Yoga for arthritis: a scoping review

Feasibility and Acceptability of Yoga for Adolescents with Juvenile Idiopathic Arthritis

BACKGROUND/OBJECTIVES

Yoga is effective for adults with arthritis but unstudied in adolescents with juvenile idiopathic arthritis (JIA).

METHODS

A pilot study assessed the feasibility and acceptability of an 8-week group yoga intervention for adolescents ages 14-18 with JIA. Each 75-min session included breathing techniques, relaxation, mindfulness, and modified yoga postures, using yoga props and a rope wall. An online video was available for home practice. The outcome measures administered at the baseline and at 8 weeks were physician global assessment with joint count, visual assessment with a joint damage assessment index, the Pediatric Quality of Life Arthritis Module 3.0 (Peds QL), and the visual analog scale for pain.

RESULTS

Thirteen out of 25 participants attended ≥1 class with a mean of 5.7 ± 2.2 classes. Common reasons for non-enrollment included distance, schedule, and lack of interest. The average distance to classes was 29.0 ± 41.7 miles. There was a trend toward improvement for joint count (p = 0.07), global assessment (p = 0.10), and the Pain and Hurt domain of the Peds QL (p = 0.13), but no other outcomes approached significance. Satisfaction data from an anonymous survey (n = 8) were high in all areas.

CONCLUSIONS

Adolescents with JIA who attended yoga reported enjoyment, pain reduction, and interest in continued practice with no adverse events. Future studies should consider stakeholder engagement to reduce barriers and larger sample sizes to test the effectiveness.

Changes in Use of Complementary and Integrative Health Therapies at the Veterans Affairs: Findings from a Whole Health System Pilot Program

Introduction: The Department of Veterans Affairs (VA) launched a Whole Health System pilot program in 18 VA "Flagship" medical centers in 2018 in part to expand the provision of complementary and integrative health (CIH) therapies. Materials and methods: A longitudinal quasi-experimental design was used to examine Veterans' use of at least 1 of 12 CIH therapies 2 years after initiation of the Flagship pilot program compared with the year before the program started. The sample included Veterans with chronic musculoskeletal pain with at least one visit to a VA primary care, mental health care, or pain clinic in each of the 3 study years. A population-average logit model was used to measure changes in the percentage of Veterans using at least one the CIH therapies over time. Results: Among Veterans with chronic musculoskeletal pain receiving health care at Flagship sites, 9.7% used a CIH therapy before the Flagship program initiation, whereas 14.2% used a therapy in the second year of the program (46.0% increase). In comparison, CIH therapy use among Veterans at non-Flagship sites increased from 10.3% to 12.0% over the same period (16.5% increase). Results from the population-average logit model show that Veterans at Flagship sites were significantly more likely to be CIH therapy users in the first (p < 0.001) and second (p < 0.001) years of the implementation compared with non-Flagship sites. Discussion: The Flagship pilot program was successful in terms of increasing the use of CIH therapies among Veterans with chronic musculoskeletal pain compared with non-Flagship sites. Conclusions: The Whole Health System implementation that included financial incentives, education, and other support to 18 VA "Flagship" medical centers helped to increase the use of CIH therapies in the VA. Future research should examine which of these efforts were most effective in expanding CIH therapy provision.

Content, Structure and Delivery Characteristics of Yoga Interventions for Managing Rheumatoid Arthritis: A Systematic Review Protocol

The global burden of rheumatoid arthritis among adults is rising. Yoga might be a potential solution for managing rheumatoid arthritis. This systematic review aims to synthesise the content, structure and delivery characteristics of effective yoga interventions for managing rheumatoid arthritis. The JBI methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines will be followed. PRISMA for systematic review protocols (PRISMA-P) was used to write the protocol. Randomised controlled trials assessing the effectiveness of yoga interventions for managing rheumatoid arthritis in adults will be included in this review. We aim to search the following databases to find published and unpublished studies: ABIM, AMED, AYUSH Research Portal, CAM-QUEST, CINAHL, CENTRAL, EMBASE, MEDLINE, PeDro, PsycInfo, SPORTDiscus, TRIP, Web of Science, DART-Europe-e-theses portal, EthOS, OpenGrey and ProQuest Dissertations and Theses. No date or language restrictions will be applied. A narrative synthesis will be conducted. Meta-regression will be conducted to explore the statistical evidence for which components (content, structure and delivery characteristics) of yoga interventions are effective.

Yoga in Patients With Inflammatory Bowel Disease: A Narrative Review

Despite advancements in the treatment of inflammatory bowel disease (IBD), the global prevalence of IBD is increasing. Patients with IBD often experience a high psychosocial burden, worsening their IBD symptoms and increasing relapse, hospitalization rates, and healthcare costs, which impairs their quality of life (QoL). Evidence suggests that mind-body intervention in many chronic illnesses is effective in improving symptoms and QoL. Yoga is the most frequently used mind-body practice globally. Meta-analyses of randomized clinical trials and prospective studies have highlighted that yoga improves symptoms and QoL of patients with IBD; however, recommendations about indications for yoga as well as dose and frequency of yoga are lacking. The present narrative review aims to describe the available evidence regarding the effects of yoga on common patient-reported outcome measures in IBD, including depression, anxiety, stress, and QoL. Physicians can hence promote yoga interventions in their discussions with patients to help control these IBD-related outcome measures.

Research Trends of Acupuncture Therapy on Knee Osteoarthritis from 2010 to 2019: A Bibliometric Analysis

Background

Acupuncture has been widely applied to relieve knee osteoarthritis (KOA) in many countries. However, the bibliometric analysis of the global use of acupuncture on KOA is largely unknown. Therefore, this study aimed to explore the current status and trends of the global use of acupuncture on KOA in recent 10 years by using CiteSpace (5.6.R3).

Methods

Publications regarding acupuncture therapy for treating KOA between 2010 and 2019 were extracted from the Web of Science database. CiteSpace was used to analyze the number of publications, countries, institutions, journals, authors, cited references and keywords by using standard bibliometric indicators.

Results

A total of 343 publications were retrieved from 2010 to 2019. The total number of publications continually increased over the past four years, and the most active journals, countries, institutions and authors in the field of acupuncture therapy on patients with KOA were identified. The Evid Based Complement Alternat Med (28) was the most prolific journal, and the Ann Intern Med (202) was the most cited journal. The most productive country and institution in this field was China (115) and University of York (18), respectively. Hugh Macpherson (18) was the most prolific author and Witt C ranked the first in the cited authors. In the ranking of frequency in cited reference, the first article was published by Scharf HP (54). The keyword of ‘randomized controlled trial’ ranked first for research developments with the highest citation burst (3.9486). Besides, there were three main frontiers in keywords for KOA research, including ‘research method, ‘age’ and ‘measure of intervention’.

Conclusion

The findings from this bibliometric study provide current status and trends in clinical research of acupuncture therapy on patients with KOA over the past ten years, which may help researchers identify hot topics and explore new directions for future research in this field.

A mixed methods evaluation of an individualised yoga therapy intervention for rheumatoid arthritis: Pilot study

OBJECTIVES

to explore patients' experiences of an individualised yoga therapy intervention for rheumatoid arthritis (RA), specifically in terms of its acceptability and impact on patient-reported outcomes.

DESIGN

Ten patients took part in a 16 week yoga therapy intervention in a hospital setting, consisting of 10 one-to-one consultations with a yoga therapist followed by two group review sessions. Changes in health (EQ-5D, HADS) were assessed pre- and post-intervention and at 12-month follow-up. In-depth interviews were conducted post-intervention and analysed using thematic analysis.

RESULTS

Attendance of the 1-to-1 sessions was high (98 %) and all participants reported strong commitment to their personalised home practice. There were significant improvements in measures of depression, anxiety, pain, quality of life and general health at post-intervention and 12-months (p < 0.05). In interviews, all but one participant reported positive changes to their symptoms and several reported reductions in their medication and broader benefits such as improved sleep, mood and energy, enabling re-engagement with life. The personally tailored nature of the practice and perceived benefits were key motivational factors. Particular value was placed on the therapeutic function of the consultation and provision of tools to manage stress and build resilience.

CONCLUSION

This yoga therapy intervention was positively received by patients with RA, with high levels of adherence to both the treatments and tailored home practice. The findings suggest that yoga therapy has potential as an adjunct therapy to improve RA symptoms, increase self-care behaviours and manage stress and negative affect such as anxiety. A larger multi-centre study is therefore warranted.

Acupuncture Therapy plus Hyaluronic Acid Injection for Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials

Objective

This meta-analysis aimed to investigate the effectiveness of acupuncture therapy plus hyaluronic acid injection versus hyaluronic acid injection alone for patients with knee osteoarthritis.

Methods

Relevant randomized controlled trials that compared the combined effect of acupuncture therapy and hyaluronic acid injection with hyaluronic acid injection alone for knee osteoarthritis patients were included. 10 studies were included in this meta-analysis, and the relative risk (RR) and weight mean difference (MD) with 95% CI for the Lysholm knee score (LKSS), visual analogue scale (VAS), and effective rate (ER) were evaluated by using RevMan 5.3 software. Besides, the bias assessment of the included studies was evaluated using the Cochrane risk of bias tool, and the GRADE (Grading of Recommendations, Assessment Development, and Evaluation) system was applied to assess the overall quality of the evidence.

Results

A total of 10 studies involving 998 participants were included in this study. Compared to hyaluronic acid injection alone, the combined therapy significantly reduced pain on the visual analogue scale (VAS) and improved the ER and knee function on the Lysholm knee score (LKSS). Of these, the pooled LKSS (MD = 8.09, 95% CI = [7.02, 9.16], p < 0.00001, 7 studies) and ER (RR = 1.23, 95% CI 1.15 to 1.31, p < 0.00001, 8 studies) suggested that combination therapy yielded a significantly higher ER and improved the LKSS scores to a greater degree than hyaluronic acid injection alone in patients with KOA. The VAS (MD = −1.39, 95% CI = [−1.99, −0.79], p < 0.00001, 7 studies) showed that the combined therapy significantly reduced pain than hyaluronic acid injection alone. The quality of evidence for the main outcomes was from very low to low according to the GRADE system.

Conclusion

Current evidence suggests that acupuncture therapy combined with hyaluronic acid injection is more effective in alleviating pain, improving the ER and knee function compared with hyaluronic acid injection alone. However, considering the low quality, small size, and high risk of the studies identified in this meta-analysis, more higher methodological quality, rigorously designed randomized controlled trials with large sample sizes are needed to confirm the results.

The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study

AIM

This study was conducted to find out the effect of yoga applied to asthma patients on the patients' respiratory functions, symptom control and quality of life.

METHODS

The sample of the study consisted of a total of randomly chosen 112 asthma patients, 56 in the experimental group and 56 in the control group, who met the research criteria and who agreed to participate in the study. A total of 12 yoga sessions, 2 sessions a week for 6 weeks, was applied to the patients in the experimental group. The patients in the control group did not receive any intervention.

RESULTS

In the intragroup comparison of average pre-test and post-test scores of respiratory function and Asthma Control Test (ACT) and Asthma Quality of Life Scale (AQLQ) total and sub-dimension scores of the patients in the experimental and control group, the difference was found to be statistically significant (p < 0.05). In addition, post-test score averages were found to increase in the experimental group, while they were found to decrease in the control group.

CONCLUSION

It was found that yoga influenced respiratory functions, symptom control and quality of life positively in asthma patients. The clinical trial registration number is NCT04107415/https://clinicaltrials.gov/ct2/show/NCT04107415.

The Association Between Yoga Use, Physical Function, and Employment in Adults With Rheumatoid Arthritis

Mind-body exercises such as yoga offer patients with rheumatoid arthritis (RA) a symptom management strategy for improving physical and mental health. Studies have evaluated yoga to manage symptoms of RA and improve physical function; however, none has examined the relationship between yoga and work status in adults with RA. The objective was to describe differences in RA symptomatology, physical function scores, and work status between adults with RA who participate in yoga and those who do not. This cross-sectional study surveyed adults with rheumatologist-diagnosed RA regarding yoga use in the past year, symptoms, physical function, and work status. Differences between yoga and non-yoga participation groups were assessed with 2-sided t tests or Pearson χ tests. Multivariate linear regression analyses were conducted to identify significant associations between yoga participation and primary outcomes. The sample included 398 adults with RA; 88% were females, 66% were white, mean age 61.8 years, mean disease duration 24.8 years; 10.6% participated in yoga. Vinyasa, Bikram, Hatha, Iyengar, and restorative yoga styles were practiced, mostly in a group setting. Yoga participants were significantly more likely to work full-time, less likely to be unable to work due to disability, and had better physical function. These findings characterize yoga practice and practitioners among adults with RA. In adults with RA, yoga participation is associated with full-time work status and better physical function than nonparticipation. This study adds additional information to the growing body of literature about adults with RA who practice yoga.

Differences in Brain Structure and Function Among Yoga Practitioners and Controls

Background: Yoga is a mind-body based physical activity that has demonstrated a variety of physiological, psychological and cognitive health benefits. Although yoga practice has shown to improve cognitive performance, few studies have examined the underlying neurological correlates.

Objective: The current study aimed to determine the differences in gray matter volume of the hippocampus, thalamus and caudate nucleus and brain activation during the Sternberg working memory task.

Method: Participants were 13 experienced yoga practitioners (mean age = 35.8), defined as having more than 3 years of regular yoga practice, and 13 age- and sex-matched controls (mean age = 35.7). All participants completed a 6-min walk test to assess fitness, psychosocial and demographic questionnaires; and underwent magnetic resonance imaging to assess gray matter volume and brain activation.

Results: There were no group differences on demographic measures of income, education and on estimated VO2max or physical activity levels. Gray matter volume differences were observed in the left hippocampus, showing greater volume in experienced yoga practitioners compared to controls (p = 0.017). The functional MRI results revealed less activation in the dorsolateral prefrontal cortex in yoga practitioners compared to controls during the encoding phase of the Sternberg task (p < 0.05). Reaction time and accuracy on the task did not differ between the groups.

Conclusions: Our results suggest an association between regular long-term yoga practice and differential structure and function of specific brain regions involved in executive function, specifically working memory, which has previously shown to improve with yoga practice. Future studies need to examine intervention effects of yoga and explore its potential to maintain and improve cognitive health across the lifespan through longitudinal and intervention studies.

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial

OBJECTIVE

Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis.

DESIGN

Single-blind, three-arm randomized controlled trial.

SETTING

Community in Southwestern Ontario, Canada.

PARTICIPANTS

A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth.

INTERVENTIONS

Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week.

MEASUREMENTS

Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention.

RESULTS

The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE.

CONCLUSIONS

The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02370667).

Impact of Spiritual Behavior on Self-Reported Illness: A Cross-Sectional Study among Women in the Kailali District of Nepal

Background

Different health behaviors influence health and illness. Spiritual well-being is one of the most important aspects of health promotion. The aim of this study was to identify the association between spiritual behavior in relation to meditation, worship, and physical exercise during yoga with self-reported disease/illness among women of the Kailali district of Nepal.

Methods

This was a cross-sectional study with 453 randomly selected women in the Kailali district of Nepal within 1 municipality and 4 village development committees (VDC) using cluster sampling. We used a semi-structured interview to collect the data for selected respondents. Socioeconomics, lifestyle, self-care, and spiritual behavior variables were independent variables, and self-reported illness in the past year was a dependent variable. Descriptive statistics, chi square, hierarchical logistic regression for odds ratio, and 95% CI were used when appropriate.

Results

Study results showed that 89% of participants were from the rural area, 29.3% were housewives, 51.4% had no formal education, 43.2% used tobacco, 42.1% did yoga, and 16.9% engaged in regular worship. Self-reported illness was associated with safe toilet-using behavior, tobacco use, junk food consumption, yoga and regular exercise, worship, and regular sleeping habits. Comparing odds ratios and 95% CIs, the women who had safe toilet behavior and did not use tobacco were 2.48 (1.98-7.98) and 2.86 (1.74-7.34) times less likely to be ill, respectively. Likewise, women who consumed junk food; did not regularly exercise, meditate, or worship; and had irregular sleeping habits were 1.65 (1.32-4.61), 2.81(1.91-5.62), 2.56 (2.01-4.88), 4.56 (3.91-8.26), and 2.45 (2.12-5.03) times more likely to become ill, respectively.

Conclusion

Our study concludes that spiritual behavior is effective for better health and low risk for disease occurrence. A spiritual health policy and separate curriculum for basic education and medical education should be promoted globally, and further research is recommended.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs

OBJECTIVE

To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis.

METHODS

A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement).

RESULTS

The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B).

CONCLUSION

Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States

Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.

Fire-Needle Moxibustion for the Treatment of Knee Osteoarthritis: A Meta-Analysis

Objectives. The aim of this study was to evaluate the effectiveness of fire-needle moxibustion as an intervention in the treatment of knee osteoarthritis (KOA). Methods. An updated meta-analysis of randomized controlled trials (RCTs) on fire-needle moxibustion in treating KOA was conducted by searching PubMed, Embase, the Cochrane Library, Web of Science, Wanfang database, and the Chinese Medical Database (CNKI) since their inception through March 2016. The meta-analysis was performed using RevMan 5.3. Results. Thirteen RCTs were identified in the systematic study which consisted of 1179 participants. Fire-needle moxibustion treatment group had a statistical significance on recovery rate as well as recovery and marked-improvement rate compared with control group. Subgroup analysis indicated that there was significant difference between fire-needle moxibustion group and control group. However, GRADE analysis indicated that the quality of evidence for all outcomes was relatively low. Only two of 13 studies reported adverse reactions (difficulty in movement and intolerance of cold). Conclusion. This meta-analysis suggests that fire-needle moxibustion is more effective than control group in symptom management of KOA. Further high quality trials should be conducted to evaluate the effectiveness of fire-needle moxibustion on KOA.

A systematic review and meta-analysis on the effects of yoga on weight-related outcomes

INTRODUCTION

Overweight and obesity are among the most important modifiable risk factors for chronic diseases and premature death. The aim of this review was to systematically assess and analyze the effects of yoga on weight-related outcomes.

METHODS

Medline/PubMed, Scopus, and the Cochrane Library were screened through March 2015 for randomized controlled trials on yoga for weight-related outcomes in the general population or overweight/obese individuals. Risk of bias was assessed using the Cochrane risk of bias tool on the following domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias.

RESULTS

Out of 445 records identified during literature search, 30 trials with a total of 2173 participants were included. No effects on weight, body mass index, body fat percentage or waist circumference were found. In studies with healthy adult participants an effect of yoga compared to usual care was found regarding waist/hip ratio (SMD=--1.00; 95% CI=--1.44, -0.55; p<0.001). In studies with overweight/obese participants only, effects relative to usual care were found for body mass index (SMD=-0.99; 95% CI=-1.67, -0.31; p=0.004). Effects however were not robust against selection bias; and publication bias could not be ruled out. No intervention-related adverse events were reported.

CONCLUSIONS

Despite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.

Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review

Osteoarthritis (OA) is a highly prevalent and disabling chronic condition. Because physical activity is a key component in OA management, effective exercise interventions are needed. Yoga is an increasingly popular multimodal mind-body exercise that aims to promote flexibility, strength, endurance, and balance. Its gentle approach is potentially a safe and effective exercise option for managing OA. The purpose of this focused review is to examine the effects of yoga on OA symptoms and physical and psychosocial outcomes. A comprehensive search was conducted using seven electronic databases. Twelve reports met inclusion criteria involving a total of 589 participants with OA-related symptoms. A variety of types, frequencies, and durations of yoga interventions were reported; Hatha and Iyengar yoga were the most commonly used types. Frequency of intervention ranged from once a week to 6 days a week. Duration of the interventions ranged from 45 to 90 mins per session for 6 to 12 wks. Yoga intervention resulted in reductions in pain, stiffness, and swelling, but results on physical function and psychosocial well-being were inconclusive because of a variety of outcome measures being used.

Have complementary therapies demonstrated effectiveness in rheumatoid arthritis?

In recent decades the treatment of rheumatoid arthritis (RA) has improved thanks to the use of highly effective drugs. However, patients usually require long term therapy, which is not free of side effects. Therefore RA patients often demand complementary medicine, they seek additional sources of relief and/or less side effects. In fact 30-60% of rheumatic patients use some form of complementary medicine. Therefore, from conventional medicine, if we want to optimally treat our patients facilitating communication with them we must know the most commonly used complementary medicines. The aim of this review is to assess, based on published scientific research, what complementary therapies commonly used by patients with RA are effective and safe.

Yoga and Cognition: A Meta-Analysis of Chronic and Acute Effects

OBJECTIVES

To review and synthesize the existing literature on the effects of yoga on cognitive function by determining effect sizes that could serve as a platform to design, calculate statistical power, and implement future studies.

METHODS

Through electronic databases, we identified acute studies and randomized controlled trials (RCTs) of yoga that reported cognitive outcomes. Inclusion criteria included the following: use of an objective measure of cognition and sufficient data reported to estimate an effect size. The meta-analysis was conducted using Comprehensive Meta-Analysis software. A random-effects model was used to calculate the overall weighted effect sizes, expressed as Hedge g.

RESULTS

Fifteen RCTs and 7 acute exposure studies examined the effects of yoga on cognition. A moderate effect (g = 0.33, standard error = 0.08, 95% confidence interval = 0.18-0.48, p < .001) of yoga on cognition was observed for RCTs, with the strongest effect for attention and processing speed (g = 0.29, p < .001), followed by executive function (g = 0.27, p = .001) and memory (g = 0.18, p = .051). Acute studies showed a stronger overall effect of yoga on cognition (g = 0.56, standard error = 0.11, 95% confidence interval = 0.33-0.78, p < .001). The effect was strongest for memory (g = 0.78, p < .001), followed by attention and processing speed measures (g = 0.49, p < .001) and executive functions (g = 0.39, p < .003).

CONCLUSIONS

Yoga practice seems to be associated with moderate improvements in cognitive function. Although the studies are limited by sample size, heterogeneous population characteristics, varied doses of yoga interventions, and a myriad of cognitive tests, these findings warrant rigorous systematic RCTs and well-designed counterbalanced acute studies to comprehensively explore yoga as a means to improve or sustain cognitive abilities across the life span.

Expectations and effects of a single yoga session on pain perception

Background:

Several studies show yoga may benefit chronic pain management. We investigated the effect of a single yoga session on the perception of pain, measured by a standardized pain provocation test in healthy yoga participants while also comparing pain perception to participants’ own expectations.

Materials and Methods:

Ninety yoga participants were recruited at hatha yoga schools in Switzerland. Pain perception was measured with a standardized algometric pain provocation test; i.e., a calibrated peg was applied for 10 seconds after which the participant rated pain intensity on a 0–10 numerical rating scale. The test was applied to the middle finger, ear lobe, and second toe before and after a 60-minute yoga session.

Results:

Sixty out of 90 (66.7%) yoga participants expected a reduced pain perception after the yoga session. However, 36 (40%) participants actually experienced less pain after compared to before the yoga session. But overall, pain perception statistically did not significantly change from before to after the yoga session at any of the three body locations assessed. The expectations and also the previous yoga experience did not significantly influence the participants’ pain perception.

Conclusions:

Regardless of the high positive expectations on the influence of yoga on pain, a single yoga session does not significantly influence pain perception induced by a pain provocation test. Hypoalgesic effects of yoga should be explained otherwise.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Meeting the public health challenge of pain in later life: what role can senior centers play?

Interest in nonpharmacologic approaches for managing pain continues to grow. The aim of this study was to determine the types of pain-relevant programs offered by senior centers and whether the programs varied by clients' race/ethnicity status and center size. A telephone survey was conducted. Respondents were presented with a list of 15 programs and the option to choose "other" and asked (1) whether the activity was offered and, if so, how often; (2) if they believed the programs had value for seniors with pain; and (3) whether the classes were advertised as a means of achieving pain relief. Of 204 center staff contacted, 195 (95.6%) participated. The most common programs offered were movement-based, including exercise (by 91.8% of the centers), dance (72.3%), walking clubs (71.8%), yoga (65.6%), and Tai Chi (53.3%) classes. Creative arts programs were also frequently offered, including music (58.5%) and fine arts (47.7%). Programs such as stress management (27%) and relaxation (26%) classes were less commonly offered. Most respondents identified movement-based programs as helpful for seniors with pain, but few identified creative arts classes as potentially beneficial. The programs/classes offered were infrequently advertised as a means of helping seniors manage pain and varied by clients' race/ethnicity status and center size. Programs that have potential utility for older adults with pain are commonly offered by senior centers. Future research should determine optimal strategies for engaging older adults in these programs in the senior center setting.

Comparison groups in yoga research: a systematic review and critical evaluation of the literature

OBJECTIVES

Comparison groups are essential for accurate testing and interpretation of yoga intervention trials. However, selecting proper comparison groups is difficult because yoga comprises a very heterogeneous set of practices and its mechanisms of effect have not been conclusively established.

METHODS

We conducted a systematic review of the control and comparison groups used in published randomized controlled trials (RCTs) of yoga.

RESULTS

We located 128 RCTs that met our inclusion criteria; of these, 65 included only a passive control and 63 included at least one active comparison group. Primary comparison groups were physical exercise (43%), relaxation/meditation (20%), and education (16%). Studies rarely provided a strong rationale for choice of comparison. Considering year of publication, the use of active controls in yoga research appears to be slowly increasing over time.

CONCLUSIONS

Given that yoga has been established as a potentially powerful intervention, future research should use active control groups. Further, care is needed to select comparison conditions that help to isolate the specific mechanisms of yoga's effects.

Why practice yoga? Practitioners’ motivations for adopting and maintaining yoga practice

We examined motives for adopting and maintaining yoga practice in a national survey of yoga practitioners (360 yoga students, 156 yoga teachers). Both students and teachers adopted yoga practice primarily for exercise and stress relief, but reported many other reasons, including flexibility, getting into shape, and depression/anxiety relief. Over 62 percent of students and 85 percent of teachers reported having changed their primary reason for practicing or discovering other reasons; for both, the top changed primary reason was spirituality. Findings suggest that most initiate yoga practice for exercise and stress relief, but for many, spirituality becomes their primary reason for maintaining practice.

The effects of mind-body therapies on the immune system: meta-analysis

Importance

Psychological and health-restorative benefits of mind-body therapies have been investigated, but their impact on the immune system remain less defined.

Objective

To conduct the first comprehensive review of available controlled trial evidence to evaluate the effects of mind-body therapies on the immune system, focusing on markers of inflammation and anti-viral related immune responses.

Methods

Data sources included MEDLINE, CINAHL, SPORTDiscus, and PsycINFO through September 1, 2013. Randomized controlled trials published in English evaluating at least four weeks of Tai Chi, Qi Gong, meditation, or Yoga that reported immune outcome measures were selected. Studies were synthesized separately by inflammatory (n = 18), anti-viral related immunity (n = 7), and enumerative (n = 14) outcomes measures. We performed random-effects meta-analyses using standardized mean difference when appropriate.

Results

Thirty-four studies published in 39 articles (total 2, 219 participants) met inclusion criteria. For inflammatory measures, after 7 to 16 weeks of mind-body intervention, there was a moderate effect on reduction of C-reactive protein (effect size [ES], 0.58; 95% confidence interval [CI], 0.04 to 1.12), a small but not statistically significant reduction of interleukin-6 (ES, 0.35; 95% CI, −0.04 to 0.75), and negligible effect on tumor necrosis factor-α (ES, 0.21; 95% CI, −0.15 to 0.58). For anti-viral related immune and enumerative measures, there were negligible effects on CD4 counts (ES, 0.15; 95% CI, −0.04 to 0.34) and natural killer cell counts (ES, 0.12, 95% CI −0.21 to 0.45). Some evidence indicated mind-body therapies increase immune responses to vaccination.

Conclusions

Mind-body therapies reduce markers of inflammation and influence virus-specific immune responses to vaccination despite minimal evidence suggesting effects on resting anti-viral or enumerative measures. These immunomodulatory effects, albeit incomplete, warrant further methodologically rigorous studies to determine the clinical implications of these findings for inflammatory and infectious disease outcomes.

Establishing key components of yoga interventions for musculoskeletal conditions: a Delphi survey

BACKGROUND

Evidence suggests yoga is a safe and effective intervention for the management of physical and psychosocial symptoms associated with musculoskeletal conditions. However, heterogeneity in the components and reporting of clinical yoga trials impedes both the generalization of study results and the replication of study protocols. The aim of this Delphi survey was to address these issues of heterogeneity, by developing a list of recommendations of key components for the design and reporting of yoga interventions for musculoskeletal conditions.

METHODS

Recognised experts involved in the design, conduct, and teaching of yoga for musculoskeletal conditions were identified from a systematic review, and invited to contribute to the Delphi survey. Forty-one of the 58 experts contacted, representing six countries, agreed to participate. A three-round Delphi was conducted via electronic surveys. Round 1 presented an open-ended question, allowing panellists to individually identify components they considered key to the design and reporting of yoga interventions for musculoskeletal conditions. Thematic analysis of Round 1 identified items for quantitative rating in Round 2; items not reaching consensus were forwarded to Round 3 for re-rating.

RESULTS

Thirty-six panellists (36/41; 88%) completed the three rounds of the Delphi survey. Panellists provided 348 comments to the Round 1 question. These comments were reduced to 49 items, grouped under five themes, for rating in subsequent rounds. A priori group consensus of ≥80% was reached on 28 items related to five themes concerning defining the yoga intervention, types of yoga practices to include in an intervention, delivery of the yoga protocol, domains of outcome measures, and reporting of yoga interventions for musculoskeletal conditions. Additionally, a priori consensus of ≥50% was reached on five items relating to minimum values for intervention parameters.

CONCLUSIONS

Expert consensus has provided a non-prescriptive reference list for the design and reporting of yoga interventions for musculoskeletal conditions. It is anticipated future research incorporating the Delphi guidelines will facilitate high quality international research in this field, increase homogeneity of intervention components and parameters, and enhance the comparison and reproducibility of research into the use of yoga for the management of musculoskeletal conditions.

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

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

Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial

BACKGROUND

Osteoarthritis (OA) is a common problem in older women that is associated with pain and disabilities. Although yoga is recommended as an exercise intervention to manage arthritis, there is limited evidence documenting its effectiveness, with little known about its long term benefits. This study's aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA.

METHODS

Eligible participants (N=36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control. The yoga intervention program was developed by a group of yoga experts (N=5). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks. The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey. Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks.

RESULTS

The recruitment target was met, with study retention at 95%. Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3 [.67], 5.8 [.67]; p=.01), stiffness (4.7 [.28], 3.4 [.28]; p=.002) and SPPB (repeated chair stands) (2.0 [.23], 2.8 [.23]; p=.03) at 8 weeks. Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4 [.54]; p=.03), function (24.5 [1.8], 19.9 [1.6]; p=.01) and total scores (35.4 [2.3], 28.6 [2.1]; p=.01) from 4 to 20 weeks. Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks. Changes in BMI and QOL were not significant. No yoga related adverse events were observed.

CONCLUSIONS

A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01832155.

Yoga in rheumatic diseases

Yoga is a popular activity which may be well suited to some individuals with specific rheumatic disorders. Regular yoga practice can increase muscle strength and endurance, proprioception, and balance, with emphasis on movement through a full range of motion to increase flexibility and mobility. Additional beneficial elements of yoga include breathing, relaxation, body awareness, and meditation, which can reduce stress and anxiety and promote a sense of calmness, general well-being, and improved quality of life. Yoga also encourages a meditative focus, increased body awareness and mindfulness; some evidence suggests yoga may help reduce inflammatory mediators including C-reactive protein and interleukin-6. Yoga is best learned under the supervision of qualified teachers who are well informed about the potential musculoskeletal needs of each individual. Here, we briefly review the literature on yoga for healthy, musculoskeletal, and rheumatic disease populations and offer recommendations for discussing ways to begin yoga with patients.

An assessment of the effects of Iyengar yoga practice on the health-related quality of life of patients with chronic respiratory diseases: a pilot study

OBJECTIVE

To assess the effects of an Iyengar yoga program (IYP) on patients with chronic respiratory diseases.

METHODS

Patients attending lung transplant clinics in a tertiary institution were invited to participate in a two-phase, 12-week IYP that included 2 h biweekly classes. Doctors completed a formal physical and clinical assessment on candidates before enrollment. Patients with New York Association Class III or IV, or dyspnea grade IV were excluded. At baseline and at the end of 12-weeks, patients completed the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ) and Health Utilities Index (HUI). Medication(s), 6 min walk test results and other clinical parameters were also recorded. Patients recorded the effects of the IYP on their daily living in journals. Nonparametric and qualitative methods were used to analyze the data.

RESULTS

Twenty-five patients diagnosed with pulmonary arterial hypertension and chronic obstructive pulmonary disease (mean age 60 years) were invited to participate. At the end of the 12-week period, changes in HADS anxiety and CRQ fatigue scores were statistically significant (P<0.05) and changes in HUI ambulation, pain, emotion and overall score were clinically important. The content of the journals revealed patients' improvement in breathing capacity, mobility, energy, sleep and included positive feedback such as: "increased tidal volume with slowing expiration", "I have an overall feeling of wellbeing" and "excellent amount of energy".

CONCLUSIONS

The findings suggest that yoga has significant potential to produce benefits. Potential benefits will be further explored in a national multisite study.

Yoga as an Alternative and Complementary Approach for Arthritis

In the United States, approximately 21% of the adults suffer from arthritis. Yoga offers one possible way of managing arthritis. The purpose of this study was to look at studies from 2010 to June 2013 and examine whether yoga can be an efficacious approach for managing arthritis. A systematic search from Medline, Cumulative Index to Nursing and Allied Health, and Alt HealthWatch databases was conducted for quantitative articles involving all schools of yoga. A total of 9 articles met the inclusion criteria. Five of these were from the United States and 4 from India. Of the 9 studies, 6 demonstrated positive changes in psychological or physiological outcomes related to arthritis. Despite the limitations not all studies using randomized controlled design, having smaller sample sizes, having different outcomes, having nonstandardized yoga intervention, not using behavioral theory, and having varying lengths, yoga appears to be a promising modality for arthritis.

Predictors of yoga use among internal medicine patients

BACKGROUND

Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients.

METHODS

A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors.

RESULTS

Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated with yoga use.

CONCLUSION

Yoga was used for their primary medical complaint by 12.19% of an internal integrative medicine patient population and was commonly perceived as beneficial. Yoga use was not associated with the patients' specific diagnosis but with sociodemographic factors, mental health, and health locus of control. To improve adherence to yoga practice, it should be considered that male, younger, and anxious patients and those with low internal health locus of control might be less intrinsically motivated to start yoga.

Quality of life and mental health in patients with chronic diseases who regularly practice yoga and those who do not: a case-control study

While clinical trials have shown evidence of efficacy of yoga in different chronic diseases, subjective health benefits associated with yoga practice under naturalistic conditions have not yet been investigated. The aim of this study was to investigate associations of regular yoga practice with quality of life and mental health in patients with chronic diseases. Using a case-control design, patients with chronic diseases who regularly practiced yoga were selected from a large observational study and compared to controls who did not regularly practice yoga and who were matched individually to each case on gender, main diagnosis, education, and age (within 5 years). Patients' quality of life (SF-36 questionnaire), mental health (Hospital Anxiety and Depression Scale), life satisfaction, and health satisfaction (Questionnaire for Life Satisfaction) were assessed. Patients who regularly practiced yoga (n = 186) had a better general health status (P = 0.012), a higher physical functioning (P = 0.001), and physical component score (P = 0.029) on the SF-36 than those who did not (n = 186). No group differences were found for the mental scales of the SF-36, anxiety, depression, life satisfaction, or health satisfaction. In conclusion, practicing yoga under naturalistic conditions seems to be associated with increased physical health but not mental health in chronically diseased patients.

Overview of systematic reviews: yoga as a therapeutic intervention for adults with acute and chronic health conditions

Objectives. Overview the quality, direction, and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult populations. Methods. We searched for systematic reviews in 10 online databases, bibliographic references, and hand-searches in yoga-related journals. Included reviews satisfy Oxman criteria and specify yoga as a primary intervention in one or more randomized controlled trials for treatment in adults. The AMSTAR tool and GRADE approach evaluated the methodological quality of reviews and quality of evidence. Results. We identified 2202 titles, of which 41 full-text articles were assessed for eligibility and 26 systematic reviews satisfied inclusion criteria. Thirteen systematic reviews include quantitative data and six papers include meta-analysis. The quality of evidence is generally low. Sixteen different types of health conditions are included. Eleven reviews show tendency towards positive effects of yoga intervention, 15 reviews report unclear results, and no, reviews report adverse effects of yoga. Yoga appears most effective for reducing symptoms in anxiety, depression, and pain. Conclusion. Although the quality of systematic reviews is high, the quality of supporting evidence is low. Significant heterogeneity and variability in reporting interventions by type of yoga, settings, and population characteristics limit the generalizability of results.

A pilot study of yoga as self-care for arthritis in minority communities

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.

"More than I expected": perceived benefits of yoga practice among older adults at risk for cardiovascular disease

OBJECTIVE

This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program.

DESIGN

This study used a constructivist-interpretive approach to naturalistic inquiry.

SETTING

A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study.

INTERVENTION

The 8-week Iyengar yoga program included two 90-min yoga classes and five 30-min home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study.

MAIN OUTCOME MEASURES

Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process.

RESULTS

Four broad themes emerged from content analysis: practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants).

CONCLUSIONS

These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease.

Effects of yoga on mental and physical health: a short summary of reviews

This report summarizes the current evidence on the effects of yoga interventions on various components of mental and physical health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the current literature. Nevertheless, there are some meta-analyses which indicate beneficial effects of yoga interventions, and there are several randomized clinical trials (RCT's) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health. Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.

Mind-body CAM interventions: current status and considerations for integration into clinical health psychology

OBJECTIVE

Complementary and alternative medicine (CAM) is increasingly used for treating myriad health conditions and for maintaining general health. The present article provides an overview of current CAM use with a specific focus on mind-body CAM and its efficacy in treating health conditions.

METHOD

Characteristics of CAM users are presented, and then evidence regarding the efficacy of mind-body treatments (biofeedback, meditation, guided imagery, progressive muscle relaxation, deep breathing, hypnosis, yoga, tai chi, and qi gong) is reviewed.

RESULTS

Demographics associated with CAM use are fairly well-established, but less is known about their psychological characteristics. Although the efficacy of mind-body CAM modalities for health conditions is receiving a great deal of research attention, studies have thus far produced a weak base of evidence. Methodological limitations of current research are reviewed. Suggestions are made for future research that will provide more conclusive knowledge regarding efficacy and, ultimately, effectiveness of mind-body CAM. Considerations for clinical applications, including training and competence, ethics, treatment tailoring, prevention efforts, and diversity, conclude the article.

CONCLUSIONS

Integration of CAM modalities into clinical health psychology can be useful for researchers taking a broader perspective on stress and coping processes, illness behaviors, and culture; for practitioners seeking to incorporate CAM perspectives into their work; and for policy makers in directing healthcare resources wisely.

Development of Specific Aspects of Spirituality during a 6-Month Intensive Yoga Practice

The majority of research on yoga focuses on its psychophysiological and therapeutic benefits, while the spiritual aspects are rarely addressed. Changes of specific aspects of spirituality were thus investigated among 160 individuals (91% women, mean age 40.9 ± 8.3 years; 57% Christians) starting a 2-year yoga teacher training. We used standardized questionnaires to measure aspects of spirituality (ASP), mindfulness (FMI—Freiburg Mindfulness Inventory), life satisfaction (BMLSS—Brief Multidimensional Life Satisfaction Scale), and positive mood (lightheartedness/relief). At the start of the course, scores of the respective ASP subscales for search for insight/wisdom, transcendence conviction, and conscious interactions/compassion were high, while those for religious orientation were low. Within the 6 month observation period, both conscious interactions/compassion (effect size, Cohen's d = .33), Religious orientation (d = .21), Lightheartedness/Relief (d = .75) and mindfulness (d = .53) increased significantly. Particularly non-religious/non-spiritual individuals showed moderate effects for an increase of conscious interactions/compassion. The results from this study suggest that an intensive yoga practice (1) may significantly increase specific aspects of practitioners' spirituality, mindfulness, and mood, (2) that these changes are dependent in part on their original spiritual/religious self-perception, and (3) that there are strong correlations amongst these constructs (i.e., conscious interactions/compassion, and mindfulness).

Yoga for osteoarthritis: nursing and research considerations

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Current treatment guidelines recommend nonpharmacological approaches such as yoga for firstline treatment of OA. Yoga is a promising mind-body practice that includes physical postures, breathing practices, and meditative mental focus. This article presents the current evidence, as well as a proposed conceptual model for future research. Current research on yoga for OA is scant but promising, showing some evidence of reduced pain, sleep disturbance, and disability. The conceptual model described here proposes musculoskeletal effects (strengthening, flexibility, relaxation), reduction of autonomic arousal, and therapeutic cognitive patterns (distraction, mindfulness) as potentially important mechanisms of yoga. This article also describes considerations for patients and health care providers when evaluating the potential usefulness and safety of yoga programs: yoga style, instructor qualifications, and amount of time spent in yoga practice.

Chair yoga: benefits for community-dwelling older adults with osteoarthritis

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.

Effects of yoga interventions on pain and pain-associated disability: a meta-analysis

We searched databases for controlled clinical studies, and performed a meta-analysis on the effectiveness of yoga interventions on pain and associated disability. Five randomized studies reported single-blinding and had a higher methodological quality; 7 studies were randomized but not blinded and had moderate quality; and 4 nonrandomized studies had low quality. In 6 studies, yoga was used to treat patients with back pain; in 2 studies to treat rheumatoid arthritis; in 2 studies to treat patients with headache/migraine; and 6 studies enrolled individuals for other indications. All studies reported positive effects in favor of the yoga interventions. With respect to pain, a random effect meta-analysis estimated the overall treatment effect at SMD = -.74 (CI: -.97; -.52, P < .0001), and an overall treatment effect at SMD = -.79 (CI: -1.02; -.56, P < .0001) for pain-related disability. Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions.

PERSPECTIVE

This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.