Yoga in rheumatic diseases

[Yoga as an intervention for chronic pain]

The use of yoga, especially as an intervention for chronic pain, is increasing worldwide. Available data on chronic low back pain, within limits also for chronic neck pain and certain types of headache, show statistically significant positive effects related to pain intensity and pain-related impairments. The data provide evidence that yoga is at least equal in efficacy and safety to other exercise interventions as well as individualized physical therapy. The dose of the intervention seems to be of secondary importance, but the establishment of a long-term independent practice after initial supervision seems to be essential; however, for other pain disorders there is still a need for research.

The Effects of Tele-Yoga in Ankylosing Spondylitis Patients: A Randomized Controlled Trial

Objective: This randomized controlled trial aimed at investigating the effects of tele-yoga on physical function, disease activity, spinal mobility, flexibility, muscular endurance, exercise capacity, balance, sleep quality, stress, depression, anxiety, quality of life (QoL), and mindfulness in patients with ankylosing spondylitis (AS). Methods: Sixty patients with AS were randomly assigned to the tele-yoga group (TYG) or wait-list control group (CG). In addition to their medical treatments, TYG participants attended online yoga classes three times per week for 8 weeks. The CG continued their standard medical treatment. Data were collected at baseline and after 8 weeks. The primary outcome measure was physical function as assessed by the Bath AS Functional Index (BASFI). Secondary outcome measures included the Bath AS Disease Activity Index (BASDAI), Bath AS Patient Global Score (BAS-G), Assessment of SpondyloArthritis International Society Health Index (ASAS HI), Bath AS Metrology Index (BASMI), sit-and-reach test, sit-up test, push-up test, incremental shuttle walk test, Balance Master test, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), 36-Item Short Form Health Survey (SF-36), and Mindful Attention Awareness Scale (MAAS). Results: Compared with the CG (n = 27), participants in the TYG (n = 28) demonstrated significant improvements in BASFI (p = 0.001). The TYG also showed significant improvements in disease activity, spinal mobility, flexibility, muscular endurance, balance, sleep quality, stress, depression, and QoL compared with the CG (p < 0.05). Conclusions: Tele-yoga practice appears to be a safe and promising intervention for patients with AS and should be considered as a part of holistic disease management because of its potential physical and psychological benefits. Clinical Trial Registration: NCT04803383.

The effectiveness of yoga as a form of exercise in the management of rheumatic diseases

Yoga, a long-standing Indian tradition, has gained popularity globally, inspiring many different disciplines to employ it as a complementary treatment for various diseases. Yoga is primarily composed of numerous physical poses and positions that are coupled with breathing techniques, profound relaxation, and meditation. There are many types of yoga with varying levels of difficulty. Yoga, consisting of various poses and postures with distinct postural mechanics, is frequently highlighted as an exercise that improves both physical and mental health. Applying the proper techniques to yoga poses can boost balance, strength, and flexibility while also improving general health and quality of life. In addition to its physical benefits, it is recognized that yoga enhances an individual's mood, anxiety, and depression levels and their ability to deal with stress. Rheumatic diseases affect many different organs, particularly the musculoskeletal structures, and negatively impact patients' quality of life. Maintaining a sufficient level of exercise is essential to preserve and enhance physical function in addition to pharmaceutical therapy, the mainstay of rheumatic disease treatment. In treatment guidelines for many rheumatic diseases, exercise, and physiotherapy techniques are stressed as the most substantial component of non-pharmacological treatment. This review considered yoga a form of exercise outside of traditional practices. From this perspective, we aimed to summarize the efficacy of yoga practices on various rheumatic diseases. Additionally, we aimed to highlight possible mechanisms of action.

Harnessing the benefits of yoga for myositis, muscle dystrophies, and other musculoskeletal disorders

The recent global increase in popularity of home-based yoga, an ancient Indian technique practiced for thousands of years, has translated into its use as a complementary therapy for a multitude of ailments. This review aims to examine the published literature regarding the effects of yoga therapy on systemic chronic diseases; in particular on the inflammatory myopathies (IMs) and other muscle disorders.

Despite the fact that the evidence base for yoga in inflammatory myositis is in its infancy, collateral results in other disorders such as muscular dystrophies are promising. A beneficial effect of yoga in chronic pain has been shown alongside an improvement in motor function and muscle strength. Patients with Duchenne muscular dystrophy with respiratory involvement may find improvement in lung function. Elderly patients may experience reduction in falls secondary to an improvement in balance while practicing long-term yoga therapy.

Further benefits are improving disorders of mental health such as depression and anxiety. A reported improvement in overall quality of life further suggests its efficacy in reducing morbidity in patients with chronic diseases, who often suffer co-existent psychological comorbidities.

Potential Role of Yoga Intervention in the Management of Chronic Non-malignant Pain

Pain is an unpleasant and upsetting experience. Persistent pain has an impact on an individual's quality of life which causes stress and mood disorders. There are currently no pain-relieving techniques available that can eliminate pain and offer relief without causing any adverse effects. These factors draw attention to traditional treatments like yoga and meditation, which can reduce biological stress and hence increase immunity, as well as alleviate the psychological and emotional suffering produced by pain. Yoga reduces the stress response and the pain cascade via the downregulation of the hypothalamus-pituitary-adrenal (HPA) axis and vagal stimulation. Yoga is a cost-effective growing health practice that, unlike pharmaceuticals, has no side effects and can help patients stay in remission for longer periods of time with fewer relapses. Yoga not only reduces stress and depression severity but also improves functional status and reduces pain perception. This article highlights the impact of yoga on pain management and on a malfunctioning immune system, which leads to improved health, pain reduction, disease management, and improvement in overall quality of life.

Yoga as a Novel Adjuvant Therapy for Patients with Idiopathic Inflammatory Myopathies

Context:

Recent studies have demonstrated that physical activity is well tolerated by patients with idiopathic inflammatory myopathies (IIMs) and can have additional benefits as an adjuvant therapy to pharmacologic agents, especially if started early. To date, no studies have examined the effects of yoga on patients with IIMs.

Aims:

The aim of this study was to evaluate the effects of yoga on self-reported difficulty in performing activities of daily living (ADL) and muscle strength in patients with mild-to-moderate IIMs.

Subjects and Methods:

A longitudinal cohort study in which participants were assessed using the Myositis Activities Profile (MAP) and manual muscle testing (MMT) before and after the completion of an 8-week instructor-guided yoga course was performed.

Statistical Analysis Used:

Wilcoxon signed-ranked test was performed for statistical analysis.

Results:

The average posttreatment MAP scores of six participants demonstrated an increase of 2.51 points, while the average MMT score of four participants demonstrated an increase of 11 points.

Conclusions:

This study is the first study to date to examine the effect of yoga as an adjuvant complementary therapy for patients with IIM. Continued research should be done on the effect of yoga as an adjuvant therapy, for in addition to increase in muscle strength and ability to perform ADL, yoga may offer potential improvements in mood, mental health, and sleep.

Yoga for Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Purpose: Rheumatoid arthritis (RA) is a pervasive inflammatory autoimmune disease that seriously impairs human health and requires more effective non-pharmacologic treatment approaches. This study aims to systematically review and evaluate the efficacy of yoga for patients with RA.

Methods: Medline (through PubMed), Cochrane Library, EMBASE (through SCOPUS), and Web of Science database were screened through for articles published until 20 July 2020. Randomized controlled trials (RCTs) of yoga in patients with RA were included. Outcomes measures were pain, physical function, disease activity, inflammatory cytokines, and grip strength. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Result: Ten trials including 840 patients with RA aged 30–70 years were identified, with 86% female participants. Meta-analysis revealed a statistically significant overall effect in favor of yoga for physical function (HAQ-DI) (5 RCTs; SMD = −0.32, 95% CI −0.58 to −0.05, I² = 15%, P = 0.02), disease activity (DAS-28) (4 RCTs; SMD = −0.38, 95% CI −0.71 to −0.06, I² = 41%, P = 0.02) and grip strength (2 RCTs; SMD = 1.30, 95% CI 0.47–2.13, I² = 63%, P = 0.002). No effects were found for pain, tender joints, swollen joints count or inflammatory cytokines (i.e., CRP, ESR, IL-6, and TNF-α).

Summary: The findings of this meta-analysis indicate that yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA. However, the balance of evidence showed that yoga had no significant effect in improving pain, tender joints, swollen joints count, and inflammatory cytokines in patients suffering from RA. Considering methodological limitations, small sample size, and low-quality, we draw a very cautious conclusion in the results of the estimate of the effect. High-quality and large-scale RCTs are urgently needed in the future, and the real result may be substantially different.

Yoga for systemic lupus erythematosus (SLE): Clinician experiences and qualitative perspectives from students and yoga instructors living with SLE

Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammation and tissue damage. It is more common and severe among Blacks, Hispanics, and Asians; with higher incidence in women. While the goals of medical treatment are to prevent flares and reduce organ damage, up to 50% of patients perceive their health to be suboptimal with unaddressed needs including fatigue and pain. Recent SLE treatment guidelines focus on improving quality of life. Yoga has shown improvements in quality-of-life and fatigue in various diagnoses. While there is growing evidence that yoga therapy may help osteoarthritis and rheumatoid arthritis symptoms, there is only one reference in the literature related to SLE.

METHODS/SETTING

An adjunct study was undertaken to evaluate adapting the Yoga as Self Care for Arthritis in Minority Communities study for a bilingual population living with SLE in the Washington, DC area. Informants included 7 patients enrolled onto the study, and 3 yoga instructors living with SLE. Qualitative methods included journals and semi-structured interviews.

RESULTS

Enrolling patients clarified revisions for intake questionnaires, and symptoms that may impact class participation. Participants demonstrated increased balance, body awareness, and tolerated a faster-paced yoga class when compared to those in the parent study. Yoga instructors' recommendations included modifying yoga based on energy levels and frequent changes in physical ability.

CONCLUSION

This paper shares perspectives from various informants and affirms the feasibility of progressing to a larger study. It summarizes our findings and recommendations towards creating a randomized controlled trial, as there are currently none in the literature.

A Qualitative Study Exploring Community Yoga Practice in Adults with Rheumatoid Arthritis

OBJECTIVE

Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA.

DESIGN

Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts.

PARTICIPANTS

A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA.

RESULTS

Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind-body, a tool for coping, pride/achievement, social, and "yoga meets you where you are").

CONCLUSION

In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA.

Mind body therapies in rehabilitation of patients with rheumatic diseases

Mind body therapies (MBT) share a global approach involving both mental and physical dimensions, and focus on relationship between brain, mind, body and behavior and their effects on health and disease. MBT include concentration based therapies and movement based therapies, comprising traditional Oriental practices and somatic techniques. The greatest part of rheumatic diseases have a chronic course, leading to progressive damages at musculoskeletal system and causing physical problems, psychological and social concerns. Thus, rheumatic patients need to be treated with a multidisciplinary approach integrating pharmacological therapies and rehabilitation techniques, that not should only aim to reduce the progression of damages at musculoskeletal system. Thus, MBT, using an overall approach, could be useful in taking care of the overall health of the patients with chronic rheumatic diseases. This review will deal with different MBT and with their effects in the most common chronic rheumatic diseases (Rheumatoid Arthritis, Ankylosing Spondylitis, Fibromyalgia Syndrome).

Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial

OBJECTIVE

To evaluate the effect of Integral-based hatha yoga in sedentary people with arthritis.

METHODS

There were 75 sedentary adults aged 18+ years with rheumatoid arthritis (RA) or knee osteoarthritis randomly assigned to 8 weeks of yoga (two 60-min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health [Medical Outcomes Study Short Form-36 (SF-36) physical component summary (PCS)] adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF-36 health-related quality of life (HRQOL), and RA disease activity. In everyone completing yoga, we explored longterm effects at 9 months.

RESULTS

Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 years (12 yrs). Average disease duration was 9 years and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5, 95% CI 2.0-10.7), walking capacity (125 m, 95% CI 15-235), positive affect (5.2, 95% CI 1.4-8.9), and lower Center for Epidemiologic Studies Depression Scale (-3.0, 95% CI -4.8 - -1.3). Significant improvements (p < 0.05) were evident in SF-36 role physical, pain, general health, vitality, and mental health scales. Balance, grip strength, and flexibility were similar between groups. Twenty-two out of 28 in the waitlist group completed yoga. Among all yoga participants, significant (p < 0.05) improvements were observed in mean PCS, flexibility, 6-min walk, and all psychological and most HRQOL domains at 8 weeks with most still evident 9 months later. Of 7 adverse events, none were associated with yoga.

CONCLUSION

Preliminary evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health and HRQOL. Clinical Trials NCT00349869.

Yoga as Therapy for Neurodegenerative Disorders: A Case Report of Therapeutic Yoga for Adrenomyeloneuropathy

Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and peripheral dexterity. A 61-y-old man diagnosed with AMN who was experiencing (1) peripheral neuropathy in his legs and feet, (2) lower-back pain (LBP), and (3) osteoarthritis received 60-min weekly therapeutic yoga sessions for a 10-mo period. Yoga therapy included hatha yoga asanas (poses) and pranayama (breathing exercises). Hatha yoga asanas were aligned with 7 Berg Balance Scale (BBS) indicators to measure improvement in balance and range of motion. The 10-mo course of therapeutic yoga resulted in improved LBP; improved flexion of the patient's hips, knees, and ankles; improved propulsion phase of walking; and improvement in the patient's ability to stand and balance without an assistive device. The effect of yoga therapy on the patient in this case study aligns with current QOL improvements noted in current research on yoga therapy for neurological disorders. The described concepts and methods of employing therapeutic yoga provide insights for clinicians into a modality that is low risk and low cost and that can support individuals with other neurological disorders, such as multiple sclerosis (MS), fibromyalgia (FM), and diseases of the peripheral nervous system. Further study is warranted to help determine the safety and efficacy of yoga therapy for these conditions.