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Bargal S, Nalgirkar V, Patil A, Langade D. Effect of Right Nostril Breathing on Cardiorespiratory Parameters and Reaction Time in Young, Healthy Humans: An Interventional Study. Indian J Community Med 2024; 49:303-307. [PMID: 38665441 PMCID: PMC11042120 DOI: 10.4103/ijcm.ijcm_544_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 04/28/2024] Open
Abstract
Background and Objective Yogic breathing helps in reduction of stress and strain in the body. Right and left nostril breathings (RNB and LNB, respectively) have different effects on cardiorespiratory parameters. The study was performed to examine the effect of RNB exercise on cardiorespiratory parameters and reaction time in young, healthy human volunteers. Materials and Methods In this prospective, interventional study, 110 young healthy volunteers underwent systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), vital capacity (VC), peak expiratory flow rate (PEFR), and reaction time (RT) examination before and after 2 weeks of performing 45 min of RNB exercise daily. Results There was notable increment in SBP (113.39 ± 17.72 vs. 117.74 ± 10.83 mmHg, P = 0.002) and DBP (67.64 ± 10.32 vs. 71.27 ± 8.68 mmHg, P = 0.002). PR increased nonsignificantly (86.44 ± 12.65/min vs. 87.32 ± 13.43/min, P = 0.476). Significant decrease in RR (14.40 ± 2.48/min vs. 12.31 ± 2.23/min, P < 0.0001) was observed. VC (3.57 ± 0.57 vs. 3.82 ± 0.55 L/min, P < 0.0001) and PEFR (441.36 ± 50.22 vs. 468.91 ± 53.66 L/min, P < 0.0001) also increased significantly. Substantial reduction in auditory reaction time (ART) (165.58 ± 32.18 vs. 147.42 ± 23.39 ms, P < 0.0001) and visual reaction time (VRT) (191.04 ± 37.94 vs. 165.86 ± 28.74 ms, P < 0.0001) was seen. After engaging in cardiorespiratory exercise, the maximal heart rate (MHR) remained unchanged (P = 0.929). Conclusion RNB results in increase in blood pressure, heart rate, VC, and PEFR and decrease in ART and VRT. Further studies in patients with cardiorespiratory diseases are necessary to understand its clinical utility.
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Affiliation(s)
- Sheela Bargal
- Physiology, D Y Patil Deemed to be University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Vivek Nalgirkar
- Physiology, D Y Patil Deemed to be University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Anant Patil
- Pharmacology, D Y Patil Deemed to be University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Deepak Langade
- Pharmacology, D Y Patil Deemed to be University School of Medicine, Navi Mumbai, Maharashtra, India
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Wu S, Wang L, He Y, Shi F, Zhuang H, Mei L, Qian Y. Effects of different mind-body exercises on glucose and lipid metabolism in patients with type 2 diabetes: A network meta-analysis. Complement Ther Clin Pract 2023; 53:101802. [PMID: 37769432 DOI: 10.1016/j.ctcp.2023.101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND This study aims to compare the relative effectiveness of different forms of mind-body exercise in improving glycolipid metabolism in patients with T2DM using a network meta-analysis. METHODS The relevant literature was systematically searched in Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang database and VIP Chinese Science. A network meta-analysis was conducted using a random-effects model within a frequentist framework. RESULTS A total of 52 studies with 6 modalities of mind-body exercise involving 4024 patients were included. Compared with controls, all exercise modalities except Yijinjing significantly improved patients' fasting blood glucose (MDs ranged from -0.72(95% CI: -1.20,-0.25) in dance to -2.06(95% CI: -2.59,-1.54) in yoga), glycated hemoglobin (MDs ranged from -0.62 (95% CI: -0.96) in taijiquan to -0.27,-0.27) in Pilates to -1.18(95% CI: 1.80,-0.57)), total cholesterol (MDs ranged from -0.73(95% CI: -1.29,-0.17) in Pilates to -0.41(95% CI: -0.62,-0.19) in Tai Chi), triglycerides (MDs ranged from -0.56 in Pilates (95% CI: -1.07,-0.04) for Pilates to -0.38 (95% CI: -0.67,-0.10)) for dance; only Tai Chi Chuan (MD:0.12 95% CI:0.04,0.20) and Baduanjin (MD:0.14 95% CI:0.06,0.22) significantly increased high-density lipoprotein cholesterol levels in patients; only yoga(MD: 0.78 95%CI: 1.20,-0.37) and Tai Chi Chuan(MD: 0.32 95%CI: 0.60,-0.04) significantly decreased high-density lipoprotein cholesterol levels in patients. CONCLUSION All mind-body exercises help to improve blood glucose and lipid levels in T2DM patients, but the ranking of relative effectiveness needs to be rationalized. Our study suggests that T2DM patients should choose appropriate mind-body exercises according to their conditions and stick to them for a long time under their healthcare professionals' guidance to achieve effective diabetes control.
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Affiliation(s)
- Sijun Wu
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Lin Wang
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Yuxuan He
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Fengrui Shi
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Huiqi Zhuang
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Linqi Mei
- School of Physical Education, Hubei University, Wuhan, 430062, China.
| | - Youling Qian
- School of Physical Education, Hubei Minzu University, Enshi, 445000, China.
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Kanchibhotla D, Subramanian S, Singh D. Management of dysmenorrhea through yoga: A narrative review. FRONTIERS IN PAIN RESEARCH 2023; 4:1107669. [PMID: 37063942 PMCID: PMC10098011 DOI: 10.3389/fpain.2023.1107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
Menstrual pain also known as dysmenorrhea is one of the most common and underrated gynecological disorders affecting menstruating women. Although the symptoms and impact might vary greatly, it is defined by cramps in the lower abdomen and pain that radiates to lower back and thighs. In some cases it is also accompanied by nausea, loose stool, dizziness etc. A primary narrative review was conducted on the impact of yoga on dysmenorrhea experienced by women. The English-language literature published until 2022 was searched across databases such as PubMed, Google Scholar and Scopus. “Yoga” and “menstrual pain” OR “dysmenorrhea” were used as keywords for the search across several databases. A total of 816 title searches were obtained across all the database searches. This review article included 10 studies based on the selection criteria. The studies examined the impact of a varied set of 39 asanas, 5 pranayamas and Yoga nidra on dysmenorrhea. The studies demonstrated a significant relief in dysmenorrhea among those who practiced Yoga (asanas/pranayama/yoga nidra) with improved pain tolerance and reduced stress levels. Regulating the stress pathways through yoga was found to be a key in regulating hormonal balance and reduction in dysmenorrhea.
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Yosri MM, Hamada HA, Abd El-Rahman Mohamed M, Yousef AM. Effect of different squatting exercises on menstrual aspects, pelvic mechanics and uterine circulation in primary dysmenorrhoea: a randomised controlled trial. J OBSTET GYNAECOL 2022; 42:3658-3665. [PMID: 36519235 DOI: 10.1080/01443615.2022.2153021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This was a randomised trial aimed to determine squatting exercises' effects on menstruation, pelvic mechanics, and uterine circulation in primary dysmenorrhoea. A total of 120 females with primary dysmenorrhoea were assigned into group (A), receiving yoga protocol, or groups (B, C & D), receiving yoga protocol added to modified wall squat, sumo squat, or deep squat, respectively. Menstrual pain and distress, pelvic inclination, and uterine circulation were measured before and after interventions using a pain scale, a questionnaire, palpation metre, and Doppler ultrasonography, respectively. There was a significant reduction in pain intensity in groups B & C (effect size = 3.97 & 5.89, respectively), compared to group A (effect size = 3.68), and in group C (effect size = 5.89) compared to group D (effect size = 3.94), pain subscale in the groups B, C & D (effect size = 1.69, 3.3 & 3.41, respectively), compared to group A (effect size= 2.47), water retention subscale in group D effect size 0.90 compared to group A (effect size =0.41) and in the questionnaire total scores in the groups C &D (effect size = 2.3 & 2.46, respectively) when compared to group A (effect size =1.94). Adding squatting exercises to yoga is more effective than yoga alone in reducing menstrual pain and distress.IMPACT STATEMENTWhat is already known on this subject? Physical exercises positively affect primary dysmenorrhoea in terms of decreased pain and distress, possibly through altering faulty posture. Squatting exercises affect lumbopelvic mechanics.What do the results of this study add? This study explores the effect of squatting exercises on pelvic inclination, menstrual aspects, and circulation.What are the implications of these findings for clinical practice and/or further research? Squatting exercises can be utilised to affect pelvic mechanics leading to decreased menstrual pain and distress, because of decreased pelvic congestion.
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Affiliation(s)
- Mahitab Mohamed Yosri
- Department of Women’s Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hamada Ahmed Hamada
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Amel Mohamed Yousef
- Department of Women’s Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Jain V, Kumar B, Sharma A, Chawla V, Yadav R, Grover S, Sharma R, Sharma R, Kumar A, Raj N. A comprehensive yoga programme for weight reduction in children & adolescents with obesity: A randomized controlled trial. Indian J Med Res 2022; 155:387-396. [DOI: 10.4103/ijmr.ijmr_525_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Amonkar N, Su WC, Bhat AN, Srinivasan SM. Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review. Front Psychiatry 2021; 12:722874. [PMID: 34867515 PMCID: PMC8637167 DOI: 10.3389/fpsyt.2021.722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (N = 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.
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Affiliation(s)
- Nidhi Amonkar
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Anjana N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Sudha M. Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
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Effects of Hatha Yoga on Cardiac Hemodynamic Parameters and Physical Capacity in Cardiac Rehabilitation Patients. J Cardiopulm Rehabil Prev 2021; 40:263-267. [PMID: 32604254 DOI: 10.1097/hcr.0000000000000503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study was to assess the effect of hatha yoga training that was added to the standard cardiac rehabilitation (CR) program on the cardiac hemodynamic parameters and physical capacity of patients with ST-elevation myocardial infarction (STEMI). METHODS The study included 70 male patients aged 45-65 yr with STEMI who were treated by angioplasty. Patients were randomized to standard CR (control group) versus standard CR plus hatha yoga (experimental group). The training program lasted for a total of 24 d for each patient, with day 1 and day 24 used for medical examinations (electrocardiogram, spiroergometric submaximal treadmill test, and echocardiography). The remaining 22 d consisted of the actual training. RESULTS After the CR program the spiroergometric stress test parameters and left ventricular ejection fraction (LVEF) improved in both the experimental and control groups. The most notable changes in echocardiography parameters and physical capacity were in the experimental group. The results showed significant main effect over time, a time-versus-group interaction in LVEF, the duration of the test, and peak oxygen uptake, and a time-versus-group interaction in metabolic equivalents (METs). We also noted the improvement of left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and heart rate over time. CONCLUSION The results revealed better effectiveness in the CR program with a modified hatha yoga training program. Hatha yoga training could be recommended as an adjunct to standard CR.
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Seguin-Fowler R, Graham M, Ward J, Eldridge G, Sriram U, Fine D. Feasibility of a yoga intervention to decrease pain in older women: a randomized controlled pilot study. BMC Geriatr 2020; 20:400. [PMID: 33046009 PMCID: PMC7552447 DOI: 10.1186/s12877-020-01818-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant proportion of older women suffer from chronic pain, which can decrease quality of life. The objective of this pilot randomized study was to evaluate the feasibility of a flow-restorative yoga intervention designed to decrease pain and related outcomes among women aged 60 or older. METHODS Flow-restorative yoga classes were held twice weekly for 1 hour and led by a certified yoga instructor. Participants randomized to the intervention group attended the yoga classes for 12 weeks and received supplemental materials for at-home practice. Those randomized to the control group were asked to maintain their normal daily routine. Feasibility was evaluated using recruitment and retention rates, class and home practice adherence rates, and participant satisfaction surveys. Outcome measures (self-reported pain, inflammatory markers, functional fitness, quality of life, resilience, and self-reported physical activity) were assessed at baseline and post-intervention. Paired t-tests or Wilcoxon signed-rank tests were used to examine changes in outcome measures within treatment groups. RESULTS Thirty-eight participants were recruited and randomized. Participants were primarily white, college-educated, and higher functioning, despite experiencing various forms of chronic pain. Attendance and retention rates were high (91 and 97%, respectively) and the majority of participants were satisfied with the yoga program (89%) and would recommend it to others (87%). Intervention participants also experienced reductions in pain interference and improvements in energy and social functioning. CONCLUSIONS This pilot study provides essential data to inform a full scale randomized trial of flow-restorative yoga for older women with chronic pain. Future studies should emphasize strategies to recruit a more diverse study population, particularly older women at higher risk of disability and functional decline. TRIAL REGISTRATION Clinicaltrials.gov , NCT03790098 . Registered 31 December 2018 - Retrospectively registered.
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Affiliation(s)
- Rebecca Seguin-Fowler
- Texas A&M AgriLife Research, 600 John Kimborough Boulevard, Suite 512, College Station, TX, USA.
| | - Meredith Graham
- Texas A&M University System, 600 John Kimborough Boulevard, Suite 512, College Station, TX, USA
| | - Judy Ward
- Cornell University, 413 Savage Hall, Ithaca, NY, 14853, USA
| | - Galen Eldridge
- Texas A&M AgriLife Research, 600 John Kimborough Boulevard, Suite 512, College Station, TX, USA
| | - Urshila Sriram
- Texas A&M AgriLife Research, 600 John Kimborough Boulevard, Suite 512, College Station, TX, USA
| | - Diane Fine
- Fine Spirit Yoga, 104 E. Lewis St, Ithaca, NY, 14850, USA
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Ho LYW, Ng SSM. Non-pharmacological interventions for fatigue in older adults: a systematic review and meta-analysis. Age Ageing 2020; 49:341-351. [PMID: 32101281 DOI: 10.1093/ageing/afaa019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/14/2019] [Accepted: 01/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-pharmacological interventions are widely used to treat fatigue in clients with specific diseases but the findings may not be applicable to older adults experiencing fatigue, which also relates to the physiological changes of ageing. Non-pharmacological interventions for fatigue alleviation in older adults have not been reviewed and meta-analysed. OBJECTIVE To evaluate the immediate and long-term effects of non-pharmacological interventions on fatigue in community-dwelling older adults. METHODS Randomised controlled trials published from 2008 to May 2018 were searched in CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PubMed and Web of Science databases. The reference lists of the publications, forward citation and clinical trial registries were also reviewed. Relevant data were extracted and meta-analysis was conducted using Cochrane Review Manager 5.3. RESULTS Eight studies, with a total of 1093 participants, were identified. Non-pharmacological interventions included mindfulness meditation, a behavioural lifestyle programme, muscle relaxation, pet insect-assisted therapy, yoga, Tai Chi and cognitive behavioural therapy. Non-pharmacological interventions elicited significant immediate positive effects on fatigue (SMD: -0.40, 95% CI -0.62 to -0.18), although there was no lasting effect. Both physical and cognitive/mental interventions effectively alleviated fatigue. CONCLUSION Non-pharmacological interventions appear to be effective in alleviating fatigue at immediate post-intervention in community-dwelling older adults. More studies with robust designs and adequate sample sizes are needed in the future.
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Affiliation(s)
- Lily Y W Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Schmid AA, Fruhauf CA, Sharp JL, Van Puymbroeck M, Bair MJ, Portz JD. Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT. J Evid Based Integr Med 2020; 24:2515690X19863763. [PMID: 31394910 PMCID: PMC6689911 DOI: 10.1177/2515690x19863763] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this feasibility pilot study was to assess benefits of 8 weeks of yoga in people with chronic pain. Participants completed baseline assessments and were randomized to yoga or usual care. Yoga was offered twice a week for 8 weeks. We assessed feasibility and the Brief Pain Inventory (BPI) was the primary outcome, assessing pain-severity and pain interference on daily activities. Eighty-three people were recruited; 67 people completed the study and were included in the analyses. Average age of participants was 50.78 ± 10.43 years and most participants had pain >10 years. The intervention appeared feasible and there were significant improvements (P < .05) in multiple measures for the yoga group, including a decrease in BPI interference scores from 7.15 ± 1.70 to 6.14 ± 2.21 (P = .007). There was a significant difference in body responsiveness and pain management scores between groups at 8 weeks. It appears that yoga was feasible and positively influenced multiple outcome measures for people with chronic pain.
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Affiliation(s)
| | | | | | | | - Matthew J Bair
- 3 Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer Dickman Portz
- 1 Colorado State University, Fort Collins, CO, USA.,4 University of Colorado, Aurora, CO, USA
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Nadig P, Shah M. Awareness about yoga and its benefits among undergraduate and post-graduate dental students. ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Swink LA, Atler KE, Klinedinst TC, Fling BW, Fruhauf CA, Schmid AA. Merging Yoga and Occupational Therapy for Parkinson’s Disease: Program Adaptation and Development. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1645257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Laura A. Swink
- Department of Occupational Therapy, Colorado State University, Fort Collins, USA
| | - Karen E. Atler
- Department of Occupational Therapy, Colorado State University, Fort Collins, USA
| | - Tara C. Klinedinst
- Department of Occupational Therapy, Colorado State University, Fort Collins, USA
| | - Brett W. Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, USA
- Molecular, Cellular, and Integrative Neuroscience Graduate Program, Colorado State University, Fort Collins, USA
| | - Christine A. Fruhauf
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, USA
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, USA
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Schmid AA, Van Puymbroeck M, Fruhauf CA, Bair MJ, Portz JD. Yoga improves occupational performance, depression, and daily activities for people with chronic pain. Work 2019; 63:181-189. [PMID: 31156199 DOI: 10.3233/wor-192919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. OBJECTIVES In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. METHODS Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. RESULTS 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. CONCLUSION Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.
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Affiliation(s)
- Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Marieke Van Puymbroeck
- Department of Parks, Clemson University, Recreation and Tourism Management, Clemson, SC, USA
| | - Christine A Fruhauf
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Matthew J Bair
- Department of Medicine, VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indiana University School of Medicine, Regenstrief Institute, Inc., Indianapolis, IN, USA
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Dunne EM, Balletto BL, Donahue ML, Feulner MM, DeCosta J, Cruess DG, Salmoirago-Blotcher E, Wing RR, Carey MP, Scott-Sheldon LAJ. The benefits of yoga for people living with HIV/AIDS: A systematic review and meta-analysis. Complement Ther Clin Pract 2018; 34:157-164. [PMID: 30712721 DOI: 10.1016/j.ctcp.2018.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) often experience psychological stress associated with disease management. This meta-analysis examines the benefits of yoga interventions on psychological distress among PLWHA. METHODS Included were studies that (a) evaluated a yoga intervention in PLWHA; (b) provided between-group or within-group changes; and (c) assessed a psychological, physiological, or biomedical outcome. RESULTS Seven studies sampling 396 PLWHA (M age = 42 years, SD = 5 years; 40% women) met inclusion criteria. PLWHA who received yoga interventions reported significant improvements in perceived stress (d+ = 0.80, 95% Confidence Interval [CI] = 0.53, 1.07), positive affect (d + = 0.73, 95% CI = 0.49, 0.98), and anxiety (d+ = 0.71, 95% CI = 0.27, 1.14) compared to controls. CONCLUSION Yoga is a promising intervention for stress management. However, the literature is limited by the small number of studies. Randomized controlled trials with objective measures of HIV-related outcomes are needed to further evaluate the benefits of yoga.
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Affiliation(s)
- Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Alpert Medical School, Brown University, Providence, RI, USA.
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | | | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Alpert Medical School, Brown University, Providence, RI, USA
| | - Rena R Wing
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Alpert Medical School, Brown University, Providence, RI, USA; Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Alpert Medical School, Brown University, Providence, RI, USA; Brown University School of Public Health, Providence, RI, USA
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Zhu MM, Lai JSM, Choy BNK, Shum JWH, Lo ACY, Ng ALK, Chan JCH, So KF. Physical exercise and glaucoma: a review on the roles of physical exercise on intraocular pressure control, ocular blood flow regulation, neuroprotection and glaucoma-related mental health. Acta Ophthalmol 2018; 96:e676-e691. [PMID: 29338126 DOI: 10.1111/aos.13661] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
Abstract
The benefits of physical exercise on health and well-being have been studied in a wide range of systemic and ocular diseases, including glaucoma, a progressive optic neuropathy characterized by accelerated apoptosis of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) and insufficient ocular perfusion have been postulated to be the two main theories in glaucoma development and progression. The effects of exercise in these two aspects have been demonstrated by numerous researches. A review in 2009 focusing on these two theories concluded that exercise results in transient IOP reduction but an inconsistent elevation in ocular perfusion. However, the majority of the studies had been conducted in healthy subjects. Over the past decade, technological advancement has brought forth new and more detailed evidence regarding the effects of exercise. Moreover, the neuroprotective effect of exercise by upregulation of neurotrophin and enhancement of mitochondrial function has been a focus of interest. Apart from visual impairment, the mental health issues in patients with glaucoma, which include anxiety and depression, should also be addressed. In this review, we mainly focus on publications from the recent years, so as to provide a comprehensive review on the impact of physical exercise on IOP, ocular perfusion, neuroprotection and mental health in patients with glaucoma.
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Affiliation(s)
- Ming Ming Zhu
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jimmy Shiu Ming Lai
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jennifer Wei Huen Shum
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Alex Lap Ki Ng
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jonathan Cheuk Hung Chan
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Kwok Fai So
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
- School of Biomedical Sciences; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
- State Key Laboratory of Brain and Cognitive Sciences; The University of Hong Kong; Hong Kong SAR China
- GHM Institute of CNS Regeneration; Ministry of Education CNS Regeneration Collaborative Joint Laboratory; Jinan University; Guangzhou China
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McGovern CE, Cheung C. Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review. J Midwifery Womens Health 2018; 63:470-482. [PMID: 29902363 DOI: 10.1111/jmwh.12729] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/02/2017] [Accepted: 12/10/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Primary dysmenorrhea is a prevalent condition causing quality of life (QOL) reduction for many women, resulting from pain as well as parallel social and psychological distress. Yoga reduces pain and sympathetic reactivity, thus promoting QOL. This article reports a systematic review of the evidence for the effectiveness of yoga as a QOL improvement method for women with primary dysmenorrhea. METHODS The PRISMA guidelines were used in preparation of this review. Ovid MEDLINE, PsycINFO, CINAHL, Scopus, PubMed, ScienceDirect, Cochrane Database of Systematic Reviews (CDSR), and Cochrane Central Register of Controlled Trials (CENTRAL) were screened through January 2017 using the keywords yoga, meditation, menstrual cycle, dysmenorrhea, pelvic pain, and prostaglandins. English-language randomized controlled trials (RCTs) and quasi-experimental studies regarding yoga, primary dysmenorrhea, and QOL were eligible; all yoga styles were included. Two independent reviewers rated the methodological quality of each study selected for review using the Downs and Black checklist; possible scores ranged from 0 to 32. Ratings were established through consensus. RESULTS The search yielded a total of 378 articles, of which 14 (age range 13-45 years, N = 1409) met the criteria for final review: 8 RCTs and 6 quasi-experimental studies. Downs and Black ratings were predominantly moderate in quality with moderate risk of bias, ranging from 15 to 23 (RCTs) and 10 to 17 (quasi-experimental studies). Statistically significant improvements along most QOL domains, including physical pain, sleep, concentration, negative feelings, social relationships, work capacity, and overall QOL, were identified after a yoga intervention. Results indicate preliminary evidence for yoga as a safe and effective QOL improvement method for women with primary dysmenorrhea. DISCUSSION Practitioners may consider yoga for management of primary dysmenorrhea. However, future research using larger RCTs of high methodological quality is needed to ascertain the magnitude of yoga's clinical significance.
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Paudyal P, Jones C, Grindey C, Dawood R, Smith H. Meditation for asthma: Systematic review and meta-analysis. J Asthma 2017; 55:771-778. [PMID: 28853958 DOI: 10.1080/02770903.2017.1365887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To conduct a comprehensive review and meta-analysis of the effectiveness of meditation on a variety of asthma outcomes. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO and AMED in June 2016 to identify randomized controlled trials (RCTs) investigating the effectiveness of meditation in adults with asthma. No restriction was put on language or year of publication. Study quality was assessed using The Cochrane Risk of Bias Assessment Tool. Meta-analysis was carried out using RevMan 5.3. RESULTS Four RCTs involving 201 patients met the inclusion criteria. Quality of studies was inconsistent with only one study reporting adequate allocation concealment. Disease-specific quality of life was assessed in two trials; a pooled result involving 62 intervention and 65 control participants indicated a significant improvement in quality of life in the meditation group compared to the control group (SMD 0.40, 95% CI 0.05-0.76). A pooled result from all four studies indicated the uncertain effect of meditation in forced expiratory volume in 1 s (FEV1) (SMD -0.67, 95% CI -2.17 to 0.82). Results from the individual trials suggest that meditation may be helpful in reducing perceived stress and the use of short-term rescue medication. CONCLUSION Our review suggests that there is some evidence that meditation is beneficial in improving quality of life in asthma patients. As two out of four studies in our review were of poor quality, further trials with better methodological quality are needed to support or refute this finding.
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Affiliation(s)
- Priyamvada Paudyal
- a Department of Primary Care and Public Health , Brighton and Sussex Medical School , Brighton , United Kingdom
| | - Christina Jones
- b Department of Clinical Medicine , Brighton and Sussex Medical School , Brighton , United Kingdom
| | - Caroline Grindey
- a Department of Primary Care and Public Health , Brighton and Sussex Medical School , Brighton , United Kingdom
| | - Rusha Dawood
- a Department of Primary Care and Public Health , Brighton and Sussex Medical School , Brighton , United Kingdom
| | - Helen Smith
- c Family Medicine and Primary Care , Lee Kong Chian School of Medicine , Singapore , Singapore
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Keerthi GS, Pal P, Pal GK, Sahoo JP, Sridhar MG, Balachander J. Effect of 12 Weeks of Yoga Therapy on Quality of Life and Indian Diabetes Risk Score in Normotensive Indian Young Adult Prediabetics and Diabetics: Randomized Control Trial. J Clin Diagn Res 2017; 11:CC10-CC14. [PMID: 29207699 DOI: 10.7860/jcdr/2017/29307.10633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/23/2017] [Indexed: 01/27/2023]
Abstract
Introduction India has become the epicentre for diabetes, a stress-related disorder affecting the working skills and day-to-day lifestyle management of younger population. Most of the studies have reported the effect of yoga on improving Quality of Life (QoL) in diabetic patients with other comorbidities. Till date, no randomized control trial reports are available to show the effect of yoga therapy on QoL and Indian Diabetes Risk Score (IDRS) in normotensive prediabetic and diabetic young individuals. Aim To determine the effect of 12 weeks of yoga therapy on QoL and IDRS among normotensive prediabetic and diabetic young Indian adults. Materials and Methods A randomized control trial was conducted in Endocrinology Outpatient Department (OPD). Normotensive participants (n=310) aged 18-45 years were divided into healthy controls (n=62), prediabetics (n=124) and diabetics (n=124). Study group subjects were randomly assigned to Group II (n=62, prediabetes-standard treatment), Group III (n=62, prediabetes-standard treatment + yoga therapy), Group IV (n=62, diabetes-standard treatment) and Group V (n=62, diabetes-standard treatment + yoga therapy). Flanagan QoL scale, IDRS questionnaire, Fasting Plasma Glucose (FPG) and insulin were assessed pre and post 12 weeks of intervention. Statistical analysis was done using Student's paired t-test and one-way ANOVA. Results Pre-post intervention analysis showed significant improvement in QoL scale with p<0.01 in Group II and Group IV; p<0.001 in Group III and Group V respectively. There was significant reduction in IDRS in Group II (p<0.05); p<0.001 in Group III, Group IV and Group V respectively. Significant difference (p<0.001) in QoL scale and IDRS were found when study groups with standard treatment along with yoga therapy were compared to standard treatment alone. Conclusion Yoga therapy along with standard treatment for 12 weeks improved QoL and attenuated the diabetes risk among Indian prediabetics and diabetics compared to standard treatment alone.
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Affiliation(s)
- Gorantla Shravya Keerthi
- PhD Scholar, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pravati Pal
- Professor, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gopal Krushna Pal
- Professor and Dean (JIPMER, Karaikal), Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jaya Prakash Sahoo
- Associate Professor, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Magadi Gopalakrishna Sridhar
- Senior Professor, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jayaraman Balachander
- Senior Professor and Medical Superintendent, Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Chair Yoga: Feasibility and Sustainability Study With Older Community-Dwelling Adults With Osteoarthritis. Holist Nurs Pract 2017; 31:148-157. [DOI: 10.1097/hnp.0000000000000184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pandey RK, Arya TVS, Kumar A, Yadav A. Effects of 6 months yoga program on renal functions and quality of life in patients suffering from chronic kidney disease. Int J Yoga 2017; 10:3-8. [PMID: 28149061 PMCID: PMC5225742 DOI: 10.4103/0973-6131.186158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: To study the effect of 6 months yoga program in patients suffering from chronic kidney disease (CKD). Materials and Methods: Fifty-four patients with CKD were studied and divided into two groups (yoga group and control group) to see the effect of yoga in CKD. Patients in the yoga group were offered yoga therapy along with other conventional treatment modalities, while the control group was only on conventional treatment. Subjects in yoga group were trained to perform specific yogic asanas for at least 5 days a week for 40–60 min a day. Regular monitoring of blood pressure, renal function, requirement of a number of dialysis, and quality of life (QOL) indicators were done. Fifty patients (yoga – 25; control-25) completed 6 months follow-up. Results: In yoga group, a significant reduction of systolic and diastolic blood pressure, significant reduction in blood urea and serum creatinine levels, and significant improvement in physical and psychological domain of the World Health Organization QOL (as assessed by BREF QOL scores) were seen after 6 months. In control group, rise of blood pressure, deterioration of renal function, and QOL were observed. Poststudy comparison between the two groups showed a statistically significant reduction of blood pressure, nonsignificant reduction in blood urea and serum creatinine, and significant improvement in physical and psychological domain of QOL in yoga group as compared to control group. For subjects in yoga group, the need for dialysis was less when compared to control group although this difference was statistically insignificant. Except for inability of some patients to perform certain yogic asanas no adverse effect was found in the study. Conclusion: Six months yoga program is safe and effective as an adjuvant therapy in improving renal functions and QOL of CKD patients.
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Affiliation(s)
- Rajendra Kumar Pandey
- Department of Internal Medicine, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
| | - Tung Vir Singh Arya
- Department of Internal Medicine, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
| | - Amit Kumar
- Department of Internal Medicine, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
| | - Ashish Yadav
- Department of International Health, Global Disease Epidemiology and Control, John Hopkins Bloomberg School of Public Health, Baltimore, USA
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Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The Effect of Chair Yoga on Biopsychosocial Changes in English- and Spanish-Speaking Community-Dwelling Older Adults with Lower-Extremity Osteoarthritis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2016; 59:604-626. [PMID: 27661469 PMCID: PMC5177482 DOI: 10.1080/01634372.2016.1239234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Chair yoga (CY), a mind-body therapy, is a safe nonpharmacological approach for managing osteoarthritis (OA) in older adults who cannot participate in standing exercise. However, there is no linguistically tailored CY program for those with limited English proficiency (LEP). This 2-arm randomized controlled trial compared the effects of a linguistically tailored yoga program (English and Spanish versions) on the outcomes of pain, physical function, and psychosocial factors compared to the effects of a linguistically tailored Health Education Program (HEP; English and Spanish versions). Participants with lower-extremity OA, recruited from 2 community sites, completed the Spanish (n = 40) or English (n = 60) version of twice-weekly 45-min CY or HEP sessions for 8 weeks. Data were collected at baseline, 4 weeks, 8 weeks, and 1- and 3-month follow-ups. English and Spanish CY groups (but neither HEP language group) showed significant decreases in pain interference. Measures of OA symptoms, balance, depression, and social activities were not significantly different between English and Spanish versions of CY and English and Spanish versions of HEP. It was concluded that the Spanish and English versions of CY and HEP were equivalent. Linguistically tailored CY could be implemented in aging-serving communities for persons with LEP.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University School of Social Work
| | - David Newman
- Florida Atlantic University Christine E. Lynn College of Nursing
| | | | | | - Mary Lou Riccio
- Florida Atlantic University Charles E. Schmidt College of Medicine
| | - Patricia Liehr
- Florida Atlantic University Christine E. Lynn College of Nursing
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Choi J, Jun JH, Lee JA, Lee MS. Yoga for Health Care in Korea: A Protocol for Systematic Review of Clinical Trials. J Acupunct Meridian Stud 2016; 9:213-9. [PMID: 27555227 DOI: 10.1016/j.jams.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/12/2022] Open
Abstract
This systematic review aims to evaluate the therapeutic effects of yoga therapy using an evidence-based approach and investigates the relationship between yoga and the meridian energies based on all available clinical studies in Korea. Sixteen electronic databases will be searched from the inception of the study until January 2016. All clinical evidences that evaluate any type of yoga and any type of control in individuals with any type of condition will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa scale for nonrandomized studies. Two authors will independently assess each study for eligibility and the risk of bias, and then they will extract the data. With its extensive, unbiased search of the Korean literature from various databases without any language restrictions, this systematic review will be useful for both practitioners in the field of yoga research as well as for patients.
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Affiliation(s)
- Jiae Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ji Hee Jun
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ju Ah Lee
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.
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Abstract
BACKGROUND Asthma is a common chronic inflammatory disorder affecting about 300 million people worldwide. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally. A number of clinical trials have been carried out to evaluate the effects of yoga practice, with inconsistent results. OBJECTIVES To assess the effects of yoga in people with asthma. SEARCH METHODS We systematically searched the Cochrane Airways Group Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched PEDro. We searched ClinicalTrials.gov and the WHO ICTRP search portal. We searched all databases from their inception to 22 July 2015, and used no restriction on language of publication. We checked the reference lists of eligible studies and relevant review articles for additional studies. We attempted to contact investigators of eligible studies and experts in the field to learn of other published and unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared yoga with usual care (or no intervention) or sham intervention in people with asthma and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events. DATA COLLECTION AND ANALYSIS We extracted bibliographic information, characteristics of participants, characteristics of interventions and controls, characteristics of methodology, and results for the outcomes of our interest from eligible studies. For continuous outcomes, we used mean difference (MD) with 95% confidence interval (CI) to denote the treatment effects, if the outcomes were measured by the same scale across studies. Alternatively, if the outcomes were measured by different scales across studies, we used standardised mean difference (SMD) with 95% CI. For dichotomous outcomes, we used risk ratio (RR) with 95% CI to measure the treatment effects. We performed meta-analysis with Review Manager 5.3. We used the fixed-effect model to pool the data, unless there was substantial heterogeneity among studies, in which case we used the random-effects model instead. For outcomes inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and summarised the findings narratively. MAIN RESULTS We included 15 RCTs with a total of 1048 participants. Most of the trials were conducted in India, followed by Europe and the United States. The majority of participants were adults of both sexes with mild to moderate asthma for six months to more than 23 years. Five studies included yoga breathing alone, while the other studies assessed yoga interventions that included breathing, posture, and meditation. Interventions lasted from two weeks to 54 months, for no more than six months in the majority of studies. The risk of bias was low across all domains in one study and unclear or high in at least one domain for the remainder.There was some evidence that yoga may improve quality of life (MD in Asthma Quality of Life Questionnaire (AQLQ) score per item 0.57 units on a 7-point scale, 95% CI 0.37 to 0.77; 5 studies; 375 participants), improve symptoms (SMD 0.37, 95% CI 0.09 to 0.65; 3 studies; 243 participants), and reduce medication usage (RR 5.35, 95% CI 1.29 to 22.11; 2 studies) in people with asthma. The MD for AQLQ score exceeded the minimal clinically important difference (MCID) of 0.5, but whether the mean changes exceeded the MCID for asthma symptoms is uncertain due to the lack of an established MCID in the severity scores used in the included studies. The effects of yoga on change from baseline forced expiratory volume in one second (MD 0.04 litres, 95% CI -0.10 to 0.19; 7 studies; 340 participants; I(2) = 68%) were not statistically significant. Two studies indicated improved asthma control, but due to very significant heterogeneity (I(2) = 98%) we did not pool data. No serious adverse events associated with yoga were reported, but the data on this outcome was limited. AUTHORS' CONCLUSIONS We found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms in people with asthma. There is more uncertainty about potential adverse effects of yoga and its impact on lung function and medication usage. RCTs with a large sample size and high methodological and reporting quality are needed to confirm the effects of yoga for asthma.
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Affiliation(s)
- Zu‐Yao Yang
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
| | - Hui‐Bin Zhong
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
| | - Chen Mao
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
| | - Jin‐Qiu Yuan
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
| | - Yafang Huang
- The Chinese University of Hong KongDivision of Epidemiology, School of Public Health and Primary CarePrince of Wales Hospital, ShatinHong KongChina
| | - Xin‐Yin Wu
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
| | - Yuan‐Mei Gao
- Chronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical UniversityDepartment of Respiratory MedicineNo. 1838, North Guangzhou AvenueGuangzhouGuangdongChina510515
| | - Jin‐Ling Tang
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CareHong Kong SARChina
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Koneru S, Tanikonda R. Role of yoga and physical activity in work-related musculoskeletal disorders among dentists. J Int Soc Prev Community Dent 2015; 5:199-204. [PMID: 26236679 PMCID: PMC4515802 DOI: 10.4103/2231-0762.159957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Work-related musculoskeletal pain is one of the occupational hazards in dentists. Aims: To find the prevalence and severity of musculoskeletal pain in dentists, to compare musculoskeletal pain among dentists practicing yoga, those practicing physical activities, and those without any physical activity, and also to know the effects of sex, age, and workload on musculoskeletal pain. Materials and Methods: A self-reporting work-related questionnaire and the Nordic questionnaire for analysis of musculoskeletal disorders were given to graduated dentists attending Indian dental conference in Mumbai, to know the musculoskeletal pain experienced in the last 12 months and feedback was obtained from 220 dentists. Results: The prevalence of musculoskeletal pain in dentists was 34.5%. Prevalence of musculoskeletal pain was 10.5%, 21.7%, and 45.6% in dentists with regular yoga practice, other physical activity, and no physical activity, respectively. There was statistically significant difference in the prevalence of musculoskeletal pain among dentists who were practicing yoga when compared with those in no regular activity group. Conclusion: Within the limitations of the study, there was significant role of physical activity on the quality and quantity of work-related musculoskeletal disorders experienced by dentists. Yoga was found to be more effective than other modes of physical activities. More research is needed on musculoskeletal problems in dentists, with an emphasis on larger sample sizes and correlating other factors like age and sex of the dentists, duration of practice, years of practicing yoga, and working hours per week.
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Affiliation(s)
- Suneetha Koneru
- Department of Periodontics, Vishnu Dental College, Andhra Pradesh, India
| | - Rambabu Tanikonda
- Department of Conservative Dentistry and Endodontics, Vishnu Dental College, Andhra Pradesh, India
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Jagannathan A, Narayanan VV, Kulkarni I, Jogdand SP, Pailoor S, Nagarathna R. Prevalence of type 2 diabetes among Yoga practitioners: A pilot cross-sectional study in two districts in India. Int J Yoga 2015; 8:148-53. [PMID: 26170597 PMCID: PMC4479895 DOI: 10.4103/0973-6131.158485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Diabetes is one of the major health diseases in the world today. The efficacy of Yoga in the management of type 2 diabetes is well-established. The aim of this study was to assess the prevalence of type 2 diabetes among Yoga practitioners in two districts of India (one each in West and South of India). Methodology: In this cross-sectional field study, 155 Yoga practitioners from Pune and 192 from Ernakulam districts were assessed using the diabetes risk test and fasting blood sugar. The data collected were entered in a statistics software package and analyzed using the Pearson's correlation analysis, t-test, univariate ANOVA, and linear regression to understand the predictors of risk for diabetes. Results: The overall prevalence of diabetes among Yoga practitioners in Central Pune was 3.6% (95% confidence interval [CI]: [0.01–0.04]). 18.9% of participants (95% CI: [0.16–0.19]) were diagnosed to be “at risk” for diabetes. In Ernakulam, the overall prevalence of diabetes among practitioners was 26% (95% CI: [0.05-0.06]) with 12% of practitioners (95% CI: [0.05-0.06]) diagnosed to be “at risk” for diabetes (prediabetic). Higher age and lesser duration of Yoga practice were significant predictors of diabetes. Conclusion: It is essential for every person above the age of 40 to undergo regular health check-ups and screening for diabetes and involve oneself in lifestyle modification programs such as Yoga for significantly long duration of time on a daily basis, to better manage diabetes.
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Affiliation(s)
- Aarti Jagannathan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - V V Narayanan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Isha Kulkarni
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Sonali P Jogdand
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - Subramanya Pailoor
- Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
| | - R Nagarathna
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
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Nagothu RS, Reddy YI, Rajagopalan A, Varma R. Right Dorsolateral Frontal Lobe N-Acetyl Aspartate and Myoinositol Concentration Estimation in Type 2 Diabetes with Magnetic Resonance Spectroscopy. J Clin Diagn Res 2015; 9:CC16-9. [PMID: 26393123 DOI: 10.7860/jcdr/2015/14153.6234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic hyperglycaemia in type 2 diabetes, effects the central nervous system by altering the concentrations of brain metabolites like N-acetyl aspartate (NAA) and myoinositol (mI), which are indicators of neuronal integrity and glial cell damage respectively. Dorsolateral frontal lobe is associated with aspects of cognition especially right frontal lobe is involved in episodic memory retrieval, ninety percent of the diabetic cases are type 2 in nature globally and yoga is very effective in stabilizing the brain metabolites by bringing the blood glucose levels to near or within the physiological range in type 2 diabetes. AIM AND OBJECTIVES The aim of the study was to observe the effects of yogasana and pranayama on glycosilated haemoglobin (HbA1c) levels and right dorsolateral frontal cortical NAA and mI concentration in type 2 diabetic subjects. MATERIALS AND METHODS It's a case control study. Sixty eight type 2 diabetic subjects of both the sex, aged between 35-65 years are included in the study, subjects are divided in to test and control group 34 each. Test group subjects did the yogasana and pranayama for a period of 6 months, 6 days in a week, 45-60 minutes daily under the supervision of a qualified yoga teacher. Control group subjects are not on any specific exercise regimen. Both the group subjects are taking oral hypoglycaemic agents. HbA1c levels are measured using the Bio-Rad D-10™ haemoglobin A1c program and Magnetic Resonance Spectroscopy (MRS) is used in assessing the metabolite concentrations. STATISTICAL ANALYSIS Analysis of data was done by using unpaired t-test. P-value for HbA1c level is <0.001, which is highly significant statistically. P-value for NAA was < 0.02 and for myoinositol was < 0.01, which are statistically significant. RESULTS HbA1c levels in control and test group subjects are 7.7 ± 1.84 and 6.02 ± 0.46 respectively. NAA concentrations in the right dorsolateral frontal lobe of control and test group are 1.44 ± 0.15 and 1.54 ± 0.19 respectively. The mI concentrations in the right dorsolateral frontal lobe of control and test group are 0.61 ± 0.22 and 0.47 ± 0.24 respectively. CONCLUSION Yogasana and pranayama minimized the neuronal and glial cellular damage in test group, which is evident by minimal changes in right dorsolateral frontal lobe NAA and mI levels in type 2 diabetic subjects.
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Affiliation(s)
| | - Yogananda Indla Reddy
- Associate Professor, Department of Physiology, MediCiti Institute of Medical Sciences , Hyderabad, India
| | - Archana Rajagopalan
- Professor, Department of Physiology, Saveetha Medical college , Chennai, India
| | - Ravi Varma
- Professor, Department of Radiology, MediCiti Institute of Medical Sciences , Hyderabad, India
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Yang K, James KA. Yoga, as a transitional platform to more active lifestyle: a 6-month pilot study in the USA. Health Promot Int 2014; 31:423-9. [DOI: 10.1093/heapro/dau108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Sharma B, Hankey A, Nagilla N, Meenakshy KB, Nagendra HR. Can yoga practices benefit health by improving organism regulation? Evidence from electrodermal measures of acupuncture meridians. Int J Yoga 2014; 7:32-40. [PMID: 25035605 PMCID: PMC4097913 DOI: 10.4103/0973-6131.123477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: To document and explain Yoga's effects on acupuncture meridian energies. To understand mechanisms behind Yoga's efficacy by testing links between yoga and traditional Chinese medicine. Materials and Methods: The study compared two groups of yoga practitioners: Novice and experienced. Novices consisted of 33 volunteers from a Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) yoga instructor training module and the experienced practitioners were 20 resident SVYASA students. The intervention was 3 weeks of a yoga training program, new for the novices, but the lifestyle of the experienced group, who were therefore assessed only once. Novices were assessed on day 2 and 23 of their program at SVYASA's Yoga Medicine Hospital, making their data a pre-post, self-as-control, prospective study. Main outcome measures were mean acumeridian energy levels assessed by AcuGraph3 measures of electrodermal resistance at acupoints; additionally, gender differences, standard deviations (SDs) of all measures, and comparison of post and experienced group data. Results: Averaged energy levels significantly improved in all 24 meridians (maximum P = 0.032, 4-P < 0.01, and 19-P < 0.001). Females improved more than males (P < 0.05), both ending at similar levels to experienced practitioners, whose SDs were lower than novices on 19/24 meridians (mean F = 3.715, P = 0.0022), and 4/5 average variables. Conclusions: AcuGraph3 electrodermal measures contain substantial information, P << 0.00001. Yoga-lifestyle practice can increase and balance acumeridian energies; long-term practice decreases group SD's. These three suggest reasons why yoga practice impacts health: One, increased prana levels are important; two and three, improved physiological regulation is the key. Further studies relating traditional Indian and Chinese medical systems are needed.
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Affiliation(s)
- Bhawna Sharma
- Divisions of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore, Karnataka, India
| | - Alex Hankey
- Divisions of Yoga and Physical Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore, Karnataka, India
| | - Niharika Nagilla
- Divisions of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore, Karnataka, India
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Kumar A, Archana E, Pai A, Nayak G, Shenoy RP, Rao A. Serum mineral status and climacteric symptoms in perimenopausal women before and after Yoga therapy, an ongoing study. J Midlife Health 2014; 4:225-9. [PMID: 24381464 PMCID: PMC3872669 DOI: 10.4103/0976-7800.122251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many women report an increased level of anxiety, irritability and mood swings during their perimenopausal state. Studies show that physically active people can reduce their anxiety and depression by practicing yoga. Serum minerals such as calcium, copper and magnesium and the ferro-oxidase, ceruloplasmin play an important role in the body during the perimenopausal period. OBJECTIVE The objective of this study is to assess the serum mineral status, anthropometric parameters and climacteric symptoms in perimenopausal women before and after yoga intervention. SUBJECTS AND METHODS A total of 30 subjects with perimenopausal symptoms, aged between 40 and 60 years (49.43 ± 6.15) were included in the study. Yoga intervention was given on a daily basis (45 min duration) for 12 weeks. The climacteric symptoms were assessed by Greene's climacteric scale and biochemical parameters were analyzed spectrophotometrically. RESULTS A significant decrease in the waist hip ratio (P < 0.036) and body mass index (P < 0.036) was observed after yoga intervention. Systolic (P < 0.064) and diastolic (P < 0.082) blood pressure (BP) showed marginal decrease after yoga therapy. Climacteric symptoms improved significantly (P < 0.001) after yoga intervention. A significant increase (P < 0.001) in serum calcium and copper and a marked decrease in serum magnesium (P < 0.05) and ceruloplasmin (P < 0.028) levels was observed, post yoga therapy. Serum magnesium negatively correlated (r = -0.467, P < 0.035) with systolic BP after yoga intervention. CONCLUSION The overall changes observed in the mineral status and climacteric symptoms suggest that yoga therapy protocol can be effectively used to improve the quality of life in perimenopausal women.
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Affiliation(s)
- Alok Kumar
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - E Archana
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - Akshatha Pai
- Department of Biochemistry, Melaka Manipal Medical College, Manipal, Karnataka, India
| | - Gayathry Nayak
- Department of Yoga, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Revathi P Shenoy
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - Anjali Rao
- Department of Biochemistry, Melaka Manipal Medical College, Manipal, Karnataka, India
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González-Villanueva L, Alvarez-Alvarez A, Ascari L, Trivino G. A tool for linguistic assessment of rehabilitation exercises. Appl Soft Comput 2014. [DOI: 10.1016/j.asoc.2013.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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González-Villanueva L, Cagnoni S, Ascari L. Design of a wearable sensing system for human motion monitoring in physical rehabilitation. SENSORS 2013; 13:7735-55. [PMID: 23774987 PMCID: PMC3715260 DOI: 10.3390/s130607735] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/21/2013] [Accepted: 06/13/2013] [Indexed: 12/25/2022]
Abstract
Human motion monitoring and analysis can be an essential part of a wide spectrum of applications, including physical rehabilitation among other potential areas of interest. Creating non-invasive systems for monitoring patients while performing rehabilitation exercises, to provide them with an objective feedback, is one of the current challenges. In this paper we present a wearable multi-sensor system for human motion monitoring, which has been developed for use in rehabilitation. It is composed of a number of small modules that embed high-precision accelerometers and wireless communications to transmit the information related to the body motion to an acquisition device. The results of a set of experiments we made to assess its performance in real-world setups demonstrate its usefulness in human motion acquisition and tracking, as required, for example, in activity recognition, physical/athletic performance evaluation and rehabilitation.
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Affiliation(s)
- Lara González-Villanueva
- Henesis S.r.l., Viale dei Mille 108, 43125 Parma, Italy; E-Mail:
- IBIS Lab, Department of Information Engineering, University of Parma, Parco Area delle Scienze 181/A, 43124 Parma, Italy; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0521-1854-211; Fax: +39-0521-1854-515
| | - Stefano Cagnoni
- IBIS Lab, Department of Information Engineering, University of Parma, Parco Area delle Scienze 181/A, 43124 Parma, Italy; E-Mail:
| | - Luca Ascari
- Henesis S.r.l., Viale dei Mille 108, 43125 Parma, Italy; E-Mail:
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Rani M, Singh U, Agrawal GG, Natu SM, Kala S, Ghildiyal A, Srivastava N. Impact of Yoga Nidra on menstrual abnormalities in females of reproductive age. J Altern Complement Med 2013; 19:925-9. [PMID: 23647406 DOI: 10.1089/acm.2010.0676] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to observe the effect of Yoga Nidra practice on hormone levels in patients who had menstrual irregularities. DESIGN The study was a randomized controlled trial. SETTINGS/LOCATION The study was conducted in the Department of Obstetrics and Gynecology at Chhatrapati Sahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India. SUBJECTS were divided randomly into 2 groups-an intervention and a control group, with 75 subjects in each group. Of these subjects, 126 completed the study protocol. SUBJECTS This study involved 150 subjects with menstrual irregularities; 126 of whom completed the protocol. INTERVENTIONS The intervention was the practice of Yoga Nidra. The yogic intervention duration was 35-40 minutes/day, five times/week for 6 months. An estimation of hormonal profile was done for both groups at baseline and after 6 months. RESULTS Thyroid-stimulating hormone (p<0.002), follicle-stimulating hormone (p<0.02), luteinizing hormone (p<0.001), and prolactin (p<0.02) were decreased significantly in the intervention group, compared with the control group. CONCLUSIONS The present study demonstrated the efficacy of Yoga Nidra on hormone profiles in patients with menstrual irregularities. Yoga Nidra practice was helpful in patients with hormone imbalances, such as dysmenorrhea, oligomenorrhea, menorrhagia, metrorrhagia, and hypomenorrhea.
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Affiliation(s)
- Monika Rani
- 1 Department of Obstetrics and Gynecology, Chhatrapati Sahuji Maharaj Medical University , Uttar Pradesh, Lucknow, India
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Middleton KR, Ward MM, Haaz S, Velummylum S, Fike A, Acevedo AT, Tataw-Ayuketah G, Dietz L, Mittleman BB, Wallen GR. A pilot study of yoga as self-care for arthritis in minority communities. Health Qual Life Outcomes 2013; 11:55. [PMID: 23548052 PMCID: PMC3637098 DOI: 10.1186/1477-7525-11-55] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. METHODS/DESIGN In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. DISCUSSION There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. TRIAL REGISTRATION ClinicalTrials.gov: NCT01617421.
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Affiliation(s)
- Kimberly R Middleton
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Michael M Ward
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | | | - Sinthujah Velummylum
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Alice Fike
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | - Ana T Acevedo
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Gladys Tataw-Ayuketah
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Laura Dietz
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Barbara B Mittleman
- National Institutes of Health, Office of Science Policy, Office of the Director, Building 1, Bethesda, MD, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
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Abstract
BACKGROUND Stress has negative effect on health and type 2 diabetes patients may be at an increased risk. Abnormally high levels of free radicals and the simultaneous decline of antioxidant defense mechanisms can increase lipid peroxidation and insulin resistance. The objective of the present study was to demonstrate the efficacy of yogic practice in geriatric patients with type 2 diabetes mellitus and also to compare the efficacy with the state of glycaemic control. MATERIALS AND METHODS Seventy three (73) healthy elderly patients of type 2 diabetes mellitus in the age group of 60 to 70 years with a history of diabetes for 5 to 10 years and with poor glycaemic control (HbA(1c) >8 %) residing in Kozhikode district were recruited for the study. The subjects were divided into three groups according to their glycaemic control. Group I with HbA(1c) 8.6-9.7 %, group II with HbA(1c) 9.8-10.7 % and group III with HbA(1c) 10.8-12.7 %. Participants did yogic practice under the supervision of experienced trainer, daily 90 minutes and for three months. Biochemical estimation of HbA(1c), glucose, lipid profile, cortisol, ferritin, malondialdehyde (MDA) and catalase activity were carried out on 0 day and 90(th) day. Seventy patients participated in a comparable control session. RESULTS The participants in the test group showed statistically significant (P < 0.001) decrease in glucose, HbA(1c), lipids, cortisol, ferritin, MDA and significant increase in catalase activity after yogic practice. CONCLUSIONS Yoga may improve risk profiles induced by stress in geriatric patients with type 2 diabetes and may have promise for the prevention or delay in diabetes complications. And at all stages of the disease a significant improvement can be achieved by yogic practice in geriatric diabetes.
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Affiliation(s)
- Rani K Beena
- Department of Life Sciences, University of Calicut, Kerala, India
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Chien LW, Chang HC, Liu CF. Effect of Yoga on Serum Homocysteine and Nitric Oxide Levels in Adolescent Women With and Without Dysmenorrhea. J Altern Complement Med 2013; 19:20-3. [DOI: 10.1089/acm.2011.0113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Li-Wei Chien
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Chi-Feng Liu
- Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Yang K. A review of yoga programs for four leading risk factors of chronic diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 4:487-91. [PMID: 18227916 PMCID: PMC2176145 DOI: 10.1093/ecam/nem154] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 09/05/2007] [Indexed: 11/25/2022]
Abstract
Yoga, a form of physical activity, is rapidly gaining in popularity and has many health benefits. Yet healthcare providers have been slow to recognize yoga for its ability to improve health conditions, and few interventions have been developed that take full advantage of its benefits. The purpose of this article is to review published studies using yoga programs and to determine the effect of yoga interventions on common risk factors of chronic diseases (overweight, hypertension, high glucose level and high cholesterol). A systematic search yielded 32 articles published between 1980 and April 2007. The studies found that yoga interventions are generally effective in reducing body weight, blood pressure, glucose level and high cholesterol, but only a few studies examined long-term adherence. Additionally, not enough studies included diverse populations at high risk for diabetes and its related common health problems.
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Affiliation(s)
- Kyeongra Yang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Park J, McCaffrey R. Chair Yoga: Benefits for Community-Dwelling Older Adults With Osteoarthritis. J Gerontol Nurs 2012; 38:12-22; quiz 24-5. [DOI: 10.3928/00989134-20120411-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 12/16/2011] [Indexed: 11/20/2022]
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Park J, McCaffrey R. Chair yoga: benefits for community-dwelling older adults with osteoarthritis. J Gerontol Nurs 2012. [PMID: 22533347 DOI: 10.3928/00989134-20120410-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this pilot study was to examine whether chair yoga was effective in reducing pain level and improving physical function and emotional well-being in a sample of community-dwelling older adults with osteoarthritis. One-way repeated measures analysis of variance was performed to examine the effectiveness of chair yoga at baseline, midpoint (4 weeks), and end of the intervention (8 weeks). Although chair yoga was effective in improving physical function and reducing stiffness in older adults with osteoarthritis, it was not effective in reducing pain level or improving depressive symptoms. Future research planned by this team will use rigorous study methods, including larger samples, randomized controlled trials, and follow up for monitoring home practice after the interventions.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Boca Raton, FL, USA.
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Massey PB. Prescribing Movement Therapies. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pandey A, Tripathi P, Pandey R, Srivatava R, Goswami S. Alternative therapies useful in the management of diabetes: A systematic review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2011; 3:504-12. [PMID: 22219583 PMCID: PMC3249697 DOI: 10.4103/0975-7406.90103] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/26/2011] [Accepted: 09/14/2011] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes.
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Affiliation(s)
- Awanish Pandey
- Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India
| | - Poonam Tripathi
- Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India
| | - Rishabh Pandey
- Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India
| | - Rashmi Srivatava
- Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India
| | - Shambaditya Goswami
- Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India
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Desai K, Bowman MA, Galantino ML, Hughes-Halbert C, Vapiwala N, Demichele A, Mao JJ. Predictors of yoga use among patients with breast cancer. Explore (NY) 2011; 6:359-63. [PMID: 21040884 DOI: 10.1016/j.explore.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population. DESIGN A cross-sectional survey study was conducted. SETTING The study was conducted at an outpatient breast oncology clinic at a large university hospital. PARTICIPANTS Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study. MAIN OUTCOME MEASUREMENT Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients. RESULTS Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66). CONCLUSION Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.
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Affiliation(s)
- Krupali Desai
- Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA 19104
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Yang K, Bernardo LM, Sereika SM, Conroy MB, Balk J, Burke LE. Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:257891. [PMID: 19690044 PMCID: PMC3096458 DOI: 10.1093/ecam/nep117] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 07/08/2009] [Indexed: 01/03/2023]
Abstract
Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.
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Affiliation(s)
- Kyeongra Yang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Relaxation Techniques and Guided Imagery. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Aljasir B, Bryson M, Al-Shehri B. Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 7:399-408. [PMID: 18955338 PMCID: PMC2892348 DOI: 10.1093/ecam/nen027] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/04/2008] [Indexed: 11/13/2022]
Abstract
The effect of practicing yoga for the management of type II Diabetes was assessed in this systematic review through searching related electronic databases and the grey literature to the end of May 2007 using Ovid. All randomized controlled clinical trials (RCTs) comparing yoga practice with other type of intervention or with regular practice or both, were included regardless of language or type of publication. Each study was assessed for quality by two independent reviewers. Mean difference was used for summarizing the effect of each study outcomes with 95% confidence intervals. Pooling of the studies did not take place due to the wide clinical variation between the studies. Publication bias was assessed by statistical methods. Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics. The studies' results show improvement in outcomes among patients with diabetes type II. These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant. The results were inconclusive and not significant for the long-term outcomes. No adverse effects were reported in any of the included studies. Short-term benefits for patients with diabetes may be achieved from practicing yoga. Further research is needed in this area. Factors like quality of the trials and other methodological issues should be improved by large randomized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II. A definitive recommendation for physicians to encourage their patients to practice yoga cannot be reached at present.
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Affiliation(s)
- Badr Aljasir
- University of Ottawa, Ottawa and University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Cora Collette Breuner
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
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Waryasz GR, McDermott AY. Exercise prescription and the patient with type 2 diabetes: a clinical approach to optimizing patient outcomes. ACTA ACUST UNITED AC 2010; 22:217-27. [PMID: 20409260 DOI: 10.1111/j.1745-7599.2010.00490.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the current recommendations for physical activity in type 2 diabetes mellitus (T2DM) and propose methods to optimize compliance, reduce the pharmaceutical burden, and improve the general health and well-being of patients with T2DM. DATA SOURCES PubMed, SportDiscus, Ovid MEDLINE, Psychinfo, Web of Science, LexisNexis, and EBM reviews. CONCLUSIONS T2DM is a condition in which physical activity has been documented to improve patient outcomes, yet research has noted that healthcare professionals inadequately address this issue, resulting in physical activity being an underutilized therapy. IMPLICATIONS FOR PRACTICE An exercise prescription consists of mode (type), frequency, intensity, duration, and progression. Determining the appropriate mode depends upon patient preference and safety issues regarding the state of T2DM or other conditions. Frequency, intensity, and duration are specific to the type of activity and should be tailored to the patient's abilities to safely perform the activity. Finally, the health professional addresses periodic progression in order to maintain the exercise stimulus needed to promote continued health improvements and prevent "plateauing." In this article, on the basis of the current scientific research, we propose recommendations that enable healthcare professionals to advocate for their patients with T2DM by offering safe and effective treatment options.
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Tavakoli M, Asghar O, Alam U, Petropoulos IN, Fadavi H, Malik RA. Novel insights on diagnosis, cause and treatment of diabetic neuropathy: focus on painful diabetic neuropathy. Ther Adv Endocrinol Metab 2010; 1:69-88. [PMID: 23148152 PMCID: PMC3475285 DOI: 10.1177/2042018810370954] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diabetic neuropathy is common, under or misdiagnosed, and causes substantial morbidity with increased mortality. Defining and developing sensitive diagnostic tests for diabetic neuropathy is not only key to implementing earlier interventions but also to ensure that the most appropriate endpoints are employed in clinical intervention trials. This is critical as many potentially effective therapies may never progress to the clinic, not due to a lack of therapeutic effect, but because the endpoints were not sufficiently sensitive or robust to identify benefit. Apart from improving glycaemic control, there is no licensed treatment for diabetic neuropathy, however, a number of pathogenetic pathways remain under active study. Painful diabetic neuropathy is a cause of considerable morbidity and whilst many pharmacological and nonpharmacological interventions are currently used, only two are approved by the US Food and Drug Administration. We address the important issue of the 'placebo effect' and also consider potential new pharmacological therapies as well as nonpharmacological interventions in the treatment of painful diabetic neuropathy.
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Affiliation(s)
- Mitra Tavakoli
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Omar Asghar
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Uazman Alam
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Ioannis N. Petropoulos
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Hassan Fadavi
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Rayaz A. Malik
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
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