The effect of a six-week program of yoga and meditation on brachial artery reactivity: do psychosocial interventions affect vascular tone?

Effect of Yoga on Endothelial Function: A Systematic Review and Meta-Analysis

Introduction: Endothelial dysfunction is the initial step in the pathogenesis of atherosclerosis; and it plays a central role in the development of cardiovascular diseases and many types of human diseases (diabetes, kidney failure, cancer, and viral infections). Strategies that are effective in protecting vascular endothelial function and retard or reversing endothelial dysfunction in the early stage appear to be potential in the prevention of vascular, cardiac, and many human diseases. Several studies have been carried out on the effects of yoga on endothelial function, but the results of these studies have not been synthesized. This study aimed at conducting a systematic review and meta-analysis to determine the effectiveness of yoga on endothelial function. Methods: A systematic review and meta-analysis of studies that assessed the effect of yoga practice on vascular endothelial function was done as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, Google Scholar, and Cochrane controlled register of trials (CENTRAL) were searched from inception to August 2022. The search strategy was constructed around yoga-based techniques and endothelial function. All the yoga-based interventional studies on endothelial function or dysfunction were included in this review. A narrative synthesis and descriptive analysis were done due to the diverse methodology of selected studies. We carried out a formal meta-analysis of controlled trials that assessed the effect of yoga on flow-mediated dilatation (FMD), a measure of endothelial function. Results: A total of 18 studies were included for review involving 1043 participants. Yoga training showed improved endothelial function in 12 studies, whereas 6 studies did not find any statistically robust effect. Meta-analysis (n = 395 participants, 6-studies, 7 comparisons) showed an increase in brachial FMD by yoga practice (mean difference = -1.23%; 95% confidence interval -2.23 to -0.23; p = 0.02). The heterogeneity between the studies was 43% (Tau2 = 0.70, χ2 = 10.49). The risk of bias was low to moderate in these studies. No adverse effects were reported. Conclusions: Yoga practice improved endothelial function. Yoga could be a safe and potential integrative medicine to improve endothelial function. However, as the statistical heterogeneity, that is, variation in the FMD among the studies was moderate, large clinical trials are necessary for its clinical recommendations.

Effect of Yoga-Based Cardiac Rehabilitation Program on Endothelial Function, Oxidative Stress, and Inflammatory Markers in Acute Myocardial Infarction: A Randomized Controlled Trial

Aims

The aim of this study was to evaluate the effects of yoga-based cardiac rehabilitation (Yoga-CaRe) on the endothelial system, oxidative stress, and inflammatory markers in patients with acute myocardial infarction (MI).

Methods

A sub-study was conducted in two clinical sites of the Yoga-CaRe trial (a multicenter randomized controlled trial). Participants with acute MI were randomized and allocated to either the Yoga-CaRe program (13 sessions with encouragement to home practice) or enhanced standard care (three educational sessions). Endothelial function, oxidative stress, and inflammatory biomarkers were assessed using biomarkers such as asymmetric dimethylarginine (ADMA), endothelial nitric oxide synthase (eNOS), endothelin-1 (ET-1), E-selectin, P-selectin, vascular cell adhesion molecule (VCAM), intercellular cell-adhesion molecule-1, total nitric oxide concentration (NOx), oxidized low-density lipoprotein (Oxd-LDL), superoxide dismutase, total antioxidant capacity (TAOC), tumor necrosis factor-alpha (TNFα), and C-reactive protein (CRP) at baseline and 12 weeks. Laboratory and statistical analysis were done by staff blinded to group allocation.

Results

Eighty-two patients (of the 110 patients recruited) completed the study. The mean age was 53.1 ± 10.6 and 51.9 ± 10.7 years in enhanced standard care and Yoga-CaRe group, respectively. At 12 weeks, Yoga-CaRe significantly reduced ADMA, ET-1, and ICMA-1 than the enhanced standard care group. Although E-selectin and VCAM at 12 weeks were reduced in both groups, enhanced standard care had a significantly higher reduction than the Yoga-CaRe group. Among markers of oxidative stress, TAOC increased in the Yoga-CaRe group. We found no difference in eNOS, NOx, P-selectin, TNFα, CRP, and Oxd-LDL between the two groups.

Conclusion

Yoga-CaRe improved the endothelial function (through a reduction in ET-1 and modulating adhesion molecules) and enhanced antioxidant capacity.

Effects of an online yoga program on anthropometric parameters among overweight female students during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) outbreak is a public health concern. However, stay-at-home regulations to prevent disease spread increased sedentary behavior with unintended adverse outcomes. Overweight is a major global health issue, and standard treatments have a poor track record of long-term effectiveness. The purpose of this study was to evaluate how online yoga affected participants who were overweight in terms of anthropometric measurements. The study, which was designed as a experimental study, enrolled sixty overweight adolescents. The participants were divided into two groups: a control group (n = 30) and an intervention group (n = 30) who performed an online yoga home exercise program comprising basic yoga practice with 15 poses and minimal rest periods on Monday Wednesday and Friday, from 5.00 to 5.45 pm for 12 weeks. The intensity of the exercise was 65–75 percent of maximum heart rate (MHR). Anthropometric parameters, including body weight (BW), body mass index (BMI), body circumference measurements (BCM), and resting heart rate (RHR) were assessed. All parameters were measured at weeks 0, 8, and 12. Within group and between group comparisons were performed. The results revealed improved BW, BMI, BCM, and RHR in the intervention group; the median BW and BMI of the intervention group was significantly decreased at week 12, and the BCM of the intervention group showed a significant decrease in the chest, waist, hip, and thigh. This declining trend started from week 8. This 12-week online yoga program decreased BW, BMI, BCM, and RHR, which indicates that practicing yoga at home is effective on anthropometric parameters and may be an alternative therapy for health promotion and controlling body weight during the COVID-19 pandemic. However, an appropriate and continuous exercise program must be followed.

Effects of Yogic Interventions on Patients Diagnosed With Cardiac Diseases. A Systematic Review and Meta-Analysis

Objective

Presently, evidence-based research studies on the efficacy of complimentary therapies like yoga for patients with different cardiac diseases are limited and conflicting. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on yogic interventions compared with usual care or non-pharmacological treatment in patients diagnosed with cardiac diseases.

Methods

We conducted an electronic search of literature published from 2006 to May 2021 through five databases. PRISMA statement was used to develop and report a systematic review and meta-analysis protocol. Sixteen RCTs were included in the systematic review and 11 RCTs were used for meta-analysis. Outcome measures were blood pressure, lipid profile, and psychosocial measures. The Cochrane collaboration tool was used to assess bias risk.

Results

The results show that yogic interventions resulted in significant reduction in systolic (d = 046; 95% CI.08–0.84; I² = 81.86%) and diastolic blood pressures (d = 0.56; 95% CI.13–0.99, I² = 84.84%). A medium statistically significant increase in HDL (d =0.67; 95% CI 0 to 1.33; I² 79.7%) and a low but significant effect on LDL (d = 0.23; 95% CI −0.08–0.54; I² 32.61%), total cholesterol (d =0.28; 95% CI −0.14–0.7; I² 63.72%), and triglycerides (d = 0.43; 95% CI −0.1–0.97; I² 76.64%) were observed. Pooled effect sizes showed a medium to low statistically significant effect on psychosocial indicators viz., QoL, stress, anxiety, and depression.

Conclusion

The meta-analysis found strong evidence of effectiveness of yogic interventions on lipid profile, blood pressure, and psychosocial outcomes in patients with diagnosed cardiac diseases.

Effects of Continuous Yoga on Body Composition in Obese Adolescents

Overweight/obesity is a pressing international health concern, and conventional treatments demonstrate poor long-term efficacy. Several studies have shown that yoga can control risk factors for cardiovascular disease, obesity, and psychosocial stress. The present study aimed to assess the effect of continuous yoga (asanas, pranayama, and Surya Namaskar yoga) on body composition in overweight participants. Forty adolescents with obesity were enrolled in this study. The study was conceived as a prospective, single-center, single-blinded randomized controlled trial. The participants were divided into 2 groups: the intervention group (n = 20), which undertook a continuous yoga practice, and the control group (n = 20). Body composition, including body weight (BW), body mass index (BMI), body fat mass (BFM), and muscle mass, was evaluated using tetrapolar bioelectrical impedance (BIA). Our results showed that the mean BMI and BFM of the yoga intervention group were significantly decreased at week 8 and week 12. The muscle mass of the yoga group continued to improve at a rate of 0.515 per week, which was statistically significant. In conclusion, a continuous yoga practice had a tendency to decrease BMI and BFM and increase muscle mass. These findings demonstrate intervention effectiveness similar to that observed in other clinical research and indicate that continuous yoga practice may be used as an alternative therapy for obesity prevention and health promotion in adolescents with obesity.

Effect of Yoga on Glucose Control and Quality of Life in Patients of Prediabetes

Objective: The objective of this study was to evaluate effect of yoga on fasting plasma glucose (FPG), postprandial plasma glucose, and hemoglobin A1C (HbA1C) and also on quality of life (QoL). Research Design and Methods: This was a cohort study in which 100 diagnosed cases of prediabetes were recruited for doing specific yoga, and they themselves act as control for the study. The measurement and comparison of FPG, prandial plasma glucose (PPG), and HbA1C were done at three different time intervals, that is, baseline, 3 months, and at 6 months. The assessment of QoL was done using SF-36 scale. Results: One hundred prediabetic cases were selected for the study in which impaired fasting glucose (IFG) was present more in younger population compared to impaired glucose tolerance (IGT) and IFG plus IGT both of which are more prevalent in middle age group. The yoga therapy was found to have favorable effect on FPG, PPG, and HbA1C along with various anthropometry measures studied in this study. After adjusting correlation coefficient for various anthropometry measures, yoga was found to be effective for controlling glycemic parameters in prediabetics. Conclusions: Yoga is a type of exercise known to improve glycemic control by changing anthropometry measures, but our study aids in knowledge about the beneficial effect beyond this known fact through other mechanisms yet to be explored.

Effects of Buddhist walking meditation on exercise capacity and quality of life of patients with chronic heart failure: A randomized controlled trial

BACKGROUND

Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF).

PURPOSE

To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF.

METHODS

Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training.

RESULTS

The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses.

CONCLUSIONS

The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.

The acute effects of vinyasa flow yoga on vascular function, lipid and glucose concentrations, and mood

While the chronic effects of certain styles of yoga on cardiometabolic factors have been investigated, little is known about the acute effects of a single yoga session on these outcomes. Moreover, vinyasa yoga's potential to modulate cardiometabolic outcomes has not been established. The purpose of this study is to determine the acute effects of a vinyasa yoga session on arterial stiffness, wave reflection, lipid and glucose concentrations, and mood in adults with prior yoga experience. Thirty yoga practitioners with a minimum of 3 months of practice experience were enrolled into the study. Carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), lipid profile, glucose concentrations, and mood (Positive and Negative Affect Scale) were assessed at baseline and immediately following a 1 -h vinyasa yoga session. After the yoga session, participants had significantly lower AIx (p < 0.001), non-HDL cholesterol (p < 0.05), and negative affect (p < 0.01) compared to baseline. These results highlight the efficacy of a single bout of yoga in altering wave reflection while improving mood and lipid concentrations in healthy adults with a history of yoga practice.

Meditation and Endocrine Health and Wellbeing

Meditation is a popular practice for reducing stress and improving mental health and wellbeing. Its effects are mediated largely by the endocrine system, including the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, and the renin-angiotensin-aldosterone system, and energy homeostasis. The limited evidence available indicates that changes associated with endocrine function following meditation correspond with improvements in mental health. However, this field of study is hampered by a lack of consensus as to definition and types of meditation and the mixed quality of reported studies. Moreover, the exact mechanisms by which meditation operates remain unclear and more robust studies are required to explore this by delineating the target populations, forms, dosages, and modes of delivery of meditation, comparison groups, and health experiences and outcomes used.

A naturalistic study of yoga, meditation, self-perceived stress, self-compassion, and mindfulness in college students

Objective: This study compared the effects of yoga and mindfulness meditation on self-compassion, mindfulness, and perceived stress in college students; and explored mind–body mechanisms and predictors of stress reduction.

Participants: Student participants (N = 92) were enrolled in either yoga or mindfulness meditation classes at a college in the southern United States from August through May of 2015–2016.

Methods: Students participated in 50-minute classes twice a week for 10 weeks, completing self-report questionnaires during the 1st and 10th week.

Results: Multiple-linear regression analysis found change in self-compassion was the strongest predictor of stress reduction.

Conclusions: Increasing self-compassion may increase the efficacy of mind–body interventions. Research into mind–body mechanisms is needed to identify intervention components that most improve student well-being.

Effectiveness of super brain yoga for children with hyperactivity disorder

PURPOSE

This study aimed at determining the effectiveness of super brain yoga for children with hyperactivity disorder.

DESIGN AND METHOD

This quasiexperimental and interventional research was conducted on 80 school-age children through a pretest-posttest design.

RESULTS

Results showed that there was a significant difference between the means of severity of hyperactivity disorder before (75.1) and after the intervention (63.5) (p < .001).

PRACTICE IMPLICATIONS

Practicing super brain yoga reduced the symptoms of hyperactivity disorder among the school-age children.

Effect of heat stress on vascular outcomes in humans

In addition to its role as an environmental stressor, scientists have recently demonstrated the potential for heat to be a therapy for improving or mitigating declines in arterial health. Many studies at both ends of the scientific controls spectrum (tightly controlled, experimental vs. practical) have demonstrated the beneficial effects of heating on microvascular function (e.g., reactive hyperemia, cutaneous vascular conductance); endothelial function (e.g., flow-mediated dilation); and arterial stiffness (e.g., pulse-wave velocity, compliance, β-stiffness index). It is important to note that findings of beneficial effects are not unanimous, likely owing to the varied methodology in both heating protocols and assessments of outcome measures. Mechanisms of action for the effects of both acute and chronic heating are also understudied. Heat science is a very promising area of human physiology research, as it has the potential to contribute to approaches addressing the global cardiovascular disease burden, particularly in aging and at risk populations, and those for whom exercise is not feasible or recommended.

Yoga for Heart Failure: A Review and Future Research

Background:

Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients.

Aim:

The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients.

Methods:

The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies.

Conclusions:

Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.

A systematic review and meta-analysis on the effects of yoga on weight-related outcomes

INTRODUCTION

Overweight and obesity are among the most important modifiable risk factors for chronic diseases and premature death. The aim of this review was to systematically assess and analyze the effects of yoga on weight-related outcomes.

METHODS

Medline/PubMed, Scopus, and the Cochrane Library were screened through March 2015 for randomized controlled trials on yoga for weight-related outcomes in the general population or overweight/obese individuals. Risk of bias was assessed using the Cochrane risk of bias tool on the following domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias.

RESULTS

Out of 445 records identified during literature search, 30 trials with a total of 2173 participants were included. No effects on weight, body mass index, body fat percentage or waist circumference were found. In studies with healthy adult participants an effect of yoga compared to usual care was found regarding waist/hip ratio (SMD=--1.00; 95% CI=--1.44, -0.55; p<0.001). In studies with overweight/obese participants only, effects relative to usual care were found for body mass index (SMD=-0.99; 95% CI=-1.67, -0.31; p=0.004). Effects however were not robust against selection bias; and publication bias could not be ruled out. No intervention-related adverse events were reported.

CONCLUSIONS

Despite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.

Protein-Pacing and Multi-Component Exercise Training Improves Physical Performance Outcomes in Exercise-Trained Women: The PRISE 3 Study

The beneficial cardiometabolic and body composition effects of combined protein-pacing (P; 5-6 meals/day at 2.0 g/kg BW/day) and multi-mode exercise (resistance, interval, stretching, endurance; RISE) training (PRISE) in obese adults has previously been established. The current study examines PRISE on physical performance (endurance, strength and power) outcomes in healthy, physically active women. Thirty exercise-trained women (>4 days exercise/week) were randomized to either PRISE (n = 15) or a control (CON, 5-6 meals/day at 1.0 g/kg BW/day; n = 15) for 12 weeks. Muscular strength (1-RM bench press, 1-RM BP) endurance (sit-ups, SUs; push-ups, PUs), power (bench throws, BTs), blood pressure (BP), augmentation index, (AIx), and abdominal fat mass were assessed at Weeks 0 (pre) and 13 (post). At baseline, no differences existed between groups. Following the 12-week intervention, PRISE had greater gains (p < 0.05) in SUs, PUs (6 ± 7 vs. 10 ± 7, 40%; 8 ± 13 vs. 14 ± 12, 43% ∆reps, respectively), BTs (11 ± 35 vs. 44 ± 34, 75% ∆watts), AIx (1 ± 9 vs. -5 ± 11, 120%), and DBP (-5 ± 9 vs. -11 ± 11, 55% ∆mmHg). These findings suggest that combined protein-pacing (P; 5-6 meals/day at 2.0 g/kg BW/day) diet and multi-component exercise (RISE) training (PRISE) enhances muscular endurance, strength, power, and cardiovascular health in exercise-trained, active women.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial

Background & objectives:

Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV's QOL, justifying an evaluation.

Methods:

In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/µl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval.

Results:

Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation (P =0.016); 12 per cent for physical (P =0.004), 11 per cent psychological (P =0.023) and 9 per cent level of independence (P =0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains.

Conclusions:

A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

The Effects of Bikram Yoga on Health: Critical Review and Clinical Trial Recommendations

Bikram yoga is a style of hatha yoga involving a standarized series of asanas performed to an instructional dialogue in a heated environment (40.6°C, 40% humidity). Several studies evaluating the effect of Bikram yoga on health-related outcomes have been published over the past decade. However, to date, there are no comprehensive reviews of this research and there remains a lack of large-scale, robustly-designed randomised controlled trials (RCT) of Bikram yoga training. The purpose of this review is to contextualise and summarise trials that have evaluated the effects of Bikram yoga on health and to provide recommendations for future research. According to published literature, Bikram yoga has been shown to improve lower body strength, lower and upper body range of motion, and balance in healthy adults. Non-RCTs report that Bikram yoga may, in some populations, improve glucose tolerance, bone mineral density, blood lipid profile, arterial stiffness, mindfulness, and perceived stress. There is vast potential for further, improved research into the effects of Bikram yoga, particularly in unhealthy populations, to better understand intervention-related adaptations and their influence on the progression of chronic disease. Future research should adhere to CONSORT guidelines for better design and reporting to improve research quality in this field.

The effects of brain wave vibration on oxidative stress response and psychological symptoms

OBJECTIVE

Brain Wave Vibration (BWV) training is a simple healing practice, a kind of Mind Body Training. This study was designed to investigate the psycho-endocrine differences between BMV practitioners and naïve controls.

METHODS

The experimental group included 54 individuals who had participated in BWV. The control group included 58 subjects who had not participated in formal BWV. Levels of plasma NO, reactive oxygen species (ROS), and superoxide dismutase (SOD) were measured, and the modified form of the Stress Response Inventory (SRI-MF), the Positive Affect and Negative Affect Scale (PANAS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were administered.

RESULTS

The BWV group demonstrated significantly higher plasma NO levels (p=0.003), and levels of ROS and SOD did not differ between the two groups. The BWV group showed lower scores in BDI (p=0.009), BAI (p=0.009) and stress level (p<0.001) and higher scores on positive affect (p=0.023) compared with the control group. NO levels were associated with increased positive affect (p = 0.024) only in BWV subjects.

CONCLUSION

BWV may increase NO, a relaxation-related factor, possibly by improving emotional state.

Effects of a 12-Week Hatha Yoga Intervention on Cardiorespiratory Endurance, Muscular Strength and Endurance, and Flexibility in Hong Kong Chinese Adults: A Controlled Clinical Trial

Objective. To examine the effects of a 12-week Hatha yoga intervention on cardiorespiratory endurance, muscular strength and endurance, and flexibility in Chinese adults. Methods. 173 adults (aged 52.0 ± 7.5 years) were assigned to either the yoga intervention group (n = 87) or the waitlist control group (n = 86). 19 dropped out from the study. Primary outcomes were changes in cardiorespiratory endurance (resting heart rate (HR) and maximal oxygen uptake (VO_2max)), muscular strength and endurance (curl-up and push-up tests), and lower back and hamstring flexibility (the modified back-saver sit-and-reach (MBS) test). Results. Compared to controls, the yoga group achieved significant improvements in VO_2max (P < 0.01), curl-up (P < 0.05) and push-up (P < 0.001) tests, and the MBS left and right leg tests (both P < 0.001) in both genders. Significant change was also found for resting HR between groups in women (P < 0.05) but not in men. Further analysis comparing participants between younger and older subgroups yielded similar findings, except that the older participants in the yoga group failed to improve resting HR or the curl-up test versus control. Adherence (89%) and attendance (94%) were high. No serious adverse events occurred. Conclusion. A 12-week Hatha yoga intervention has favorable effects on cardiorespiratory endurance, muscular strength and endurance, and flexibility in Chinese adults.

A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine

BACKGROUND

Persons living with HIV (PLWH) who also use crack cocaine may have stressful, chaotic lives and typically do not engage in standard medical care that addresses a multitude of extenuating life circumstances. Yoga/meditation (YM) improves quality of life (QOL) and biomarkers of stress, but the effect of this intervention is almost unknown in PLWH, particularly those who use crack cocaine.

OBJECTIVES

This pilot study sought to compare the feasibility and acceptability of 60-minute, twice-per-week sessions of YM for 2 months with those of no-contact control and to evaluate the effects of the intervention on QOL (according to the Short Form-36, Perceived Stress Scale [PSS], and Impact of Events Scale [IES]) and salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) among PLWH who use crack cocaine.

DESIGN

Participants were randomly assigned to YM or no-contact control and were assessed at baseline, 2 months after the intervention, and 4 months' follow-up.

RESULTS

The YM program was acceptable and feasible, with high overall attendance (89%) and individual participation in yoga sessions (83%). YM participants showed modest improvements on QOL. The PSS total score and the IES intrusion score improved significantly 2 months after the intervention, but cortisol and DHEA-S did not change.

CONCLUSIONS

This pilot study showed a high level of feasibility and acceptability and modest effects on measures of QOL among PLWH who use crack cocaine. The results suggest utility of YM as a simple, safe, and inexpensive format to improve QOL in a population that has many medical difficulties and extenuating stressors.

Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters

Beyond its hemodynamic function, the heart also acts as a neuroendocrine and immunoregulatory organ. A dynamic communication between the heart and other organs takes place constantly to maintain cardiovascular homeostasis. The current understanding highlights the importance of the endocrine, immune, and nervous factors to fine-tune the crosstalk of the cardiovascular system with the entire body. Once disrupted, this complex interorgan communication may promote the onset and the progression of cardiovascular diseases. Thus, expanding our knowledge on how these factors influence the cardiovascular system can lead to novel therapeutic strategies to improve patient care. In the present paper, we review novel concepts on the role of endocrine, immune, and nervous factors in the modulation of microvascular coronary function.

Randomised controlled trial of a 12 week yoga intervention on negative affective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients

BACKGROUND

Negative affective states such as anxiety, depression and stress are significant risk factors for cardiovascular disease, particularly in cardiac and post-cardiac rehabilitation populations.Yoga is a balanced practice of physical exercise, breathing control and meditation that can reduce psychosocial symptoms as well as improve cardiovascular and cognitive function. It has the potential to positively affect multiple disease pathways and may prove to be a practical adjunct to cardiac rehabilitation in further reducing cardiac risk factors as well as improving self-efficacy and post-cardiac rehabilitation adherence to healthy lifestyle behaviours.

METHOD AND DESIGN

This is a parallel arm, multi-centre, randomised controlled trial that will assess the outcomes of post- phase 2 cardiac rehabilitation patients assigned to a yoga intervention in comparison to a no-treatment wait-list control group. Participants randomised to the yoga group will engage in a 12 week yoga program comprising of two group based sessions and one self-administered home session each week. Group based sessions will be led by an experienced yoga instructor. This will involve teaching beginner students a hatha yoga sequence that incorporates asana (poses and postures), pranayama (breathing control) and meditation. The primary outcomes of this study are negative affective states of anxiety, depression and stress assessed using the Depression Anxiety Stress Scale. Secondary outcomes include measures of quality of life, and cardiovascular and cognitive function. The cardiovascular outcomes will include blood pressure, heart rate, heart rate variability, pulse wave velocity, carotid intima media thickness measurements, lipid/glucose profiles and C-reactive protein assays. Assessments will be conducted prior to (week 0), mid-way through (week 6) and following the intervention period (week 12) as well as at a four week follow-up (week 16).

DISCUSSION

This study will determine the effect of yoga practice on negative affective states, cardiovascular and cognitive function in post-phase 2 cardiac rehabilitation patients. The findings may provide evidence to incorporate yoga into standardised cardiac rehabilitation programs as a practical adjunct to improve the management of psychosocial symptoms associated with cardiovascular events in addition to improving patients' cognitive and cardiovascular functions.

TRIAL REGISTRATION

ACTRN12612000358842.

Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis

BACKGROUND

Due to new treatment modalities in the last decades, a decline in cardiovascular deaths has been observed. There is an emerging field of secondary prevention and behavioural programmes with increased interest in the use of mind-body practices. Until now, these have not been established in cardiovascular disease treatment programmes.

DESIGN

We performed a systematic review and meta-analysis of the available evidence on the effectiveness of mind-body practices for patients with diagnosed cardiac disease.

METHODS

We included randomized controlled trials (RCTs), published in English, reporting mind-body practices for patients with diagnosed cardiac disease. EMBASE, MEDLINE, Pubmed, Web of Science, The Cochrane Central Register of Controlled Trials and PsycINFO were searched up to July 2013. Two reviewers independently identified studies for inclusion and extracted data on study characteristics, outcomes (Quality of Life, anxiety, depression, physical parameters and exercise tolerance) and quality assessment. Standardized effect sizes (Cohen's d) were calculated comparing the outcomes between the intervention and control group and random effects meta-analysis was conducted.

RESULTS

We identified 11 unique RCTs with an overall low quality. The studies evaluated mindfulness-based stress reduction, transcendental meditation, progressive muscle relaxation and stress management. Pooled analyses revealed effect sizes of 0.45 (95%CI 0.20-0.72) for physical quality of life, 0.68 (95%CI 0.10-1.26) for mental quality of life, 0.61 (95%CI 0.23-0.99) for depression, 0.52 (95%CI 0.26-0.78) for anxiety, 0.48 (95%CI 0.27-0.69) for systolic blood pressure and 0.36 (95%CI 0.15-0.57) for diastolic blood pressure.

CONCLUSIONS

Mind-body practices have encouraging results for patients with cardiac disease. Our review demonstrates the need for high-quality studies in this field.

Serum mineral status and climacteric symptoms in perimenopausal women before and after Yoga therapy, an ongoing study

BACKGROUND

Many women report an increased level of anxiety, irritability and mood swings during their perimenopausal state. Studies show that physically active people can reduce their anxiety and depression by practicing yoga. Serum minerals such as calcium, copper and magnesium and the ferro-oxidase, ceruloplasmin play an important role in the body during the perimenopausal period.

OBJECTIVE

The objective of this study is to assess the serum mineral status, anthropometric parameters and climacteric symptoms in perimenopausal women before and after yoga intervention.

SUBJECTS AND METHODS

A total of 30 subjects with perimenopausal symptoms, aged between 40 and 60 years (49.43 ± 6.15) were included in the study. Yoga intervention was given on a daily basis (45 min duration) for 12 weeks. The climacteric symptoms were assessed by Greene's climacteric scale and biochemical parameters were analyzed spectrophotometrically.

RESULTS

A significant decrease in the waist hip ratio (P < 0.036) and body mass index (P < 0.036) was observed after yoga intervention. Systolic (P < 0.064) and diastolic (P < 0.082) blood pressure (BP) showed marginal decrease after yoga therapy. Climacteric symptoms improved significantly (P < 0.001) after yoga intervention. A significant increase (P < 0.001) in serum calcium and copper and a marked decrease in serum magnesium (P < 0.05) and ceruloplasmin (P < 0.028) levels was observed, post yoga therapy. Serum magnesium negatively correlated (r = -0.467, P < 0.035) with systolic BP after yoga intervention.

CONCLUSION

The overall changes observed in the mineral status and climacteric symptoms suggest that yoga therapy protocol can be effectively used to improve the quality of life in perimenopausal women.

Impact of Yoga Nidra on menstrual abnormalities in females of reproductive age

OBJECTIVES

The aim of this study was to observe the effect of Yoga Nidra practice on hormone levels in patients who had menstrual irregularities.

DESIGN

The study was a randomized controlled trial.

SETTINGS/LOCATION

The study was conducted in the Department of Obstetrics and Gynecology at Chhatrapati Sahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India. SUBJECTS were divided randomly into 2 groups-an intervention and a control group, with 75 subjects in each group. Of these subjects, 126 completed the study protocol.

SUBJECTS

This study involved 150 subjects with menstrual irregularities; 126 of whom completed the protocol.

INTERVENTIONS

The intervention was the practice of Yoga Nidra. The yogic intervention duration was 35-40 minutes/day, five times/week for 6 months. An estimation of hormonal profile was done for both groups at baseline and after 6 months.

RESULTS

Thyroid-stimulating hormone (p<0.002), follicle-stimulating hormone (p<0.02), luteinizing hormone (p<0.001), and prolactin (p<0.02) were decreased significantly in the intervention group, compared with the control group.

CONCLUSIONS

The present study demonstrated the efficacy of Yoga Nidra on hormone profiles in patients with menstrual irregularities. Yoga Nidra practice was helpful in patients with hormone imbalances, such as dysmenorrhea, oligomenorrhea, menorrhagia, metrorrhagia, and hypomenorrhea.

A pilot study of yoga as self-care for arthritis in minority communities

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.

Complementary and integrative treatments: expanding the continuum of care

This article is an introduction to the concepts of complementary, alternative, and integrative medicine. It discusses the scope and prevalence of complementary and integrative medicine (CIM) use among otolaryngology patients. Specific types of CIM are characterized in the context of their origins, philosophic and historical bases, scientific evidence, and applicability to the practice of otolaryngology. The author's intent is to provide a framework for discussing CIM with patients and integrating it into treatment paradigms in an evidence-based manner.

Hatha yoga and vascular function: results from cross-sectional and interventional studies

The aim of this study was to determine the effect of hatha yoga on arterial elasticity and endothelial function. First, a cross-sectional study was performed to determine whether yoga practitioners would demonstrate greater arterial compliance and endothelium-dependent vasodilation than their sedentary peers. Second, an intervention study involving 13 sedentary middle-aged and older adults (51 ± 7 years) was performed to determine whether 12 weeks of hatha yoga would elicit increases in arterial compliance and endothelial function. In the cross-sectional study involving a total of 34 subjects, there were no group differences in body fatness, blood lipid and lipoprotein concentrations, carotid artery compliance or brachial artery flow-mediated dilation (FMD). Hemoglobin A1c was lower in yoga practitioners than in sedentary adults (P < 0.05). Total cholesterol and hemoglobin A1c decreased after the intervention (P < 0.05) while carotid artery compliance and brachial artery FMD did not change. The results of both cross-sectional and interventional studies indicate that regular practice of hatha yoga is not associated with improvements in vascular functions.

An assessment of a sequence of yoga exercises to patients with arterial hypertension

This quasi-experimental study describes the effects of a yoga sequence following hemodynamic and biochemical parameters in patients with hypertension. Thirty-three volunteers participated in the study (control = 16 and yoga = 17) for four months. Blood pressure measurements, cardiac and respiratory rate were collected monthly, while the biochemical profile was taken at the beginning and end of the program. To analyze the data, Student's t test and repeated measures analyses were performed. The yoga group showed a significant reduction of systolic blood pressure, heart and respiratory rate (p < 0.05). As for the biochemical profile, the yoga group showed correlation coefficients between initial values and final responses greater than the control of fasting glucose, total cholesterol, LDL-cholesterol and triglycerides. The elaborated sequence practice promoted significant cardiovascular and metabolic benefits. The yoga exercises performed in the proposed sequence constitute complementary non-pharmacological control of blood pressure in patients with hypertension.

Physiological effects of yogic practices and transcendental meditation in health and disease

Yoga is an ancient Indian way of life, which includes changes in mental attitude, diet, and the practice of specific techniques such as yoga asanas (postures), breathing practices (pranayamas), and meditation to attain the highest level of consciousness. Since a decade, there has been a surge in the research on yoga, but we do find very few reviews regarding yogic practices and transcendental meditation (TM) in health and disease. Keeping this in view, a Medline search was done to review relevant articles in English literature on evaluation of physiological effects of yogic practices and TM. Data were constructed; issues were reviewed and found that there were considerable health benefits, including improved cognition, respiration, reduced cardiovascular risk, body mass index, blood pressure, and diabetes. Yoga also influenced immunity and ameliorated joint disorders.

A review of yoga programs for four leading risk factors of chronic diseases

Yoga, a form of physical activity, is rapidly gaining in popularity and has many health benefits. Yet healthcare providers have been slow to recognize yoga for its ability to improve health conditions, and few interventions have been developed that take full advantage of its benefits. The purpose of this article is to review published studies using yoga programs and to determine the effect of yoga interventions on common risk factors of chronic diseases (overweight, hypertension, high glucose level and high cholesterol). A systematic search yielded 32 articles published between 1980 and April 2007. The studies found that yoga interventions are generally effective in reducing body weight, blood pressure, glucose level and high cholesterol, but only a few studies examined long-term adherence. Additionally, not enough studies included diverse populations at high risk for diabetes and its related common health problems.

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.

How mental stress affects endothelial function

Mental stress is an important factor contributing to recognized mechanisms underlying cardiovascular events. Among these, stress-related endothelial dysfunction is an early risk factor that predicts future development of severe cardiovascular disorders. Acute mental stress by a variety of tests impairs endothelial function in humans, although the opposite results have been reported by some investigators. Chronic stress always deteriorates endothelial function in humans and experimental animals. Stress hormones, such as glucocorticoids and pro-inflammatory cytokines, and endothelin-1 liberated in response to mental stress participate in endothelial dysfunction possibly via downregulation of endothelial nitric oxide synthase (eNOS) expression, eNOS inactivation, decreased nitric oxide (NO) actions, and increased NO degradation, together with vasoconstriction counteracting against NO-induced vasodilatation. Catecholamines do not directly affect endothelial function but impair its function when blood pressure elevation by the amines is sustained. Endogenous opioids favorably affect endothelial function, which counteract deteriorating effects of other stress hormones and mediators. Inhibition of cortisol and endothelin-1 production, prevention of pro-inflammatory mediator accumulation, hypnotics, mirthful laughter, humor orientation, and lifestyle modification would contribute to the prevention and treatment for stress-related endothelial dysfunction and future serious cardiovascular disease.

Benefits of yoga for African American heart failure patients

BACKGROUND

The number of African American (AA) patients living with heart failure (HF) has been increasing, especially among the economically disadvantaged. Yoga therapy has been found to improve physical and psychological parameters among healthy individuals, but its effect in patients with HF remains unknown. The purpose of this study was to examine the effects of yoga therapy on cardiovascular endurance (VO2peak), flexibility, quality of life (QoL), and inflammatory markers on medically stable HF patients.

METHODS

Forty patients (38 AA, 1 Asian, and 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, n = 21) or the control group (CG, n = 19). All patients were asked to follow a home walk program. Premeasurement and postmeasurement included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ).

RESULTS

The statistical analyses (assessed by ANOVA and t-tests) were significant for favorable changes in the YG, compared with those in the CG, for flexibility (P = 0.012), treadmill time (P = 0.002), VO2peak (P = 0.003), and the biomarkers (IL-6, P = 0.004; CRP, P = 0.016; and EC-SOD, P = 0.012). Within the YG, pretest to posttest scores for the total (P = 0.02) and physical subscales (P < 0.001) of the MLwHFQ were improved.

CONCLUSIONS

Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.

Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial

The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY) has been purported to reduce blood pressure (BP) though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC) (based on individual dietary adjustment) on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P < .05), but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05). 24 h DBP (P < .01) and MAP (P < .05) decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.

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 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.