Additional Practice of Yoga Breathing With Intermittent Breath Holding Enhances Psychological Functions in Yoga Practitioners: A Randomized Controlled Trial

The Effect of Diaphragmatic Breathing as a Complementary Therapeutic Strategy in Stress of Children and Teenagers 6-18 Years Old

BACKGROUND

Few studies are reported on interventions that have been carried out in children and adolescents using diaphragmatic breathing (DB) together with methods like counseling, muscle relaxation, therapeutic exercise, and music therapy.

OBJECTIVE

The goal of the review is to evaluate the effectiveness of DB as complementary therapy in the stress of the pediatric population (6-18 years old).

METHODS

Detailed research was carried out in the current literature to find relevant studies published from 2010 to October 2024 in PubMed and Cochrane Library. Thirteen studies that fulfilled the inclusion criteria were included in the study. Nine studies involved obese and overweight pediatric populations and the other four involved pediatric patients.

RESULTS

The interventions comprised two 8-week studies in an obese pediatric population, seven studies in healthy children and adolescents with normal weight. The studies were based on DB, muscle relaxation, nutrition, counseling, music therapy, and slow breathing exercises. The participants in the intervention group improved in comparison to those in the control group in terms of stress and depression in most included studies, in terms of school performance in two studies, in terms of better family relationships in one study, and showed improvement in anthropometric indicators in two studies. In four studies that involved pediatric patients, stress and fear of medical procedures were reduced.

CONCLUSIONS

DB can effectively contribute on its own or in combination with other therapeutic methods to improving physiological and psychological indicators in the pediatric population. It is useful to integrate stress management programs that include DB training as clinical practice in primary healthcare and in school schedules for elementary and high-school students.

Clinical effectiveness of guided breathing exercises in reducing anxiety, stress, and depression in COVID-19 patients

The COVID-19 pandemic has led to an increase in the prevalence of anxiety, stress and depression among affected people. This study was conducted with the aim of investigating the clinical effectiveness of guided breathing exercises in reducing anxiety, stress and depression in patients with COVID-19. A quasi-experimental study design was used, involving a sample of COVID-19 patients who underwent guided breathing exercises as a complementary therapy. After simple sampling, eligible subjects were randomly divided into two groups: intervention (30 patients) and control (30 patients) using random block method. The Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was administered before and after the intervention to evaluate changes in anxiety, stress, and depression levels. The results of this study demonstrated that clinically guided breathing exercises had a significant effect on reducing anxiety and stress in COVID-19 patients. The intervention significantly reduced anxiety and stress scores (p < 0.001). However, there was no significant reduction in depression scores among patients who participated in guided breathing exercises (p = 0.946). Guided breathing exercises are an effective complementary technique in reducing the level of anxiety and stress in COVID-19 patients. Moreover, the exercises may provide a worthy non-pharmacological approach to managing psychological distress in COVID-19 patients.

Using a Biofeedback-Based Mindfulness Practice System to Enhance Mindfulness and Alleviate Anxiety in College Students: A Randomized Controlled Trial

Objective: College students experience intense anxiety, for which biofeedback mindfulness techniques show effectiveness in relief. However, typical biofeedback products often lead to user fatigue and boredom because of a single or fixed feedback and lack of focus on mindfulness enhancement. Materials and Methods: In this research, we developed Mindjourney, a VR-based respiratory feedback mindfulness system, designed to enhance mindfulness and alleviate anxiety through continuous/noncontinuous feedback and nonjudgmental reward/punishment for self-perception and attention management. A randomized controlled trial involved 72 college students, split equally into short-term (n = 34, age: 23.11 ± 1.729) and 4-week long-term (n = 38, age: 24.12 ± 1.408) groups, with equal randomization for intervention and control groups. Pre/postintervention tests were measured by using Trait Anxiety Inventory (TAI) and Five Facet Mindfulness Questionnaire (FFMQ) for long-term groups and Galvanic Skin Response and State Anxiety Inventory (SAI) for short-term groups. Results: Results showed that the long-term intervention group showed a significant increase in mindfulness (P = 0.001 for FFMQ total score). Furthermore, observe and act with awareness subscales showed significant increase after intervention (P = 0.034 for observe, P < 0.001 for act with awareness) compared with the control group. Both intervention groups demonstrated a significant decrease in anxiety levels compared with the control groups (P = 0.049 for SAI, P = 0.01 for TAI). Moreover, participants expressed high interest in this biofeedback mindfulness system and willingness for long-term usage. Conclusion: The proposed biofeedback mindfulness practice system could potentially facilitate mindfulness practice and serve as a convenient tool for anxiety relief in campus college students.

Yoga as a therapeutic approach to mental health in university students: a randomized controlled trial

Objectives

The purpose of this study has been to analyze the efficacy of a yoga-based intervention on stress, emotional wellbeing, state anxiety and trait anxiety in university students.

Methods

This study was a randomized controlled trial. The sample consisted of 129 university students, of which 65 underwent a yoga training for 12 weeks and a control group that did not carry out any type of intervention. The primary outcome was stress, which was collected through The Perceived Stress Scale (PSS). The secondary outcomes were emotional wellbeing which was measured through the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and anxiety through State-Trait Anxiety Inventory (STAI). All variables were measured before and after the intervention.

Results

Participants in the experimental group showed statistically significant improvements in the primary outcome perceived stress (Cohen's d = 0.44) and the secondary outcomes emotional wellbeing (Cohen's d = 0.47), and both state anxiety (Cohen's d = 0.38) and trait anxiety (Cohen's d = 0.80) compared to the control group that did not carry out any type of physical training.

Conclusion

This study demonstrated that a 12-week yoga intervention can significantly reduce perceived stress and anxiety, and improve emotional wellbeing in university students. Initially, the experimental group (EG) reported higher levels of stress and anxiety than the control group (CG), but after the intervention, the EG experienced significant improvements compared to the CG.

Current evidence for hypopressive exercises in healthy women: A systematic review

BACKGROUND

Hypopressive exercises have been mainly used in the treatment of pelvic floor dysfunctions. Recently it has started to spread among healthy women. However, no comprehensive review is available in this population.

PURPOSE

Assess the current evidence of the effects of hypopressive exercises on healthy women.

METHODS

This study was registered on PROSPERO (CRD42020203103). The search was performed in Scielo, Pubmed, Lilacs, Embase, Scopus, Pedro, Trip Database, Web of Science, and Google Scholar. The last search was performed on November 1st, 2021. Inclusion criteria were randomized controlled trials and single-arm trials, healthy women, acute or late effects of hypopressive exercises, and pre and post-training analysis. Exclusion criteria included non-original research, conference proceedings, dissertations and theses. Downs and Black checklist were used to assess the methodological quality. Study design, participants characteristics, description of the intervention, follow-up period, variables, instruments, and outcomes were extracted and recorded.

RESULTS

From the 410 studies, five were selected. The variable of major interest was waist circumference, which showed a decrease with exercise. It also seemed to have plausible positive effects on height, lower back mobility, abdominal and pelvic floor muscle contraction, respiratory flow and apnea, and hemodynamic responses.

CONCLUSION

This study suggests that the current literature on the effects of hypopressive exercise on healthy women is very limited. Despite the plausible positive effects identified, we cannot recommend its practice due to the serious methodological problems. Therefore, more studies are needed to elucidate the benefits and adverse effects of hypopressive exercises.

Effects of usual yoga practice on the diaphragmatic contractility: A cross-sectional controlled study

Objectives

The aim of this study is to observe and compare the effects of regular yoga practice on the main inspiratory muscle, the diaphragm, by analyzing its thickness, excursion, velocity and contraction time, using ultrasound.

Design

A Cross-Sectional Controlled Study.

Participants

80 healthy subjects (40 habitual yoga practitioners and 40 non-practitioners), without previous respiratory pathology participated in this study. During maximum diaphragmatic breathing, the diaphragmatic thickness (at rest and after maximum inspiration), excursion, velocity and contraction time were measured by ultrasound.

Results

in the experimental group, practicing yoga, statistically significant differences (p < 0.001) were observed compared to the control group, not practicing, in the thickness of the diaphragm at rest (0.26 ± 0.02 vs 0.22 ± 0.01 cm); the diaphragmatic thickness in maximum inspiration (0.34 ± 0.03 vs 0.28 ± 0.03 cm); contraction velocity (1.54 ± 0.54 vs 2.23 ± 0.86 cm/s), contraction time (3.28 ± 0.45 vs 2.58 ± 0.49 s) and Borg scale of perceived exertion (1.05 ± 1.6 vs 1.70 ± 1.34), p = 0.05. However, the diaphragmatic excursion was greater in the control group (5.45 ± 1.42 vs 4.87 ± 1.33 cm) with no statistically significant differences (p = 0.06).

Conclusions

the regular practice of yoga improves the parameters of diaphragm thickness, speed and contraction time measured in ultrasound and the sensation of perceived exertion during a maximum inspiration. So it can be considered as another method for training the inspiratory muscles in clinical practice.

Immediate effect of a meditation technique on blood glucose, state anxiety and relaxation in patients with type 2 diabetes: a pilot randomized crossover study

OBJECTIVES

Type 2 diabetes mellitus (T2DM) is a major burden on global health and economy. Various Yogic techniques are found to be beneficial in the management of T2DM. Mind Sound Resonance Technique (MSRT) is one of the yoga-based meditation techniques observed to be effective in clinical settings.

METHODS

Thirty-two patients with T2DM were randomized to either MSRT or supine rest (SR) sessions on two separate days separated by a washout period of one day. Fasting blood glucose levels were measured before and immediately after the sessions. State anxiety and subjective feeling of relaxation were assessed using Spielberg's state anxiety inventory (STAI) and Visual Analogue Scale (VAS) respectively.

RESULTS

There were significant differences between MSRT and SR groups in fasting blood glucose (p=0.019), STAI scores (p<0.001) and subjective relaxation (p<0.001). Within group analyses revealed significant reductions (p<0.001) in fasting blood glucose and STAI scores, along with an increase in subjective relaxation following the practice of MSRT, whereas, non-significant changes were found following the SR session.

CONCLUSIONS

A single session of MSRT was found to reduce blood glucose levels and state anxiety along with enhanced relaxation when compared to SR.

Promoting psychological well-being in preschool children: study protocol for a randomized controlled trial of a mindfulness- and yoga-based socio-emotional learning intervention

BACKGROUND

Mental health issues in youths have cascading negative effects on school outcomes, professional life, and physical health. Psychological well-being (P-WB) is an important protective factor against mental illness. Preliminary research suggests that mindfulness- and yoga-based socio-emotional learning (SEL) interventions can each have a positive impact on preschoolers P-WB. The objective of this trial is to rigorously evaluate the effect of a 24-week combined mindfulness- and yoga- based SEL intervention in preschool children from a French socio-economically disadvantaged area.

METHODS

The P-WB promotion intervention is compared to a wait-list control condition in a cluster randomized controlled trial (RCT). Sixty-four pre-Kindergarten classrooms are randomized to the intervention or control group. Primary outcomes measure self-management capacity and core P-WB components: connection, insight, engagement, and positive relationship. Secondary outcomes include measures of mental health, executive functioning, and school performance. Primary and secondary outcomes are assessed through teacher questionnaires, standardized observations of children in school context, and experimental tasks and by collecting results of the national evaluation at first grade. All children-level outcomes are evaluated at pre-intervention, at the end of the intervention, and 1 year later (follow-up analysis), to the exception of school performance which is evaluated at follow-up only. Intention-to-treat analyses, accounting for clustering within classes, will adopt a random effects linear regression model to examine outcomes for the intervention versus control children.

DISCUSSION

This is the first trial to rigorously evaluate a combined mindfulness- and yoga-based P-WB promotion intervention, and the first RCT evaluating a SEL curriculum in French schools. Results may have key implications for P-WB promotion in preschool children.

TRIAL REGISTRATION

https://www.drks.de/ DRKS00028623. Retrospectively registered on 30 May 2022.

Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments

Mind-Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients.

Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot

Purpose

Nearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness.

Methods

This cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO₂TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.]

Results

Forty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO₂TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO₂TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO₂TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all).

Conclusions

Implementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.

Trial Registration

ClinicalTrials.gov, Identifier: NCT05266833

The role of trataka in ameliorating visual strain and promoting psychological well-being during prolonged use of digital displays: A randomized controlled trial

BACKGROUND: The prolonged usage of digital displays leads to visual strain and, in turn, impairs psychological well-being. The practice of Yoga is said to enhance psychological functions and reduce visual strain. OBJECTIVE: The present study assessed the effect of the trataka (Yogic visual concentration) practice on the visual strain, mind-wandering, and mindfulness. METHODS: One hundred six volunteers equally distributed in the experimental and control groups completed the study. Visual Fatigue Scale (VFS), visual symptoms checklist (VSC), mind-wandering questionnaire (MWQ), and State Mindfulness Attention Awareness Scale (SMAAS) were administered at baseline and at the end of two weeks. RESULTS: All variables were similar at the baseline in both groups, and significant differences were noted at the end of two weeks between both groups. There was a significant reduction in VFS and VSC scores, MWQ, along with an increase in SMAAS scores in the experimental group. Although there were significant changes in VFS, MWQ, and SMAAS in the control group, the magnitude of change was minimal. CONCLUSIONS: The practice of trataka was found to reduce the visual strain, mind wandering while improving the state mindfulness. The practice can be implemented to mitigate visual strain and associated psychological implications due to prolonged exposure to digital displays, which has increased during the COVID-19 pandemic.

Comparing the Psychological Effects of Meditation- and Breathing-Focused Yoga Practice in Undergraduate Students

Objectives

The present study aimed to compare the psychological effects of meditation- and breathing-focused yoga practice in undergraduate students.

Methods

A 12-weeks yoga intervention was conducted among a group of undergraduate students enrolled in four yoga classes at an academically prestigious university in Beijing, China. Four classes were randomized to meditation-focused yoga or breathing-focused yoga. A total of 86 participants finished surveys before and after the 12-weeks intervention, measuring work intention, mindfulness, and perceived stress. The repeated-measure multivariate analysis of covariance (MANCOVA) followed by univariate analyses were conducted to examine the differences in work intention, mindfulness, and stress between the two yoga intervention groups over the semester, after controlling for age and gender.

Results

The repeated-measure MANCOVA revealed significant group differences with a median effect size [Wilks' lambda, Λ = 0.90, F(3, 80) = 3.10, p = 0.031, η² = 0.104]. Subsequent univariate analyses showed that students in the breathing-focused yoga group had significant higher work intentions [F _{(1, 82)} = 5.22; p = 0.025; η² _p = 0.060] and mindfulness [F _{(1, 82)} = 6.33; p = 0.014; η² _p = 0.072] but marginally lower stress [F _{(1, 82)} = 4.20; p = 0.044; η² _p = 0.049] than students in the meditation-focused yoga group.

Conclusion

Yoga practice with a focus on breathing is more effective than that with a focus on meditation for undergraduates to retain energy for work, keep attention and awareness, and reduce stress.

Effect of Mind Sound Resonance Technique (MSRT - A yoga-based relaxation technique) on psychological variables and cognition in school children: A randomized controlled trial

OBJECTIVE

School children undergo stress, which could impact their psychological functions and cognitive abilities. Yoga practices have been found useful in enhancing psychological functions and performance. The current study was planned to evaluate a yoga-based relaxation technique's efficacy as an extracurricular activity on psychological state and cognitive function.

DESIGN AND SETTING

This study was a parallel-group randomized controlled trial conducted at a government school in south India.

PARTICIPANTS

Sixty students with age ranging between 14-16 years (mean age ± SD; 15.3 ± 0.71 years) satisfying the inclusion and exclusion criteria were randomized to experimental and control groups with an allocation ratio of 1:1.

INTERVENTION

Experimental group received Mind Sound Resonance Technique (MSRT), whereas the control group performed supine rest (SR) for two-weeks.

OUTCOME MEASURES

Participants were assessed with State trait anxiety inventory - short form, Mind Wandering Questionnaire, State Mindfulness Attention Awareness Scale, and Trail making task at baseline and post-intervention.

RESULTS

Experimental group showed a reduction in state anxiety and mind wandering with improvement in state mindfulness and performance in the Trail-making task compared to the control group.

CONCLUSION

Results of the current trial indicate the beneficial role of MSRT in enhancing psychological and cognitive functions in children. Further, large-scale trials are warranted to ascertain the usefulness of the technique.