The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms

What can the psychoneuroimmunology of yoga teach us about depression's psychopathology?

Depression, the most prevailing mental health condition, remains untreated in over 30% of patients. This cluster presents with sub-clinical inflammation. Investigations trialling anti-inflammatory medications had mixed results. The lack of results may result from inflammation's complexity and targeting only a few of depression's abnormal pathways. Mind-body therapies' biological and neuro-imaging studies offer valuable insights into depression psychopathology. Interestingly, mind-body therapies, like yoga, reverse the aberrant pathways in depression. These aberrant pathways include decreased cognitive function, interoception, neuroplasticity, salience and default mode networks connectivity, parasympathetic tone, increased hypothalamic-pituitary-adrenal (HPA) axis activity, and metabolic hyper/hypofunction. Abundant evidence found yogic techniques improving self-reported depressive symptoms across various populations. Yoga may be more effective in treating depression in conjunction with pharmacological and cognitive therapies. Yoga's psychoneuroimmunology teaches us that reducing allostatic load is crucial in improving depressive symptoms. Mind-body therapies promote parasympathetic tone, downregulate the HPA axis, reduce inflammation and boost immunity. The reduced inflammation promotes neuroplasticity and, subsequently, neurogenesis. Improving interoception resolves the metabolic needs prediction error and restores homeostasis. Additionally, by improving functional connectivity within the salience network, they restore the dynamic switching between the default mode and central executive networks, reducing rumination and mind-wandering. Future investigations should engineer therapies targeting the mechanisms mentioned above. The creation of multi-disciplinary health teams offering a combination of pharmacological, gene, neurofeedback, behavioural, mind-body and psychological therapies may treat treatment-resistant depression.

Validation and efficacy of a tele-yoga intervention for improving psychological stress, mental health and sleep difficulties of stressed adults diagnosed with long COVID: a prospective, multi-center, open-label single-arm study

The objective of this study was to validate and test the efficacy of a 16-week tele-yoga intervention for perceived stress, anxiety, depression, and insomnia in individuals who had had COVID-19 infection in the previous year, and had reported moderately high levels of psychological stress (PSS ≥14). 25 and 50-min versions of the program were developed. They were then validated using Lawshe's content validity ratio after obtaining feedback from 20 yoga therapy experts. The safety and efficacy of the two programs were subsequently tested in a prospective, multicenter, open-label single-arm study. Eighty-six adults (18 male, 68 female) were recruited from two tertiary mental healthcare institutions, 48 in NIMHANS, Bengaluru; and 38 in SCARF, Chennai. Participants were assessed at weeks zero, 4, and 16 using validated tools. Data were analyzed using a Mixed Model, Intention to Treat approach. After week 16, 31 subjects remained in the trial and continued to practice yoga without any side effects. Subjects who adhered in the trial had significantly higher levels of baseline anxiety and depression as compared to subjects who dropped out. Results at week 4 included significant reductions in levels of perceived stress, anxiety, and insomnia; improvements were maintained at week 16. Correlations between number of yoga sessions and post-intervention PSS scores were negative (r = -0.49), and significant (p<  0.05). Both tele-yoga programs proved safe, useful tools to counteract perceived stress, anxiety and insomnia. Future trials should explore the utility of tele-yoga as a tool to enhance well-being and manage stress.

Liberating the Postpartum Body: The Effects of Movement on Body Image Amongst Postpartum Ultra-Orthodox Women in Israel

Body image is a major postpartum problem negatively correlated with postpartum depression. The present study tests this correlation amongst ultra-Orthodox women in Israel and analyses whether movement classes are effective in improving postpartum body image. Utilising a mixed-methods approach, the study followed two groups of ultra-Orthodox postpartum women (n = 45): one group that participated in movement classes (n = 23) and a comparison group that did not (n = 22). Results of the study found a negative correlation between depression and body image amongst ultra-Orthodox women (r(53) =  -0.342, p < .05) and a trend of movement classes positively affecting postpartum body image (t(43) = 1.388, p = .086). Furthermore, semi-structured interviews found three themes as to how movement 1. Regulates emotions, 2. Releases stress and 3. Places the mother at the centre. Discussion of the results highlights the importance of maintaining positive body image and emotional health in the postpartum period, and that, according to the perception of participants in this study, movement positively contributed to their sense of self and coping abilities. These connections are critical regarding ultra-Orthodox women, whose birth rate is significantly higher relative to broader society. The current study should serve as a basis for encouraging postpartum movement participation amongst ultra-Orthodox and other similar conservative religious sectors of society.

Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis

BACKGROUND

Perinatal depression can have profound impacts on both families and society. Exercise therapy is gradually becoming a widely used adjunct treatment for perinatal depression. Some studies have already focused on the relationship between physical activity and perinatal depression (PND). However, there is currently a lack of systematic and comprehensive evidence to address the crucial question of making optimal choices among different forms of physical activity. This study aims to compare and rank different physical activity intervention strategies and identify the most effective one for perinatal depression.

METHODS

Four databases, namely PubMed, Cochrane Library, Embase, and Web of Science, were searched for randomized controlled trials assessing the impact of physical activity interventions on perinatal depression. The search covered the period from the inception of the databases until May 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 15.1.

RESULTS

A total of 48 studies were included in the analysis. The results indicate that relaxation therapy has the most effective outcome in reducing perinatal depression (SUCRA = 99.4%). Following that is mind-body exercise (SUCRA = 80.6%). Traditional aerobics and aquatic sports were also effective interventions (SUCRA = 70.9% and 67.1%, respectively).

CONCLUSION

Our study suggests that integrated mental and physical (MAP) training such as relaxation therapy and mind-body exercise show better performance in reducing perinatal depression. Additionally, while exercise has proven to be effective, the challenge lies in finding ways to encourage people to maintain a consistent exercise routine.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD 42,023,469,537).

Meta-analysis of the effect of different exercise modalities in the prevention and treatment of perinatal depression

BACKGROUND

The incidence of perinatal depression is increasing and has become a global public health problem to be addressed.

OBJECTIVE

To explore the prevention and treatment effects of different exercise methods on perinatal depression.

METHODS

A meta-analysis was conducted by searching databases for published "exercise interventions for perinatal depression "related randomized controlled trials, up to July 20, 2022.

RESULTS

48 randomized controlled trials were included, with a total of 5282 pregnant women. (1) Exercise prevention of prenatal depression has a low effective stress intervention effect, ranking from high to low as yoga, aerobic+resistance. (2) Exercise therapy for prenatal depression has a significant intervention effect, followed by gymnastics, pelvic floor muscle training, aerobic exercise, aerobic+resistance, and yoga. (3) Exercise prevention of postpartum depression has a low effective intervention effect, followed by yoga, aerobic exercise, aerobic+resistance, and gymnastics. (4) Exercise has a moderate equivalent stress intervention effect on treating postpartum depression, followed by aerobic exercise, water exercise, yoga, fertility dance, and stroller walking.

LIMITATIONS

Due to the small number of included literature on single exercise modalities, and maternity is a special population, most of the trial procedures included in the text were not blinded, which has a certain risk of bias and affects the accuracy of the Meta-analysis results.

CONCLUSIONS

The therapeutic effect of exercise in the prevention and treatment of perinatal depression is superior to the preventive effect, and the effect of prenatal prevention and treatment is better than that of postpartum, with a moderate effect.

The role of stress in perinatal depression and anxiety - A systematic review

Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.

The effect of emotional freedom technique and music applied to pregnant women who experienced prenatal loss on psychological growth, well-being, and cortisol level: A randomized controlled trial

INTRODUCTION

Research has shown that application of emotional freedom technique and music ensures psychological growth, increases well-being, and decreases cortisol level.

PURPOSE

In the study, it was aimed to determine the effect of EFT and music applied to pregnant women who had experienced prenatal loss on their psychological growth, well-being, and cortisol level.

METHODS

The study was conducted as a randomized controlled trial in a city hospital in eastern Türkiye with 159 pregnant women, 53 of whom were in the EFT, 53 in the music group, and 53 in the control group. The study data were collected through Subjective Units of Disturbance Scale (SUDS), Subjective Units of Experience (SUE) Scale, Post Traumatic Growth Inventory (PTGI), and WHO-5 Well-Being Index, and saliva samples were taken for cortisol evaluation. EFT was applied to the women two times every other week; the women in the music group listened to music two times every other week. Throughout the week following the first intervention, the women continued the interventions at home.

RESULTS

It was determined that EFT and music significantly decreased the participants' subjective anxiety and salivary cortisol median scores, the lowest anxiety was in the EFT group, and PTGI and WHO-5 Well-Being Index mean scores increased (p < 0.005). Further analyses showed that EFT was more effective in terms of increasing well-being than music (p < 0.001; a > b > c). It was determined that the anxiety levels and salivary cortisol median values of the control group were statistically significantly higher compared to the EFT and music groups (p < 0.001).

CONCLUSION

It was found that EFT and music applied to the women who had experienced prenatal loss decreased anxiety, ensured psychological growth, improved well-being, and decreased salivary cortisol level.

Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries

Background

Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression.

Methods

To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables.

Results

412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242).

Conclusion

The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.

Physiological and affective responses to green space virtual reality among pregnant women

BACKGROUND

Benefits of green spaces on stress reduction have been shown in previous studies. Most existing studies to date have focused on the general population. However, there is a lack of understanding of physiological mechanisms underlying the beneficial effects of green space among special populations, such as pregnant women.

OBJECTIVES

To examine physiological and affective responses to green space on stress recovery among pregnant women, using simulated green space exposure through virtual reality (VR).

METHODS

We recruited 63 pregnant women between 8 and 14 weeks' gestational age for a laboratory experiment. Participants were randomly assigned to view one of three, 5-min, VR videos of an urban scene with different green space levels (i.e., non-green, moderate, and high) after a laboratory stressor, the Trier Social Stress Test. Physiological stress responses were measured via changes in blood pressure, heart rate, skin conductance level, salivary alpha-amylase, and salivary cortisol. Affective response was measured using the Positive and Negative Affect Scale.

RESULTS

We found that visual exposure to a green space environment in VR was associated with both physiological and affective stress reduction among pregnant women, including lower systolic blood pressure [-4.6 mmHg, 95% confidence interval (CI): -8.8, -0.4], reduced salivary alpha-amylase concentration (-1.2 ng/ml, 95% CI: -2.2, -0.2), improved overall positive affect (score: 6.6, 95% CI: 0.3, 13.0) and decreased negative affect of anxiety (score: -2.6, 95% CI: -5.19, -0.04) compared to non-green space environment. Exposure to high green space environment in park-like setting had the strongest impacts on stress recovery.

CONCLUSION

This study demonstrated that virtual green space exposure could effectively ease stress and improve mental health and well-being during pregnancy. Even a short immersion in VR-based green space environment may bring health benefits, which has significant implications for pregnant women when access to an actual nature may not be possible.

Feasibility, acceptability, and preliminary efficacy of yoga to improve maternal mental health and immune function during the COVID-19 crisis (Yoga-M2 trial): a pilot randomized controlled trial

Introduction

Women are vulnerable during pregnancy as they experience multiple physical and psychological problems which can lead to stress and poor quality of life ultimately affecting the development of the fetus and their health during and after pregnancy. Prior evidence suggests that prenatal yoga can improve maternal health and well-being and can have a beneficial effect on immune system functioning. To date, no study has been conducted in a rural, low-resource setting in India to assess the feasibility, acceptability, and preliminary efficacy of a yoga-based intervention on perceived stress, quality of life, pro-inflammatory biomarkers, and symptoms of upper respiratory tract infections.

Methods

To address this gap and assess whether a yoga-based intervention could improve maternal mental health and immunity during the COVID-19 crisis (Yoga-M2 trial), a single-blind individual randomized parallel group-controlled pilot trial with a 1:1 allocation ratio was implemented. We randomly allocated 51 adult pregnant women, with gestational age between 12-24 weeks in the Yoga-M2 arm (n = 25) or the enhanced usual care arm (EUC) (n = 26). Feasibility and acceptability were assessed using the process data and In-Depth Interviews (IDIs) with the trial participants and yoga instructors. Multiple linear regression was used to compare follow-up scores for quantitative outcomes.

Results

A three-month follow-up assessment was completed for 48 out of 51 participants (94.12%). We did not find any statistically significant difference between both arms in total Perceived Stress Scale scores, quality of life (Eq-5D-5L index), and serum C Reactive Protein levels at the three-month follow-up assessment. The critical barriers to practicing yoga were lack of knowledge about the benefits of yoga, lack of 'felt need' to practice yoga, lack of time to practice, lack of space, lack of transport, and lack of peer group to practice yoga. Despite this, women who regularly practiced yoga described the benefits and factors which motivated them to practice regularly.

Discussion

The learnings from this trial will help design the explanatory trial in the future and the study findings can also be used by the primary health care system to deliver yoga-based interventions in the newly created health and wellness centers.

Trial registration

This trial was prospectively registered with the Clinical Trials Registry of India on 25 January 2022. https://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=65173&EncHid=&userName=CTRI/2022/01/039701. Trial registration number: CTRI/2022/01/039701.

Stress, subjective wellbeing and self-knowledge in higher education teachers: A pilot study through bodyfulness approaches

Work-related stress is a major cause of health problems worldwide. Faculty in educational institutions, including universities, also face high levels of stress, which undoubtedly affects their performance, level of personal satisfaction and wellbeing, and the relationship with students. Training interventions based on embodied learning can promote self-knowledge, emotional regulation and stress reduction, thereby increasing levels of psychological well-being. The present pilot study analyzed the impact of body awareness training in 31 university teachers using a controlled, randomized pre-post experimental design, with two experimental groups and a control group (n = 10). The two interventions were: Hatha Yoga (n = 11) and Dance Movement Therapy/Body Mind Centering (n = 10), which we have termed Body Movement Awareness. Variables related to body awareness, mindfulness, wellbeing, life satisfaction and stress were measured using self-perception tests. Cortisol levels, heart rate variability and sleep quality were also analyzed. Finally, participants' reflections were analyzed according to a qualitative approach. The results showed significant differences between the control group and the Hatha Yoga group in terms of stress reduction and wellbeing. The Body Movement Awareness group exhibited evidence of contributions on self-knowledge, communication and kinesthetic empathy, key elements in the educational field. Despite the inherent limitations of the study, the conclusions are encouraging and open new lines of research from embodied approaches that introduce creative movement and group experience as part of the process of emotional regulation and self-knowledge.

Exercise and yoga during pregnancy and their impact on depression: a systematic literature review

It is well established that exercise can improve depressive symptoms in the general population; however, it is not clear if these benefits are also seen in pregnancy. This review aimed to synthesize the evidence that examines whether exercise during pregnancy impacts depressive and associated symptoms (e.g. anxiety) during the perinatal period. The review was conducted in accordance with PRISMA guidelines and reporting criteria; literature was searched using PubMed, Scopus and Web of Science database engines. Clinical trials published in English evaluating the effects of a defined exercise protocol during pregnancy on depressive and/or anxiety symptoms during the perinatal period were included. Studies without a control group were excluded. Risk of bias was conducted by Cochrane assessment to appraise the quality of the included studies. Twenty-seven articles, between 1994 and 2019, were included. Of these, only 5 specifically recruited women with depression (n = 334), which all assessed a yoga-based intervention; 4 of these studies showed a statistically significant improvement in depressive and/or anxiety symptoms in the intervention group compared to baseline; however, 2 of these studies also showed an improvement in the control group. The remaining 22 studies used various exercise interventions in pregnant women (n = 4808) with 20 studies reporting that exercise during pregnancy has the ability to improve depressive and/or anxiety measures in the perinatal period compared to either baseline or control. The evidence suggests that exercise of various types in pregnancy can reduce depressive and/or anxiety symptoms in the perinatal period in otherwise healthy women. Specifically in women with antenatal depression, the incorporation of yoga in pregnancy can improve depressive/anxiety symptoms in the perinatal period; however, this is based on a small number of studies, and it is not clear whether this is superior to non-exercise controls. Further studies are needed to determine the potential therapeutic effects of exercise of various types during pregnancy on symptoms of antenatal depression.

Yoga and mental health: what every psychiatrist needs to know

Yoga was developed primarily as a tool for self-mastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.

The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis

Background

Yoga is a popular mind-body medicine frequently recommended to pregnant women. Gaps remain in our understanding of the core components of effective pregnancy yoga programmes. This systematic review and meta-analysis examined the characteristics and effectiveness of pregnancy yoga interventions, incorporating the FITT (frequency, intensity, time/duration and type) principle of exercise prescription.

Methods

Nine electronic databases were searched: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga interventions were eligible. Covidence was used to screen titles, abstracts, and full-text articles. Outcomes of interest were stress, anxiety, depression, quality of life, labour duration, pain management in labour and mode of birth. The Cochrane Collaboration’s Risk of Bias Assessment tool was used to assess methodological quality of studies and GRADE criteria (GRADEpro) evaluated quality of the evidence. Meta-analysis was performed using RevMan 5.3.

Results

Of 862 citations retrieved, 31 studies met inclusion criteria. Twenty-nine studies with 2217 pregnant women were included for meta-analysis. Pregnancy yoga interventions reduced anxiety (SMD: -0.91; 95% CI: − 1.49 to − 0.33; p = 0.002), depression (SMD: -0.47; 95% CI: − 0.9 to − 0.04, P = 0.03) and perceived stress (SMD: -1.03; 95% CI: − 1.55 to − 0.52; p < 0.001). Yoga interventions also reduced duration of labour (MD = − 117.75; 95% CI − 153.80 to − 81.71, p < 0.001) and, increased odds of normal vaginal birth (OR 2.58; 95% CI 1.46–4.56, p < 0.001) and tolerance for pain. The quality of evidence (GRADE criteria) was low to very low for all outcomes. Twelve or more yoga sessions delivered weekly/bi-weekly had a statistically significant impact on mode of birth, while 12 or more yoga sessions of long duration (> 60 min) had a statistically significant impact on perceived stress.

Conclusion

The evidence highlights positive effects of pregnancy yoga on anxiety, depression, perceived stress, mode of birth and duration of labour.

Systematic review registration: PROSPERO, CRD42019119916. Registered on 11th January 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04474-9.

Physical Activity, Yoga, and Exercise Prescription for Postpartum and Midlife Weight Management: A Practical Review for Clinicians

This narrative review is aimed to practically review and evaluate the existing evidence and illuminate the effectiveness of physical activity, yoga, and exercise for postpartum and midlife weight management. A comprehensive review was conducted using electronic databases such as PubMed and google scholar using search terms physical activity, exercise, yoga, postpartum, midlife, weight loss, weight reduction, and all the probable terms. This helped in generating evidence-based information and formulating practical physical activity prescriptions to be used by obstetricians, general clinicians, nutritionists, and other allied healthcare personnel. Overweight and obesity in postpartum and midlife women present long-term health risks and complications. Indulging in optimum physical activity comprising exercise and yoga will help in weight management, increasing muscular strength, and endurance thus improving overall health and well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-022-01627-w.

Effect of physical activity on prevention of postpartum depression: A dose-response meta-analysis of 186,412 women

BACKGROUND

Physical activity (PA) is considered a favorable preventive intervention for postpartum depression (PPD), but evidence defining a corresponding dose-response relationship is lacking. This meta-analysis was conducted to assess the protective effects of PA on PPD and define a potential dose-response relationship between them.

METHODS

PubMed, Medline, Embase, and Web of Science were searched from 1968 to May 2022. Only randomized control trials (RCTs) and prospective studies were considered, and the PICOS tool was used to identify eligible articles based on the inclusion and exclusion criteria. Effect-size estimates were unified as odds ratio (OR) and 95% confidence interval (CI). We calculated the ORs and their 95% CI for studies that did not report them using the Practical Meta-Analysis Effect Size Calculator.

RESULTS

A total of 23 studies were eligible, including 14 RCTs and 9 prospective cohort studies. The overall analysis showed a statistically significant positive association between PA and PPD prevention (adjusted OR = 0.73; 95% CI: 0.61-0.87; P < 0.001). Subgroup analyses indicated that studies conducted in Europe demonstrated a significant correlation between PA and reduced PPD risk (adjusted OR = 0.85, 95% CI: 0.76-0.95, P = 0.004). Concerning PA type, sports activity was associated with relieving PPD symptoms (adjusted OR = 0.89, 95% CI: 0.78 to 1.00, P < 0.001), while work (adjusted OR = 1.05, 95% CI: 0.37-2.97, P = 0.065) and household activities (adjusted OR = 1.16, 95% CI: 0.89-1.52, P = 0.986) contributed to a greater risk of PPD. Our dose-response analysis revealed a reverse J-shaped trend between ascending PA duration and PPD incidence.

CONCLUSION

This meta-analysis identified PA as a potential intervention to reduce the risk of PPD. The dose-response analysis revealed that at least 90 min of PA per week could efficiently decrease the risk of PPD.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335731.

Effects of a Single Yoga Session on Cardiac Interoceptive Accuracy and Emotional Experience

BACKGROUND

There is an increasing body of research supporting the idea that cardiac interoceptive accuracy (IAc) can be improved by training. Findings concerning the effects of a single yoga session on IAc and the related construct emotional experience are sparse. The aim of this study was to examine if a single yoga session increases IAc and improves emotional experience.

METHODS

137 students were randomly assigned to a 20-min yoga session (n = 47), an endurance session (n = 46), or an inactive control condition (n = 44). IAc and emotional experience were assessed before and after the sessions.

RESULTS

There were no significant changes in IAc, or positive and negative affect. IAc at baseline and the change in positive effect were found as predictors for IAc after the yoga session.

CONCLUSION

A 20-min yoga session seems to be not applicable to improve IAc and emotional experience. Future studies should investigate long-term interventions and diverse healthy and clinical populations.

The effect of music, massage, yoga and exercise on antenatal depression: A meta-analysis

BACKGROUND

Prenatal depression affects 20.7 percent of women worldwide, which was associated with preterm birth, low birth weight and Apgar score, as well as cognitive, emotional and behavioral development disorders. We conducted a systematic review and meta-analysis to retrieve the latest and best evidence about music, massage, yoga and exercise in the prevention and treatment of prenatal depression, and to preliminarily compare the four methods to explore the most effective means. We also compared different types of yoga and music, in order to find the most effective type of intervention.

METHODS

A comprehensive literature search was carried out through six databases on randomized controlled trials (RCTs). Effects were summarized by a random effects model using mean differences with 95% confidence intervals. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

This research found low to very low evidence that yoga, exercise, music and massage could reduce antenatal depression. Among them, music may be the most effective intervention, and integrated yoga other than simple yoga would improve prenatal depression. The effect of Chinese Medicine Five Element Music may be better than ordinary music.

CONCLUSION

It is important to support prenatal depression patients to make informed decisions about their behavior therapy.

Complementary and Alternative Medicine for Threatened Miscarriage: Advantages and Risks

Threatened miscarriage is one of the most common complications causing pregnancy loss, and it affects approximately 20% of confirmed pregnancies. More and more women are seeking treatment with complementary and alternative medicine (CAM) for this common complication, and it has been reported that women have had successful pregnancies after threatened miscarriage when being treated with CAM, which mainly includes Chinese herbal medicines, acupuncture, and nutritional supplements as well as psychological interventions and other approaches. However, many experts are concerned about the safety and adverse events of certain CAM approaches in women with threatened miscarriage. Therefore, this review focuses on the status of CAM for threatened miscarriage and presents the potential therapeutic efficacy and safety of CAM based on some clinical and experimental studies. We thus hope to provide some instructive suggestions for the application of CAM for treating threatened miscarriage in the future.

Yoga and psychiatric disorders: a review of biomarker evidence

Traditionally, yoga has been used as a means for spiritual growth but over the past two decades or so its therapeutic benefits in psychiatric disorders have been scientifically explored. Yoga has been shown to be useful as a mono-therapy in mild to moderate depression and as an adjuvant in several psychiatric disorders including schizophrenia, anxiety disorders, substance use disorders and Mild Cognitive Impairment. Furthermore, systematic attempts have been made to understand the biological correlates of yoga in these psychiatric disorders. Given that no psychiatric disorder has strong and established biomarkers, it is interesting that preliminary research has demonstrated significant changes in certain important biomarkers following regular yoga practice. In this brief review, we provide an update on the effects of yoga on biochemical, neuro-physiological and neuro-imaging related bio-markers in psychiatric disorders. Although findings and trends are promising, much more research is warranted to establish a definite biological basis for yoga in psychiatry.

The effect of yoga on uterine artery Doppler indices, maternal and fetal complications in pregnant women: A quasi-experimental study

BACKGROUND

Today, the effect of yoga has been examined on various physical and psychological dimensions of pregnant women. However, there are still sparse studies on the effect of yoga on the uterine artery indices as well as maternal and fetal complications.

OBJECTIVE

The aim was to determine the effect of yoga on uterine artery Doppler indices, maternal and fetal Complications.

MATERIALS AND METHODS

This quasi-experiential study was conducted, on 100 pregnant women. The participants were assigned to yoga and control groups. In the yoga group, the participants exercised yoga for 1 h. On the other hand, the control group received routine care.

RESULTS

The results showed that in the yoga group, the functional indices of the uterine artery (S/D, PI, RI, and DN) improved more significantly compared to the control (p = 0.01). The results also showed that in the yoga group, maternal complications (diabetes and preeclampsia), as well as fetal complications (SAG, IUGR), were significantly lower compared to the control (p = 0.01).

CONCLUSION

This study revealed the positive effects of yoga on improving fetal development indices and reducing maternal and fetal complications following pregnancy. It can be used as a Complementary therapy alongside other treatments for mothers.

Potential benefits of Yoga in pregnancy-related complications during the COVID-19 pandemic and implications for working women

BACKGROUND

Pregnancy is a vulnerable period of growth and enrichment along with many physiological and psychological challenges. These changes can lead to complications if compounded by external stress and anxiety. COVID-19 has emerged as a chief stressor among the general population and is a serious threat among vulnerable populations. Therefore, there is a need for stress management tools, such as Yoga and physical exercises, both at home and at work. These can be adopted during the pandemic with proper maintenance of social distancing.

OBJECTIVE

To evaluate and compile literature that has reported the health outcomes of Yoga intervention on pregnancy at the workplace and analyzes both the restrictions as well as advantages of its beneficial effects in comparison to physical exercises.

METHODOLOGY

A comprehensive literature review was conducted utilizing PubMed and Google Scholar. The keywords used for the search include "Yoga", "work", "complications", "physical exercise", "drugs" and "COVID" indifferent permutations and combinations with "pregnancy". We compiled the literature with respect to pregnancy complications and the effects of drugs, physical activity and Yoga for preventing these complications.

RESULTS

We noted that pregnancy-related complications are becoming more prevalent because of a sedentary lifestyle, restricted physical activity and growing stress. In such situations, a home or workplace Yoga protocol can combine both exercise and mindfulness-based alleviation of anxiety for both working and non-working women.

CONCLUSION

Yoga can be effective for combating stress and anxiety besides boosting immunity in pregnant working women confronted with the COVID-19 pandemic.

Effect of supportive counseling on pregnancy-specific stress, general stress, and prenatal health behaviors: A multicenter randomized controlled trial

OBJECTIVE

The aim of this study was to investigate the effects of group supportive counseling (SC) on pregnancy-specific stress, general stress, and healthy behavior of pregnant women.

METHODS

This randomized controlled trial study was conducted on 80 pregnant women in two groups; SC for six sessions, once a week for two hours (n = 40), and antenatal usual care (AUC) (n = 40). All Participants completed questionnaires measuring pregnancy-specific stress, state anxiety, prenatal health behaviors, perceived stress, and provided a saliva sample for measurement of cortisol at pre-intervention and 6-week post-intervention.

RESULTS

The post-intervention results indicated that the outcome scores decreased more significantly in group SC than in the AUC for total NuPDQ, for state-anxiety, for PSS-14, and for unhealthy behaviors with a large effect size. Also, healthy behaviors were promoted more significantly in SC group than in AUC. However, salivary cortisol levels did not differ between group SC and AUC groups.

CONCLUSION

Group supportive counselling can promote pregnancy stress and healthy behaviors.

PRACTICE IMPLICATIONS

Addition of supportive counseling to prenatal usual care may be suggested for pregnant women with any gestational age who seek methods for improving pregnancy stress and healthy behaviors.

A conceptual model describing mechanisms for how yoga practice may support positive embodiment

Yoga practice has been associated with various indices of positive embodiment in correlational and intervention studies. Yet, systematic, theoretically-grounded models detailing specific mechanisms by which yoga supports positive embodiment are lacking. In this article, we present a conceptual model that describes mechanisms (i.e., mediators and moderators) that can be used to guide research to help answer how, for whom, and under what conditions yoga practice may promote positive embodiment. Based on existing theoretical frameworks and empirical findings, this model suggests that (a) yoga practice may cultivate embodying experiences during yoga (e.g., state mindfulness), (b) these embodying experiences may build stable embodying experiences that generalize beyond the yoga context (e.g., trait mindfulness), and (c) these stable embodying experiences may then promote embodying practices (e.g., mindful self-care). This mediational chain is likely moderated by the yoga context (e.g., instructional focus, presence of mirrors, diversity of bodies represented) and yoga practitioners' social identities (e.g., body size, physical limitations), social and personal histories (e.g., experiences with weight stigma and trauma), and personality traits and motives (e.g., body comparison, appearance-focused motives to practice yoga). Using the structure of this conceptual model, we offer researchers ideas for testable models and study designs that can support them.

The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol

Background: The purpose of this review is to systematically examine the reported clinical effectiveness of pregnancy yoga.  The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies.  Studies will be categorised as effectiveness or efficacy studies and this continuum of efficacy versus effectiveness will be incorporated into the full review.  Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga and reporting on effect will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies.  The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality.  Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model.  The outcomes of interest are quality of life, stress, anxiety, depression, mode of birth, labour duration and pain management in labour. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention.   Registration: PROSPERO, CRD42019119916.  Registered on 11th January 2019.

The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol

Background: The purpose of the proposed review is to systematically examine the clinical effectiveness of pregnancy yoga.  The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies.   Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies.  The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality.  Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention.   Registration: PROSPERO, CRD42019119916.  Registered on 11th January 2019.

Physical activity during pregnancy and postpartum depression: Systematic review and meta-analysis

BACKGROUND

It is still largely unknown whether physical activity (PA) during pregnancy may be useful to avert subsequent postpartum depression (PPD). We conducted a systematic review and meta-analysis to determine the preventive effects of PA during pregnancy on PPD.

METHODS

A systematic review of English and non-English articles was conducted using CINAHL, Cochrane Controlled Trials Register, PsycINFO, MEDLINE, SportDiscuss and Web of Science databases. Studies which tested the effect of any type of PA measured during pregnancy on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors using predefined data fields, including study quality indicators. The protocol was registered on PROSPERO (CRD42018087086).

RESULTS

Twenty one studies, fit our selection criteria. Among them, seventeen studies were included in the meta-analysis, representing 93 676 women. Robust Variance Estimation random-effects meta-analysis indicated a significant reduction in postpartum depression scores (Overall SMD = -0.22 [95% CI -0.42 to -0.01], p = 0.04; I² = 86.4%) for women physically active during pregnancy relative to those who were not active. This association was reinforced in intervention studies (SMD = -0.58 [9% CI -1.09 to -0.08]).

LIMITATIONS

Overall meta-analysis showed important heterogeneity in PA assessment, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of physical activity practiced.

CONCLUSIONS

PA during pregnancy appears to reduce the risk of PPD symptoms. High quality studies addressing the role of PA in the perinatal period and its impact on new mother's mental health remain necessary.

Prenatal stress and the development of psychopathology: Lifestyle behaviors as a fundamental part of the puzzle

Maternal psychological stress, depression, and anxiety during pregnancy (prenatal stress; PNS) are thought to impact fetal development with long-term effects on offspring outcome. These effects would include physical and mental health, including psychopathology. Maternal sleep, diet, and exercise during pregnancy are lifestyle behaviors that are understudied and often solely included in PNS studies as confounders. However, there are indications that these lifestyle behaviors may actually constitute essential mediators between PNS and fetal programming processes. The goal of this theoretical review was to investigate this idea by looking at the evidence for associations between PNS and sleep, diet, and exercise, and by piecing together the information on potential underlying mechanisms and causal pathways through which these factors may affect the offspring. The analysis of the literature led to the conclusion that sleep, diet, and exercise during pregnancy, may have fundamental roles as mediators between PNS and maternal pregnancy physiology. By integrating these lifestyle behaviors into models of prenatal programming of development, a qualitatively higher and more comprehensive understanding of the prenatal origins of psychopathology can be obtained. The review finalizes by discussing some of the present challenges facing the field of PNS and offspring programming, and offering solutions for future research.

Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis

Objective

To examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period.

Design

Systematic review with random effects meta-analysis and meta-regression.

Data sources

Online databases were searched up to 6 January 2017.

Study eligibility criteria

Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety).

Results

A total of 52 studies (n=131 406) were included. ‘Moderate’ quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: −0.38, 95% CI −0.51 to –0.25, I2=10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95% CI 0.21 to 0.53, I2=0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150 min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training).

Summary/Conclusions

Prenatal exercise reduced the odds and severity of prenatal depression.

'It definitely made a difference': A grounded theory study of yoga for pregnancy and women's self-efficacy for labour

OBJECTIVE

To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth.

DESIGN

A longitudinal grounded theory study.

METHODS

Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework.

SETTING

Three yoga for pregnancy teachers' classes in England.

PARTICIPANTS

Twenty two women attending yoga for pregnancy classes.

FINDINGS

Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.

The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women

Few published studies have examined the relationship between exercise during pregnancy, quality of life (QOL), and postpartum depressive symptoms in healthy pregnant women. A prospective cohort of 578 healthy pregnant women were followed during their pregnancy through 6 months postpartum. Levels of self-reported exercise and QOL before, during, and following pregnancy were assessed using standardized questionnaires during each trimester of pregnancy and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 weeks gestation and 6 weeks postpartum. Participants were classified as having "sufficient exercise" if they achieved at least 150 min of exercise per week. Sufficient exercisers reported significantly higher ratings on most domains of QOL during each trimester of pregnancy and in the postpartum follow-up, compared with insufficient exercisers. There were no significant between-group differences in depressive symptoms. In examining the impact of exercise during each trimester, active women who became sedentary during their third trimester demonstrated a decline in their QOL. Achieving recommended levels of exercise during pregnancy was associated with higher QOL during pregnancy and the postpartum in healthy pregnant women. Decreasing the amount of exercise during pregnancy was associated with reduced QOL. These results suggest that it may be important for health care professionals to counsel healthy pregnant women about both the benefits of being physically active during pregnancy, and to provide guidance on how to remain physically active during a healthy pregnancy.

Effects of Aromatherapy Massage on Pregnant Women's Stress and Immune Function: A Longitudinal, Prospective, Randomized Controlled Trial

OBJECTIVES

This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy.

METHODS

This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay.

RESULTS

The pregnant women in the intervention group had lower salivary cortisol (p < 0.001) and higher IgA (p < 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p < 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline).

CONCLUSIONS

This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study)

BACKGROUND

In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

METHODS

The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

DISCUSSION

This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

TRIAL REGISTRATION

NCT02925481.

The Efficacy of Yoga as a Form of Treatment for Depression

The purpose of this article was to systematically review yoga interventions aimed at improving depressive symptoms. A total of 23 interventions published between 2011 and May 2016 were evaluated in this review. Three study designs were used: randomized control trials, quasi-experimental, and pretest/posttest, with majority being randomized control trials. Most of the studies were in the United States. Various yoga schools were used, with the most common being Hatha yoga. The number of participants participating in the studies ranged from 14 to 136, implying that most studies had a small sample. The duration of the intervention period varied greatly, with the majority being 6 weeks or longer. Limitations of the interventions involved the small sample sizes used by the majority of the studies, most studies examining the short-term effect of yoga for depression, and the nonutilization of behavioral theories. Despite the limitations, it can be concluded that the yoga interventions were effective in reducing depression.

Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial

OBJECTIVE

The effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks' gestation between women receiving prenatal yoga and those receiving routine prenatal care.

DESIGN

For this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks' gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n=48) or control (n=46) groups using Clinstat block randomization.

INTERVENTION

The 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care.

MAIN OUTCOME MEASURES

In both groups, participants' salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks' gestation.

RESULTS

The intervention group had lower salivary cortisol (p<0.001) and higher immunoglobulin A (p<0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p=0.018), and infants born to women in the intervention group weighed more than those born to the control group (p<0.001).

CONCLUSION

Prenatal yoga significantly reduced pregnant women's stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.

Longitudinal and Immediate Effect of Kundalini Yoga on Salivary Levels of Cortisol and Activity of Alpha-Amylase and Its Effect on Perceived Stress

Context:

Stress is defined as an alteration of an organism's balance in response to a demand perceived from the environment. Diverse methods exist to evaluate physiological response. A noninvasive method is salivary measurement of cortisol and alpha-amylase. A growing body of evidence suggests that the regular practice of Yoga would be an effective treatment for stress.

Aims:

To determine the Kundalini Yoga (KY) effect, immediate and after 3 months of regular practice, on the perception of psychological stress and the salivary levels of cortisol and alpha-amylase activity.

Settings and Design:

To determine the psychological perceived stress, levels of cortisol and alpha-amylase activity in saliva, and compare between the participants to KY classes performed for 3 months and a group that does not practice any type of yoga.

Subjects and Methods:

The total sample consisted of 26 people between 18 and 45-year-old; 13 taking part in KY classes given at the Faculty of Dentistry, University of Chile and 13 controls. Salivary samples were collected, enzyme-linked immunosorbent assay was performed to quantify cortisol and kinetic reaction test was made to determine alpha-amylase activity. Perceived Stress Scale was applied at the beginning and at the end of the intervention.

Statistical Analysis Used:

Statistical analysis was applied using Stata v11.1 software. Shapiro–Wilk test was used to determine data distribution. The paired analysis was fulfilled by t-test or Wilcoxon signed-rank test. T-test or Mann–Whitney's test was applied to compare longitudinal data. A statistical significance was considered when P < 0.05.

Results:

KY practice had an immediate effect on salivary cortisol. The activity of alpha-amylase did not show significant changes. A significant decrease of perceived stress in the study group was found.

Conclusions:

KY practice shows an immediate effect on salivary cortisol levels and on perceived stress after 3 months of practice.

An Exploratory Study Using Cortisol to Describe the Response of Incarcerated Women IPV Survivors to MAMBRA Intervention

Objective. To determine if incarcerated women survivors of IPV had a physiological response to the Music and Account-Making for Behavioral-Related Adaptation (MAMBRA) intervention, as measured by cortisol levels. Methods. A single-group repeated measures designed exploratory study was used to pilot-test MAMBRA. A convenience sample (n = 33) was recruited in a Midwestern women's correctional facility. Serving as their own control, participants provided demographics and pre-/post-MAMBRA salivary samples while attending four MAMBRA sessions. Baseline data were compared to participants' data collected over the remaining 3 MAMBRA sessions. Data were analyzed with descriptive and univariate statistics with an alpha of .05 and post-hoc power of .65. Results. Participants were predominantly White (52%), single (80%), and early middle-aged (x-AGE=38.7±9.4), with a history of physical/nonphysical spousal abuse. Using a subsample (n = 26), salivary cortisol decreased between the pre-/post-MAMBRA over the sessions (F(3,75) = 4.59, p < .01). Conclusion. Participants had a physiological response to the MAMBRA intervention as evidenced by the decreased cortisol between the pre-/post-MAMBRA. This is the first step in examining MAMBRA's clinical utility as an intervention for female IPV survivors. Future longitudinal studies will examine MAMBRA's effectiveness given this change in cortisol.

The effect of guided relaxation on cortisol and affect: Stress reactivity as a moderator

Stress-reduction interventions have been linked with enhanced well-being and health. This study examined affect and cortisol in 111 individuals randomly assigned to a single 35-minute guided relaxation or a stress management lecture control group. Positive affect increased more in the relaxation compared to the control group ( F = 6.62, p = .01). Dispositional stress reactivity had a moderating influence ( R²  = .248, p < .001), such that individuals high in stress reactivity showed highest increases in positive affect to the relaxation. Results indicate that a single guided relaxation intervention improves positive affect among individuals high in stress reactivity.

Yoga research review

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy.

Certified Nurse-Midwives' Experiences with Gestational Weight Management

Excessive gestational weight gain is associated with fetal metabolic reprogramming and subsequent childhood obesity, as well as maternal recalcitrant obesity and its successive morbidities. We conducted a review of the literature and an explorative, descriptive study of the techniques and strategies used by a subset of certified nurse-midwives to help women achieve optimal gestational weight gain. We also identified barriers to this outcome. With more effective management approaches to gestational weight gain, adverse maternal and neonatal health outcomes could potentially be prevented. http://dx.doi.org/10.1016/j.nwh.2015.12.007.

Efficacy of yoga for depressed postpartum women: A randomized controlled trial

BACKGROUND

Up to 20% of women experience postpartum depression (PPD). PPD is associated with anxiety and poor health-related quality of life (HRQOL). Efficacious treatments are critical; many women with PPD prefer complementary therapies. Thus, the current study examined yoga as a complementary therapy for PPD.

METHODS

Fifty-seven postpartum women with scores ≥12 on the Hamilton Depression Rating Scale were randomly assigned to a yoga (N = 28) or wait-list control (N = 29) group. The yoga intervention consisted of 16 classes over 8 weeks. Outcomes were depression, anxiety, and HRQOL.

RESULTS

The yoga group experienced significantly greater rate of improvement in depression, anxiety, and HRQOL, relative to the control group with moderate to large effects. Reliable Change Index analyses revealed that 78% of women in the yoga group experienced clinically significant change.

CONCLUSION

These findings support yoga as a promising complementary therapy for PPD, and warrant large-scale replication studies.

TRIAL REGISTRATION

http://clinicaltrials.gov/NCT02213601.

Yoga for prenatal depression: a systematic review and meta-analysis

BACKGROUND

Prenatal depression can negatively affect the physical and mental health of both mother and fetus. The aim of this study was to determine the effectiveness of yoga as an intervention in the management of prenatal depression.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Embase, the Cochrane Library and PsycINFO from all retrieved articles describing such trials up to July 2014.

RESULTS

Six RCTs were identified in the systematic search. The sample consisted of 375 pregnant women, most of whom were between 20 and 40 years of age. The diagnoses of depression were determined by their scores on Structured Clinical Interview for DSM-IV and the Center for Epidemiological Studies Depression Scale. When compared with comparison groups (e.g., standard prenatal care, standard antenatal exercises, social support, etc.), the level of depression statistically significantly reduced in yoga groups (standardized mean difference [SMD], -0.59; 95% confidence interval [CI], -0.94 to -0.25; p = 0.0007). One subgroup analysis revealed that both the levels of depressive symptoms in prenatally depressed women (SMD, -0.46; CI, -0.90 to -0.03; p = 0.04) and non-depressed women (SMD, -0.87; CI, -1.22 to -0.52; p < 0.00001) were statistically significantly lower in yoga group than that in control group. There were two kinds of yoga: the physical-exercise-based yoga and integrated yoga, which, besides physical exercises, included pranayama, meditation or deep relaxation. Therefore, the other subgroup analysis was conducted to estimate effects of the two kinds of yoga on prenatal depression. The results showed that the level of depression was significantly decreased in the integrated yoga group (SMD, -0.79; CI, -1.07 to -0.51; p < 0.00001) but not significantly reduced in physical-exercise-based yoga group (SMD, -0.41; CI, -1.01 to -0.18; p = 0.17).

CONCLUSIONS

Prenatal yoga intervention in pregnant women may be effective in partly reducing depressive symptoms.