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

A controlled trial assessing the acceptability and efficacy of a yoga-based eating disorder prevention program among division I athletes: Eat Breathe Thrive (EBT)

OBJECTIVE

This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes.

METHOD

Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants' completion of online surveys across three time-points.

RESULTS

Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable.

DISCUSSION

Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

Eat Breathe Thrive: an interpretative phenomenological analysis of a yoga-based eating disorder intervention

A growing body of evidence suggests that yoga-based interventions might aid in the prevention and treatment of eating disorders. The current qualitative study used Interpretative Phenomenological Analysis (IPA) to analyze the nature and degree of impact of a yoga and mindfulness-based eating disorder prevention intervention Eat Breath Thrive (EBT). Data was collected via semi-structured interviews with 16 participants over the age of 18 who took part in the EBT program between 2018 and 2022. Using IPA methodology, and after several rounds of coding, emergent themes were interpreted and organized to develop a theoretical model explaining the mechanism of change experienced and described by EBT participants. The resulting model outlines an experiential progression from psychoeducation and skill development/practice to increased mindful awareness, and empowered state experiences which led to the following outcomes: independent positive action, self-initiated positive state experiences, and increased embodied well-being. Participants reported increased self-compassion and self-acceptance, with decreased emphasis on disordered eating behaviors. Qualitative data is necessary for understanding why yoga works, from an experiential perspective. This study adds to the new, and rapidly expanding body of research supporting the positive effects of yoga and mindfulness on the prevention and treatment of eating disorders.

Yoga as an adjunct treatment for eating disorders: a qualitative enquiry of client perspectives

BACKGROUND

This qualitative enquiry explores the experiences and perspectives of individuals with an eating disorder (ED) regarding their perceptions of yoga as an adjunct intervention to psychotherapy. It also explores the feasibility, acceptability, and safety of yoga from their perspectives.

METHODS

This study used a practice-based evidence framework and employed semi-structured interviews with 16 females with an ED. Participants were asked about their perspectives on the use of yoga as an adjunct intervention in ED recovery, perceived risks and what factors supported or hindered engagement. Thematic template analysis was used.

RESULTS

Three topic areas were elaborated. The first included participants' perceptions of how yoga enhanced their ED recovery. The second included how and when participants came to find yoga in their ED recovery. The final topic explored factors that supported participants with ED to engage in yoga. These resulted in the development of guiding principles to consider when designing a yoga intervention for EDs.

CONCLUSIONS

This study adds further to the emerging evidence that yoga can bring complementary benefits to ED recovery and provides a biopsychosocial-spiritual framework for understanding these. Findings provide an understanding of how yoga programs can be adapted to improve safety and engagement for people with an ED. Yoga programs for people with EDs should be co-designed to ensure that the physical, social, and cultural environment is accessible and acceptable.

Mindful monitoring and accepting the body in physical activity mediates the associations between physical activity and positive body image in a sample of young physically active adults

Introduction

The study aimed to extend research on the possible mechanisms that explain the associations between physical activity (PA), mindfulness during PA and positive body image. In the present study, we tested the mediating role of state mindfulness during PA in the association between PA and trait body appreciation. We also explored the moderating roles of sex and body mass index (BMI) in these associations.

Methods

In total, 759 students participated in the study but after applying the inclusion criteria 539 questionnaires were approved for analysis, with a mean age of 23.3 ± 7.2 years (49.7% were women). Study participants completed the online survey, which included sociodemographic details, PA data, the State Mindfulness Scale for Physical Activity 2 (SMS-PA-2) and the Body Appreciation Scale 2 (BAS-2).

Results

Monitoring and accepting the body during exercise mediated the association between PA and body appreciation. BMI moderated the association between accepting the body during exercise and body appreciation: for heavier individuals with BMI > 24.99 kg/m2, the associations between accepting the body during exercise and body appreciation were higher (B = 0.53, p < 0.001) compared to those whose body weight was in the normal range (B = 0.21, p < 0.001).

Conclusion

Strengthening mindfulness and promoting mindful body acceptance during exercise might enhance a positive body image, especially in individuals with a higher BMI.

A single-subject research design evaluating a co-created yoga program for adults with gynecologic cancer: feasibility study protocol

BACKGROUND

Worldwide, > 1.3 million adults are diagnosed with a gynecologic cancer each year, affecting their wellbeing and quality of life. This manuscript describes the protocol for a study that sought to assess the feasibility, acceptability, and fidelity of a community-based co-created yoga program and proposed evaluative methods, and estimate program effects on self-reported outcomes.

METHODS

Using a multiple baseline single-subject research design with a follow-up phase (ABA), quantitative and qualitative data were collected from program participants and the instructor. Participants were randomly assigned to varying baseline lengths and completed weekly surveys for 3-5 weeks pre-program. Then, participants engaged in a bi-modal 12-week hatha yoga program consisting of 2 60-min group classes a week, with optional supplemental features (January-April, 2023). Participants completed surveys after classes 1, 12, and 24. All yoga classes were audio- and video-recorded. Post-program, participants completed surveys 1, 4, and 8 weeks after the last class and took part in a semi-structured interview 1 week after to discuss program acceptability, suitability, relevance, and potential benefits. Feasibility outcomes (i.e., recruitment, retention, and program adherence rates, engagement with optional program features) were tracked by the instructor assistant and study team during the study. The yoga instructor was interviewed about their experience delivering the program 2 weeks after the last class.

PLANNED ANALYSIS

Feasibility outcomes will be analyzed using descriptive statistics. Interview transcripts will be coded using reflexive thematic analysis. Class recordings will be coded using duration and frequency coding. Survey responses for self-reported outcomes will be analyzed visually and using multilevel modeling.

EXPECTED OUTCOMES

Data will help determine refinements, if any, required to the program and instructor guidebook, implementation approach, and proposed evaluation methods before scale-up projects and definitive trials are started.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05610982. November 3, 2022.

Effects of Online Mindful Somatic Psychoeducation Program on Mental Health During the COVID-19

OBJECTIVE

This study aims to determine the effects of online mindful somatic psychoeducation program (o-MSP) on mental health in female university students during the coronavirus disease-2019 (COVID-19).

METHODS

Thirty-eight female university students were randomly assigned to an intervention group (IG, n=19) or a control group (CG, n=19). IG received o-MSP for 2-hours per session, twice weekly for 4-weeks; CG maintained their usual daily routine for 4-weeks. Measurements were performed pre- and post-intervention to assess stress, anxiety, and social connectedness using Perceived Stress Scale, State-Trait Anxiety Inventory, and Social Connectedness Scale. A qualitative analysis of changes in soma and social connectedness, subjectification of the soma, and mind-body integration was conducted through online interviews.

RESULTS

Regarding stress and social connectedness, there were no significant difference between the groups (p>0.05). However, significant differences were observed in the main effect of time of measurement and time×group interaction, with IG showing significant improvement post-intervention, unlike CG (p<0.05). Regarding anxiety, there were significant differences in the main effect of time of measurement, time×group interaction, and group factor (p<0.05). Post-intervention, CG did not show a significant change, while IG showed a significant decrease (p<0.05). Qualitative analysis revealed that participants experienced "changes in soma and social connectedness," "subjectification of soma-body," and "embodiment of mind-body integration," and reported improved mental health.

CONCLUSION

The o-MSP effectively reduced stress and anxiety in female university students and improved social connectedness. This suggests that o-MSP can be used to manage the mental health of university students in various settings.

Mindfulness, Physical Activity and Sports Participation: Validity Evidence of the Lithuanian Translation of the State Mindfulness Scale for Physical Activity 2 in Physically Active Young Adults

The aim of the present study was to examine the psychometric properties of the Lithuanian translation of State Mindfulness in Physical Activity (SMS-PA-2) in a sample of physically active students. A total sample of 539 students from universities and colleges (50.3% men; mean age 23.3 ± 7.2 years) were asked to provide demographical data, report physical activity (PA) and PA habits and fill in measures of trait awareness, autonomous motivation in physical activity, trait body appreciation, trait body functionality appreciation and disordered eating attitudes and behaviours and self-esteem via an online anonymous survey. Students also provided information about their participation in organized team sports, organized individual sports, recreational sports and home exercise. Results. The SMS-PA-2 replicated the original four-factor structure, with good internal consistency (except for the Accepting Mind subscale). Invariance analyses across sex groups revealed an acceptable fit of the configural, metric and scalar models. However, in the multi-group analysis, metric invariance and scalar invariance were not confirmed. The SMS-PA-2 was positively associated with leisure-time PA, PA habits, more self-determined motivation for exercise, trait awareness, trait body appreciation, trait body functionality appreciation and self-esteem. A negative association was observed between the SMS-PA-2 and disordered eating attitudes and behaviours. Home exercisers and students engaged in team sports demonstrated lower levels of state mindfulness in PA than those engaged in organized individual and recreational sports. The Lithuanian version of the SMS-PA-2 is a reliable and valid instrument for measuring state mindfulness in PA. This instrument is recommended for researchers who aim to investigate the role of state mindfulness in the PA in Lithuanian-language-speaking samples of young adults. Future studies should explore the Lithuanian version of the SMS-PA-2 by asking participants to fill questionnaires in immediately after the PA session, and measurement invariance between sexes should be further tested.

Women's experiences with yoga after a cancer diagnosis: a qualitative meta-synthesis-part I

BACKGROUND

Qualitative research on women's experiences participating in yoga after a cancer diagnosis is growing; systematic synthesis and integration of results are necessary to facilitate the transfer and implementation of knowledge among researchers and end-users. Thus, the purpose of this meta-synthesis was to: (1) integrate findings from qualitative studies, (2) compare and contrast findings to elucidate patterns or contradictions in conclusions, and (3) develop an overarching interpretation of women's experiences participating in yoga after a cancer diagnosis.

METHODS

Using meta-study methodology, six electronic databases were searched using a sensitive search strategy in November 2020, a supplemental scan of reference lists was conducted in August 2021, and the database search was replicated in October 2021. Two reviewers independently screened titles/abstracts and full-texts to determine eligibility.

RESULTS

The searches yielded 6804 citations after de-duplication. Data from 24 articles meeting the eligibility criteria were extracted, and the results, methods, and theoretical approach(es) were analyzed. The analysis revealed that there was a predominant focus on two focal points in the primary articles: (1) women's well-being and quality of life (QoL; part I) and (2) intervention preferences (part II). Five overarching categories emerged related to well-being and QoL: (1) yoga can support improvements in multiple dimensions of QoL in women diagnosed with cancer, (2) women diagnosed with cancer experience an interaction between QoL dimensions, (3) elements of yoga that support improvements in QoL dimensions, (4) breathwork and meditation are integral elements of yoga, and (5) yoga practice may support lifestyle behavior change. The articles reviewed had notable limitations related to: (1) reporting about instructor(s), content of the intervention, and environmental characteristics of the setting, (2) identifying and incorporating optimal features in the intervention design, (3) incorporating theory and real-world considerations into the study procedures, and (4) including positive and negative conceptualizations of QoL as an interconnected and multidimensional concept.

CONCLUSION

Moving forward, it remains critical to identify the ideal structure and content of yoga programs for promoting well-being and QoL among women diagnosed with cancer, as well as to explore barriers and facilitators to sustainable program implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021229253.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

How can we help you? A global investigation into girls' body image experiences in sport and intervention preferences

Existing interventions that target the intersection of girls' body image and sports participation are marginally effective, which is, in part, due to methodological limitations pertaining to intervention development (i.e., not theoretically or stakeholder informed). In this research, girls were consulted on their positive and negative body image experiences in sport and their preferences for fostering and remedying these experiences, respectively, in a new intervention. One-hundred and two girls (11-17-years; n = 91) and youth advisory board members (18-35-years; n = 15) from 13 countries participated in semi-structured focus groups and/or surveys. Template analysis of focus group and survey data resulted in 10 first-level themes and three integrative themes, which highlighted factors that both hinder and help girls' body image while playing sport, as well as girls' intervention preferences and cross-national considerations that will eventually impact the adaptation, localisation, and scaling of the intervention. Overall, girls favoured a girl and woman-only, multimodal intervention that upskilled them in appreciating their bodies, while challenging others' harmful behaviours. Stakeholder insights are crucial in creating acceptable, effective, and scalable interventions. Insights from this consultation phase will inform the development of a new scalable, evidence- and stakeholder-informed intervention that aims to foster girls' positive body image and sports enjoyment.

Internalisation of stereotyped body appearance standards and body dissatisfaction in adolescent boys: Moderating role of sports participation

The aim of this study was to test the moderating role of sport participation in the mediation model of media pressures, internalisation of appearance ideals and body dissatisfaction in adolescent boys. Five hundred and seventy adolescent boys (mean age 17.2 ± 0.45; range 15-19 years) participated in the cross-sectional study. Adolescents completed a questionnaire consisting of measures of attitudes towards sociocultural pressures on appearance, body dissatisfaction and sport participation (participation in achievement sport, leisure exercising and non-participation in any sports). Sports participation moderated the associations between the internalisation of stereotyped appearance ideals and body dissatisfaction. In athletes, the effect of internalisation of thin body ideals on body dissatisfaction was not significant, while the effect of internalisation of muscular/athletic body ideals was negative. In leisure exercisers, the effect of internalisation of muscular body ideals on body dissatisfaction was not significant, yet internalisation of thin body ideals had a significant effect on body dissatisfaction. The strongest associations between appearance ideals internalisation and body dissatisfaction were found in adolescent boys who reported no participation in sports. Sports participation might be an effective tool in decreasing the negative effect of internalisation of stereotyped appearance ideals on adolescent boys' body image.

Women's experiences with yoga after a cancer diagnosis: A qualitative meta-synthesis – Part II

A review of qualitative research exploring women's experiences with yoga after a cancer diagnosis can provide important insights into their motives, barriers, and preferences for yoga participation, which can be used to enhance engagement. In this meta-study meta-synthesis, 6 electronic databases were systematically searched to identify qualitative studies focused on women diagnosed with cancer who engage in yoga. The search yielded 6878 results after de-duplication; of these, 24 articles were eligible and included. Extracted data pertaining to the results, methods, and theoretical approach(es) were analyzed. This paper synthesizes and integrates results from 16 of the 24 articles focused on women's motives, barriers, and preferences for participating in yoga programs and interventions; it is Part II of a 2-part meta-study meta-synthesis. Motives to participate in yoga included: rehabilitation, physical activity, social support, and novel experience. Barriers centred around time constraints, lack of intentionality, online adaptation difficulties, health condition, and cost. Main approaches to delivering yoga comprised: in-person, in-person with an at-home component, asynchronous online, and synchronous online. Each mode of delivery presented its own benefits and challenges, with suggestions for improvement; participants highlighted the value of supportive and knowledgeable instructors, the ability to connect with others, and the importance of comprehensive classes focused on more than just movement. Participants' challenges also highlighted a need to actively seek solutions to anticipated challenges prior to delivering interventions and programs. Findings provide information that can be used to develop and deliver yoga interventions and programs to women diagnosed with cancer that prioritize their needs and preferences. REGISTRATION: PROSPERO; registration number: CRD42021229253; February 17, 2021.

The Value of Mind-Body Connection in Physical Activity for Older People

Exercise that targets balance and strength is proven to prevent falls in older age. The Successful AGEing yoga trial is the first large randomized controlled trial to assess the impact of yoga on falls in people aged ≥60 years. We conducted a realist process evaluation to explain the strong participant engagement observed using interviews (21 participants and three yoga instructors) and focus groups (12 participants and four yoga instructors). Results showed that relaxation, breathing, and yoga's mind-body connection created a satisfying internal focus on bodily sensation which was valued by participants. The mechanisms of mindfulness and embodiment appeared to facilitate this. Mindfulness and embodiment are also linked to, and enhance engagement with, other forms of physical activity. By focusing creatively on these mechanisms, we can develop a range of programs that target improvements in physical and mental health (including reducing falls and fear of falls) and appeal to older people.

'My words become my hands': Yoga instructors' experiences of adapting teleyoga in the SAGE fall prevention trial-A qualitative analysis

Objective

This research identifies practical lessons regarding the delivery of teleyoga. Our objectives are to (1) describe challenges and opportunities experienced by yoga instructors when moving the Successful AGEing (SAGE) yoga programme online, and (2) describe how yoga instructors adapted to manage the challenges and leverage opportunities presented by teleyoga.

Methods

This study is a secondary analysis of the data from a previous realist process evaluation of the SAGE yoga trial. The SAGE yoga trial is testing the effect of a yoga-based exercise programme on falls among 700 community-dwelling people aged 60+ years. We draw on focus groups and interviews with four SAGE yoga instructors which we analysed using previously developed programme theories combined with inductive coding and an analytical workshop.

Results

The concerns of the yoga instructors about teleyoga can be characterised into four broad issues: threats to safety, altered interpersonal dynamics, facilitating mind-body connection and difficulties with technology. The SAGE instructors identified eight modifications they used to manage these challenges: a 1:1 participant interview prior to programme commencement, more descriptive verbal instructions, increased focus on interoception, increased attention and support, slower more structured class flow, simplifying poses, adapting the studio environment and IT support.

Conclusions

We have created a typology of strategies for addressing challenges in the delivery of teleyoga for older people. As well as maximising engagement with teleyoga, these manageable strategies could be applied by other instructors to a wide range of telehealth classes, improving the uptake and adherence of beneficial online programmes and services.

Yoga and nonsuicidal self-injury: Mediational effects of self-compassion and body appreciation

Non-suicidal self-injury (NSSI) is a prevalent maladaptive body-focused behavior among youth and young adults. Yoga is associated with improved mindfulness, body image, and self-compassion; all of which are associated with decreased NSSI. This study evaluated the relationship between yoga and NSSI frequency, and if the relationship would be mediated by mindfulness, self-compassion, and/or body appreciation. Participants were recruited from a random sample of university students via email and included those with some yoga experience (N = 384; M_age = 19.98, SD = 2.20). Participants completed an anonymous online survey assessing their levels of yoga participation, NSSI, mindfulness, self-compassion, and body appreciation. Bias corrected serial mediation regression models indicated the relationship between yoga participation and NSSI frequency was significantly mediated by self-compassion followed by body appreciation. Body appreciation was also a significant single mediator of yoga's relationship with NSSI. Mindfulness was not a significant mediator in any of the analyzes. Yoga practice is associated with reduced NSSI behaviors through its positive relationships with body appreciation and self-compassion. Body appreciation appears to be an important mechanism underlying the link between yoga participation and NSSI behavior suggesting that interventions promoting positive body image, such as yoga, could be innovative strategies for clinicians to consider.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-Inclusive Yoga and Body Gratitude Journaling Intervention to Enhance Positive Embodiment in Higher Weight College Women

The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition (n = 36) or to a wait-list control (n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos ≥3–4 times per week as suggested. Although 71% reported completing the body gratitude journal ≥1–2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga vs. wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.

Spatial-Temporal Graph Convolutional Framework for Yoga Action Recognition and Grading

The rapid development of the Internet has changed our lives. Many people gradually like online video yoga teaching. However, yoga beginners cannot master the standard yoga poses just by learning through videos, and high yoga poses can bring great damage or even disability to the body if they are not standard. To address this problem, we propose a yoga action recognition and grading system based on spatial-temporal graph convolutional neural network. Firstly, we capture yoga movement data using a depth camera. Then we label the yoga exercise videos frame by frame using long short-term memory network; then we extract the skeletal joint point features sequentially using graph convolution; then we arrange each video frame from spatial-temporal dimension and correlate the joint points in each frame and neighboring frames with spatial-temporal information to obtain the connection between joints. Finally, the identified yoga movements are predicted and graded. Experiment proves that our method can accurately identify and classify yoga poses; it also can identify whether yoga poses are standard or not and give feedback to yogis in time to prevent body damage caused by nonstandard poses.

What helps older people persevere with yoga classes? A realist process evaluation of a COVID-19-affected yoga program for fall prevention

Background

Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants.

Methods

Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures.

Results

Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It’s worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga’s special properties (embodiment and mindfulness).

Conclusions

This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga’s intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12818-5.

Internalized weight stigma and intuitive eating among stressed adults during a mindful yoga intervention: associations with changes in mindfulness and self-compassion

Purpose

Internalized weight stigma (IWS) is common in the United States of America across body weight categories, and is implicated in the development of distress and unhealthy eating behaviors (e.g. overeating, disordered eating) that can foster poor cardiometabolic health. While emerging intervention research shows early promise in reducing IWS, long-term efficacy is unclear and novel strategies remain needed. This analysis examined whether participation in a mindful yoga intervention was associated with reduced IWS and increased intuitive eating, an adaptive eating behavior, and whether these changes correlated with each other or with changes in mindfulness and self-compassion.

Methods

Participants were stressed adults with low fruit and vegetable intake (N = 78, 64.1% White, M. Body Mass Index  25.59 ± 4.45) enrolled in a parent clinical trial of a 12-week mindful yoga intervention. Validated self-report measures of IWS, intuitive eating, mindfulness, and self-compassion were administered at pre-treatment, mid-treatment (8 weeks), post-treatment (12 weeks), and 4-month follow-up (24 weeks).

Results

Linear mixed modeling revealed significant improvements in IWS and intuitive eating across the four timepoints (p < .001). Reduced IWS correlated with increased intuitive eating pre- to post-treatment (p = .01). Improved self-compassion and mindfulness correlated with intuitive eating (both p = . 04), but not IWS (p = .74 and p = .56, respectively).

Conclusion

This study offers preliminary support for the hypothesis that mindful yoga may promote intuitive eating and reduce IWS among stressed adults with poor diet, and suggests that changes in these factors may co-occur over time. Further investigation with controlled designs is necessary to better understand the temporality and causality of these relationships.Trial registration: ClinicalTrials.gov identifier: NCT02098018.

Using Realist Evaluation to Understand Process Outcomes in a COVID-19-Impacted Yoga Intervention Trial: A Worked Example

Realist evaluation offers a valuable way to understand how interventions function and thus how they can be improved and locally adapted. Consequently, realist evaluation is increasingly conducted in parallel with intervention trials. It comprises a clear philosophical foundation and view of causality, pragmatic mixed data collection methods, and a theory-driven approach in which hypothesised program theories are tested and refined. However, detailed methods for data analysis are seldom well-described in realist studies and no clear method for analysing and presenting realist evaluation data has yet emerged. In this methodological paper we use the worked example of our realist process evaluation of the SAGE yoga trial to illustrate an applied process of data analysis and presentation of findings. We show how we drew on other realist studies for ideas, provide examples of six key tasks involved in conducting a realist process evaluation (including coding data and structuring results) and describe strategies that did not work and our rationale for rejecting them. This detailed account of the decisions and methods that worked for us is intended to provide a practical and informed point of departure for researchers conducting a realist evaluation.

Yoga-Based Group Intervention for In-patients With Schizophrenia Spectrum Disorders-A Qualitative Approach

Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity. Nevertheless, participants encountered challenges; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation. YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.

Prevention of eating disorders: 2020 in review

Fifteen prevention-related publications in Eating Disorders during 2020 are reviewed. Two models frame this analysis: (1) the Mental Health Intervention Spectrum: health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into a cycle: rationale, theory, and methodology, shaped by critical, integrative reviews → clarification of risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination. In this cycle the first two phases and the last phase inform advocacy for social policies supporting prevention. Ten articles comprising a special issue on yoga demonstrate the value of investing in translational prevention science that acknowledges (a) embodying experiences as a broad category of protective factors; (b) the utility of multidimensional theoretical models; and (c) social justice issues that advocacy efforts must address to make programs widely and equitably available. Other articles reviewed show, for example, that studies of emotion dysregulation and emotional eating are needed to enter a prevention cycle that moves us beyond body image (or weight/shape) concerns in defining high-risk groups and developing indicated prevention. Finally, implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies are discussed.

Updates in the treatment of eating disorders in 2020: a year in review in eating disorders: the journal of treatment & prevention

Several important studies advancing treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2020. This review summarizes the recent contributions to the literature on the treatment of eating disorders, including dialectical behavior therapy, yoga for positive embodiment, and treatment innovations in children and adolescents with eating disorders. Dialectical behavior therapy can be effectively used in complex eating disorder presentations, such as with comorbid substance use disorder and with suicidal behavior, and can be adapted for culturally-responsive treatments for binge eating and for guided self-help. Yoga may promote positive embodiment, which is supported by conceptual frameworks, studies evaluating yoga treatment interventions, and systematic reviews. Advances in eating disorder treatment for children and youth include the development of the Emotional Eating Scale adapted for children and adolescents, a review of primary care interventions for eating disorder treatment, and siblings' perspectives on eating disorder treatment. Research on novel methods including telementoring and innovative treatment modalities invoking feminism are promising areas of future research.

Translation and Validation of the Brazilian Portuguese Version of the Broad Conceptualization of Beauty Scale With Brazilian Women

In many countries, women are socialized to adopt a narrow definition of beauty. Research has revealed that, in the United States and China, the ability to broadly conceptualize beauty (perceive beauty in diverse body sizes, shapes, and appearances) is linked to women’s lower anti-fat attitudes, higher body appreciation, and higher well-being. In this study, we translated an existing measure of this construct, the Broad Conceptualization of Beauty Scale (BCBS), into Brazilian Portuguese and evaluated the factor structure and reliability and validity of its scores with a diverse sample of 563 Portuguese women. Findings revealed that the Brazilian Portuguese BCBS contains two factors—external/appearance features of beauty (BCBS-E) and internal features of beauty (BCBS-I)—contrary to the unidimensional factor structure found in previous studies. Support for internal consistency and 3-week test–retest reliability was garnered. Total BCBS and BCBS-E scores evidenced convergent, discriminant, and incremental validity, whereas the BCBS-I did not accrue substantial convergent or incremental validity support beyond its inverse bivariate association with anti-fat attitudes. We recommend the use of the Brazilian Portuguese BCBS in body image research programs as well as clinical practice and prevention programs with Brazilian women seeking support for body dissatisfaction and disordered eating.

Testing modified gender-moderated exercise and self-esteem (EXSEM) model of positive body image in adolescents

The most acceptable model explaining the associations between physical exercise and self-esteem is the exercise and self-esteem model (EXSEM). The present cross-sectional study tested the mediating role of body appreciation and physical fitness perception in the associations between physical activity and self-esteem in modified EXSEM. Overall, 1412 Lithuanian adolescents (40.2% were boys, mean age 17.0 (SD = 0.5) years) completed online questionnaires. The study was implemented in 2019 from October to December. Perceived physical fitness and body appreciation mediated the associations in the EXSEM. Physical fitness perception was directly associated with the self-esteem of girls, but not boys. Gender moderated EXSEM associations in body appreciation and perceived physical fitness showed stronger mediation effects for the adolescent girls compared to boys. Increasing physical activity, positive body image and perception of physical fitness might help to foster mental health, especially in girls.

Yoga practice among ethnically/racially diverse emerging adults: Associations with body image, mindful and disordered eating, and muscle-enhancing behaviors

BACKGROUND

This study explores cross-sectional associations between yoga and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of ethnically/racially diverse emerging adults.

METHOD

An ethnically/racially diverse population-based sample of 1,568 emerging adults (18-26 years) completed surveys as part of EAT 2010-2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI).

RESULTS

Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non-yoga practitioners to use steroids (3.8 vs. 0.7%, p < .001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p < .010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non-yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant.

DISCUSSION

Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non-yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors.

Body functionality: A review of the literature

Body functionality describes everything that the body is able to do, across diverse domains (e.g., bodily senses, creative endeavours). Nearly a decade ago, leading scholars identified research on body functionality as a priority for the body image field. The field has responded, as shown by the recent rise of body functionality research. We considered this an opportune time to (a) define body functionality (what it is and is not); (b) present theoretical frameworks of body functionality; (c) articulate first-generation and current measures relating to body functionality; (d) offer functionality-focused body image interventions that can improve appreciation for one's body functionality (and body image more broadly); (e) summarise additional areas of research related to body functionality and positive body image; and (f) provide considerations and directions for future research and interventions incorporating body functionality. Research has underscored body functionality as a valuable construct with respect to positive body image and well-being, particularly when individuals appreciate what their bodies can do and conceptualise their body functionality holistically. Yet, the experience of body functionality is nuanced across social identities. Overall, the field has greatly advanced knowledge about body functionality, and we are excited to see the next generation of research that emerges.

Nature exposure and positive body image: (Re-)examining the mediating roles of connectedness to nature and trait mindfulness

Previous studies have reported a significant association between nature exposure and positive body image, but understandings of the mechanisms that help to explain this link remain nascent. Here, we considered the extent to which trait mindfulness and connectedness to nature, respectively, mediate the aforementioned relationship both in parallel and serially. An online sample of 398 participants (199 women, 196 men, 3 other; age M = 28.1 years) from the United Kingdom completed measures of self-reported nature exposure, mindful awareness and acceptance, connectedness to nature, and body appreciation. Results indicated that inter-correlations between scores on all measures were significant and positive. Following the elimination of non-significant pathways, path analysis resulted in an adequately-fitting model in which the direct relationship between nature exposure and body appreciation was significant. In addition, connectedness to nature - but not trait mindfulness - significantly mediated the direct relationship. Finally, we also found evidence of a serial mediation, where the association between nature exposure and body appreciation was mediated by mindful awareness followed by connectedness to nature. The implications of these results for scholarly and practitioner understanding of the impact of nature exposure on positive body image are discussed in conclusion.

Future directions for research on yoga and positive embodiment

This article provides the concluding thoughts on the special issue, Yoga for Positive Embodiment in Eating Disorder Prevention and Treatment, which illustrate the progress being made on the relationship between yoga practice and the different indicators of positive embodiment that is relevant for the prevention and treatment of eating disorders. Based on the current body or work, we offer recommendations for the next steps for researchers for population-based, qualitative, and prevention and intervention research.

Eating disorders, embodiment, and yoga: a conceptual overview

Yoga and its relation to embodiment and disordered eating has only recently received research attention. Nevertheless, early research indicates that yoga is an effective tool in the prevention and treatment of eating disorders. It is assumed that yoga ameliorates eating disorder symptoms and facilitates a shift from negative towards positive body image and well-being by cultivating positive embodiment (i.e., the ability to feel a sense of connection between mind and body). In order to provide the context of the constructs of disordered eating, embodiment, and yoga, this article presents a brief overview and conceptualization of these constructs. The three major eating disorders and current treatment methods are described. Further, the philosophical roots and theoretical models of embodiment are delineated and their communal core features are outlined. Lastly, the origin, basic principles, and modern interpretations of yoga are discussed.

Yoga and eating disorder prevention and treatment: A comprehensive review and meta-analysis

Yoga is frequently used in conjunction with standard treatment approaches for eating disorders. However, yoga's efficacy and effectiveness in preventing and treating eating disorders has remained unclear. The aim of this comprehensive review and meta-analysis is to review the extant literature and assess the effects of yoga in the prevention and intervention of eating disorder symptoms and correlates in both clinical and non-clinical populations. Studies assessing yoga and its effect on eating disorder symptoms and/or body image as related to disordered eating, were eligible for inclusion. The comprehensive review details correlational, non-controlled, non-randomized controlled, and yoga comparison studies. For the meta-analysis, only randomized controlled trials comparing a yoga-based intervention to a non-yoga control group were included. In total, 43 studies are included in this review, with 11 trials involving 754 participants included in the meta-analysis. Results of the comprehensive review and meta-analyses results indicated yoga interventions demonstrated a small, significant effect on global eating disorder psychopathology, a moderate-to-large effect on binge eating and bulimia, and a small effect on body image concerns, as compared to the control conditions. There was no statistically significant effect on dietary restraint in either direction. Additionally, results indicated a small-to-moderate effect on a composite measure of eating disorder-related constructs. These findings suggest that yoga-based interventions may be an effective approach supporting the prevention and treatment of eating disorders.