Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis

Exploring the link between physical activity and cardiovascular disease among Indian elderly: Evidence from the Longitudinal Aging Study in India(LASI)

INTRODUCTION

Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity globally, particularly among older adults. In India, the rapid demographic transition has resulted in a significant increase in the aging population, necessitating a deeper understanding of the factors influencing CVD prevalence. This study examines the association between physical activity and the prevalence of CVD among individuals aged 60 and above.

DATA & METHODS

This study utilized cross-sectional data from the LASI-Wave 1, comprising a nationally representative sample of 28,935 individuals. Logistic regression analysis was employed to investigate the relationship between physical activity and CVD. Population Attributable Factor (PAF) was calculated to determine the proportion of CVD cases preventable by recommended physical activity levels.

RESULTS

Adequate physical activity significantly lowered the risk of CVD by 28% (OR 0.72, 95% CI 0.67-0.78). Inadequate physical activity also showed a protective effect (OR 0.88, 95% CI 0.83-0.94) compared to those who were physically inactive. Other significant factors influencing CVD risk included age, sex, educational level, living arrangements, self-rated health status, body mass index, smoking habits, and multi-morbidity. The comparison between adequate physical activity levels and physically inactive shows a PAF estimate of 0.093 (95% CI: 0.071 - 0.114), indicating that 9.3% of cardiovascular disease cases could be prevented by increasing physical activity from inactive to adequate levels.

CONCLUSION

The findings highlight the significant role of physical activity in reducing CVD risk among older adults in India. Promoting regular physical activity through community-based programs and healthcare interventions could substantially lower the risk of CVD.

Clinical effects of a yoga-based intervention for patients with schizophrenia - A six-month randomized controlled trial

BACKGROUND

Yoga has shown promise as an add-on therapy for patients with schizophrenia. However, most studies have been short-term, with methodological limitations.

METHODS

We conducted a six-month parallel-group randomized-controlled trial (with rater blinding) to evaluate the effectiveness of a yoga-based intervention in improving symptoms and quality of life in patients with schizophrenia. We recruited 110 patients from an urban tertiary hospital and a semi-urban community centre who met DSM 5 criteria for schizophrenia and were on stable medication for at least six weeks. Participants were randomly assigned to either yoga add-on therapy (YT) or treatment-as-usual (TAU) groups. Clinical assessments were conducted at baseline and at one, three and six months. The primary outcome was changes in positive/negative symptom scores and secondary outcomes included changes in quality of life, perceived stress and socio-occupational functioning.

RESULTS

Intention to treat analysis with a longitudinal mixed model approach revealed a significant group-by-time interaction with the YT group showing medium effect improvements in negative symptoms (η2p = 0.06) and small effect improvements in positive symptoms (η2p = 0.012), WHOQOL-BREF quality of life [psychological well-being (η2p = 0.015) and environmental health (η2p = 0.048)] when compared to TAU. The patients successfully learned and performed yoga practices without reporting any significant adverse effects.

DISCUSSION

Our findings suggest that yoga-based intervention may be a valuable adjuvant therapy for medication-stabilized patients with schizophrenia, especially in ameliorating negative symptoms and enhancing quality of life. Future controlled trials, including active physical interventions, are crucial to validate yoga's efficacy, optimize clinical use, and elucidate underlying mechanisms.

Effect of a single session of yoga and meditation on stress reactivity: A systematic review

This systematic review synthesises the evidence for the effectiveness of a single session of yoga or its components including meditation and breathing techniques in reducing acute stress reactivity in healthy adults. Following the PRISMA guidelines, we searched Medline, EMBASE, Cochrane, CINAHL, and PsycINFO on 30th July 2023 for randomised controlled or crossover trials of yoga components and reporting physiological and/or psychological outcome measure(s) related to stress reactivity. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Data were synthesised narratively. Twenty-one out of 28 eligible studies (n = 2574) relating to 31 interventions (meditation [n = 22], breathing [n = 4] and yoga [n = 5]) reported outcomes in favour of the intervention. Stress reactivity was reported to be reduced by 71% of studies measuring physiological outcomes and 65% of studies measuring psychological outcomes. These studies show that a single session of yoga components is effective in reducing acute stress reactivity in adults and could be recommended for stress management. Future studies with larger populations and a more equal representation of genders and age groups are warranted.

Cardiorespiratory Effects of Yogic Versus Slow Breathing in Individuals with a Spinal Cord Injury: An Exploratory Cohort Study

Background: An intricate physiological and pathophysiological connection exists between the heart and lungs, which is especially important in individuals with spinal cord injury (SCI). While an exercise intervention may seem the best approach to leverage this relationship, the prior work has shown that, despite numerous health benefits, regular exercise training does not improve cardiorespiratory control in individuals with SCI. Breath training presents an alternative intervention that is uniquely accessible, with yogic breathing directly engaging linked fluctuations in respiration and cardiovascular control. In addition, there is evidence across a range of populations that regular yogic breathing reduces cardiovascular disease risk. It is possible that the chronic decrease in breathing frequency associated with regular yogic breathing, rather than the specific yogic breathing techniques themselves, is the primary contributor to the observed risk reduction. Methods: Therefore, in 12 individuals with traumatic SCI from C4 to T8, the authors compared Unpaced and conventional 0.083 Hz (Slow) paced breathing with various yogic breathing techniques including: (1) inspiratory-expiratory breath holds (i.e., Kumbhaka or "Box Breathing"), (2) extended exhalation (1:2 duty cycle), and (3) expiratory resistance via throat constriction (i.e., Ujjayi). Beat-to-beat heart rate and blood pressure were measured as well as end-tidal CO2 and O2 saturation were measured. Statistical analysis was performed using a one-way repeated-measures analysis of variance with post hoc pairwise t tests corrected for multiple comparisons. Results: As expected, all slow breathing patterns markedly increased respiratory sinus arrhythmia (RSA) compared with Unpaced in all (n = 12) individuals. More importantly, Ujjayi breathing appeared to improve ventilatory efficiency over Unpaced breathing in individuals with SCI by increasing O2 saturation (97.6% vs. 96.1%; p = 0.042) and tended to decrease end-tidal CO2 (32 mmHg vs. 35 mmHg; p = 0.08). While other slow breathing patterns demonstrated similar effects, only Ujjayi improved RSA while increasing heart rate and improving ventilatory efficiency. Conclusions: Hence, slow breathing per se can result in important cardiorespiratory changes, but the yogic breathing practice of Ujjayi, with glottic throat resistance, may hold the greatest promise for improving cardiorespiratory control in individuals with SCI (CTR ID No. NCT05480618).

Yoga Nidra for hypertension: A systematic review and meta-analysis

BACKGROUND

Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity.

OBJECTIVE

The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension.

METHODS

A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively.

RESULTS

Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias.

DISCUSSION

This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted.

CONCLUSION

This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

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

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

Effects of a complex yoga-based intervention on physical characteristics

Empirical studies on yoga have shown that regular practice can have a beneficial effect on risk factors of cardiovascular diseases; also, it can decrease body weight, body fat and increase muscle mass. Positive effects on balance and flexibility were also reported. This study evaluated the impact of a 3-month complex yoga-based program, including physical exercises, education, and social support, with a quasi-randomized design in a middle-aged community sample. The intervention group consisted of 46 participants while the passive control group was 29 participants. The intervention group showed a significant increase in core muscle strength and hamstring flexibility and a decrease in body  fat. No significant changes were found concerning risk factors of cardiovascular diseases, body weight, muscle mass, balancing ability, and dietary habits. A 3-month yoga intervention cannot substantially impact the cardiovascular system and body weight control in middle-aged adults.

The impact of yoga on aging physiology: A review

Frailty represents diminished reserve across multiple physiologic systems, accompanied by increased vulnerability to stressors and increased morbidity and mortality. With population aging, strategies to prevent and manage frailty are priorities in clinical medicine and public health. Current evidence-based approaches to frailty management are multimodal in nature. Yoga, an increasingly popular and highly adaptable mind-body practice, is multi-component, incorporating physical postures, breathing practices, meditation, and other elements, and may be a strategy for frailty management. Here, we summarize the evidence linking yoga practice to mitigation of age-related degradation across multiple physiologic systems, including cardiovascular, pulmonary, musculoskeletal, and nervous systems. We discuss putative mechanisms of action including modulation of the hypothalamic-pituitary-adrenal axis. Finally, we consider implications for clinical practice and future research.

Yoga practice can reduce metabolic syndrome and cardiovascular risk in climacteric women

To evaluate the effect of yoga on the frequency of MetS and its impact on cardiovascular risk markers in climacteric women. We recruited 84 sedentary women between 40 and 65 years diagnosed with MetS. Participants were randomly assigned to a 24-week yoga intervention or control group. We evaluated the frequency of MetS and changes in the individual components of MetS at baseline and after 24 weeks. We also assessed the impact of yoga practices on cardiovascular risk through the following markers: High-sensitivity C-reactive Protein (hs-CRP), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), and Atherogenic Index of Plasma (AIP). The frequency of MetS reduced significantly after 24 weeks of yoga practice (- 34.1%; p < 0.001). Statistical analysis showed that the frequency of MetS was significantly lower in the yoga group (65.9%; n = 27) than in the control group (93.0%; n = 40) after 24 weeks (p = 0.002). Regarding the individual components of MetS, yoga practitioners had statistically lower waist circumference, systolic blood pressure, triglycerides, HDLc, and glucose serum concentrations than the control group after 24 weeks. Yoga practitioners also had a significant decrease in hs-CRP serum concentrations (3.27 ± 2.95 mg/L vs. 2.52 ± 2.14 mg/L; p = 0.040) and a lower frequency of moderate or high cardiovascular risk (48.8% vs. 34.1%; p = 0.001) after 24 weeks of practice. The yoga group had LAP values significantly lower than the control group after the intervention period (55.8 ± 38.04 vs. 73.9 ± 40.7; p = 0.039). Yoga practice demonstrated to be an effective therapeutic to manage MetS and reduce cardiovascular risk in climacteric women.

Effect of mind-body exercise on risk factors for metabolic syndrome including insulin resistance: a meta-analysis

Objective

To systematically evaluate the effects of mind-body exercise on risk factors of metabolic syndrome such as insulin resistance.

Methods

Web of Science, PubMed, The Cochrane Library, EBSCO host, Embase, China Knowledge Network, China Biomedical Literature Database, Wanfang, and VIP were searched for the period from the establishment of the database to 1 July 2023, and randomized controlled trials of mind-body exercise interventions in patients with metabolic syndrome were collected. We applied the Cochrane Risk of Bias tool RoB2 to evaluate the methodological quality of the included literature and used RevMan5.4 software and Stata15.1 for statistical analysis.

Results

A total of 14 randomized controlled trials with 1148 patients were included in this study. Meta-analysis showed that mind-body exercise significantly improved insulin resistance [SMD=-0.78, 95% CI: (-1.13, -0.43), P<0.0001], waist circumference [SMD=-2.20, 95% CI: (-3.34, -1.06), P=0.0001], body mass index (SMD=-1.50, 95% CI: [-2.03, -0.97), P<0.00001], systolic blood pressure [SMD=-3.65, 95% CI: 9-5.56, -1.74), P=0.0002], diastolic blood pressure [SMD=-3.32, 95% CI: (- 3.77, -2.87), P<0.00001], fasting blood glucose [SMD=-0.57, 95% CI: (-0.99, -0.15), P=0.008], triglycerides [SMD=-0.27, 95% CI: (-0.46, -0.08), P=0.004], high-density lipoprotein cholesterol [SMD=0.58, the 95% CI: (0.28, 0.87), P=0.0001]. Subgroup analysis showed that the intervention program with exercise form of fitness qigong, exercise cycle of 24-48 weeks, and exercise frequency of 6-7 times/week could significantly improve each risk factor.

Conclusion

Mind-body exercise is effective in improving risk factors in patients with metabolic syndrome. Current evidence recommends an intervention program of low to moderate intensity fitness qigong, with 6-7 sessions per week for 24-48 weeks in patients with metabolic syndrome.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023454135.

Role of Yoga in Cardiovascular Diseases

Cardiovascular diseases are a collection of conditions that affect the blood vessels and the heart. These conditions include cardiac rehabilitation, hypertension, cardiac failure, rheumatic heart disease, peripheral artery disease, and coronary heart disease. Poor nutrition, alcohol, lack of exercise, smoking, etc are the main behavioral risk factors for heart disease. This study delivers a methodical review of yoga's role in the management and inhibition of cardiovascular diseases and their associated risk factors. This review suggests that proper maintenance of fitness and stress employing yoga effectively lowers cardiovascular disease. In this review, various asanas, and pranayama like Marjaryasana, Kapalabhati, Halasana, etc have been discussed. Also, their role in the prevention of coronary heart disease (CHD). In addition to this different metabolic syndrome associated with cardiovascular diseases and the relation of yoga with hypertension has been discussed. The review has documented satisfactory proof and concludes that yogic exercise enhances cardiovascular health and reduces associated risk factors.

Gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga

Introduction

Patients with paroxysmal atrial fibrillation experience low health-related quality of life which can be improved by performing yoga. The aim of this study was to evaluate gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga.

Methods

This is a secondary analysis of subgroups, investigating the yoga groups, from two randomized controlled trials (RCT 1: yoga group versus control group, RCT 2: a three-armed randomized study with yoga, control and relaxation groups). The yoga groups performed MediYoga for one hour/week over a 12-week period in both studies. Quality of life (SF-36), blood pressure and heart rate were collected at baseline and end of study.

Results

No differences were found between the women and men. Within the women's group, there were improvements in vitality (p = 0.011), social function (p = 0.022), mental health (p = 0.007) and Mental Components Summary (p = 0.022). There were differences within the men's group in bodily pain (p = 0.005), general health (p = 0.003), vitality (p = 0.026), social function (p = 0.005), role-emotion (p = 0.011) and Mental Components Summary (p = 0.018). Within the women's group, differences were observed in systolic blood pressure (p = 0.010) and diastolic blood pressure (p = <0.001). The men's group also showed improvement in diastolic blood pressure (p = 0.021).

Conclusion

MediYoga improved mental health as well as diastolic blood pressure in both men and women with PAF. This study suggests that both men and women, with PAF, may benefit from complementary treatment such as yoga.Clinical Trial Gov Id: NCT01789372.

Effects of yoga on anxiety, pain, inflammatory and stress biomarkers in patients undergoing cardiac surgery: A systematic review and meta-analysis

BACKGROUND

The most common surgical method of managing coronary artery disease is coronary artery bypass grafting (CABG). Stress, anxiety, and pain are commonly identified postoperative symptoms and are closely correlated to patient recovery.

OBJECTIVE

The purpose of this review was to investigate the effects of yoga interventions on anxiety, pain, inflammatory and stress biomarkers in CABG surgery patients.

METHODS

and analysis: The databases PUBMED, The Cochrane CENTRAL, EMBASE, CINAHL, Scopus, and Web of Science were comprehensively searched from the inception to December 2022. The quantitative research studies that evaluated the effects of yoga on anxiety, pain, inflammatory and stress biomarkers in CABG patients were included. This systematic review and meta-analysis followed the Cochrane guidelines and is reported using the PRISMA checklist. The RevMan 5.4 software was used for the meta-analysis.

RESULTS

Seventeen studies met the inclusion criteria, representing 1227 patients with a mean age of 58 years. All studies have reported that yoga interventions significantly reduced anxiety, pain, inflammatory and stress biomarkers in the experimental group compared to the control group. According to the GRADE criteria, moderate quality of evidence was found on effects of yoga intervention in CABG surgery patients.

CONCLUSION

Yoga has been shown to benefit patients undergoing CABG surgery. It can be used as an adjunctive intervention. However, more rigorous randomized controlled trials are required to generate high-quality evidence for yoga interventions.

REGISTRATION

PROSPERO CRD42020175833.

Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP): A Qualitative Study Exploring the Trial Team's Facilitators and Challenges in Conducting a Feasibility Trial in India

BACKGROUND

In India, around 77 million people are at high risk of developing type 2 diabetes mellitus (T2DM). Yoga interventions can be effective in preventing T2DM. We conducted a feasibility randomized controlled trial (RCT) in India, and the intervention was the Yoga Programme for T2DM Prevention (YOGA-DP). This study aimed to identify and explore the facilitators and challenges in conducting the feasibility trial in India, and more specifically, to explore the perceptions and experiences of trial staff in relation to running the feasibility trial and Yoga instructors in relation to delivering the intervention.

METHODS

An exploratory qualitative study was conducted at two trial sites in India (Yoga centers in New Delhi and Bengaluru). Semi-structured interviews were conducted with ten participants (six trial staff and four Yoga instructors) to explore their perceptions and experiences related to the study's aim. Data were analyzed using deductive as well as inductive logic and an interpretative phenomenological approach.

RESULTS

Feasibility-trial-related facilitators were useful participant recruitment strategies and help and support received from the trial coordination center. Intervention-related facilitators were strengths of the intervention content, structure, and delivery (including materials) and competencies of Yoga instructors. Feasibility-trial-related challenges were lack of awareness about T2DM among potential participants, stigma and fear associated with T2DM among potential participants, difficulties in explaining the research and obtaining written informed consent from potential participants, expectations and demands of potential participants and control-group participants, gender and language issues in participant recruitment, other participant recruitment-related challenges, issues in participant follow-up, and issues in data collection and trial documentation. Intervention-related challenges were the limited interest of participants in Yoga, participants' time constraints on practicing Yoga, participants' health issues hindered Yoga practice, beginners' difficulties with practicing Yoga, participants' demotivation to practice Yoga at home, issues with the Yoga practice venue, confusion regarding the intervention structure, issues with intervention materials, and the incompetence of Yoga instructors.

CONCLUSIONS

The perceptions and experiences of trial staff and Yoga instructors helped us to understand the facilitators and challenges in running a feasibility trial and delivering the intervention for T2DM prevention, respectively. These findings and their suggestions will be used when designing the definitive RCT for evaluating YOGA-DP's effectiveness, and may be helpful to researchers planning similar trials.

TRIAL REGISTRATION NUMBER

India (CTRI) CTRI/2019/05/018893.

Expectations of Tele-Yoga in Persons With Long-Term Illness: Qualitative Content Analysis

BACKGROUND

Yoga is a mind-body exercise that has demonstrated its feasibility and safety even for individuals with severe long-term illness. Engaging in yoga has the potential to yield positive effects on both physical and mental well-being. Tele-yoga is a novel approach to rehabilitation in which participants practice group yoga with a live-streamed yoga instructor digitally via a tablet. This is especially beneficial for individuals who may find it difficult to leave their homes to participate in an exercise session. As part of our ongoing evaluation of the tele-yoga intervention in individuals with long-term illness, we have undertaken an exploration of participants' expectations regarding yoga in general and tele-yoga specifically. Understanding these expectations is crucial, as they can significantly impact their satisfaction with treatment and care and influence overall intervention outcomes.

OBJECTIVE

This study aims to explore the expectations of tele-yoga among individuals with long-term illness before starting a tele-yoga intervention.

METHODS

The study employed an inductive qualitative design and is part of a process evaluation within an ongoing randomized controlled trial. A total of 89 participants were interviewed before the start of the tele-yoga intervention. The interview guide encompassed questions about their general perceptions of yoga and the specific expectations they held for the upcoming tele-yoga sessions. The interviews were transcribed and analyzed using inductive qualitative content analysis.

RESULTS

Participants expressed their expectations for tele-yoga, focusing on the anticipated improvements in physical function and overall health. These expectations included hopes for reduced respiratory issues; relief from discomfort, aches, and pains; as well as increased physical flexibility, coordination, and overall well-being. Besides, they expected to achieve improved psychological well-being and performance; to acquire strategies to manage stress, anger, and anxiety; and to have their motivational drive strengthened and influence other activities. Participants described tele-yoga as a new and exciting technical solution that would facilitate the delivery of yoga. A few participants remained a little hesitant toward the use of technology, with some expectations based on previous experiences. When asked about expectations, some had no idea about what to expect. Participants also had varying perspectives on yoga, with some finding it mysterious and difficult to understand. Participants expressed thoughts that they found the idea of tele-yoga taking place in groups exciting and enjoyable. They also had expectations that being part of a group would provide opportunities for mutual inspiration and encouragement among the group members.

CONCLUSIONS

Expectations before an intervention can provide valuable insights into understanding the factors influencing adherence to tele-yoga and its outcomes. Our findings provide a wide range of expectations for tele-yoga, spanning both physical and mental aspects. Moreover, the technology's potential to facilitate yoga delivery and the supportive nature of digital group interactions were evident from the results.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03703609; https://clinicaltrials.gov/ct2/show/NCT03703609.

A scoping review of integrated yoga and psychological approaches for the treatment of eating disorders

BACKGROUND

Eating disorders are serious mental health conditions that significantly impact the social and economic burden of mental ill health in Australia. Best practice treatment for eating disorders includes a multi-axial approach, including medical, psychiatric, and psychological approaches. More recently, complementary and alternative therapy approaches, such as yoga, are used to support eating disorder recovery.

METHODS

This scoping review identified and examined current research exploring the use of yoga alongside psychological approaches for the treatment and management of eating disorders across the lifespan.

RESULTS

Results highlighted the lack of available research, with only four studies identified. Three of these studies piloted programs and identified promising results with a reduction of eating disorder symptomatology. However, these results remain tentative due to methodological limitations and the overall lack of available evidence. In the future, researchers are encouraged to clearly articulate the theoretical concepts that underpin their yoga programs and focus on adequately powered and designed trials, such as RCTs, to accurately compare treatment effects between interventions combining yoga with psychological interventions and standard psychological treatment. Qualitative enquiry is also recommended to provide further insights regarding what makes interventions successful.

CONCLUSIONS

Current evidence suggests further guidance and pragmatic recommendations to guide researchers and clinicians alike are required, ultimately improving outcomes for people experiencing an eating disorder across the lifespan.

Yoga as Adjunct Therapy for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background  Chronic heart failure (CHF) is a prevalent cardiovascular condition that can significantly impact the quality of life and increase mortality risk. Yoga is a mind-body therapy that has been studied as a potential complementary treatment for CHF. However, the effectiveness of yoga in improving outcomes in patients with CHF remains uncertain. Methods  We conducted a systematic review of randomized controlled trials (RCTs) evaluating the effects of yoga on outcomes in patients with CHF. We searched the PubMed, Embase, Scopus, Cochrane Library, and IndMED databases from inception to March 2023. The outcomes of interest were left ventricular ejection fraction (LVEF), cardiac biomarkers, exercise capacity, quality of life, and cardiac function. Results  We identified 11 RCTs that met our inclusion criteria, involving a total of 552 participants. The meta-analysis showed that yoga was associated with significant improvements in peak VO 2 (mean difference [MD]= 3.29; 95% Confidence Interval [CI]: 1.64 to 4.94; I 2 = 0%), exercise capacity (MD=101.54; 95% CI: 6.24 to 196.83; I 2 = 96%), quality of life (MD = -19.99; 95% CI: -25.76 to -14.22; I 2  = 43%), NT-proBNP (MD = -288.78; 95% CI: -492.20 to -85.37; I 2  = 94%), and 6-minute walk test (MD = 101.54; 95% CI: 6.24-196.83; I 2  = 96%), but not in the left ventricular ejection fraction (MD = 4.28; 95% CI: -1.14 to 9.70; I 2  = 93%). Subgroup analysis suggested that the effect of yoga on the quality of life is more pronounced in patients with the "New York Heart Association" (NYHA) class I and II CHF patients and in those who practiced yoga for longer durations. No serious adverse events related to yoga were reported. Most of the included studies were of "low" quality. Conclusion  Current evidence suggests that yoga may be an effective complementary and integrative therapy for improving peak VO 2 exercise capacity, NT-proBNP, and quality of life in patients with CHF. However, the low-quality evidence does not render us to conclude anything beyond doubt or draw any firm clinical recommendation. Future high-quality studies are needed to explore the optimal duration and frequency of yoga practice and its effects on long-term outcomes in this population.

Understanding health behavior change by motivation and reward mechanisms: a review of the literature

The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.

Exercise intensity of real-time remotely delivered yoga via videoconferencing: Comparison with in-person yoga

BACKGROUND AND PURPOSE

Yoga has been studied as a rehabilitation option, but barriers to attendance remain. Videoconferencing, where participants can receive online, real-time instruction and supervision, may reduce the barriers. However, whether exercise intensity is equivalent to that of in-person yoga, and the relationship between proficiency and intensity remain unclear. The present study aimed to investigate whether the intensity of exercise is different between real-time remotely-delivered yoga via videoconferencing (RDY) and in-person yoga (IPY) and its relationship to proficiency.

MATERIALS AND METHODS

Healthy yoga beginners (n = 11) and yoga practitioners (n = 11) performed yoga (Sun Salutation) consisting of 12 physical postures in real-time remotely delivered via videoconferencing and in-person (RDY, IPY, respectively), each for 10 min on different days, in random order, using an expiratory gas analyzer. Oxygen consumption was collected, metabolic equivalents (METs) were calculated based on the data, exercise intensity was compared between RDY and IPY, and differences of METs between beginners and practitioners in both interventions were also assessed.

RESULTS

Twenty-two participants (mean age ± standard deviation, 47.2 ± 10.8 years) completed the study. There were no significant differences in METs between RDY and IPY (5.0 ± 0.5, 5.0 ± 0.7, respectively, P = 0.92), and no difference by proficiency level in both RDY (beginners: 5.0 ± 0.4, practitioners: 5.0 ± 0.6, P = 0.77) and IPY (beginners: 5.0 ± 0.7, practitioners: 5.0 ± 0.7, P = 0.91). No serious adverse events occurred in both interventions.

CONCLUSION

The exercise intensity of RDY is equivalent to IPY regardless of proficiency with no adverse events in RDY occurring in this study.

Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India: A Multicenter Feasibility Randomized Controlled Trial

INTRODUCTION

Many Indians are at high risk of type 2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YOGA-DP), a 24-week structured lifestyle education and exercise (Yoga) program that included 27 group Yoga sessions and self-practice of Yoga at home. In this study, the feasibility of undertaking a definitive randomized controlled trial (RCT) was explored that will evaluate the intervention's effectiveness among high-risk individuals in India.

METHODS

A multicenter, two-arm, parallel-group, feasibility RCT was conducted in India. The outcome assessors and data analysts were blinded. Adults with a fasting blood glucose level of 100-125 mg/dL (i.e., at high risk of T2DM) were eligible. Participants were randomized centrally using a computer-generated randomization schedule. In the intervention group, participants received YOGA-DP. In the control group, participants received enhanced standard care.

RESULTS

In this feasibility trial, the recruitment of participants took 4 months (from May to September 2019). We screened 711 people and assessed 160 for eligibility. Sixty-five participants (33 in the intervention group and 32 in the control group) were randomized, and 57 (88%) participants were followed up for 6 months (32 in the intervention group and 25 in the control group). In the intervention group, the group Yoga sessions were continuously attended by 32 (97%) participants (median (interquartile range, IQR) number of sessions attended = 27 (3)). In the intervention group, Yoga was self-practiced at home by 30 (91%) participants (median (IQR) number of days per week and minutes per day self-practiced = 2 (2) and 35 (15), respectively). In the control group, one (3%) participant attended external Yoga sessions (on Pranayama) for 1 week during the feasibility trial period. There was no serious adverse event.

CONCLUSIONS

The participant recruitment and follow-up and adherence to the intervention were promising in this feasibility study. In the control group, the potential contamination was low. Therefore, it should be feasible to undertake a definitive RCT in the future that will evaluate YOGA-DP's effectiveness among high-risk people in India.

FEASIBILITY TRIAL REGISTRATION

Clinical Trials Registry-India (CTRI) CTRI/2019/05/018893; registered on May 1, 2019.

Vascular Responses following Light Therapy: A Pilot Study with Healthy Volunteers

(1) Background: Studies have reported the effectiveness of light therapy in various medical conditions. Our pilot study aimed to assess the effect of Maharishi light therapy (MLT) on physiological parameters, such as the heart rate (HR), HR variability (HRV), blood pressure (BP), BP variability (BPV), and the retinal microvasculature of healthy participants; (2) Methodology: Thirty (14 males and 16 females) healthy, non-smoking participants between 23 and 71 years old (46 ± 18 years) were included in this randomized crossover study. Each participant was tested with a placebo (using LED light) and gem lights, 24 h apart. Hemodynamic parameters were recorded during the session, and 24 h heart rate and BP levels were assessed via mobile devices. Retinal vascular responses were captured with fundus images and the subsequent analysis of retinal vessel widths. A linear model, using repeated measures ANOVA, was used to compare the responses across the sexes and to assess the effect of the MLT; (3) Results: Changes in the central retinal artery equivalent (CRAE) (p < 0.001) and central retinal vein equivalent (CRVE) (p = 0.002) parameters were observed. CRAE and CRVE decreased under MLT and increased under the placebo condition from before to after. However, the baseline values of the participants already differed significantly before the application of any therapy, and the variation in the retinal vessel diameters was already large in the baseline measurements. This suggests that the observed effect results may only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. Furthermore, no significant effects were observed in any other investigated parameters; (4) Conclusion: Our study with healthy participants finds significant changes in retinal parameters, but the biological variation in the baseline measurements was large to begin with. This suggests that the observed effect results only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. However, in the future, larger studies in which MLT is applied for longer periods and/or in patients with different diseases could discover the physiological impacts of this type of therapy.

[Alternative treatment strategies for atrial fibrillation : Benefits from yoga?]

Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity, mortality, and healthcare utilization. Since the procedures used to treat atrial fibrillation have a number of limitations and risks, there is a growing interest in alternative treatment strategies for patients with atrial fibrillation. One such option is yoga. To date, only a few studies are available on its effect on atrial fibrillation. However, these suggest that yoga may indeed be able to reduce the frequency of the arrhythmia and its progression. The risk factors for atrial fibrillation and quality of life in affected patients are also positively affected. As adverse effects and complications are extremely rare with competent guidance, yoga may already be recommended now. However, further clinical studies are needed to provide recommendations that meet evidence-based criteria.

Effects of Yoga and Aerobic Exercise on Verbal Fluency in Physically Inactive Older Adults: Randomized Controlled Trial (FitForAge)

Purpose

To compare the effects on verbal fluency of a supported yoga-based exercise intervention to an aerobic exercise intervention and a wait-list control group.

Participants and Methods

Eighty-two physically-inactive but otherwise healthy adults (mean age 72.5 years, range 65-85, 77% female) were recruited into a 12-week, three-group, parallel randomized controlled trial. Participants were supported to complete ≥3 Hatha yoga classes per/week or ≥3 structured aerobic exercise sessions/week. A wait-list control group continued usual daily activities only. Verbal fluency, including total-FAS, animals, and verbs, was assessed before and after interventions. Group effects were assessed using analysis of covariance (ANCOVA).

Results

Twenty-seven participants were randomized to yoga, 29 to aerobic exercise and 26 to a waitlist. At 12-week follow-up, compared to baseline, there were increases in mean total-FAS in the yoga (+5.0 words, p=0.002) and aerobic exercise groups (+6.6 words, p=0.004). Mean total-FAS in the wait-list control group remained stable (-0.5 words, p=0.838). There were medium-magnitude estimated treatment effects on total-FAS for yoga versus wait-list control and aerobic exercise versus wait-list control: Hedges' g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. In addition, small-to-medium magnitude estimated treatment effects were seen on animals and verbs for yoga versus wait-list control and aerobic exercise versus wait-list control: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.

Conclusion

Participation in yoga or aerobic exercise was associated with estimated improvements in verbal fluency compared to a non-active control group. Yoga and aerobic exercise may be promising approaches by which to promote cognitive function among older adults.

Trial Registration

DRKS00015093, U1111-1217-4248.

The Effect of Yoga on Cardiovascular Disease Risk Factors: A Meta-Analysis

Yoga has been increasingly popular yet has shown inconsistent benefits on cardiovascular disease (CVD) risk factors. We aimed to systematically analyze the effect of yoga on modifiable CVD risk factors. We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through June 2022 for studies evaluating the association between yoga and blood pressure, lipid profile, HbA1c and body mass index (BMI). Two investigators independently reviewed data. Conflicts were resolved through consensus. Random-effects meta-analyses were used. 64 RCTs including a total of 16,797 participants were eligible for inclusion in the meta-analysis. Yoga therapy improved both systolic as well as diastolic blood pressure (weight mean difference [WMD] (95% Confidence interval [CI]) of -4.56 [-6.37, -2.75] mm Hg, WMD [95% CI] - 3.39 [-5.01, -1.76] mm Hg respectively). There was also an improvement in BMI as well as hemoglobin A1c (HbA1c) (WMD [95% CI] of -0.57 [-1.05, -0.10] kg/m², WMD [95% CI] of -0.14 [-0.24, -0.030] mmol/L respectively) . In addition, all parameters of the lipid profile, including low-density lipoprotein cholesterol (LDL-C) showed a significant improvement with yoga therapy (WMD [95% CI] -7.59 [-12.23, -2.95] mg/dL for LDL-C). Yoga has a modest yet positive effect on blood pressure, BMI, lipid profile and HbA1c and, therefore, may play an ancillary role in primary prevention of CVD.

Laughter yoga as an enjoyable therapeutic approach for glycemic control in individuals with type 2 diabetes: A randomized controlled trial

BACKGROUND

Laughter has been reported to have various health benefits. However, data on the long-term effects of laughter interventions on diabetes are limited. This study aimed to investigate whether laughter yoga can improve glycemic control among individuals with type 2 diabetes.

METHODS

In a single-center, randomized controlled trial, 42 participants with type 2 diabetes were randomly assigned to either the intervention or the control group. The intervention consisted of a 12-week laughter yoga program. Hemoglobin A1c (HbA1c), body weight, waist circumference, psychological factors, and sleep duration were evaluated at baseline and week 12.

RESULTS

Intention-to-treat analysis showed that participants in the laughter yoga group experienced significant improvements in HbA1c levels (between-group difference: -0.31%; 95% CI -0.54, -0.09) and positive affect scores (between-group difference: 0.62 points; 95% CI 0.003, 1.23). Sleep duration tended to increase in the laughter yoga group with a between-group difference of 0.4 hours (95% CI -0.05, 0.86; P = 0.080). The mean attendance rate for laughter yoga program was high (92.9%).

CONCLUSIONS

A 12-week laughter yoga program is feasible for individuals with type 2 diabetes and improves glycemic control. These findings suggest that having fun could be a self-care intervention. Further studies with larger numbers of participants are warranted to better evaluate the effects of laughter yoga.

CLINICAL TRIAL REGISTRATION

http://www.chinadrugtrials.org.cn, identifier UMIN000047164.

Impact of Yoga Versus Memory Enhancement Training on Hippocampal Connectivity in Older Women at Risk for Alzheimer's Disease

BACKGROUND

Yoga may be an ideal early intervention for those with modifiable risk factors for Alzheimer's disease (AD) development.

OBJECTIVE

To examine the effects of Kundalini yoga (KY) training versus memory enhancement training (MET) on the resting-state connectivity of hippocampal subregions in women with subjective memory decline and cardiovascular risk factors for AD.

METHODS

Participants comprised women with subjective memory decline and cardiovascular risk factors who participated in a parent randomized controlled trial (NCT03503669) of 12-weeks of KY versus MET and completed pre- and post-intervention resting-state magnetic resonance imaging scans (yoga: n = 11, age = 61.45±6.58 years; MET: n = 11, age = 64.55±6.41 years). Group differences in parcellated (Cole-anticevic atlas) hippocampal connectivity changes (post- minus pre-intervention) were evaluated by partial least squares analysis, controlling for age. Correlations between hippocampal connectivity and perceived stress and frequency of forgetting (assessed by questionnaires) were also evaluated.

RESULTS

A left anterior hippocampal subregion assigned to the default mode network (DMN) in the Cole-anticevic atlas showed greater increases in connectivity with largely ventral visual stream regions with KY than with MET (p < 0.001), which showed associations with lower stress (p < 0.05). Several posterior hippocampal subregions assigned to sensory-based networks in the Cole-anticevic atlas showed greater increases in connectivity with regions largely in the DMN and frontoparietal network with MET than with KY (p < 0.001), which showed associations with lower frequency of forgetting (p < 0.05).

CONCLUSION

KY training may better target stress-related hippocampal connectivity, whereas MET may better target hippocampal sensory-integration supporting better memory reliability, in women with subjective memory decline and cardiovascular risk factors.

Association Between Device-Measured Physical Activity and Incident Heart Failure: A Prospective Cohort Study of 94 739 UK Biobank Participants

BACKGROUND

Studies of objectively measured physical activity (PA) have investigated acute cardiovascular outcomes but not heart failure (HF), an emerging chronic condition. This study aimed to investigate the dose-response relationship between device-measured PA and HF by intensity of PA.

METHODS

This was a prospective cohort study of 94 739 UK Biobank participants who had device-measured PA in 2013 to 2015 and were free from myocardial infarction and HF. PA was measured with a wrist-worn accelerometer, and time spent on light-, moderate-, and vigorous-intensity PA was extracted. Incident HF was ascertained from linked hospital and death records. Cox proportional hazard models with cubic penalized splines were used to study the associations, which were adjusted for sociodemographic and lifestyle factors. Competing risk was handled with cause-specific hazard ratios.

RESULTS

The overall incidence of HF was 98.5 per 10 000 person-years over a median 6.1 years of follow-up. Compared with participants who undertook no moderate- to vigorous-intensity PA, those who performed 150 to 300 min/wk of moderate-intensity PA (hazard ratio, 0.37 [95% CI, 0.34-0.41]) and 75 to 150 min/wk of vigorous-intensity PA (hazard ratio, 0.34 [95% CI, 0.25-0.46]) were at lower HF risk. The association between vigorous-intensity PA and HF was reverse-J shaped with a potentially lower risk reduction above 150 min/wk.

CONCLUSIONS

Device-measured PA, especially moderate-intensity PA, was associated with a lower risk of HF. Current vigorous-intensity PA recommendations should be encouraged but not increased. In contrast, increasing moderate-intensity PA may be beneficial even among those meeting current recommendations.

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

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

A Randomized Controlled Trial of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: Effects on Patient-Reported Outcomes

Lifestyle interventions can have a positive impact on quality of life and psychological parameters in patients with metabolic syndrome (MetS). In this randomized controlled trial, 145 participants with MetS (62.8% women; 59.7 ± 9.3 years) were randomized to (1) 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or (2) 10 weeks of lifestyle modification only (LM; n = 72). Outcomes were assessed at weeks 0, 1, 12, and 24, and included quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS). At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups—only POMS vigor was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24. Fasting can induce mood-modulating effects in the short term. LM induced several positive effects on quality of life and psychological parameters in patients with MetS.

Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial

BACKGROUND

Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only.

METHODS

Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas.

INTERVENTIONS

(a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72).

MAIN OUTCOMES AND MEASURES

Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24.

RESULTS

A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = -0.8; 95% confidence interval [CI] = -1.7, -0.1), diastolic blood pressure (Δ = -4.8; 95% CI = -5.5, -4.1), BMI (Δ = -1.7; 95% CI = -2.0, -1.4), weight (Δ = -1.7; 95% CI = -2.0, -1.4), waist circumference (Δ = -2.6; 95% CI = -5.0, -0.2), glucose (Δ = -10.3; 95% CI = -19.0, -1.6), insulin (Δ = -2.9; 95% CI = -5.3, -0.4), HbA1c (Δ = -0.2; 95% CI = -0.4, -0.05;), triglycerides (Δ = -48.9; 95% CI = -81.0, -16.9), IL-6 (Δ = -1.2; 95% CI = -2.5, -0.005), and the 10-year risk of acute coronary events (Δ = -4.9; 95% CI = -9.5, -0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = -11.9; 95% CI = -21.8, -2.0). Group differences at week 24 were found for weight (Δ = -2, 7; 95% CI = -4.8, -0.5), BMI (Δ = -1.0; 95% CI = -1.8, -0.3), glucose (Δ = -7.7; 95% CI = -13.5, -1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred.

CONCLUSIONS

A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term.

The Psychophysiological Profile and Cardiac Autonomic Reactivity in Long-Term Female Yoga Practitioners: A Comparison with Runners and Sedentary Individuals

Yoga practice, a means of stress management, has been reported to optimize psychophysiological health; however, its underlying mechanisms remain unclear. The purpose of the present study was to examine the psychophysiological profile and cardiac autonomic reactivity in long-term yoga practitioners and compare them to runners and sedentary individuals. Psychological health and aerobic fitness level were evaluated using self-reported questionnaires and a 3-min step test. Blood pressure (BP), heart rate (HR), respiration rate (RR), and heart rate variability (HRV) parameters were recorded at rest, as well as during and following psychological stress, which was elicited by the Stroop color and word test and the mental arithmetic task. The yoga group demonstrated a lower RR (10.35 ± 2.13 bpm) as compared to the other two groups, and a lower HR (66.60 ± 7.55 bpm) and diastolic BP (67.75 ± 8.38 mmHg) at rest when compared to the sedentary group (all p < 0.05). HRV parameters following mental stress returned to the baseline in yoga and running groups, but not in the sedentary group. The anxiety level in the running group was significantly lower than that in the sedentary group (p < 0.05). These findings suggested that yoga practitioners may have a greater homeostatic capacity and autonomic resilience than do sedentary individuals.

Feasibility Trial of Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) among High-Risk People in India: A Qualitative Study to Explore Participants' Trial- and Intervention-Related Barriers and Facilitators

Yoga-based interventions can be effective in preventing type 2 diabetes mellitus (T2DM). We developed a Yoga programme for T2DM prevention (YOGA-DP) and conducted a feasibility randomised controlled trial (RCT) among high-risk people in India. This qualitative study's objective was to identify and explore participants' trial- and intervention-related barriers and facilitators. The feasibility trial was conducted at two Yoga centres in New Delhi and Bengaluru, India. In this qualitative study, 25 trial participants (13 intervention group, 12 control group) were recruited for semi-structured interviews. Data were analysed using deductive logic and an interpretative phenomenological approach. Amongst intervention and control participants, key barriers to trial participation were inadequate information about recruitment and randomisation processes and the negative influence of non-participants. Free blood tests to aid T2DM prevention, site staff's friendly behaviour and friends' positive influence facilitated trial participation. Amongst intervention participants, readability and understanding of the programme booklets, dislike of the Yoga diary, poor quality Yoga mats, difficulty in using the programme video, household commitment during home sessions, unplanned travel, difficulty in practising Yoga poses, hesitation in attending programme sessions with the YOGA-DP instructor of the opposite sex and mixed-sex group programme sessions were key barriers to intervention participation. Adequate information was provided on T2DM prevention and self-care, good venue and other support provided for programme sessions, YOGA-DP instructors' positive behaviour and improvements in physical and mental well-being facilitated intervention participation. In conclusion, we identified and explored participants' trial- and intervention-related barriers and facilitators. We identified an almost equal number of barriers (n = 12) and facilitators (n = 13); however, intervention-related barriers and facilitators were greater than for participating in the trial. These findings will inform the design of the planned definitive RCT design and intervention and can also be used to design other Yoga interventions and RCTs.

Role of Yoga practices on cognitive functions

Yoga is the science of conditioning one's mind and body via the practise of shatkarma, asana, pranayama, mudra, and meditation. The aim of this review of literature is to give theoretical rationale for identifying (a) the specific attributes of yoga poses that have been used in yoga protocols of various studies but have not been explicitly explored, & (b) the minimum time necessary to keep a posture to bring about a corresponding change in performance among the aforementioned cognitive functions (s) In humans, The most prevalent and under-treated problems are cognitive decline & psychological health problems. Different studies have been carried out to determine the influence of Yoga on human cognitive and psychological health indices. However, no comprehensive examination of the effects of yoga-based therapy on human cognitive and mental health has been undertaken to far. Yoga is an ancient science that places a premium on disease prevention and treatment, as well as the percentage of health. Yoga is recognized to delay the effects of aging and has been found to be effective in the therapy of aging-related disorders. Yoga is a centuries-old discipline that is said to improve both physical and emotional well-being.

Yoga as a treatment for vasovagal syncope: A systematic review and meta-analysis

BACKGROUND

Yoga therapy is being used for vasovagal syncope (VVS). However, there is no sufficient evidence. We aimed to evaluate the effect of yoga as an adjunct to the standard therapy on patients with recurrent VVS.

METHODS

Electronic databases were systematically searched to collect studies assessing the clinical effects of yoga along with guideline-directed treatment in patients with recurrent VVS. The outcomes were the number of VVS attacks and quality of life (QoL) assessment by Syncope Functional Status Questionnaire (SFSQ) scores at 12 months. We used the Mantel- Haenszel random-effects model to calculate the mean difference (MD) and 95% confidence interval (CI). We used The Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa Scale for risk of bias assessment.

RESULTS

Four studies were included, two RCTs and two observational studies. The total of participants was 309, with a mean age of 36.4 ± 13.5 years. The male participants represented 141 (45.6%) being males. The baseline syncope burden was 3.5 ± 2.38 episodes over 15.6 ± 12.8 months. Yoga therapy significantly reduced the number of episodes of syncope and presyncope compared to the control group (MD -1.86; 95% CI -3.30, -0.43; P = 0.01). Nevertheless, yoga therapy did not show significant improvement in the QoL assessed by SFSQ scores (MD -30.69; 95% CI -62.22,0.83; P = 0.06).

CONCLUSION

Yoga therapy is a useful lifestyle intervention that can reduce the frequency of syncope and presyncope among patients with recurrent VVS. However, higher-quality RCTs are needed to confirm our results.

'Joining a group was inspiring': a qualitative study of service users' experiences of yoga on social prescription

Background

Yoga is becoming an increasingly popular holistic approach in the West to manage long-term health conditions. This study presents the evaluation of a pilot yoga intervention, Yoga4Health, that was developed for the NHS to be socially prescribed to patients at risk of developing specific health conditions (risk factors for cardiovascular disease, pre-diabetes, anxiety/depression or experiencing social isolation). The aim of this qualitative study was to explore service users’ experiences of Yoga4Health and the acceptability of the programme.

Methods

Qualitative data were collected from three sources: 1. Open-ended questions on questionnaires completed by services users at three different time-points (baseline, post intervention and 3 months); 2. Interviews and focus groups with a subset of participants (n = 22); 3. interviews with yoga teachers delivering Yoga4Health (n = 7). Each data source was analysed thematically, then findings were combined.

Results

Of participants completing baseline questionnaires (n = 240), 82.5% were female, 50% White, with a mean age of 53 (range 23–82) years. Baseline questionnaires revealed key motivations to attend Yoga4Health were to improve psychological and physical health, and believing Yoga4Health would be accessible for people with their health condition. Post-intervention, participants reported a range of benefits across psychological, physical and social domains from Yoga4Health. Increased confidence in self-management of health was also reported, and a number of participants described making positive lifestyle changes after attending the programme. Unanticipated benefits of yoga emerged for participants, such as enjoyment and social connectedness, which facilitated ongoing attendance and practice. Also key to facilitating practice (during and after the intervention) were suitability of the classes for those with health conditions, practising with a group and qualities of the yoga teacher. Home practice was supported by course materials (manual, videos), as well as the teaching of techniques for everyday application that offered immediate benefits, such as breathing practices. Follow-up questionnaires revealed a key challenge was continuation of practice once the intervention had finished, with the structure of a class important in supporting practice.

Conclusions

Yoga4Health was a highly acceptable intervention to services users, which brought a range of biopsychosocial improvements, suggesting yoga is an appropriate intervention to offer on social prescription.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03514-3.

Effects of a Yoga-Based Stress Intervention Program on the Blood Pressure of Young Police Officers: A Randomized Controlled Trial

Objectives: Despite improvements in health education and treatment, arterial hypertension remains a major health problem of increasing epidemiological importance. The purpose of this randomized controlled trial was to determine the impact of regular yoga breathing exercises on blood pressure, work-related stress, and the prevalence of arterial hypertension in young police academy trainees with no existing comorbidities. Design: A single-center, prospective, randomized controlled trial. Subjects: The study included 120 healthy trainees aged between 18 and 39 years who practiced weekly yoga exercises with an emphasis on breathing (prāṇāyāma) over an observation period of 6 months. Results: These regular exercises lowered the blood pressure of the participants by 1.34 mmHg (right arm, p = 0.007), increased their regenerative capacity (Recovery Experience Questionnaire [REQ] scale +2.77, p < 0.001) and resilience (Resilience Scale [RS] +4.6, p = 0.001), and concomitantly reduced the level of perceived stress (Perceived Stress Scale [PSS] -0.9, p < 0.001). In contrast, blood pressure in the control group had slightly increased over the study period by 0.1 mmHg (right arm, p < 0.001) and 1.0 mmHg (left arm, p = 0.03), and subjective scores had significantly worsened (REQ scale -3.4, p < 0.001; RS -2.29, p = 0.001; PSS +0.88, p < 0.001). Conclusions: The results point to a significant correlation between blood pressure and both regenerative capacity and stress level. Thus, the study confirms the hypothesis that yoga exercises reduce perceived stress and exert positive effects on blood pressure. Clinical Trial Registration Number: DRKS00025921.

Effects of exercise in non-treatment seeking adults with alcohol use disorder: A three-armed randomized controlled trial (FitForChange)

BACKGROUND

Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD.

METHODS

Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back).

RESULTS

A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011].

CONCLUSIONS

Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.

Effects of a 6 Week Yoga Intervention on Executive Functioning in Women Screening Positive for Adult ADHD: A Pilot Study

Purpose

Little is known about the effects of yoga training in adults with ADHD symptoms. This pilot study sought to determine the feasibility and selected psychological effects of 6 weeks of yoga training in women screening positive for adult ADHD compared to a wait-list control group.

Methods

A randomized trial was conducted with 32 adult women (18–24 years) who volunteered after screening positive for adult ADHD as assessed by the Adult ADHD Self-Report Scale (ASRS). Participants were randomized to 6 weeks of Bikram yoga training or to a wait-list control group. The yoga intervention consisted of two 90-min classes per week. Multilevel models were used to test hypothesized interactions of yoga-induced improvements compared to controls across time (baseline, 3 weeks, and 6 weeks). The primary outcomes assessed inhibitory control, cognitive flexibility and working memory using the NIH Toolbox. Separate models with trait mindfulness, trait anxiety and expectations for change in either attention or working memory as covariates tested whether these variables mediated the changes in the three measures of executive function. Secondary outcomes included mood, perceived functional impairment and motivation for, and hyperactivity during, the cognitive tests.

Results

No adverse events were observed. Attendance averaged 91.7% among the 69% of the sample that did not dropout. No significant Group X Time interactions were found for any of the psychological outcomes and the null executive function findings were unchanged when including the covariates.

Conclusion

Six-weeks of yoga training twice per week is potentially feasible for women experiencing ADHD symptoms, but an exercise stimulus of this duration and magnitude yields no beneficial cognitive or mood outcomes.

Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults

Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.

Complementary medicine use in stroke survivors: a US nationally representative survey

Background

Stroke is the second most common cause of death worldwide. Even after surviving, long-term rehabilitation often becomes necessary and does not always lead to complete recovery. Guidelines focus on prevention of risk factors and present concepts for rehabilitation after a stroke. Additional to these recommendations, complementary medicine (CM) utilization is common among patients with neurological conditions. CM also offers a wide range of therapies for both prevention and rehabilitation in stroke. There is limited information available on CM utilization among stroke survivors and differences to patients without former stroke diagnosis.

Methods and results

This analysis was based on data of the 2017 National Health Interview survey (NHIS, n = 26,742; response rate 80,7%). We analyzed the prevalence of consultations among stroke patients with CM practitioners within the last 12 months and reasons for utilization. 3.1% of participants reported a stroke, individuals without a prior stroke diagnosis were more likely to have used CM in the past 12 months (31.3% without versus 28.9% with stroke). Consultations with a chiropractor and of using mind-body-medicine was higher in individuals without stroke diagnosis, while more stroke survivors had consulted a naturopath. Equal proportions had consulted a homeopath. Most common therapy approaches among stroke survivors were spiritual meditation (13.7%), progressive relaxation (5.4%), yoga (5.2%), mindfulness meditation (4.3%), mantra meditation (3.1%), guided imagery (2.6%) and tai chi (1.7%). CM use in stroke survivors was associated with female sex (adjusted odds ratio [AOR] = 2.12, 95% confidence interval [CI] = 1.56–2.88) and higher education (AOR = 1.94, CI = 1.42–2.65).

Conclusion

Stroke patients were less likely to take advantage of complementary medicine than the general population. Since there are many safe and beneficial options, stroke survivors might profit from better information about the existing possibilities regarding prevention and rehabilitation.

Antihypertensive effects of yoga in a general patient population: real-world evidence from electronic health records, a retrospective case-control study

BACKGROUND

Despite decades of research and established treatment strategies, hypertension remains a prevalent and intractable problem at the population level. Yoga, a lifestyle-based practice, has demonstrated antihypertensive effects in clinical trial settings, but little is known about its effectiveness in the real world. Here, we use electronic health records to investigate the antihypertensive effects of yoga as used by patients in their daily lives.

METHODS

A retrospective, observational case-control study of 1815 records among 1355 yoga exposed patients and 40,326 records among 8682 yoga non-exposed patients collected between 2006 and 2016 from a regional academic health system. Linear mixed-effects models were used to estimate the average treatment effect of yoga on systolic and diastolic blood pressures. Mixed effects logistic regression models were used to calculate odds ratios for yoga use and four blood pressure categories: normal, elevated, stage I, and stage II hypertension.

RESULTS

Yoga patients are predominantly white (88.0%) and female (87.8%) with median age 46 years (IQR 32-57) who use yoga one time per week (62.3%). Yoga is associated with lower systolic (- 2.8 mmHg, standard error 0.6; p < .001) and diastolic (- 1.5 mmHg, standard error 0.5; p = 0.001) blood pressures. Patients using yoga have 85% increased odds (OR 1.85, 95% CI 1.39-2.46) of having normal blood pressure relative to yoga non-exposed patients. Patients aged 40-59 years have 67% decreased odds (0.33, 95% CI 0.14-0.75) of having stage II hypertension. All effect sizes are age-dependent.

CONCLUSIONS

Yoga, as used by patients in their daily lives, may be an effective strategy for blood pressure control and the prevention of hypertension at the population level.

Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials

Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.

For Exercise, Relaxation, or Spirituality: Exploring Participation Motives and Conformity to Masculine Norms among Male and Female Yoga Participants

Yoga is a traditional practice from India with the potential to promote physical activity and health. Participation worldwide remains low, particularly among men. To better understand yoga participation parameters, with a special focus on what influences male participation, this study examined gender differences in participation motives and conformity to masculine norms. It also explored these factors across three participant subgroups who differed in their engagement with the physical and the more psycho-spiritual aspects of yoga. A total of 546 yoga participants (138 males, 399 females, 9 others), 18–73 years old, completed an online survey that included an adapted version of the Exercise Motivation Inventory–2 and three subscales from the Conformity to Masculine Norms Inventory–46. Results showed significant gender differences in participation motives and conformity to masculine norms. Females were more motivated by positive affect, health/fitness, nimbleness, mind–body integration, and coping/stress management, whereas males were more motivated by supplementary activity and competition/social recognition. These differences should be considered in tailoring messages to promote uptake and continued participation. Furthermore, males were more likely than females to conform to emotional control and heterosexual self-presentation masculine norms. Future research may examine how differences in masculine norm adherence influences uptake, particularly among men.

Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

BACKGROUND

Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of Type 2 Diabetes Mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM.

MATERIALS AND METHODS

Electronic databases such as PubMed, Scopus, Cochrane Library and Science Direct from start of the study till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was Malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and Superoxide Dismutase (SOD) levels.

RESULTS

A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: -1.87: 95% CI -3.83 to -0.09; P = 0.06; I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%).

CONCLUSION

The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.

Yoga Prevents Gray Matter Atrophy in Women at Risk for Alzheimer's Disease: A Randomized Controlled Trial

BACKGROUND

Female sex, subjective cognitive decline (SCD), and cardiovascular risk factors (CVRFs) are known risk factors for developing Alzheimer's disease (AD). We previously demonstrated that yoga improved depression, resilience, memory and executive functions, increased hippocampal choline concentrations, and modulated brain connectivity in older adults with mild cognitive impairment.

OBJECTIVE

In this study (NCT03503669), we investigated brain gray matter volume (GMV) changes in older women with SCD and CVRFs following three months of yoga compared to memory enhancement training (MET).

METHODS

Eleven women (mean age = 61.45, SD = 6.58) with CVRF and SCD completed twelve weeks of Kundalini Yoga and Kirtan Kriya (KY + KK) while eleven women (mean age = 64.55, SD = 6.41) underwent MET. Anxiety, resilience, stress, and depression were assessed at baseline and 12 weeks, as were T1-weighted MRI scans (Siemens 3T Prisma scanner). We used Freesurfer 6.0 and tested group differences in GMV change, applying Monte-Carlo simulations with alpha = 0.05. Region-of-interest analysis was performed for hippocampus and amygdala.

RESULTS

Compared to KY + KK, MET showed reductions in GMV in left prefrontal, pre- and post-central, supramarginal, superior temporal and pericalcarine cortices, right paracentral, postcentral, superior and inferior parietal cortices, the banks of the superior temporal sulcus, and the pars opercularis. Right hippocampal volume increased after yoga but did not survive corrections.

CONCLUSION

Yoga training may offer neuroprotective effects compared to MET in preventing neurodegenerative changes and cognitive decline, even over short time intervals. Future analyses will address changes in functional connectivity in both groups.

Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol

BACKGROUND

Following cancer treatment, adults commonly report worsened patient-reported outcomes (PROs) such as anxiety, stress, depression, persistent and upsetting cognitive complaints, unrelenting fatigue, and reduced quality of life. Poorer PROs are associated with disrupted autonomic nervous system functioning as measured by heart rate variability (HRV), both of which have been associated with greater morbidity and mortality. Interventions to improve HRV and PROs among adults following cancer treatment are needed. Yoga therapy holds promise as an intervention to improve HRV and PROs. Therefore, we conducted a single-subject exploratory experimental study to investigate the effects of yoga therapy on HRV and specific PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life) in adults treated for cancer. To reduce publication bias, improve reproducibility, and serve as a reference for forthcoming reporting of study results, we present the study protocol for this study herein.

METHODS

Participants were adults who completed cancer treatment that were recruited from the Ottawa Integrative Cancer Centre. Consenting and eligible participants received one 1:1 yoga therapy session (ie, 1 participant, 1 Yoga Therapist) and 6 weekly group-based yoga therapy sessions (ie, 2-3 participants, 1 Yoga Therapist). Participants completed assessments 7 times: 3 times prior to the program (ie, -6 weeks, -3 weeks, immediately prior to the 1:1 yoga therapy session), immediately following the 1:1 yoga therapy session, prior to the first group-based yoga therapy session, after the last group-based yoga therapy session, and at a 6-week follow-up. Hierarchical linear modeling will be used to test the average effects of the yoga therapy program across participants.

DISCUSSION

This study will explore several novel hypotheses, including whether yoga therapy can improve HRV and/or specific PROs among adults treated for cancer acutely (ie, during a 1:1 yoga therapy session) and/or through repeated exposure (ie, after completing 6 weeks of group-based yoga therapy). Although the findings will require confirmation or refutation in future trials, they may provide initial evidence that YT may benefit adults treated for cancer.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN64763228. Registered on December 12, 2021. This trial was registered retrospectively. URL of trial registry record: https://www.isrctn.com/ISRCTN64763228.

Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease

Coronary artery disease carries a high morbidity and mortality worldwide, and exercise-based cardiac rehabilitation programmes play a large role in secondary prevention. Exercise-based rehabilitation programmes are expensive, and in certain subgroups uptake is poor. Yoga has been suggested to show improvements in cardiovascular health which would support its use in cardiac rehabilitation programmes. We carried out a review of current randomized controlled trials to determine if yoga-based cardiac rehabilitation leads to reduced cardiac risk factors, and improved physiological and psychological outcomes in patients with coronary artery disease compared to standard care. Six randomized controlled studies were identified after a medical database search, and meta-analysis was carried out for the different outcomes. Overall, the addition of yoga to standard care resulted in improved subjective feeling of cardiac health and quality of life. There was also a trend towards improvement in left ventricular systolic function. Improvement in cardiac risk factors, MACE and psychological health in this cohort has still to be proven, but was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up. Future studies with longer follow-up and larger patient numbers would aid in accurately assessing the long-term benefit of yoga-based rehabilitation.

Is Weekly Frequency of Yoga Practice Sufficient? Physiological Effects of Hatha Yoga Among Healthy Novice Women

Beneficial physical and physiological health outcomes of yoga practice are well-supported by empirical data. However, whether weekly frequency of training is sufficient to evoke positive changes, is still an open question. The present intervention study investigated the effects of 10 weekly sessions of beginner level hatha yoga with respect to indicators of physical fitness and physiological markers. 82 young women (mean age of 22.0 ± 3.83 years) participated in the study. The yoga group (N = 49) attended a yoga course consisting of 10 sessions (1.5 h each) on a weekly basis. The control group (N = 33) did not receive any intervention. BMI, body fat percentage, balance (one-leg-stand test with open and closed eyes, functional reach test), flexibility (side bend test, modified sit and reach test) core muscle strength (plank test) as well as resting heart rate (HR), and heart rate variability (HRV) were assessed 1 week before and after the course. Both frequentist and Bayesian analysis showed an improvement in flexibility and balance in the yoga group compared to the control group. The yoga group showed also increased core muscle strength. No changes with respect to BMI, body fat percentage, resting HR and HRV were found. Ninety minute beginner level hatha yoga classes were characterized by 93.39 HR and 195 kcal energy consumption on average. The present findings suggest that weekly setting of a 10-session long hatha yoga training leads to improvements in balance, flexibility and core muscle strength among healthy young women. However, for changes in BMI, body fat percentage, resting HR and HRV longer, and/or more intense interventions are needed.