Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials

Yoga and meditation for menopausal symptoms in breast cancer survivors: a qualitative study exploring participants' experiences

PURPOSE

Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, they often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore breast cancer survivors' experiences and effects of a yoga and meditation intervention supplementing previously reported RCT outcomes.

METHODS

The qualitative data included in this study were part of a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. All participants who underwent the yoga intervention (n = 19) were invited to take part in semi-structured interviews after all quantitative data collection had been completed. Interviews (n = 9) were recorded, transcribed, and then coded into superordinate themes using thematic analysis.

RESULTS

Nine female participants were interviewed, and the following themes emerged: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, and spiritual level); (4) differences between the study yoga intervention and other physical activities.

CONCLUSIONS

In accordance with the accounts of participants, yoga might offer a promising intervention for breast cancer survivors. All those interviewed either currently attended a yoga class or expressed a desire to continue practicing yoga. Additionally, our findings inform future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e., breast cancer specific), or considering that different intervention components might need different assistance to encourage long-term use.

The Effect of Yoga on Menopause Symptoms: A Randomized Controlled Trial

The research was conducted as a randomized controlled study with the aim of determining the effect of yoga on menopause symptoms. Menopausal women between the ages of 40 and 60 years were included in the research. There were 31 menopausal women in each of 2 groups, making a total of 62. A Descriptive Characteristics Form and the Menopause Rating Scale (MRS) were used to collect data. In the research, the yoga group practiced yoga for 60 minutes twice a week for 10 weeks. In the final lesson of the 10 weeks of yoga training, the women were again given the MRS. No intervention was performed on the control group. The median score on the MRS of the women in the yoga group was 16 (11-21) in the pretest, and 5 (3-9) in the posttest (P < .05). The median score on the subscale of psychological complaints of the women in the yoga group was 6 (3-8) in the pretest, and 1 (1-2) in the posttest (P < .05). The median score on the subscale of urogenital complaints of the women in the yoga group was 3 (3-5) in the pretest, and 1 (0-2) in the posttest (P < .05). The median score on the subscale of somatic complaints of the women in the yoga group was 7 (4-10) in the pretest, and 1 (1-3) in the posttest (P < .05). It was concluded from the research that 60 minutes of yoga 2 days a week for 10 weeks may reduce the psychological, somatic, and urogenital symptoms experienced in menopause.

Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis

OBJECTIVE

To investigate the effects of yoga on depressive symptoms, anxiety, sleep quality, and mood of patients with rheumatic diseases through a systematic literature review with meta-analysis.

LITERATURE SURVEY

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Cochrane recommendations and risk of bias tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Studies were selected using the PICOS (participants, intervention, comparison, outcome, and study) strategy. Searches were carried out until March 2022 and performed in Web of Science, PubMed, SportDiscus, Scopus, Cochrane, and EBSCO databases.

METHODOLOGY

Data were extracted to identify the differences between yoga and control and exercise groups and effect sizes.

SYNTHESIS

In total, 27 studies were included for qualitative analysis and 18 for meta-analysis. The studies found investigated yoga in patients with osteoarthritis, fibromyalgia, rheumatoid arthritis, and chronic fatigue syndrome. Regarding the risk of bias, the majority of studies showed a high risk or uncertain risk of bias in several criteria. Regarding the meta-analysis, yoga was favored to decrease depressive symptoms (standard mean difference [SMD]:-0.88; 95% confidence interval [CI]:-1.42; -0.34), anxiety (SMD: -0.51; 95% CI = -0.81 to -0.20), and improve sleep quality SMD = -0.96; 95% CI = -1.36 to -0.56). No differences were found between yoga and other exercise modalities in depression (p < .01).

CONCLUSIONS

Yoga is effective in improving depression, anxiety, and sleep quality of patients with rheumatic diseases. However, research in this field still needs further studies, because of methodological issues in the studies and a reduced number of studies conducted on each rheumatic disease and on the effects of yoga on each variable.

The effect of yoga on pulmonary function in patients with asthma: A meta-analysis

BACKGROUND

Asthma is one of the most common non-communicable diseases. Yoga with physical postures, breathing exercises, meditation, and relaxation may play an essential role in the complementary management of lower respiratory diseases. The study aimed to evaluate the impact of yoga (posture, breathing exercises, and meditation) on pulmonary function tests, asthma control tests, and health-related quality of adult asthmatic patients.

METHODS

MEDLINE, PubMed, Embase, Cochrane, Scopus, Google Scholar, ResearchGate, Clinical Key, and Academia electronic search engines were explored to search the relevant literature. The present study included adult asthmatic patients (age -18 and 60 years) with mild to moderate asthma, per GINA (Global Initiative for Asthma) guidelines. The effect of yoga was assessed on the following outcomes; pulmonary function tests, including FeV1 (Forced expiratory volume 1 s), FVC (Forced vital capacity), FeV1/FVC, peak expiratory flow rate (PEFR), health-related quality of life, and asthma control test. A fixed-effect model was applied to compute significance for statistical heterogeneity. P-value <0.05 was considered for statistical significance.

RESULTS

Finally, fifteen articles were included for meta-analysis. The forest plot for overall effect of yoga intervention and usual care favors the yoga intervention for improvement in pulmonary function as FeV1 (SMD = 0.96, CI = 0.77-1.14, I2 = 54%), FVC (SMD = 0.35, CI = 0.14-0.55, p = 0.11, I2 = 50%), Fev1/FVC (SMD = 0.18, CI = -0.38-0.02, p = 0.02, I2 = 50%), PEFR (SMD = 0.38, CI = 0.18-0.58, p = 0.0003, I2 = 0%), asthma control test (SMD = 0.16, CI = 0.15-0.48, p = 0.31, I2 = 86%) and health-related quality of life (SMD = 0.26, CI = 0.18-0.34, p = 0.02, I2 = 51%) of asthmatic patients.

CONCLUSION

This meta-analysis provides a moderate level of evidence regarding yoga as a complementary therapy in managing mild to moderate asthmatic patients. It also adds to the current knowledge of the same.

Efficacy of the Complementary and Alternative Therapies for the Management of Psychological Symptoms of Menopause: A Systematic Review of Randomized Controlled Trials

Menopause is not a high-risk period for psychiatric illness but can cause psychological issues; the most common of which are anxiety and depression, which can impair coping and reduce women’s quality of life. Thus, many women have leaned toward complementary and alternative medicine (CAM) for the relief of menopause-related symptoms. No rigorous study exists in the literature on the effects of CAMs on the psychological symptoms of menopause despite this growing patient interest. This systematic review aimed to assess the efficacy of CAM interventions on psychological symptoms of menopause. Databases (PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar) were searched from January 2000 to May 2021 using the keywords: menopause, menopausal symptoms, psychological symptoms, and complementary and alternative medicine. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) for randomized clinical trials. Of the 704 articles found, 33 articles with 3,092 participants entered the final review. Aromatherapy, massage, yoga, and acupuncture, as well as some dietary and herbal supplements improved psychological symptoms during menopause based on the findings of the current study. However, the effectiveness of reflexology and exercise was debatable. However, necessary precautions should be taken when using them in clinical settings despite the positive effect of various CAM interventions on reducing psychological symptoms. More studies with a higher methodology quality are required to make better decisions about the effect of various CAM interventions on the psychological symptoms of menopause.

Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle

OBJECTIVE

Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence.

TARGET POPULATION

Perimenopausal and postmenopausal women.

BENEFITS, HARMS, AND COSTS

Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment.

EVIDENCE

Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Directive clinique no 422a : Ménopause : symptômes vasomoteurs, agents thérapeutiques d'ordonnance, médecines douces et complémentaires, nutrition et mode de vie

OBJECTIF

Proposer des stratégies pour améliorer les soins aux femmes ménopausées ou en périménopause d'après les plus récentes données probantes publiées.

POPULATION CIBLE

Femmes ménopausées ou en périménopause. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées que leur communiqueront les fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques offertes pour la prise en charge des symptômes et morbidités associés à la ménopause, y compris l'abstention thérapeutique. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, Medline et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: médecins, y compris gynécologues, obstétriciens, médecins de famille, internistes, urgentologues; infirmières, y compris infirmières autorisées et infirmières praticiennes; pharmaciens; stagiaires, y compris étudiants en médecine, résidents, moniteurs cliniques; et autres fournisseurs de soins auprès de la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

The influence of phytoestrogens on different physiological and pathological processes: An overview

Functional foods have nutritional properties and organic functions, which are beneficial to health. Certain types of functional food components are so-called phytoestrogens, non-steroidal compounds derived from the metabolism of precursors contained in plants, which originate secondary metabotypes known to induce biological responses and by mimicry or modulating the action of endogenous estrogen. These molecules are involved in several physiological and pathological processes related to reproduction, bone remodeling, skin, cardiovascular, nervous, immune systems, and metabolism. This review aimed to present an overview of phytoestrogens regarding their chemical structure, actions, and effects in the organism given several pathologies. Several studies have demonstrated beneficial phytoestrogen actions, such as lipid profile improvement, cognitive function, menopause, oxidative stress, among others. Phytoestrogens effects are not completely elucidated, being necessary future research to understand the exact action mechanisms, whether they are via estrogen receptor or whether other hidden mechanisms produce these effects. Thus, this review makes a general approach to the phytoestrogen actions, beneficial effects, risk and limitations. However, the complexities of biological effects after ingestion of phytoestrogens and the differences in their metabolism and bioavailability indicate that interpretation of either risk or benefits needs to be made with caution.

Complementary and Alternative Medicine for Menopause

Menopause is associated with problematic symptoms, including hot flashes, sleep problems, mood disorders, sexual dysfunction, weight gain, and declines in cognitive functioning. Many women seek complementary and alternative medicine (CAM) for symptom management. This article critically reviews the existing literature on CAM treatments most commonly used for menopausal symptoms. Electronic searches were conducted to identify relevant, English-language literature published through March 2017. Results indicate that mind and body practices may be of benefit in reducing stress and bothersomeness of some menopausal symptoms. In particular, hypnosis is a mind-body intervention that has consistently shown to have a clinically significant effect on reducing hot flashes. Evidence is mixed in regard to the efficacy of natural products and there are some safety concerns. Health care providers should consider the evidence on CAM in providing an integrative health approach to menopausal symptom management.

Reasons, Years and Frequency of Yoga Practice: Effect on Emotion Response Reactivity

Yoga practice, even in the short term, is supposed to enhance wellbeing and counteract psychopathology through modification of emotion reactivity. Yoga teaches that emotional responses may be less pronounced with longer and more frequent practice, and potentially when people perform yoga for mental rather than physical reasons. We tested 36 yoga practitioners of varying experience (between 6 months and 11 years of practice). We assessed participants’ self-reported emotional experience and peripheral physiological reactions (heart rate, skin conductance, respiration) when seeing positive and negative pictures. Results were analyzed as a function of the years of, frequency of, and reasons for yoga practice. We found a heart rate increase with the degree participants performed yoga for mental reasons. In addition, years of yoga practice were significantly associated with reduced abdominal respiratory rate when facing negative pictures, speaking in favor of reduced arousal with yoga experience. Finally, regarding frequency of practice, a higher frequency in the last month was linked to less negative and positive experiences as well as a reduced abdominal respiratory amplitude when viewing positive pictures. Altogether, these results demonstrate that intense short-term yoga practice might relate to a (i) decrease in the intensity of self-reported emotional experiences and (ii) deepened respiration. Short-term effects might be shaped by what participants expect as practice benefits. However, several years of practice might be needed to decrease respiratory arousal in the face of negative situations, which likely is a manifestation of an evolution in the emotion regulation process.

Incidence of menopausal symptoms in postmenopausal breast cancer patients treated with aromatase inhibitors

Aromatase inhibitors (AIs) are the standard of care for postmenopausal women with estrogen receptor-positive breast cancer. Here, we performed a meta-analysis to evaluate the occurrence of menopausal symptoms in breast cancer patients receiving the AI therapy. Patients treated with AIs had an increased risk of all-grade arthralgia (1.63 [95% CI: 1.34–1.98]) and insomnia (1.24 [95% CI: 1.14–1.34]). The overall incidence of hot flashes, fatigue, arthralgia, sweating, and insomnia in patients receiving AIs was 30.47% (95% CI: 25.51%–35.93%), 17.16% (95% CI: 14%–20.85%), 17.91% (95% CI: 11.29%–27.22%), 14.64% (95% CI: 11.46%–18.52%), and 16.52% (95% CI: 12.45%–21.6 %), respectively. Both arthralgia (RR = 0.34, 95% CI: 0.16–0.75) and sweating (RR = 11.02, 95% CI: 4.11–29.57) differed between patients with early- and advanced-stage breast cancer. Our findings indicates that AIs are associated with a significant risk of developing arthralgia and insomnia in breast cancer patients. Effective early detection and management of menopausal symptoms would likely lead to safer use of AIs in breast cancer patients.

Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome is the most frequent gastrointestinal disorder. It is assumed that lifestyle interventions might be a rational treatment approach.

AIM

To examine the effect of a yoga-based intervention vs a low-FODMAP diet on patients with irritable bowel syndrome.

METHODS

Fifty-nine patients with irritable bowel syndrome undertook a single-blind, randomised controlled trial involving yoga or a low-FODMAP diet for 12 weeks. Patients in the yoga group received two sessions weekly, while patients in the low-FODMAP group received a total of three sessions of nutritional counselling. The primary outcome was a change in gastrointestinal symptoms (IBS-SSS). Secondary outcomes explored changes in quality of life (IBS-QOL), health (SF-36), perceived stress (CPSS, PSQ), body awareness (BAQ), body responsiveness (BRS) and safety of the interventions. Outcomes were examined in weeks 12 and 24 by assessors "blinded" to patients' group allocation.

RESULTS

No statistically significant difference was found between the intervention groups, with regard to IBS-SSS score, at either 12 (Δ = 31.80; 95%CI = -11.90, 75.50; P = .151) or 24 weeks (Δ = 33.41; 95%CI = -4.21, 71.04; P = .081). Within-group comparisons showed statistically significant effects for yoga and low-FODMAP diet at both 12 and 24 weeks (all P < .001). Comparable within-group effects occurred for the other outcomes. One patient in each intervention group experienced serious adverse events (P = 1.00) and another, also in each group, experienced nonserious adverse events (P = 1.00).

CONCLUSIONS

Patients with irritable bowel syndrome might benefit from yoga and a low-FODMAP diet, as both groups showed a reduction in gastrointestinal symptoms. More research on the underlying mechanisms of both interventions is warranted, as well as exploration of potential benefits from their combined use.

Yoga for menopausal symptoms-A systematic review and meta-analysis

OBJECTIVES

To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms.

METHODS

Medline (via PubMed), the Cochrane Central Register of Controlled Trials, and Scopus were screened through to February 21, 2017 for randomized controlled trials (RCTs) comparing the effects of yoga on menopausal symptoms to those of no treatment or active comparators. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Two authors independently assessed risk of bias using the Cochrane risk of bias tool.

RESULTS

Thirteen RCTs with 1306 participants were included. Compared with no treatment, yoga reduced total menopausal symptoms (SMD=-1.05; 95% CI -1.57 to -0.53), psychological (SMD=-0.75; 95% CI -1.17 to -0.34), somatic (SMD=-0.65; 95% CI -1.05 to -0.25), vasomotor (SMD=-0.76; 95% CI -1.27 to -0.25), and urogenital symptoms (SMD=-0.53; 95% CI -0.81 to -0.25). Compared with exercise controls, only an effect on vasomotor symptoms was found (SMD=-0.45; 95% CI -0.87 to -0.04). Effects were robust against selection bias, but not against detection and attrition bias. No serious adverse events were reported.

CONCLUSION

Yoga seems to be effective and safe for reducing menopausal symptoms. Effects are comparable to those of other exercise interventions.

Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis

OBJECTIVES

Vasomotor symptoms (VMS), commonly reported during menopausal transition, negatively affect psychological health and health-related quality of life (HRQoL). While hormone therapy is an effective treatment, its use is limited by concerns about possible harms. Thus, many women with VMS seek nonhormonal, nonpharmacologic treatment options. However, evidence to guide clinical recommendations is inconclusive. This study reviewed the effectiveness of yoga, tai chi and qigong on vasomotor, psychological symptoms, and HRQoL in peri- or post-menopausal women.

DESIGN

MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL and the Allied and Complementary Medicine Database were searched. Researchers identified systematic reviews (SR) or RCTs that evaluated yoga, tai chi, or qigong for vasomotor, psychological symptoms, and health-related quality of life (HRQoL) in peri- or post-menopausal women. Data were abstracted on study design, participants, interventions and outcomes. Risk of bias (ROB) was assessed and updated meta-analyses were performed.

RESULTS

We identified one high-quality SR (5 RCTs, 582 participants) and 3 new RCTs (345 participants) published after the SR evaluating yoga for vasomotor, psychological symptoms, and HRQoL; no studies evaluated tai chi or qigong. Updated meta-analyses indicate that, compared to controls, yoga reduced VMS (5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.49 to -0.05) and psychological symptoms (6 trials, SDM -0.32; 95% CI -0.47 to -0.17). Effects on quality of life were reported infrequently. Key limitations are that adverse effects were rarely reported and outcome measures lacked standardization.

CONCLUSIONS

Results from this meta-analysis suggest that yoga may be a useful therapy to manage bothersome vasomotor and psychological symptoms.

The Effect of Yoga on Menstrual Disorders: A Systematic Review

OBJECTIVE

To summarize and evaluate evidence for the effect of yoga on menstrual disorders.

METHODS

PubMed, CINAHL/MEDLINE, Web of Science, AMED, and Scopus were searched for English-language literature relevant to the review question. All primary research studies were included.

RESULTS

Fifteen studies described in 18 papers were included in the review. A range of yoga interventions were used. Some studies used a combination of Asana, Pranayama, and other yogic relaxation or meditation techniques. All included studies reported some change in their outcome measures, suggesting reduced symptoms of menstrual distress following a yoga intervention; however, the heterogeneity and intensity of the interventions and outcome measures meant that findings have limited generalizability and applicability in practice settings.

CONCLUSIONS

Further research on the relationship between yoga practice and menstrual disorders is warranted, but there must be both consistency in the methods, measures, and quality of studies and a shift toward research on yoga practices that are replicable outside of the clinical trial setting.

Broadening our perspectives on complementary and alternative medicine for menopause: A narrative review

Complementary and alternative medicine (CAM) is widely used for menopause, although not all women disclose use to their healthcare providers. This narrative review aims to expand providers' understanding of cross-cultural approaches to treating and managing menopause by providing an overarching framework and perspective on CAM treatments. Increased provider understanding and awareness may improve not only provider-patient communication but also effectiveness of treatments. The distinction between illness (what patients suffer) and disease (what physicians treat) highlights the gap between what patients seek and doctors provide, and may help clarify why many women seek CAM at menopause. For example, CAM is often sought by women for whom biomedicine has been unsuccessful or inaccessible. We review the relevance to menopause of three CAM categories: natural products, mind-body practices including meditation, and other complementary health approaches including traditional Chinese medicine (TCM) and Japanese Kampo. Assessing the effectiveness of CAM is challenging because of the individualized nature of illness patterns and associated treatments, which complicate the design of randomized controlled trials. Because many women seek CAM due to inefficacy of biomedical treatments, or cultural or economic marginalization, biomedical practitioners who make an effort to learn about CAM and ask patients about their CAM use or interest may dramatically improve the patient-provider relationship and rapport, as well as harnessing the 'meaning response' (Moerman, 2002) imbued in the clinical encounter. By working with women to integrate their CAM-related health-seeking behaviors and treatments, providers may also boost the efficacy of their own biomedical treatments.

The Effects of Traditional Chinese Exercise in Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Traditional Chinese exercise (TCE) includes a variety of exercise, which is being accepted by more and more people in the treatment of knee osteoarthritis (OA) from different countries. With the attendant, many clinical reports focus on it. Our meta-analysis aimed to systematically assess the effects of traditional Chinese exercise on pain, stiffness, physical function, quality of life, mental health and adverse events in people with knee osteoarthritis.

METHODS

PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and Chinese Biomedical Literature Database (CBM) were searched from the time of their inception through April 2016 and risk of bias was independently assessed by two authors. Outcome measures included pain, physical functional, joint stiffness, quality of life, mental health and safety. For pooled outcomes, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

RESULTS

Eight randomized controlled trials with a sample size of 375 cases met the criteria to be included in the study indicating that high quality literature is lacking in this field. Results of the meta-analysis showed that short-term TCE could relieve pain (SMD: -0.77;95% CI: -1.13 to -0.41; P<0.0001), improve physical function (SMD -0.75; 95% CI: -0.98 to -0.52; P<0.00001), and alleviate stiffness (SMD: -0.56; 95%: CI -0.96 to -0.16; P<0.006), but had no significant effect on quality of life (SMD: 0.57; 95% CI: 0.17 to 0.97; P = 0.005), and mental health (SMD 4.12; 95% CI: -0.50 to 8.73; P = 0.08). Moreover, TCE was not associated with serious adverse events.

CONCLUSIONS

Our systematic review revealed that short-term TCE was potentially beneficial in terms of reducing pain, improving physical function and alleviating stiffness. These results may suggest that TCE could prove useful as an adjuvant treatment for patients with knee OA. Further studies are urgently needed to confirm these results.

Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review

BACKGROUND & AIMS

This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS.

METHODS

MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations.

RESULTS

Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear.

CONCLUSIONS

The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS. ClinicalTrials.gov number, NCT02721836.

Self-Administered Mind-Body Practices for Reducing Health Disparities: An Interprofessional Opinion and Call to Action

Health disparities (HD) continue to persist in the United States which underscores the importance of using low-cost, accessible, evidence-based strategies that can improve health outcomes, especially for chronic conditions that are prevalent among underserved minority populations. Complementary/integrative health modalities, particularly self-administered mind-body practices (MBP), can be extremely useful in reducing HD because they are intrinsically patient-centered and they empower patients to actively engage in self-care of health and self-management of symptoms. Interprofessional healthcare providers and patients can engage in powerful partnerships that encompass self-administered MBP to improve health. This is a call to action for interprofessional researchers to engage in high-quality research regarding efficacy and cost-effectiveness of self-administered MBP, for practitioners to engage patients in self-administered MBP for health promotion, disease prevention, and symptom management, and for healthcare institutions to integrate self-administered MBP into conventional health practices to reduce HD in their communities.

Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society

OBJECTIVE

To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS.

METHODS

NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees.

RESULTS

Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making.

CONCLUSIONS

Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.

Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial

OBJECTIVE

Exercise may help alleviate menopausal and depressive symptoms in middle-aged women, but sufficient evidence does not currently exist to fully support this theory. Whereas frequent moderate- to vigorous-intensity exercise may be associated with the risk of menopausal hot flashes, light-intensity exercise, such as stretching, is not likely to increase the occurrence of hot flashes. Little is, however, known about the effects of light-intensity exercise on menopausal and depressive symptoms. We examined the effects of a 3-week stretching program on the menopausal and depressive symptoms in middle-aged, Japanese women.

METHODS

Forty Japanese women, aged 40 to 61 years, were recruited (mean age, 51.1 ± 7.3 y). The participants were randomly assigned to either a stretching or a control group. The stretching group (n = 20) participated in a 3-week intervention program that involved 10 minutes of daily stretching, just before bedtime. The control group (n = 20) was assigned to a waiting list. Menopausal symptoms were evaluated using the Simplified Menopausal Index, which measures vasomotor, psychological, and somatic symptoms. Depressive symptoms were assessed using the Self-Rating Depression Scale.

RESULTS

The compliance rate was 75.8% during the 3-week intervention program. The total Simplified Menopausal Index scores, including the vasomotor, psychological, and somatic symptoms, and the Self-Rating Depression Scale scores significantly decreased in the stretching group compared with that in the control group. No adverse events, including increased hot flashes, were reported by the participants during the study period.

CONCLUSIONS

These findings suggest that 10 minutes of stretching before bedtime decreases menopausal and depressive symptoms in middle-aged, Japanese women.

Hatha Yoga practice decreases menopause symptoms and improves quality of life: A randomized controlled trial

OBJECTIVES

Yoga practice includes a group of specific psychophysical techniques. Although previous studies showed beneficial effects of yoga for health and rehabilitation, improving quality of life, there are few studies on the possible therapeutic application of yoga during the climacteric period. The purpose of this study was to investigate the psychophysiological effects of Hatha Yoga regular practice in post-menopausal women.

METHODS

Eighty-eight post-menopausal women volunteered for this 12-week trial. They were randomly assigned to one of three groups: control (no intervention), exercise, and yoga. Questionnaires were applied in order to evaluate climacteric syndrome (Menopause Rating Scale), stress (Lipp Stress Symptom Inventory), quality of life (Brief World Health Organization Quality of Life), depression (Beck Depression Inventory) and anxiety (State/Trait Anxiety Inventories). Physiological changes were evaluated through hormone levels (cortisol, FSH, LH, progesterone and estradiol).

RESULTS

At 12 weeks, yoga practitioners showed statistically lower scores for menopausal symptoms, stress levels and depression symptoms, as well as significantly higher scores in quality of life when compared to control and exercise groups. Only control group presented a significant increase in cortisol levels. The yoga and exercise groups showed decreased levels of FSH and LH when compared to control group.

CONCLUSIONS

These results suggest that yoga promotes positive psychophysiological changes in post-menopausal women and may be applied as a complementary therapy towards this population.

Effects of flaxseed and Hypericum perforatum on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women: a systematic review and meta-analysis

OBJECTIVE

In this study, we aimed at evaluation of the efficacy of Hypericum perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women.

MATERIALS AND METHODS

We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (RCT) to explore trials that assessed the effectiveness of H. perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers. In this regard, the following terms were used "menopause AND H. perforatum OR flaxseed OR Linum usitatissimum. Only randomized controlled trials were included in the study.

RESULTS

Nine RCTs were included in this systematic review. Based on the literature, flaxseed showed beneficial effect on hot flash frequency and intensity, which was not statistically significant. According to two trials, flaxseed showed estrogenic effects; however, no conclusion regarding cancer promoting or protecting effects can be made. The evidence of the efficacy of the flaxseed on alleviating vaginal atrophy was also limited due to inconsistent findings in this regard. One trial declared that Vitex agnus-castus and H. perforatum showed comparable decrease in the frequency of hot flashes.

CONCLUSION

The results of our systematic review suggest beneficial effect on vasomotor symptom with both of flaxseed and H. perforatum. Consistent conclusion regarding estrogen-dependent cancers and maturation value is limited due to small number of trials related to flaxseed. Further trials are still needed to confirm the results of our systematic review.

[Algorithm for the diagnosis, treatment, and prevention of stress (for general practitioners)]

By inducing physical and mental disorders, human stresses are known to lead to long-term serious consequences and frequent use of more medical resources. Owing to long-term clinical trials, a management algorithm based on the principles of personalized medicine has been elaborated to minimize the consequences of stress, to activate natural adaptation mechanisms and to enhance stress resistance.

Yoga for prenatal depression: a systematic review and meta-analysis

BACKGROUND

Prenatal depression can negatively affect the physical and mental health of both mother and fetus. The aim of this study was to determine the effectiveness of yoga as an intervention in the management of prenatal depression.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Embase, the Cochrane Library and PsycINFO from all retrieved articles describing such trials up to July 2014.

RESULTS

Six RCTs were identified in the systematic search. The sample consisted of 375 pregnant women, most of whom were between 20 and 40 years of age. The diagnoses of depression were determined by their scores on Structured Clinical Interview for DSM-IV and the Center for Epidemiological Studies Depression Scale. When compared with comparison groups (e.g., standard prenatal care, standard antenatal exercises, social support, etc.), the level of depression statistically significantly reduced in yoga groups (standardized mean difference [SMD], -0.59; 95% confidence interval [CI], -0.94 to -0.25; p = 0.0007). One subgroup analysis revealed that both the levels of depressive symptoms in prenatally depressed women (SMD, -0.46; CI, -0.90 to -0.03; p = 0.04) and non-depressed women (SMD, -0.87; CI, -1.22 to -0.52; p < 0.00001) were statistically significantly lower in yoga group than that in control group. There were two kinds of yoga: the physical-exercise-based yoga and integrated yoga, which, besides physical exercises, included pranayama, meditation or deep relaxation. Therefore, the other subgroup analysis was conducted to estimate effects of the two kinds of yoga on prenatal depression. The results showed that the level of depression was significantly decreased in the integrated yoga group (SMD, -0.79; CI, -1.07 to -0.51; p < 0.00001) but not significantly reduced in physical-exercise-based yoga group (SMD, -0.41; CI, -1.01 to -0.18; p = 0.17).

CONCLUSIONS

Prenatal yoga intervention in pregnant women may be effective in partly reducing depressive symptoms.

Yoga for multiple sclerosis: a systematic review and meta-analysis

While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear. The aim of this review was to systematically assess and meta-analyze the available data on efficacy and safety of yoga in patients with multiple sclerosis. Medline/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through March 2014. Randomized controlled trials (RCTs) of yoga for patients with multiple sclerosis were included if they assessed health-related quality of life, fatigue, and/or mobility. Mood, cognitive function, and safety were defined as secondary outcome measures. Risk of bias was assessed using the Cochrane tool. Seven RCTs with a total of 670 patients were included. Evidence for short-term effects of yoga compared to usual care were found for fatigue (standardized mean difference [SMD] = -0.52; 95% confidence intervals (CI)  =  -1.02 to -0.02; p = 0.04; heterogeneity: I2 = 60%; Chi2 = 7.43; p = 0.06) and mood (SMD = -0.55; 95%CI =  -0.96 to -0.13; p = 0.01; heterogeneity: I2 = 0%; Chi2 = 1.25; p = 0.53), but not for health-related quality of life, muscle function, or cognitive function. The effects on fatigue and mood were not robust against bias. No short-term or longer term effects of yoga compared to exercise were found. Yoga was not associated with serious adverse events. In conclusion, since no methodological sound evidence was found, no recommendation can be made regarding yoga as a routine intervention for patients with multiple sclerosis. Yoga might be considered a treatment option for patients who are not adherent to recommended exercise regimens.

Characteristics of randomized controlled trials of yoga: a bibliometric analysis

Background

A growing number of randomized controlled trials (RCTs) have investigated the therapeutic value of yoga interventions. This bibliometric analysis aimed to provide a comprehensive review of the characteristics of the totality of available randomized yoga trials.

Methods

All RCTs of yoga were eligible. Medline/PubMed, Scopus, the Cochrane Library, IndMED, and the tables of content of yoga specialty journals not listed in medical databases were screened through February 2014. Bibliometric data, data on participants, and intervention were extracted and analyzed descriptively.

Results

Published between 1975 and 2014, a total of 366 papers were included, reporting 312 RCTs from 23 different countries with 22,548 participants. The median study sample size was 59 (range 8–410, interquartile range = 31, 93). Two hundred sixty-four RCTs (84.6%) were conducted with adults, 105 (33.7%) with older adults and 31 (9.9%) with children. Eighty-four RCTs (26.9%) were conducted with healthy participants. Other trials enrolled patients with one of 63 varied medical conditions; the most common being breast cancer (17 RCTs, 5.4%), depression (14 RCTs, 4.5%), asthma (14 RCTs, 4.5%) and type 2 diabetes mellitus (13 RCTs, 4.2%). Whilst 119 RCTs (38.1%) did not define the style of yoga used, 35 RCTs (11.2%) used Hatha yoga and 30 RCTs (9.6%) yoga breathing. The remaining 128 RCTs (41.0%) used 46 varied yoga styles, with a median intervention length of 9 weeks (range 1 day to 1 year; interquartile range = 5, 12). Two hundred and forty-four RCTs (78.2%) used yoga postures, 232 RCTs (74.4%) used breath control, 153 RCTs (49.0%) used meditation and 32 RCTs (10.3%) used philosophy lectures. One hundred and seventy-four RCTs (55.6%) compared yoga with no specific treatment; 21 varied control interventions were used in the remaining RCTs.

Conclusions

This bibliometric analysis presents the most complete up-to-date overview on published randomized yoga trials. While the available research evidence is sparse for most conditions, there was a marked increase in published RCTs in recent years.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6882-14-328) contains supplementary material, which is available to authorized users.

Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance

Cognitive decline is a frequent complaint during the menopause transition and among post-menopausal women. Changes in memory correspond with diminished estrogen production. Further, many peri- and post-menopausal women report sleep concerns, depression, and hot flashes, and these factors may contribute to cognitive decline. Hormone therapy can increase estrogen but is contraindicated for many women. Mind-body medicine has been shown to have beneficial effects on sleep, mood, and hot flashes, among post-menopausal women. Further, mind-body medicine holds potential in addressing symptoms of cognitive decline post-menopause. This study proposes an initial framework for how mind-body interventions may improve cognitive performance and inform future research seeking to identify the common and specific factors associated with mind-body medicine for addressing memory decline in peri- and post-menopausal women. It is our hope that this article will eventually lead to a more holistic and integrative approach to the treatment of cognitive deficits in peri- and post-menopausal women.

Yoga for asthma: a systematic review and meta-analysis

BACKGROUND

Although yoga is frequently used by patients with asthma, its efficacy in alleviating asthma remains unclear.

OBJECTIVE

To systematically assess and meta-analyze the available data on efficacy and safety of yoga in alleviating asthma.

METHODS

MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through January 2014. Randomized controlled trials of yoga for patients with asthma were included if they assessed asthma control, symptoms, quality of life, and/or pulmonary function. For each outcome, standardized mean differences (SMDs) or risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane tool.

RESULTS

Fourteen randomized controlled trials with 824 patients were included. Evidence for effects of yoga compared with usual care was found for asthma control (RR, 10.64; 95% CI, 1.98 to 57.19; P = .006), asthma symptoms (SMD, -0.37; 95% CI, -0.55 to -0.19; P < .001), quality of life (SMD, 0.86; 95% CI, 0.39 to 1.33; P < .001), peak expiratory flow rate (SMD, 0.49; 95% CI, 0.32 to 0.67; P < .001), and ratio of forced expiratory volume in 1 second to forced vital capacity (SMD, 0.50; 95% CI, 0.24 to 0.75; P < .001); evidence for effects of yoga compared with psychological interventions was found for quality of life (SMD, 0.61; 95% CI, 0.22 to 0.99; P = .002) and peak expiratory flow rate (SMD, 2.87; 95% CI, 0.14 to 5.60; P = .04). No evidence for effects of yoga compared with sham yoga or breathing exercises was revealed. No effect was robust against all potential sources of bias. Yoga was not associated with serious adverse events.

CONCLUSION

Yoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.

Yoga for depression: a systematic review and meta-analysis

BACKGROUND

Mind-body medical interventions are commonly used to cope with depression and yoga is one of the most commonly used mind-body interventions. The aim of this review was to systematically assess and meta-analyze the effectiveness of yoga for depression.

METHODS

Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through January 2013. Randomized controlled trials (RCTs) of yoga for patients with depressive disorders and individuals with elevated levels of depression were included. Main outcomes were severity of depression and remission rates, secondary outcomes were anxiety, quality of life, and safety.

RESULTS

Twelve RCTs with 619 participants were included. Three RCTs had low risk of bias. Regarding severity of depression, there was moderate evidence for short-term effects of yoga compared to usual care (standardized mean difference (SMD) = -0.69; 95% confidence interval (CI) -0.99, -0.39; P < .001), and limited evidence compared to relaxation (SMD = -0.62; 95%CI -1.03, -0.22; P = .003), and aerobic exercise (SMD = -0.59; 95% CI -0.99, -0.18; P = .004). Limited evidence was found for short-term effects of yoga on anxiety compared to relaxation (SMD = -0.79; 95% CI -1.3, -0.26; P = .004). Subgroup analyses revealed evidence for effects in patients with depressive disorders and in individuals with elevated levels of depression. Due to the paucity and heterogeneity of the RCTs, no meta-analyses on long-term effects were possible. No RCT reported safety data.

CONCLUSIONS

Despite methodological drawbacks of the included studies, yoga could be considered an ancillary treatment option for patients with depressive disorders and individuals with elevated levels of depression.

Adverse events associated with yoga: a systematic review of published case reports and case series

While yoga is gaining increased popularity in North America and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga. Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder stand, lotus position, and forceful breathing were the most common yoga postures and breathing techniques cited. Twenty-seven adverse events (35.5%) affected the musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case (1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice, yoga should be practiced carefully under the guidance of a qualified instructor. Beginners should avoid extreme practices such as headstand, lotus position and forceful breathing. Individuals with medical preconditions should work with their physician and yoga teacher to appropriately adapt postures; patients with glaucoma should avoid inversions and patients with compromised bone should avoid forceful yoga practices.

A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee

OBJECTIVES

This paper aimed to systematically review and meta-analyze the effectiveness of Tai Chi for osteoarthritis of the knee.

METHODS

MEDLINE, the Cochrane Library, EMBASE, Scopus, PsycInfo and CAMBASE were screened through April 2013. Randomized controlled trials (RCTs) comparing Tai Chi to control conditions were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Outcome measures included pain, physical functional, joint stiffness, quality of life, and safety. For each outcome, standardized mean differences and 95% confidence intervals were calculated.

RESULTS

5 RCTs with a total of 252 patients were included. Four studies had a low risk of bias. Analysis showed moderate overall evidence for short-term effectiveness for pain, physical function, and stiffness. Strong evidence was found for short-term improvement of the physical component of quality of life. No long-term effects were observed. Tai Chi therapy was not associated with serious adverse events.

CONCLUSION

This systematic review found moderate evidence for short-term improvement of pain, physical function and stiffness in patients with osteoarthritis of the knee practicing Tai Chi. Assuming that Tai Chi is at least short-term effective and safe it might be preliminarily recommended as an adjuvant treatment for patients with osteoarthritis of the knee. More high quality RCTs are urgently needed to confirm these results.

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.

Yoga for schizophrenia: a systematic review and meta-analysis

BACKGROUND

The aim of this review was to systematically review and meta-analyze the effects of yoga on symptoms of schizophrenia, quality of life, function, and hospitalization in patients with schizophrenia.

METHODS

MEDLINE/Pubmed, Scopus, the Cochrane Library, PsycInfo, and IndMED were screened through August 2012. Randomized controlled trials (RCTs) comparing yoga to usual care or non-pharmacological interventions were analyzed when they assessed symptoms or quality of life in patients with schizophrenia. Cognitive function, social function, hospitalization, and safety were defined as secondary outcomes. Risk of bias was assessed using the risk of bias tool recommended by the Cochrane Back Review Group. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

RESULTS

Five RCTs with a total of 337 patients were included; 2 RCTs had low risk of bias. Two RCTs compared yoga to usual care; 1 RCT compared yoga to exercise; and 2 3-arm RCTs compared yoga to usual care and exercise. No evidence was found for short-term effects of yoga compared to usual care on positive symptoms (SMD = -0.58; 95% CI -1.52 to 0.37; P = 0.23), or negative symptoms (SMD = -0.59; 95% CI -1.87 to 0.69; P = 0.36). Moderate evidence was found for short-term effects on quality of life compared to usual care (SMD = 2.28; 95% CI 0.42 to 4.14; P = 0.02). These effects were only present in studies with high risk of bias. No evidence was found for short-term effects on social function (SMD = 1.20; 95% CI -0.78 to 3.18; P = 0.23). Comparing yoga to exercise, no evidence was found for short-term effects on positive symptoms (SMD = -0.35; 95% CI -0.75 to 0.05; P = 0.09), negative symptoms (SMD = -0.28; 95% CI -1.42 to 0.86; P = 0.63), quality of life (SMD = 0.17; 95% CI -0.27 to 0.61; P = 0.45), or social function (SMD = 0.20; 95% CI -0.27 to 0.67; P = 0.41). Only 1 RCT reported adverse events.

CONCLUSIONS

This systematic review found only moderate evidence for short-term effects of yoga on quality of life. As these effects were not clearly distinguishable from bias and safety of the intervention was unclear, no recommendation can be made regarding yoga as a routine intervention for schizophrenia patients.

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.