusion criteria. These studies subsequently were classified as uncontrolled (n = 30), wait list controlled (n = 16), or comparison (n = 35). The most common comparison intervention (n = 10) involved exercise. These studies were included in this review.

RESULTS

In the studies reviewed, yoga interventions appeared to be equal or superior to exercise in nearly every outcome measured except those involving physical fitness.

CONCLUSIONS

The studies comparing the effects of yoga and exercise seem to indicate that, in both healthy and diseased populations, yoga may be as effective as or better than exercise at improving a variety of health-related outcome measures. Future clinical trials are needed to examine the distinctions between exercise and yoga, particularly how the two modalities may differ in their effects on the SNS/HPA axis. Additional studies using rigorous methodologies are needed to examine the health benefits of the various types of yoga.

Perspectives on yoga inputs in the management of chronic pain

Chronic pain is multi-dimensional. At the physical level itself, beyond the nociceptive pathway, there is hyper arousal state of the components of the nervous system, which negatively influences tension component of the muscles, patterns of breathing, energy levels and mindset, all of which exacerbate the distress and affect the quality of life of the individual and family. Beginning with the physical body, Yoga eventually influences all aspects of the person: vital, mental, emotional, intellectual and spiritual. It offers various levels and approaches to relax, energize, remodel and strengthen body and psyche. The asanas and pranayama harmonize the physiological system and initiate a "relaxation response" in the neuro endocrinal system. This consists of decreased metabolism, quieter breathing, stable blood pressure, reduced muscle tension, lower heart rate and slow brain wave pattern. As the neural discharge pattern gets modulated, hyper arousal of the nervous system and the static load on postural muscle come down. The function of viscera improves with the sense of relaxation and sleep gets deeper and sustained; fatigue diminishes. Several subtle level notional corrections can happen in case the subject meditates and that changes the context of the disease, pain and the meaning of life. Meditation and pranayama, along with relaxing asanas, can help individuals deal with the emotional aspects of chronic pain, reduce anxiety and depression effectively and improve the quality of life perceived.

Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research

BACKGROUND

The purpose of this article is to review the evidence for the efficacy of hatha yoga for depression and possible mechanisms by which yoga may have an impact on depression, and to outline directions for future research.

METHODS

Literature review and synthesis.

RESULTS AND CONCLUSIONS

A literature search for clinical trials examining yoga for depression uncovered eight trials: 5 including individuals with clinical depression, and 3 for individuals with elevated depression symptoms. Although results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations. We would argue, however, that there are several reasons to consider constructing careful research on yoga for depression. First, current strategies for treating depression are not sufficient for many individuals, and patients have several concerns about existing treatments. Yoga may be an attractive alternative to or a good way to augment current depression treatment strategies. Second, aspects of yoga-including mindfulness promotion and exercise-are thought to be "active ingredients" of other successful treatments for depression. Third, there are plausible biological, psychological, and behavioral mechanisms by which yoga may have an impact on depression. We provide suggestions for the next steps in the study of yoga as a treatment for depression.

Mind-Body Therapies and Osteoarthritis of the Knee

Osteoarthritis of the knee is a major cause of disability among adults worldwide. Important treatment options include nonpharmacologic therapies, and especially symptom management strategies in which patients take an active role. Among these, mind-body therapies may have particular promise for alleviating the distressful symptoms associated with osteoarthritis of the knee. However, systematic reviews are lacking. The objective of this paper is to review English-language articles describing clinical studies evaluating the effects of patient-driven mind-body therapies on symptoms of knee osteoarthritis. Eight studies, representing a total of 267 participants, met the inclusion criteria. Interventions included tai chi, qigong, and yoga. Collectively, these studies suggest that specific mind-body practices may help alleviate pain and enhance physical function in adults suffering from osteoarthritis of the knee. However, sample sizes are small, rigorous investigations are few, and the potential benefits of several mind-body therapies have not yet been systematically tested. Additional high-quality studies are needed to clarify the effects of specific mind-body therapies on standardized measures of pain, physical function, and related indices in persons with osteoarthritis of the knee, and to investigate possible underlying mechanisms.

Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial

OBJECTIVES

This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer centre.

METHODS

Eighty-eight stage II and III breast cancer outpatients were randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to their radiotherapy treatment. Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days. Assessments included European Organization for Research in the Treatment of Cancer-Quality of Life (EORTCQoL C30) functional scales and Positive and Negative Affect Schedule (PANAS). Assessments were done at baseline and after 6 weeks of radiotherapy treatment.

RESULTS

An intention to treat GLM repeated measures ANOVA showed significant difference across groups over time for positive affect, negative affect and emotional function and social function. There was significant improvement in positive affect (ES = 0.59, p = 0.007, 95%CI 1.25 to 7.8), emotional function (ES = 0.71, p = 0.001, 95%CI 6.45 to 25.33) and cognitive function (ES = 0.48, p = 0.03, 95%CI 1.2 to 18.5), and decrease in negative affect (ES = 0.84, p<0.001, 95%CI -13.4 to -4.4) in the yoga group as compared to controls. There was a significant positive correlation between positive affect with role function, social function and global quality of life. There was a significant negative correlation between negative affect with physical function, role function, emotional function and social function.

CONCLUSION

The results suggest a possible role for yoga to improve quality of life and affect in breast cancer outpatients.

Integrative Tumor Board: a case report and discussion from Dana-Farber Cancer Institute

A 34-year-old woman carrying a BRCA1 gene and a significant family history was diagnosed with T1c, N1 breast cancer. The tumor was estrogen receptor, progesterone receptor, and HER-2/Neu negative. The patient received dose-dense chemotherapy with Adriamycin and Cytoxan followed by Taxol, and left breast irradiation. Later, a bilateral S-GAP flap reconstruction with right prophylactic mastectomy and left mastectomy were performed. During her treatment, the patient had an integrative medicine consultation and was seen by a team of health care providers specializing in integrative therapies, including integrative nutrition, therapeutic massage, acupuncture, and yoga. Each modality contributed unique benefit in her care that led to a satisfactory outcome for the patient. A detailed discussion regarding her care from each modality is presented. The case elucidates the need for integrative approaches for cancer patients in a conventional medical setting.

Nonpharmacological approaches in the management of hypertension

PURPOSE

The purpose of this article is to discuss the holistic evaluation of the hypertensive patient and review evidence-based nonpharmacological treatments to help patients achieve maximum therapeutic benefits with minimal side effects.

DATA SOURCES

Health sciences literature was reviewed using the following databases: Medline, PubMed, and Cumulative Index to Nursing and Allied Health Literature.

CONCLUSIONS

Hypertension remains a major public health problem, affecting 65 million Americans and contributing to excess morbidity, mortality, and indirect and direct healthcare costs. Improving clinical outcomes will reduce human suffering as well as the economic burden associated with this disease. Nonpharmacological strategies are recommended as successful primary and adjunctive treatment options for lowering blood pressure. Moreover, the benefits of many of these approaches extend to and promote overall health and well-being.

IMPLICATIONS FOR PRACTICE

Nurse practitioners who incorporate nonpharmacological options in the management of hypertension can improve clinical outcomes.

Yoga as a treatment for binge eating disorder: a preliminary study

OBJECTIVE

To examine the efficacy of a 12-week yoga program aimed at reducing binge eating severity.

DESIGN

A randomised trial was undertaken assigning participants to yoga (n=45) or wait-list control (n=45) groups. Of these, 25 in each group were analysed.

PARTICIPANTS

A community-based sample of women between 25 and 63 years of age who identified with diagnostic criteria for binge eating disorder (BED) and a BMI>25 were recruited for the study.

MAIN OUTCOME MEASURES

Primary outcomes included the Binge Eating Scale (BES) and International Physical Activity Questionnaire (IPAQ). Secondary outcomes comprised measures for BMI, hips and waist.

RESULTS

For the yoga group, self-reported reductions in binge eating and increases in physical activity were statistically significant. Small yet statistically significant reductions for BMI, hips and waist measurement were obtained. The wait-list control group did not improve significantly on any measures.

CONCLUSION

In conjunction with formal weekly sessions, home-based yoga programs are potentially efficacious for the treatment of binge eating.

Subjective Sleep Quality and hormonal modulation in long-term yoga practitioners

Yoga represents a fascinating mind-body approach, wherein body movements (asana), breathing exercises (pranayama) and meditation are integrated into a single multidimensional practice. Numerous beneficial mental and physical effects have been classically ascribed to this holistic ancient method. The purpose of the present study has been to examine the effects of long-term yoga practice on Subjective Sleep Quality (SSQ) and on several hormonal parameters of the hypothalamus-pituitary-adrenal (HPA) axis. Twenty-six subjects (16 experimental and 10 controls) were recruited to be part of the study. Experimental subjects were regular yoga practitioners with a minimum of 3 years of practice. Blood samples for the quantification of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEA-S) were drawn from all subjects. Likewise, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess SSQ. As statistical analysis, Mann-Whitney U-test was performed. The yoga group displayed lower PSQI scores and higher blood cortisol levels than control subjects. Therefore, it can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol. These preliminary results suggest interesting clinical implications which should be further researched.

Restorative yoga for women with breast cancer: findings from a randomized pilot study

OBJECTIVES

Restorative yoga (RY) is a gentle type of yoga that may be beneficial for cancer patients and post-treatment survivors. Study goals were: to determine the feasibility of implementing a RY intervention for women with breast cancer; and to examine group differences in self-reported emotional, health-related quality of life, and symptom outcomes.

METHODS

Women with breast cancer (n=44; mean age 55.8 years) enrolled in this study; 34% were actively undergoing cancer treatment. Study participants were randomized to the intervention (10 weekly 75-minute RY classes) or a waitlist control group. Participants completed questionnaires at Week 0 (baseline) and Week 10 (immediately post-intervention for the yoga group).

RESULTS

Group differences favoring the yoga group were seen for mental health, depression, positive affect, and spirituality (peace/meaning). Significant baseline*group interactions were observed for negative affect and emotional well-being. Women with higher negative affect and lower emotional well-being at baseline derived greater benefit from the yoga intervention compared to those with similar values at baseline in the control group. The yoga group demonstrated a significant within-group improvement in fatigue; no significant difference was noted for the control group.

CONCLUSIONS

Although limited by sample size, these pilot data suggest potential benefit of RY on emotional outcomes and fatigue in cancer patients. This study demonstrates that a RY intervention is feasible for women with breast cancer; implications for study design and implementation are noted with an emphasis on program adoption and participant adherence.

Yoga for veterans with chronic low-back pain

OBJECTIVES

Chronic back pain affects a large proportion of both the general population and of military veterans. Although numerous therapies exist for treating chronic back pain, they can be costly and tend to have limited effectiveness. Thus, demonstrating the efficacy and cost-effectiveness of additional treatment alternatives is important. The purpose of our study was to examine the benefits of a yoga intervention for Veterans Administration (VA) patients. SUBJECTS/INTERVENTION: VA patients with chronic back pain were referred by their primary care providers to a yoga program as part of clinical care. Before starting yoga, a VA physician trained in yoga evaluated each patient to ensure that they could participate safely.

DESIGN

The research study consisted of completing a short battery of questionnaires at baseline and again 10 weeks later.

OUTCOME MEASURES

Questionnaires included measures of pain, depression, energy/fatigue, health-related quality of life, and program satisfaction. Paired t-tests were used to compare baseline scores to those at the 10-week follow-up for the single group, pre-post design. Correlations were used to examine whether yoga attendance and home practice were associated with better outcomes.

RESULTS

Baseline and follow-up data were available for 33 participants. Participants were VA patients with a mean age of 55 years. They were 21% female, 70% white, 52% married, 68% college graduates, and 44% were retired. Significant improvements were found for pain, depression, energy/fatigue, and the Short Form-12 Mental Health Scale. The number of yoga sessions attended and the frequency of home practice were associated with improved outcomes. Participants appeared highly satisfied with the yoga instructor and moderately satisfied with the ease of participation and health benefits of the yoga program.

CONCLUSIONS

Preliminary data suggest that a yoga intervention for VA patients with chronic back pain may improve the health of veterans. However, the limitations of a pre-post study design make conclusions tentative. A larger randomized, controlled trial of the yoga program is planned.