Does practicing hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness?

The effects of acute exercise on stress reactivity assessed via a multidimensional approach: a systematic review

Psychological stress is associated with numerous deleterious health effects. Accumulating evidence suggests acute exercise reduces stress reactivity. As stressors activate a wide array of psychological and physiological systems it is imperative stress responses are examined through a multidimensional lens. Moreover, it seems prudent to consider whether stress responses are influenced by exercise intervention characteristics such as modality, duration, intensity, timing, as well as participant fitness/physical activity levels. The current review therefore examined the role of acute exercise on stress reactivity through a multidimensional approach, as well as whether exercise intervention characteristics and participant fitness/physical activity levels may moderate these effects. Stress reactivity was assessed via heart rate, blood pressure, cortisol, catecholamines, and self-report. A systematic search following PRISMA guidelines of five databases was updated in November 2022. Reviewed studies met the following criteria: English language, participants aged ≥ 18, use of acute exercise, use of a validated stress-inducing task, and assessment(s) of stress reactivity. Thirty-one studies (1386 participants) were included. Acute exercise resulted in reliable reductions to blood pressure and cortisol. Acute exercise yielded mostly negligible effects on heart rate reactivity and negligible effects on self-report measures. As for exercise intervention characteristics, intensity-dependent effects were present, such that higher intensities yielded larger reductions to reactivity measures, while limited evidence was present for duration, modality, and timing-dependent effects. Regarding participant fitness/physical activity levels, the effects on stress reactivity were mixed. Future work should standardize the definitions and assessment time points of stress reactivity, as well as investigate the interaction between physiological and psychological stress responses in real-world contexts.

Cardiorespiratory responses: Pilates compared to different walking speeds in healthy adults

BACKGROUND

The impact of a single-session Pilates exercise on cardiorespiratory fitness and metabolic parameters is still uncertain.

AIMS

The aim of this study was to examine the cardiorespiratory changes during a single-session Pilates exercise and compare cardiorespiratory fitness-related parameters with walking at different speeds on a treadmill, at low (3.2 kph) and moderate intensities (4.8 kph).

METHODS

Cardiorespiratory responses were measured with a cardiopulmonary exercise test device in 31 healthy young adults at rest, during a single Pilates session, walking at 3.2 kph and walking at 4.8 kph. The study design employed a cross-over design. Participants were randomly assigned to two experimental groups: a Pilates training session following treadmill walking or treadmill walking following a Pilates training session.

RESULTS

Mean MET, oxygen and energy consumption during Pilates were similar to walking at 3.2 kph (p > 0.05), but significantly lower than walking at 4.8 kph (p < 0.05). The mean heart rate during Pilates was higher than walking at 3.2 kph (p < 0.05), but similar to walking at 4.8 kph (p > 0.05). Significantly higher carbohydrate metabolism was used during Pilates compared to walking (p < 0.05).

CONCLUSION

The cardiopulmonary responses to a single Pilates session are similar to walking at a speed of 3.2 kph but lower than walking at 4.8 kph. These results indicate that while Pilates may not generate sufficient cardiopulmonary changes to enhance cardiorespiratory fitness as a moderate-intensity exercise in healthy young adults, it may still offer other benefits such as improvements in flexibility, core strength, and posture.

Affective responses to stretching exercises: Exploring the timing of assessments

Affective responses during exercise have been identified as a predictor of exercise adherence. However, research has been mostly limited to aerobic and resistance exercise. Considering that stretching activities are also an important component of physical fitness, this quasi-experimental study was designed to: 1) compare affective responses during and immediately after stretching exercises in apparently healthy adults, and 2) assess the consistency and repeatability of affect ratings obtained one week apart. For this purpose, we analyzed the Feeling Scale (FS) and Felt Arousal Scale (FAS) ratings using Time (during and after stretching) x Intensity (light, moderate, vigorous) x Stretched Muscle Group (quadriceps, hamstrings, glutes, latissimus dorsi, triceps) with repeated measures analysis of variance (ANCOVA) in 34 participants (21 males; aged 32.8 ± 8.6 years). The repeatability of FS and FAS ratings was assessed using two-way random-effects models, Intraclass Correlation Coefficients (ICC), and Bland-Altman plots. FS scores were higher following the stretching exercises, whereas FAS scores were lower, particularly in the vigorous intensity. In general, the inter-day repeatability for FS and FAS measurements was good across muscle groups. ICC tended to be higher at vigorous intensities. Ratings of core affect can be collected during static passive stretches using the FAS and FAS in ecologically valid settings. These results suggest that an adequate assessment of core affective responses to stretching activities should be performed during the exercises.

Applied high-intensity interval cardio yoga improves cardiometabolic fitness, energetic contributions, and metabolic flexibility in healthy adults

Purpose: Currently, there is no interventional approach to increase the intensity of Surya Namaskar a popular hatha yoga sequence used worldwide. Therefore, this study investigated how tempo-based high-intensity interval cardio yoga (HIICY) and traditional interval hatha yoga (TIHY) affects cardiometabolic fitness in active adults. Methods: Twenty physically active male and female individuals were randomly separated into HIICY (5 males, 5 females, 1.5 s tempo) and TIHY (5 males, 5 females, 3 s tempo) groups. The intervention included twelve exercise sessions for 4 weeks in both groups. Participants conducted a ramp test to determine their maximal oxygen uptake (V ˙ O2max), maximal velocity at V ˙ O2max (vV ˙ O2max), and maximal heart rate (HRmax). Afterward, they performed a 10-min high-intensity cardio yoga test (HICYT) to determine heart rate (HRpeak and HRmean), oxygen uptake (V ˙ O2peak and V ˙ O2mean), respiratory exchange ratio (RER), blood lactate concentrations (La- peak and ∆La-), fat and carbohydrate oxidations (FATox, CHOox), and energetic contributions (oxidative; W Oxi, glycolytic; W Gly, and phosphagen; W PCr, total energy demand; W Total). Results: V ˙ O2max and vV ˙ O2max showed time and group × time interactions (p < 0.01, p < 0.0001, p < 0.001, respectively). V ˙ O2max after HIICY was significantly higher than in pre-testing and following TIHY (p < 0.001, p < 0.0001, respectively). V ˙ O2peak, V ˙ O2mean, RER, HRpeak, and HRmean during the 10-min HICYT showed significant time effects (p < 0.05). ∆La- indicated a group × time interaction (p < 0.05). Group x time interaction effects for FATox at the fourth and sixth minute were observed (p < 0.05, respectively). Absolute (kJ) and relative (%) W Oxi, W Gly, and W Total showed time and group × time interaction effects (p < 0.05, p < 0.01, respectively). Furthermore, %W Gly was reduced following HIICY (p < 0.05). Additionally, V ˙ O2max and vV ˙ O2max were highly correlated with W Oxi in kJ (r = 0.91, 0.80, respectively). Moderate to high correlations were observed among CHOox, FATox, and absolute V ˙ O2max (r = 0.76, 0.62, respectively). Conclusion: A 4-week period of HIICY improved cardiometabolic fitness, oxidative capacity, and metabolic flexibility compared with TIHY, in physically active adults. Therefore, HIICY is suitable as HY-specific HIIT and time-efficient approach for relatively healthy individuals.

Comparative Analysis of Heart Rate Variability Parameters between Surya Namaskar and Stationary Bike Exercise Groups

Background

Yoga practice has multiple health benefits. Surya Namaskar (SN) also known as sun salutation presents mental and physical health benefits equivalent to physical exercise. It consists of a sequence of 12 Hatha yoga postures with coordinated breathing.

Aims

This study evaluated the effect of SN against mild intensity stationary cycling exercise (SCE) on parameters of heart rate variability (HRV).

Methodology

This study was conducted in the department of physiology of a nationally important institute after obtaining ethics approval. A total of 40 healthy participants (males aged 46 ± 2.3 years) were enrolled in the study and divided into two groups, namely SN group and exercise group (SG and EG). The allocation on the group was based on subjects' choice and interest in performing SN or SCE. Baseline HRV, anthropometric measurement, and blood pressure were assessed. SG was subjected to 14 rounds of SN in about 20 min and EG to a 20-min mild-intensity stationary cycling session (30%-50% maximal heart rate). Assessments were conducted preexercise and postexercise recovery. HRV was assessed with the NeuralChek device.

Results

SN led to increased SDNN, pNN50, RMSSD, and total power, indicating improved autonomic balance, cardiovascular health, and parasympathetic dominance. Conversely, SCE decreased SDNN, pNN50, and RMSSD, suggesting immediate postexercise sympathetic dominance. Spectral analysis of HRV highlighted autonomic balance differences, with SN increasing low frequency (LF%) reflecting both sympathetic and parasympathetic dominance, whereas exercise reduced LF% due to sympathetic activation. Minimal changes were observed in high-frequency percentage. SN combines flexibility, strength, and balance, providing a balanced physical activity. This balance results in a mixed autonomic response, with sympathetic activity for the physical effort and parasympathetic activity for the relaxation components.

Conclusions

SN positively impacted HRV, promoting parasympathetic dominance and cardiovascular health, whereas exercise induced sympathetic activation with potential recovery benefits. Monitoring HRV offers insights into cardiovascular fitness and well-being. The study underscores the merits of incorporating yoga such as SN into daily activity routines.

Effect of yoga on anthropometry, quality of life, and lipid profile in patients with obesity and central obesity: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity.

METHODOLOGY

The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence.

RESULTS

15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD -0.84, 95% CI [-5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD -3.47, 95% CI [-6.20 to -0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD -7.58, 95% CI [-11.51 to -3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD -17.12, 95% CI [-32.24 to -2.00]) and triglycerides (MD -21.75, 95% CI [-38.77 to -4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence.

CONCLUSION

From our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.

Body Loading during an Intensive Yoga Exercise Routine and a Cycle Ergometer Test

The present study compared the effects on the cardiovascular, respiratory, and metabolic functions of the practice of an intensive yoga exercise routine called Dynamic Suryanamaskar (DSN) and a cycle ergometer test (CET) of increasing intensity. The study involved 18 middle-aged volunteers who had previously practiced DSN. The study was conducted in two series (i.e., as CET and DSN with similar intensity) until complete exhaustion. At rest (R), at the ventilatory anaerobic threshold (VAT), and at the maximum workload (ML), the variables characterizing cardiovascular, respiratory, and metabolic functions were determined. In addition, the subjective intensity of both efforts was determined using the Borg test. No functional differences were observed in the cardiovascular, respiratory, and metabolic systems at similar CET and DSN intensities. Respondents experienced less subjective workload during DSN than during CET (p < 0.001). Since DSN intensifies the activity of the cardiovascular, respiratory, and metabolic systems to a similar degree to CET both at VAT and ML, but causes less subjective fatigue, this yogic practice can be used as a laboratory exercise test and as an effective training medium.

Psychophysiological Adaptations to Yoga Practice in Overweight and Obese Individuals: A Topical Review

Physical activity has been documented as a foundational approach for weight management and obesity, improving several cardiometabolic and mental health indices. However, it is not clear whether yoga practice can induce beneficial improvements in anthropometric and body composition parameters, performance, metabolic health, and well-being among overweight/obese people. The aim of this topical review was to catalog training studies examining the psychophysiological responses to yoga interventions in order to detect which outcomes have been investigated, the research methods applied, and the conclusions. The inclusion/exclusion criteria were met by 22 published articles involving 1178 (56% female) overweight/obese participants. This brief review on yoga-induced adaptations demonstrates that this widely used meditative movement activity can meaningfully improve the vast majority of the selected markers. These beneficial alterations are focused mostly on various anthropometric and body composition variables, cardiovascular disease risk factors, physical fitness parameters, quality of life, and stress in previously inactive overweight/obese individuals. Instead, yoga-based physical exercise interventions investigating anxiety, depression, mood state, exercise enjoyment, affect valence, and adherence were limited. Further research should focus on the yoga intervention configuration and potential mechanisms behind favorable changes in various psychophysiological indices through large-scale, rigorously designed randomized controlled trials implementing long-term interventions in overweight/obese individuals.

Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression

INTRODUCTION

A metabolic equivalent (MET) is one of the most common methods used to objectively quantify physical activity intensity. Although the MET provides an 'objective' measure, it does not account for inter-individual differences in cardiorespiratory fitness. In contrast, 'relative' measures of physical activity intensity, such as heart rate reserve (HRR), do account for cardiorespiratory fitness. The purpose of this systematic review with meta-regression was to compare measures of absolute and relative physical activity intensity collected during walking.

METHODS

A systematic search of four databases (SPORTDiscus, Medline, Academic Search Premier and CINAHL) was completed. Keyword searches were: (i) step* OR walk* OR strid* OR "physical activity"; (ii) absolute OR "absolute intensity" OR mets OR metabolic equivalent OR actigraph* OR acceleromet*; (iii) relative OR "relative intensity" OR "heart rate" OR "heart rate reserve" OR "VO2 reserve" OR VO2* OR "VO2 uptake" OR HRmax* OR metmax. Categories (i) to (iii) were combined using 'AND;' with studies related to running excluded. A Bayesian regression was conducted to quantify the relationship between METs and %HRR, with Bayesian logistic regression conducted to examine the classification agreement between methods. A modified Downs and Black scale incorporating 13 questions relative to cross-sectional study design was used to assess quality and risk of bias in all included studies.

RESULTS

A total of 15 papers were included in the systematic review. A comparison of means between absolute (METs) and relative (%HRR, %HRmax, %VO2R, %VO2max, HRindex) values in 8 studies identified agreement in how intensity was classified (light, moderate or vigorous) in 60% of the trials. We received raw data from three authors, incorporating 3 studies and 290 participants. A Bayesian random intercept logistic regression was conducted to examine the agreement between relative and absolute intensity, showing agreement in 43% of all trials. Two studies had identical relative variables (%HRR) totalling 240 participants included in the Bayesian random intercept regression. The best performing model was a log-log regression, which showed that for every 1% increase in METs, %HRR increased by 1.12% (95% CI: 1.10-1.14). Specifically, the model predicts at the lower bound of absolute moderate intensity (3 METs), %HRR was estimated to be 33% (95%CI: 18-57) and at vigorous intensity (6 METs) %HRR was estimated to be 71% (38-100).

CONCLUSION

This study highlights the discrepancies between absolute and relative measures of physical activity intensity during walking with large disagreement observed between methods and large variation in %HRR at a given MET. Consequently, health professionals should be aware of this lack of agreement between absolute and relative measures. Moreover, if we are to move towards a more individualised approach to exercise prescription and monitoring as advocated, relative intensity could be more highly prioritised.

A comparison of the energy demands of quadrupedal movement training to walking

Background

Quadrupedal movement training (QMT) is a novel alternative form of exercise recently shown to improve several fitness characteristics including flexibility, movement quality, and dynamic balance. However, the specific energy demands of this style of training remain unknown. Therefore, the purpose of this study was to compare the energy expenditure (EE) of a beginner-level quadrupedal movement training (QMT) class using Animal Flow (AF) to walking, and to compare EE between segments of the AF class and gender.

Methods

Participants (15 male, 15 female) completed 60-min sessions of AF, treadmill walking at a self-selected intensity (SSIT) and treadmill walking at an intensity that matched the heart rate of the AF session (HRTM). Indirect calorimetry was used to estimate energy expenditure.

Results

AF resulted in an EE of 6.7 ± 1.8 kcal/min, 5.4 ± 1.0 METs, and HR of 127.1 ± 16.1 bpm (63.4 ± 8.1% of the subjects' age-predicted maximum HR), while SSIT resulted in an EE of 5.1 ± 1.0 kcal/min, 4.3 ± 0.7 METs, HR of 99.8 ± 13.5 bpm (49.8 ± 6.7% age-predicted maximum HR), and HRTM resulted in and EE of 7.6 ± 2.2 kcal/min, 6.1 ± 1.0 METs, and HR of 124.9 ± 16.3 bpm (62.3 ± 8.2% age-predicted maximum HR). Overall, EE, METs, HR and respiratory data for AF was greater than SSIT (p's < 0.001) and either comparable or slightly less than HRTM. The Flow segment showed the highest EE (8.7 ± 2.7 kcal/min), METs (7.0 ± 1.7) and HR (153.2 ± 15.7 bpm). Aside from HR, males demonstrated greater EE, METs, and respiratory values across all sessions and segments of AF than females.

Conclusions

QMT using AF meets the ACSM's criteria for moderate-intensity physical activity and should be considered a viable alternative to help meet physical activity guidelines.

Effectiveness of an 8-week hatha yoga intervention to improve lower back pain in university office workers: A mixed-methods pilot exploratory study

BACKGROUND: Hatha yoga programs have been shown to be effective at improving low back pain among a variety of populations; however, methods to decrease low back pain of university office employees have not been studied. OBJECTIVE: To examine the impact of an 8-week hatha yoga intervention on measures of health among university office employees. METHOD: Seven participants completed the 8-week yoga intervention. All measures, including anthropometric measures and online questionnaires, were completed at baseline and post-intervention. RESULTS: Baseline pain intensity (6.6±3.1) and pain interference (15.6±4.7) reflected a moderate level of back pain and moderate to severe interference. Pain intensity showed a non-significant improvement with medium-to-large effect size [p = 0.07, (d = 0.7)]. There was a significant improvement with a large effect size [p = 0.002, (d = 2.4)] in pain interference. Baseline anxiety (7.4±3.6) reflected a borderline abnormal symptom level, but anxiety significantly reduced to normal levels at post-intervention with a medium effect size [p = 0.002 (d = 0.5)]. Focus group themes were improvements in health and development of a sense of community. CONCLUSIONS: Hatha yoga may be an effective mode of low-impact physical activity to decrease pain and improve mental health while facilitating a sense of community for office workers employed by a university. This study demonstrates promising results with large effect sizes; however, more research with larger sample size and randomized treatment and control groups are needed for future study efforts.

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives

This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions.

Design and Method

The JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021.

Results

The literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD -6.49 and -2.78; 95CI% -8.94- -4.04 and -4.11- -1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions.

Conclusion

Despite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review.

Systematic Review Registration

[PROSPERO], identifier [CRD42019139404].

Metabolic Energy Contributions During High-Intensity Hatha Yoga and Physiological Comparisons Between Active and Passive (Savasana) Recovery

Purpose: The objective of this study was to investigate metabolic energy contributions during high-intensity hatha yoga (HIHY) and to compare changes in physiological variables between active and passive recovery methods.

Methods: The study involved 20 women yoga instructors (n = 20) who performed 10 min of HIHY (vigorous sun salutation). Upon completion, they were randomly assigned to either active (walking; n = 10) or passive (savasana; n = 10) recovery groups for a period of 10 min. During HIHY, physiological variables such as heart rate (HR_peak and HR_mean), oxygen uptake (VO_2peak and VO_2mean), and blood lactate concentrations (peak La⁻) were measured. Energetic contributions (phosphagen; W_PCR, glycolytic; W_Gly, and oxidative; W_Oxi) in kJ and % were estimated using VO₂ and La⁻ data. Furthermore, the metabolic equivalents (METs) of VO_2peak and VO_2mean were calculated. To compare different recovery modes, HR_post, ΔHR, VO_2post, ΔVO₂, recovery La⁻, and recovery ΔLa⁻ were analyzed.

Results: The results revealed that HR_peak, VO_2peak, and peak La⁻ during HIHY showed no differences between the two groups (p > 0.05). Values of HR_peak, HR_mean, METs of VO_2peak and VO_2mean, and La⁻ during HIHY were 95.6% of HR_max, 88.7% of HR_max, 10.54 ± 1.18, 8.67 ±.98 METs, and 8.31 ± 2.18 mmol·L⁻¹, respectively. Furthermore, W_Oxi was significantly higher compared with W_PCR, W_Gly, and anaerobic contribution (W_PCR + W_Gly), in kJ and % (p < 0.0001). VO_2post and recovery ΔLa⁻ were significantly higher in the active recovery group (p < 0.0001, p = 0.0369, respectively). Values of ΔVO₂ and recovery La⁻ were significantly lower in the active group compared with the passive group (p = 0.0115, p = 0.0291, respectively).

Conclusions: The study concluded that high-intensity hatha yoga which was performed for 10 min is a suitable option for relatively healthy people in the modern workplace who may have hatha yoga experience but do not have time to perform a prolonged exercise. Following active recovery, they can participate in further HIHY sessions during short breaks. Furthermore, a faster return to work can be supported by physiological recovery.

Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial

OBJECTIVE

This study examined the feasibility and comparison of two styles of yoga within the context of a standard behavioral weight-loss intervention (SBWI).

METHODS

Fifty adults with obesity (BMI: 31.3 ± 3.8 kg/m² ) participated in this 6-month study that included a SBWI and a calorie- and fat-reduced diet. Randomization was to restorative Hatha (SBWI+RES) or Vinyasa (SBWI+VIN) yoga. Yoga was prescribed to increase from 20 to 40 to 60 minutes per session across the intervention. Weight was assessed at baseline and 6 months. Perceptions of yoga were assessed at the completion of the intervention.

RESULTS

Adjusted weight loss was -3.4 kg (95% CI: -6.4 to -0.5) in SBWI+RES and -3.8 kg (95% CI: -6.8 to -0.9) in SBWI+VIN (P < 0.001), with no difference between groups. Of all participants, 74.4% reported that they would continue participation in yoga after the SBWI. Session duration was a barrier as yoga increased from 20 to 40 to 60 minutes per day, with 0%, 7.5%, and 48.8% reporting this barrier, respectively.

CONCLUSIONS

Among adults with obesity, yoga participation, within the context of a SBWI, appears to be feasible, with weight loss not differing by style of yoga. Progressing to 60 minutes per session appears to be a barrier to engagement in yoga in this population.

The effects of a 6-month moderate-intensity Hatha yoga-based training program on health-related fitness in middle-aged sedentary women: a randomized controlled study

BACKGROUND

There is paucity of data examining the effectiveness of long-term Hatha yoga-based (HY) programs focused on the health-related fitness (H-RF) of asymptomatic, sedentary women. The purpose of this study was to examine the effects of a 6-month HY-based training program on H-RF components in sedentary middle-aged women.

METHODS

Eighty sedentary women were randomly assigned into either the HY group (HYG) (N.=42) or the control group (CG) (N.=38). The 6-month HYG program involved a progressive series of Vinyasa Flow poses performed 3 times/week for 60 minutes (40 minutes within the exercise zone of 60-75% HR<inf>max</inf>). The CG participants did not undergo any physical training or education. Health-related fitness parameters included measures of pre- and post-training: body composition, muscular strength and maximal voluntary isometric torques of elbow flexors and knee extensors, cardio-respiratory fitness, lower back and hamstring flexibility and a static-dynamic balance.

RESULTS

Two-way mixed design ANOVA revealed significant main effects for all the indicators of H-RF. Tukey post-hoc tests confirmed that the HYG demonstrated significant improvements in every variable tested. Examples of the benefits achieved include (all P<.001): an average loss of 1.03 kg and a 4.82% decrease in body fat, 14.6% and 13.1% gains in isometric strength of the knee extensors and elbow flexors respectively, an increase in relative VO<inf>2max</inf> of 6.1% (33.12±5.30 to 35.14±4.82 mL/kg/min), a 4-cm or 10.4% increase in their MSAR, and an average improved Balance Index of 5.6 mm/s. Reversely, the CG showed non-significant changes in H-RF variables (all P>0.05; percent range from -1.4% to 1.1%).

CONCLUSIONS

By participating in a moderate-intensity 6-month HY-based training program, middle-aged women can significantly improve their HR-F status. The application of progressive target heart rate goals facilitated greater than expected improvements in cardio-respiratory fitness and improvements in body composition.

Energy expenditure during a Vinyasa yoga session

BACKGROUND

Vinyasa yoga has been recently promoted as one of the most popular mindful exercises to improve overall health, including body weight management. The purpose of this study was to determine the metabolic response of 24 moderately trained individuals during a 90-min group Vinyasa yoga routine.

METHODS

Heart rate (HR) time course of 12 males and 12 females (age: 39±7.33 years) was recorded during two group Vinyasa yoga sessions consisted of four sections (warm-up, high-intensity Surya Namaskar (HSN), no Surya Namaskar postures, and cool-down). Maximal oxygen uptake (V̇O<inf>2peak</inf>) and maximum HR had been estimated earlier after a maximal treadmill test. V̇O<inf>2</inf> during Vinyasa yoga sessions was estimated from individual regression equations using the relationship of V̇O<inf>2</inf> and HR values derived from V̇O<inf>2peak</inf> test, while the metabolic rate (kcal/min) was calculated from the relationship of HR and kcal/min. Total session energy consumption was the average value of the two yoga sessions.

RESULTS

The 2 (gender) × 4 (sections) mixed ANOVA revealed no significant interaction between the two factors (P=0.101) for the mean metabolic rate (7.1±2.6 kcal/min). Mean metabolic rate thought was higher (P=0.015) in males compared to females at each section. Also, significant differences were found among the four Vinyasa yoga sections (P<0.001) in the rate of energy expenditure, with HSN presenting the highest mean values (P<0.05).

CONCLUSIONS

It seems that systematic participation in Vinyasa yoga may effectively improve cardiorespiratory fitness and promote body weight loss, as an alternative method to traditional aerobic exercise.

Yoga as a complementary therapy for metabolic syndrome: A narrative review

Metabolic syndrome (MS) is associated with a sedentary and stressful lifestyle and affects underactive people disproportionately. Yoga is considered to be a low-impact mind-body stress-relieving exercise, and researchers are increasing their focus on the benefits of yoga for managing metabolic disorders. It is also important for physicians and health care professionals to understand the therapeutic efficacy of yoga intervention, in terms of its type, duration and frequency on various MS risk factors. The present review summarizes the current scientific understanding of the effects of yoga on MS risk factors such as glucose homeostasis markers, lipid profile, adipocytokines and cardiovascular risk factors, and discusses the possible mechanisms of action. MEDLINE, PubMed, Scopus and Cochrane Library were searched from their inception up to December 2019, using the keywords "metabolic syndrome," "diabetes," "cardiovascular diseases," "obesity" and "yoga." The literature summarized in this review have shown mixed effects of yoga on MS risk factors and do not provide robust evidence for its efficacy. More rigorous research and well-designed trials that have a higher standard of methodology and evaluate yoga's long-term impacts on MS are needed. Understanding yoga's biochemical and molecular mechanisms of action on various metabolic pathways is also needed.

Innovative Mind-Body Intervention Day Easy Exercise Increases Peripheral Blood CD34+ Cells in Adults

Mind-body interventions (MBIs) have many health benefits, such as reducing stress, modulating blood pressure, and improving sleep and life quality. The long-term practice of Tai chi, an MBI, also increases the number of CD34⁺ cells, which are surface markers of hematopoietic stem cells, so prolonged Tai chi practice may have antiaging effects. We developed the day easy exercise (DEE), an innovative MBI, that is easy to learn and requires only a small exercise area and a short practice time. The aim of this study was to explore whether DEE, like Tai chi, has antiaging effects after short-term practice. Total 44 individuals (25 to 62 years old) with or without 3-month DEE practice were divided into young- and middle-aged groups (≤30 and >30 years old) and peripheral blood was collected at 0, 1, 2, and 3 months for analysis of CD34⁺ cells. The number of CD34⁺ cells in peripheral blood remained unchanged in control young- and middle-aged groups. After DEE, the number of CD34⁺ cells in peripheral blood was increased over time in both young- and middle-aged groups. For young-aged adults, the cell number was markedly increased by threefold at 3 months after DEE, and for middle-aged adults, the increase was significant from the first month. DEE practice indeed increased the number of CD34⁺ cells in peripheral blood and the increase was more significant for older people in a shorter time. This is the first study to provide evidence that the DEE may have antiaging effects and could be beneficial for older people.

Integrated Yoga Practice in Cardiac Rehabilitation Program: A Randomized Control Trial

Background: Coronary artery disease (CAD) is a detrimental noncommunicable disease, which is increasing due to sedentary lifestyle and urbanization in the young population. It is further elevated with risk factors such as stress, anxiety, depression, an increase in triglycerides, dyslipidemia, hyperglycemia, hypertension, and so on, which manifests as atherosclerotic disease. Yoga-based lifestyle intervention is a noninvasive effective treatment method to control and prevent cardiac risk factors in CAD patients. Yoga has been used in India as a therapeutic method to manage hypertension and other chronic disorders and is fast gaining popularity as an effective means for the alleviation of stress, improvement of fitness, and enhancement of well-being. This study aimed to determine the feasibility of introducing the integrated approach of yoga therapy (IAYT) in a cardiac rehabilitation center in India and understand its usefulness in improving the cardiac function and managing the cardiac risk factors in acute myocardial infarction patients with left ventricular dysfunction. Methods and Design: Cardiac patients were randomized to a yoga-practicing group (n = 33) and a control group (n = 33). The yoga-practicing group was instructed to attend three supervised IAYT classes 3 days per week for 12 weeks at the hospital yoga center. The control group received standard care that included pharmacologic treatment and the instructions of the cardiologist. The outcome measures were assessed at baseline (T1 = 0) and completion (T2 = 3 months). The primary outcome measure was the left ventricular ejection fraction (LVEF). Results: There was no statistically significant difference in LVEF (U = 420.500, p value = 0.218) between the two groups. However, the yoga-practicing group showed significant reduction in depression (Cardiac Depression Scale [CDS], U = 71, p value = 0.0), anxiety (Hamilton Anxiety Rating Scale [HAM-A], U = 128, p value = 0.0), and a significant increase in quality of life (QOL) scores (Duke Activity Status Index [DASI], U = 146, p value = 0.0; and metabolic equivalents (METs), U = 136, p value = 0.0) at 3 months compared to control. Overall, the CAD patients practicing yoga showed a favorable profile compared to control individuals on CDS, HAM-A, DASI, and MET outcomes. Control and yoga practicing groups did not differ significantly in the lipid levels. Conclusion: This study indicated that the integration of yoga practice in a cardiac rehabilitation program is feasible and has no added benefit in improving the cardiac function. However, the addition of yoga to cardiac rehabilitation may be beneficial in reducing depression and anxiety and improving QOL in patients.

Range of Yoga Intensities From Savasana to Sweating: A Systematic Review

Background: There is limited research examining the intensity of yoga and intensity variations between different styles. The purpose of this review is to examine the intensity of yoga based on different physiologic responses both between different yoga styles and within styles of yoga. Methods: Articles were searched for on the PubMed database in early 2019. Inclusion criteria were as follows: (1) written in English, (2) cite a specific style of yoga and include whole yoga session, and (3) measure metabolic or heart rate response. Results: Ten articles were reviewed; articles reported oxygen consumption (n = 1), heart rate (n = 4), or both variables (n = 5). Yoga styles assessed included ashtanga (n = 2), Bikram (n = 3), gentle (n = 1), hatha (n = 3), Iyengar (n = 1), power (n = 1), and vinyasa (n = 1). Oxygen consumption commonly categorized yoga as a light-intensity activity, while heart rate responses classified different yoga into multiple intensities. Conclusion: This review demonstrates that large differences in intensity classifications are observed between different styles of yoga. Furthermore, metabolic and heart rate responses can be variable, leading to inconsistent intensity classifications. This is likely due to their nonlinear relationship during yoga. Thus, it is imperative that the field of yoga research works together to create a standard for reporting yoga.

Business Travel and Behavioral and Mental Health

OBJECTIVE

Assess associations between business travel and behavioral and mental health.

METHODS

Cross-sectional analyses of de-identified electronic medical record data from EHE International, Inc. a provider of corporate wellness programs.

RESULTS

Higher levels of business travel were associated with poorer outcomes. Compared with traveling 1 to 6 nights/mo for work, those who traveled 21+ nights were more likely to: smoke (prevalence ratio [PR] = 3.74, 95% confidence interval [CI] 2.56, 5.46), report trouble sleeping (PR = 1.37, 95% CI 1.09, 1.71), be sedentary (PR = 1.95, 95% CI 1.56, 2.43), and score above clinical thresholds for alcohol dependence (CAGE score >1: PR = 2.04, 95% CI 1.26, 3.29), and mild or worse anxiety (Generalized Anxiety Scale [GAD-7] score >4: PR = 1.69, 95% CI 1.29, 2.21), and depression symptoms (Patient Health Questionnaire [PHQ-9] score >4: PR = 2.27, 95% CI 1.70, 3.03).

CONCLUSIONS

Employers should provide programs to help employees manage stress and maintain health while traveling for work.

Metabolic Demands of Yoga at Varying Tempos and Compared With Walking

BACKGROUND

Yoga is a popular alternative to walking, but the tempo at which asanas must be performed to elicit comparable metabolic and cardiorespiratory demands is unknown. Therefore, the authors aim to compare the metabolic demands of moderate-intensity walking to Surya Namaskar yoga performed at varying tempos.

METHODS

Inactive obese adults with limited prior yoga experience (n = 10) completed 10 minutes of treadmill walking at a self-selected pace (rating of perceived exertion = 12-13) and three, 10-minute bouts of yoga at a low (6 s/pose; LSUN), medium (4 s/pose; MSUN), and high (3 s/pose; HSUN) tempo with 10-minutes rest between exercise bouts.

RESULTS

Mean metabolic equivalents observed in MSUN (3.64 [0.607]), HSUN (4.22 [0.459]), and treadmill (5.29 [1.147]) were greater than 3.0 (P ≤ .01), but not LSUN (3.28 [0.529], P = .13). Treadmill elicited greater caloric and kilocaloric expenditure (1.36 [0.23] L·min-1; 64 [11] kcal) than LSUN (0.87 [0.24] L·min-1; 39 [11] kcal) and MSUN (1.00 [0.29] L·min-1; 45 [13] kcal) (P ≤ .01). Absolute V˙O2 between yoga tempos were not different, but relative V˙O2 was higher in HSUN (14.89 [1.74] mL·min-1·kg) versus LSUN (11.39 [1.83] mL·min-1·kg) (P = .02).

CONCLUSIONS

Yoga can meet (LSUN) or exceed (MSUN and HSUN) moderate-intensity exercise recommendations. For unfit or obese populations, varying tempos of yoga practice may serve as a lower-impact option for beginning an exercise program.

Acute Cardiovascular Responses to a Session of Bikram Yoga: A Pilot Uncontrolled Trial

INTRODUCTION

Main cardiovascular parameters such as heart rate (HR), blood pressure, and myocardial oxygen consumption (MOC) are tightly regulated by a multifactorial, nonlinear control system. Increased HR because of physical activity is often accompanied by an increase in blood pressure. Postural changes have an effect on the baroreceptors, and stretching exercises and isometric contractions modulate muscle mechanoreceptors eliciting increases in blood pressure. However, a hot environment increases the core temperature inducing vasodilation and plasma volume changes that might contribute to a drop in blood pressure. During the practice of Bikram yoga, all these factors converge and little is known about the resulting changes in blood pressure and MOC.

METHODS

Sixteen apparently healthy female volunteers, regular practitioners of Bikram yoga, were evaluated during a 90 min session. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured immediately after each posture and HR was measured continuously during the practice.

RESULTS

HR and estimated MOC increased significantly over baseline during the exercise (+62.3% and +63.6%, respectively). HR mean value across the entire Bikram yoga session was 126.6 ± 14.3 bpm reaching a maximum of 168.1 ± 20.2 bpm. SBP was not significantly increased over baseline at any time during the practice with a mean value of 117.0 ± 10.1 mmHg and DBP was significantly decreased over baseline most of the time (-10.1%, mean 71.2 ± 7.3 mmHg) with particular decline toward the end of the practice during the floor postures.

CONCLUSIONS

DBP during the practice of Bikram yoga was significantly different from that previously reported for nonheated Hatha yoga for normotensive subjects. Further studies evaluating the same group at both conditions are needed to better characterize the magnitude of the changes in HR, SBP, DBP, and MOC.

Use of a 'pose rate' to quantify yoga

OBJECTIVE

To develop a method that describes the physical activity completed during yoga, and to use this method to compare three different yoga video categories: weight loss, beginner, and stress relief/meditation.

DESIGN

This study conducted content analysis of commercially available yoga videos in which pre-determined characteristics of yoga routines were recorded. Outcome measures included the yoga routine characteristics of: duration of each yoga routine, number of completed poses, body position of each pose, and pose rate.

RESULTS

Twenty-two routines from yoga videos were analyzed. Duration of routine between the three different categories was not significantly different. There were significant differences between the video categories based on the characteristics of total number of poses and the pose rate, with weight loss routines having the highest values compare to beginner routines and stress relief/meditation (total number of poses: 74.1, 34.3, 25.6 poses, p < 0.05; Pose rate: 2.5m 1.5, 1.1 poses/min, p < 0.05, respectively). Additionally, differences were observed between body postures in poses with weight loss videos including more standing poses (38.8, 17.0, 5.7 poses, p < 0.05, respectively) and a lower percentage of seated (9.9%, 15.8%, 39.0%, p < 0.05, respectively) and supine poses (10.9%, 18.5%, 28.8%, p < 0.05, respectively) compared to the beginner and stress/meditation videos.

CONCLUSIONS

The characteristics of total poses, pose rate, and total standing poses showed significant differences between different styles of yoga. Further research should be conducted to validate these characteristics as an intensity measures and to assess if these characteristics have variations between different yoga styles.

Active mind-body movement therapies as an adjunct to or in comparison with pulmonary rehabilitation for people with chronic obstructive pulmonary disease

BACKGROUND

Active mind-body movement therapies (AMBMTs), including but not limited to yoga, tai chi, and qigong, have been applied as exercise modalities for people with chronic obstructive pulmonary disease (COPD). AMBMT strategies have been found to be more effective than usual care; however, whether AMBMT is inferior, equivalent, or superior to pulmonary rehabilitation (PR) in people with COPD remains to be determined.

OBJECTIVES

To assess the effects of AMBMTs compared with, or in addition to, PR in the management of COPD.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register of trials and major Chinese databases, as well as trial registries from inception to July 2017. In addition, we searched references of primary studies and review articles. We updated this search in July 2018 but have not yet incorporated these results.

SELECTION CRITERIA

We included (1) randomised controlled trials (RCTs) comparing AMBMT (i.e. controlled breathing and/or focused meditation/attention interventions for which patients must actively move their joints and muscles for at least four weeks with no minimum intervention frequency) versus PR (any inpatient or outpatient, community-based or home-based rehabilitation programme lasting at least four weeks, with no minimum intervention frequency, that included conventional exercise training with or without education or psychological support) and (2) RCTs comparing AMBMT + PR versus PR alone in people with COPD. Two independent review authors screened and selected studies for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors if necessary to ask them to provide missing data. We calculated mean differences (MDs) using a random-effects model.

MAIN RESULTS

We included in the meta-analysis 10 studies with 762 participants across one or more comparisons. The sample size of included studies ranged from 11 to 206 participants. Nine out of 10 studies involving all levels of COPD severity were conducted in China with adults from 55 to 88 years of age, a higher proportion of whom were male (78%). Nine out of 10 studies provided tai chi and/or qigong programmes as AMBMT, and one study provided yoga. Overall, the term 'PR' has been uncritically applied in the vast majority of studies, which limits comparison of AMBMT and PR. For example, eight out of 10 studies considered walking training as equal to PR and used this as conventional exercise training within PR. Overall study quality for main comparisons was moderate to very low mainly owing to imprecision, indirectness (exercise component inconsistent with recommendations), and risk of bias issues. The primary outcomes for our review were quality of life, dyspnoea, and serious adverse events.When researchers compared AMBMT versus PR alone (mainly unstructured walking training), statistically significant improvements in disease-specific quality of life (QoL) (St. George's Respiratory Questionnaire (SGRQ) total score) favoured AMBMT: mean difference (MD) -5.83, 95% confidence interval (CI) -8.75 to -2.92; three trials; 249 participants; low-quality evidence. The common effect size, but not the 95% CI around the pooled treatment effect, exceeded the minimal clinically important difference (MCID) of minus four. The COPD Assessment Test (CAT) also revealed statistically significant improvements favouring AMBMT over PR, with scores exceeding the MCID of three, with an MD of 6.58 units (95% CI -9.16 to - 4.00 units; one trial; 74 participants; low-quality evidence). Results show no between-group differences with regard to dyspnoea measured by the modified Medical Research Council Scale (MD 0.00 units, 95% CI -0.37 to 0.37; two trials; 127 participants; low-quality evidence), the Borg Scale (MD 0.44 units, 95% CI -0.88 to 0.00; one trial; 139 participants; low-quality evidence), or the Chronic Respiratory Questionnaire (CRQ) Dyspnoea Scale (MD -0.21, 95% CI -2.81 to 2.38; one trial; 11 participants; low-quality evidence). Comparisons of AMBMT versus PR alone did not include assessments of generic quality of life, adverse events, limb muscle function, exacerbations, or adherence.Comparisons of AMBMT added to PR versus PR alone (mainly unstructured walking training) revealed significant improvements in generic QoL as measured by Short Form (SF)-36 for both the SF-36 general health summary score (MD 5.42, 95% CI 3.82 to 7.02; one trial; 80 participants; very low-quality evidence) and the SF-36 mental health summary score (MD 3.29, 95% CI 1.45 to 4.95; one trial; 80 participants; very low-quality evidence). With regard to disease-specific QoL, investigators noted no significant improvement with addition of AMBMT to PR versus PR alone (SGRQ total score: MD -2.57, 95% CI -7.76 to 2.62 units; one trial; 192 participants; moderate-quality evidence; CRQ Dyspnoea Scale score: MD 0.04, 95% CI -2.18 to 2.26 units; one trial; 80 participants; very low-quality evidence). Comparisons of AMBMT + PR versus PR alone did not include assessments of dyspnoea, adverse events, limb muscle function, exacerbations, or adherence.

AUTHORS' CONCLUSIONS

Given the quality of available evidence, the effects of AMBMT versus PR or of AMBMT added to PR versus PR alone in people with stable COPD remain inconclusive. Evidence of low quality suggests better disease-specific QoL with AMBMT versus PR in people with stable COPD, and evidence of very low quality suggests no differences in dyspnoea between AMBMT and PR. Evidence of moderate quality shows that AMBMT added to PR does not result in improved disease-specific QoL, and evidence of very low quality suggests that AMBMT added to PR may lead to better generic QoL versus PR alone. Future studies with adequate descriptions of conventional exercise training (i.e. information on duration, intensity, and progression) delivered by trained professionals with a comprehensive understanding of respiratory physiology, exercise science, and the pathology of COPD are needed before definitive conclusions can be drawn regarding treatment outcomes with AMBMT versus PR or AMBMT added to PR versus PR alone for patients with COPD.

Oxygen Consumption during Viniyoga Practice in Adults

Context:

The purpose of this study was to measure the oxygen consumption (V̇O₂) during Viniyoga yoga movements (asanas) and to compare V̇O₂ walking among adults.

Methods:

Yoga practitioners (n = 10) were recruited to measure V̇O₂ while at rest (30 min), practicing yoga (16 movements with different variations), and treadmill walking at 2 mph (10 min) and 3 mph (10 min). V̇O₂ was measured using a whole-room indirect calorimetry. Each yoga movement was categorized by body orientation as standing, lying, and sitting. The differences in V̇O₂ between yoga and walking were examined using Pearson's correlations. Differences in V̇O₂ between poses (standing, sitting, and lying) were examined using linear regression models. V̇O₂.

Results:

Mean yoga-V̇O₂ for the entire yoga session was 3.7 (standard deviation [SD] 0.43, range: 4.4–8.9) ml/kg/min. Yoga-V̇O₂ varied by body orientation: standing = 7.5 (SD = 1.5) ml/kg/min, lying = 5.3 (SD = 1.0) ml/kg/min, and sitting = 5.4 (SD = 1.1) ml/kg/min. After adjusting for body mass, frequency of yoga practice, and resting energy expenditure, female gender was negatively associated with mean yoga V̇O₂ for standing (B = −112.19, P < 0.05), lying (B = −141.87, P < 0.05), and sitting (B = −129.96, P < 0.05). Mean V̇O₂ for walking 2 mph was comparable with sitting (r = 0.836, P < 0.05) and lying (r = 0.735, P < 0.05) whereas walking at 3 mph was comparable with standing (r = 0.718, P < 0.05) and sitting (r = 0.760, P < 0.05).

Conclusion:

We conclude that V̇O₂ during yoga practice is comparable to V̇O₂ during slow treadmill walking and may vary based on gender and body orientation.

Heart rate and thermal responses to power yoga

BACKGROUND

and Purpose: Yoga has grown in popularity and may offer a viable alternative form of physical activity. The purpose of this study was to examine heart rate, hydration, and thermal responses to a power yoga sequence.

MATERIALS AND METHODS

Twenty-seven men and women (n = 4/23; Mean ± SD age = 23.3 ± 3.3 years; BMI = 23 ± 3 kg m^-2) underwent ∼45 min of power yoga. Heart rate and skin temperature were recorded. Mass was measured before and after exercise to estimate fluid loss. Time spent in light, moderate, and vigorous heart rate zones was calculated.

RESULTS

Heart rate and skin temperature increased (p < 0.0001). Participants spent more time in moderate and vigorous heart rate zones than in light intensity (p < 0.0001). There was a reduction in body mass (-0.28 ± 0.13 kg, p < 0.0001).

CONCLUSION

Power yoga may be considered moderate-vigorous intensity exercise, based on heart-rate.

Military-Tailored Yoga for Veterans with Post-traumatic Stress Disorder

Introduction

Among veterans of post-9/11 conflicts, estimates of post-traumatic stress disorder (PTSD) range from 9% shortly after returning from deployment to 31% a year after deployment. Clinical and pharmaceutically based treatments are underutilized. This could be due to concerns related to lost duty days, as well as PTSD patients' fears of stigma of having a mental health condition. Yoga has been shown to reduce PTSD symptoms in the civilian population, but few studies have tested the impact of yoga on veterans of post-9/11 conflicts. The purpose of this study is to test the impact of yoga on post-9/11 veterans diagnosed with PTSD.

Materials and Methods

Participants were 18 yr of age or older and veterans of post-9/11 conflicts. They had subthreshold or diagnostic-level PTSD related to their combat military service, as determined by a score of 30 or higher on the PTSD Checklist-Military version (PCL-M). Veterans participated in 60-min weekly yoga sessions for 6 wk taught by a Warriors at Ease-trained yoga instructor who is a, post-9/11 veteran. The yoga sessions incorporated Vinyasa-style yoga and a trauma-sensitive, military-culture informed approach advocated by two separate organizations: Warriors at Ease and Meghan's Foundation. Data were collected at baseline and again after 7 wk. The primary outcome was PCL-M score. Participants also completed the Patient Health Questionnaire, the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, and the Mindful Attention Awareness Scale at both time points.

Results

Eighteen Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans completed the pre- and post-intervention self-report questionnaires. Age ranged from 26 to 62 yr (median = 43 yr), length of service ranged from 2 to 34 yr (median = 18.8 yr), and 13 (72.2%) had completed college. Decreased PTSD symptomatology was demonstrated in the three-symptom clusters represented in the PCL-M (i.e., hyperarousal, re-experiencing, and avoidance). In addition, the total score on the PCL-M decreased significantly, by both statistical and clinical measures. The participants also demonstrated improved mindfulness scores and reported decreased insomnia, depression, and anxiety symptoms.

Conclusion

This study demonstrates that a trauma-sensitive yoga intervention may be effective for veterans with PTSD symptoms, whether as stand-alone or adjunctive therapy. The impressive decrease in PTSD symptomatology may be due to the tailored military-specific nature of this intervention and the fact that it was led by a veteran of post-9/11 conflicts. More research is needed with a larger sample and a more diverse veteran population.

Yoga for Heart Failure: A Review and Future Research

Background:

Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients.

Aim:

The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients.

Methods:

The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies.

Conclusions:

Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.

Association between exercise type and quality of life in a community-dwelling older people: A cross-sectional study

OBJECTIVES

This study aimed to investigate the effects of three major representative exercises (resistance, flexibility, and walking) on quality of life (QoL) in a population of community-dwelling older adults.

MATERIALS AND METHODS

This cross-sectional study used public data from the Sixth Korean National Health and Nutrition Examination Survey in 2014 (n = 1,586 older people). Demographic factors, three types of exercise, five EuroQoL subsets (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and QoL scores (EQ-VAS) were investigated. The independent associations between each exercise and the five QoL subsets were determined using odds ratios (OR) adjusted for three demographic factors (age group, sex, and area of residence), using multivariate logistic regression analysis.

RESULTS

The EQ-VAS scores of the exercisers was significantly higher than those of the non-exercisers for all exercise types. Subjects with problems in mobility dimension performed less exercise of all types of than those with normal mobility (resistance: OR, 0.687; flexibility: OR, 0.733, and walking: OR, 0.489). The self-care dimension was independently correlated with flexibility (OR, 0.558) and walking (OR, 0.485).

CONCLUSION

All types of exercisers showed higher QoL scores than non-exercisers. Among the QoL dimensions, mobility and self-care were independently associated with flexibility and walking exercise in this older people, suggesting that engaging in regular flexibility and walking exercise is important for achieving higher QoL in the older people.

Objective and subjective measures of exercise intensity during thermo-neutral and hot yoga

While hot yoga has gained enormous popularity in recent years, owing in part to increased environmental challenge associated with exercise in the heat, it is not clear whether hot yoga is more vigorous than thermo-neutral yoga. Therefore, the aim of this study was to determine objective and subjective measures of exercise intensity during constant intensity yoga in a hot and thermo-neutral environment. Using a randomized, crossover design, 14 participants completed 2 identical ∼20-min yoga sessions in a hot (35.3 ± 0.8 °C; humidity: 20.5% ± 1.4%) and thermo-neutral (22.1 ± 0.2 °C; humidity: 27.8% ± 1.6%) environment. Oxygen consumption and heart rate (HR) were recorded as objective measures (percentage of maximal oxygen consumption and percentage of maximal HR (%HRmax)) and rating of perceived exertion (RPE) was recorded as a subjective measure of exercise intensity. There was no difference in exercise intensity based on percentage of maximal oxygen consumption during hot versus thermo-neutral yoga (30.9% ± 2.3% vs. 30.5% ± 1.8%, p = 0.68). However, exercise intensity was significantly higher during hot versus thermo-neutral yoga based on %HRmax (67.0% ± 2.3% vs. 60.8% ± 1.9%, p = 0.01) and RPE (12 ± 1 vs. 11 ± 1, p = 0.04). According to established exercise intensities, hot yoga was classified as light-intensity exercise based on percentage of maximal oxygen consumption but moderate-intensity exercise based on %HRmax and RPE while thermo-neutral yoga was classified as light-intensity exercise based on percentage of maximal oxygen uptake, %HRmax, and RPE. Despite the added hemodynamic stress and perception that yoga is more strenuous in a hot environment, we observed similar oxygen consumption during hot versus thermo-neutral yoga, classifying both exercise modalities as light-intensity exercise.

A single session of hatha yoga improves stress reactivity and recovery after an acute psychological stress task-A counterbalanced, randomized-crossover trial in healthy individuals

OBJECTIVES

Yoga is promoted as an anti-stress activity, however, little is known about the mechanisms through which it acts. The present study investigated the acute effects of a hatha yoga session, displayed on a video, on the response to and recovery from an acute psychological stressor.

METHODS

Twenty-four healthy young adults took part in a counterbalanced, randomized-crossover trial, with a yoga and a control condition (watching TV). Participants attended the laboratory in the afternoon on two days and each session comprised a baseline, control or yoga task, stress task and recovery. Blood pressure (BP), heart rate (HR) and salivary cortisol responses were measured. State cognitive- and somatic-anxiety along with self-confidence were assessed before and after the stressor.

RESULTS

Although no difference in the BP or HR responses to stress were found between conditions, systolic BP (p=0.047) and diastolic BP (p=0.018) recovery from stress were significantly accelerated and salivary cortisol reactivity was significantly lower (p=0.01) in the yoga condition. A yoga session also increased self-confidence (p=0.006) in preparation for the task and after completion. Moreover, self-confidence reported after the stress task was considered debilitative towards performance in the control condition, but remained facilitative in the yoga condition.

CONCLUSION

Our results show that a single video-instructed session of hatha yoga was able to improve stress reactivity and recovery from an acute stress task in healthy individuals. These positive preliminary findings encourage further investigation in at-risk populations in which the magnitude of effects may be greater, and support the use of yoga for stress reactivity and recovery.

A Systematic Review of the Energy Cost and Metabolic Intensity of Yoga

PURPOSE

With the increasing popularity of Hatha yoga, it is important to understand the energy cost and METs of yoga practice within the context of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) physical activity guidelines.

METHODS

This systematic review evaluated the energy cost and metabolic intensity of yoga practice including yoga asanas (poses/postures) and pranayamas (breath exercises) measured by indirect calorimetry. The English-speaking literature was surveyed via PubMed using the general terms "yoga" and "energy expenditure" with no date limitations.

RESULTS

Thirteen manuscripts were initially identified with an additional four located from review of manuscript references. Of the 17 studies, 10 evaluated the energy cost and METs of full yoga sessions or flow through Surya Namaskar (sun salutations), eight of individual asanas, and five of pranayamas. METs for yoga practice averaged 3.3 ± 1.6 (range = 1.83-7.4 METs) and 2.9 ± 0.8 METs when one outlier (i.e., 7.4 METs for Surya Namaskar) was omitted. METs for individual asanas averaged 2.2 ± 0.7 (range = 1.4-4.0 METs), whereas that of pranayamas was 1.3 ± 0.3. On the basis of ACSM/AHA classification, the intensity of most asanas and full yoga sessions ranged from light (less than 3 METs) to moderate aerobic intensity (3-6 METs), with the majority classified as light intensity.

CONCLUSION

This review suggests that yoga is typically classified as a light-intensity physical activity. However, a few sequences/poses, including Surya Namaskar, meet the criteria for moderate- to vigorous-intensity activity. In accordance with the ACSM/AHA guidelines, the practice of asana sequences with MET intensities higher than three (i.e., >10 min) can be accumulated throughout the day and count toward daily recommendations for moderate- or vigorous-intensity physical activity.

Cardiopulmonary and Metabolic Effects of Yoga in Healthy Volunteers

BACKGROUND

Yoga the spiritual union of mind with the divine intelligence of the universe aims to liberate a human being from conflicts of body-mind duality. Beneficial cardiovascular and pulmonary effects of yoga are in par with aerobic exercise, even amounting to replace the exercise model. We conducted an interventional study in healthy volunteers, to analyze the impact of short-term yoga training on cardiovascular, pulmonary, autonomic function tests, lipid profile, and thyroid function tests.

MATERIALS AND METHODS

A sample of fifty new recruits attending the district yoga center was subject to 75 min yoga practice a day for 41 days. Basal values of cardiovascular, pulmonary, autonomic function tests, lipid profile, and thyroid function tests were recorded before yoga training and were reassessed for postyoga changes after 41 days.

RESULTS

After yoga practice there was a significant reduction in the resting heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure of the participants. Effects on autonomic function tests were variable and inconclusive. There was a significant increase in forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate after yoga. A significant reduction in body mass index was observed. Effects on metabolic parameters were promising with a significant reduction in fasting blood sugar level, serum total cholesterol, serum triglycerides serum low-density lipoprotein levels, and significant increase in high-density lipoprotein. There was no significant change in thyroid function tests after yoga.

CONCLUSION

Short-term yoga practice has no effect on thyroid functions. Yoga practice was found beneficial in maintaining physiological milieu pertaining to cardiovascular and other metabolic parameters.

Characteristics of Yoga Practitioners, Motivators, and Yoga Techniques of Choice: A Cross-sectional Study

Background

The characteristics of yoga practitioners and factors motivating people to practice yoga have been studied in the US and in Australia. This study aimed to determine the characteristics of yoga users in India, the factors that motivate them to practice yoga, and the yoga techniques of choice.

Materials and methods

The study was a one-time, cross-sectional survey based on convenience sampling. Inclusion criteria were (a) a minimum of 1 week experience of yoga and (b) at least 10 years of age. 14,250 people received the survey. After excluding those who did not meet the inclusion criteria or filled in the survey incompletely or incorrectly, 5,157 respondents were included in the study.

Results

Out of 5,157 respondents, there were more males (67.3%), aged between 21 and 44 years (33.7% of the sample surveyed), educated up to high school (62.5%), students (39.3%), and those who had between 1 and 12 months of experience in yoga (54.4%). The first most common reason to practice yoga for all respondents was physical fitness. Three of the remaining reasons to practice yoga differed significantly with age: (i) yoga for disease management (χ² = 17.62, p < 0.005), (ii) yoga as a hobby (χ² = 10.87, p < 0.05), and (iii) yoga based on the guru’s (teacher’s) instructions (χ² = 20.05, p < 0.001). The yoga technique of choice [i.e., (i) asanas (χ² = 23.17, p < 0.001), (ii) pranayama (χ² = 19.87, p < 0.001), or (iii) meditation (χ² = 9.64, p < 0.05)] differed significantly across age groups.

Conclusion

In India, a yoga practitioner was more likely to be male, between 21 and 44 years of age, high school educated, and a student. The reasons to practice yoga and the yoga technique of choice differed significantly with age.

Aligning Yoga With Its Evolving Role in Health Care: Comments on Yoga Practice, Policy, Research

Evidence is accumulating that suggests that yoga has beneficial effects in mitigating the impact of certain diseases. As a result, efforts are being made to medicalize yoga and use it within integrative medicine as a therapy. However, there are substantial shortcomings in the practice, policy, and research of yoga that undermine its optimal use. Yoga as a modality functions within a context. Therefore, it is important to occasionally step back and examine the entirety of the context from a high vantage to assess whether the tactical and programmatic endeavors are aligned with the strategic intended purpose. This commentary discusses a few policy issues relevant to some key stakeholders. It suggests that yoga therapists need to calibrate their model of yoga by reducing emphasis on postures and increasing it on meditation and breathing exercises while catering to clients with chronic conditions. It recommends that yoga research should be more critical in evaluating yoga's fundamental tenets and use reductionist approach to do so. It proposes that autonomous regulators should extricate injury prone postures from the body of yoga practice for regulatory purposes, rather than regulate yoga summarily. It is suggested that payers should pay for yoga. However, they should use payment model as it is used for vaccination, instead of paying as it is done for physiotherapy. It concludes that yoga can help, but before it can help it needs help itself, and the various stakeholders need to reflect on the big picture so that they can collaborate on these improvements.

Decline in the Use of Medicalized Yoga Between 2002 and 2012 While the Overall Yoga Use Increased in the United States: A Conundrum

We analyzed the National Health Institute Survey Alternative Medicine supplement yoga data for 2002, 2007, and 2012 to answer the following questions: (1) Do the claims about increase in the use of yoga hold true at the level of specific health problems? (2) Do trends support a proposition that yoga is believed to be helpful in amelioration of disease conditions? (3) Do the prescribing patterns of health care providers correspond with the increasing popularity of yoga? Data were analyzed using SAS software, version 9.4. Response percentages were compared using chi-square test after adjusting for age. Between 2002 and 2012, use of yoga increased but adherence failed to increase, and use for specific health problems and for back pain declined; use of health care providers’ referral–driven yoga declined between 2007 and 2012. All results were statistically significant. Our results suggest that the use of medicalized yoga declined between 2002 and 2012.

Unproven Therapies for Diabetes and Their Implications

Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.

Differences in energy expenditure during high-speed versus standard-speed yoga: A randomized sequence crossover trial

OBJECTIVES

To compare energy expenditure and volume of oxygen consumption and carbon dioxide production during a high-speed yoga and a standard-speed yoga program.

DESIGN

Randomized repeated measures controlled trial.

SETTING

A laboratory of neuromuscular research and active aging.

INTERVENTIONS

Sun-Salutation B was performed, for eight minutes, at a high speed versus and a standard-speed separately while oxygen consumption was recorded. Caloric expenditure was calculated using volume of oxygen consumption and carbon dioxide production.

MAIN OUTCOME MEASURES

Difference in energy expenditure (kcal) of HSY and SSY.

RESULTS

Significant differences were observed in energy expenditure between yoga speeds with high-speed yoga producing significantly higher energy expenditure than standard-speed yoga (MD=18.55, SE=1.86, p<0.01). Significant differences were also seen between high-speed and standard-speed yoga for volume of oxygen consumed and carbon dioxide produced.

CONCLUSIONS

High-speed yoga results in a significantly greater caloric expenditure than standard-speed yoga. High-speed yoga may be an effective alternative program for those targeting cardiometabolic markers.

Yoga in Women With Abdominal Obesityߞa Randomized Controlled Trial

BACKGROUND

Abdominal obesity is a major risk factor for morbidity and mortality. The aim of this study was to investigate the effect of yoga on waist circumference and other anthropometric and self-reported variables in women with abdominal obesity.

METHODS

60 women with abdominal obesity (waist circumference ≥ 88 cm; body-mass index [BMI] ≥ 25) were randomly allocated in a 2:1 ratio to either a 12-week yoga intervention (n = 40) or a waiting list (n = 20). The waist circumference was the primary endpoint. Secondary (exploratory) endpoints included the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, blood pressure, health-related quality of life, self-esteem, subjective stress, body awareness, and body responsiveness, and the safety of the intervention. The persons assessing the outcomes were blinded to the group to which the patients belonged.

RESULTS

The patients in the yoga group participated in a mean of 30.2±9.2 (maximum, 42) hours of supervised yoga practice. Their abdominal circum - ference was significantly reduced in comparison to the participants on the waiting list, with an intergroup difference of -3.8 cm (95% confidence interval [-6.1; -1,.5]; p = 0.001). There were further, moderate intergroup differences in the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, mental and physical well-being, self-esteem, subjective stress, body awareness, and trust in bodily sensations (all p<0.05). There were no serious adverse events. None of the participants embarked on a low-calorie diet while participating in the study.

CONCLUSION

The 12-week yoga intervention had moderately strong positive effects on anthropometric and self-reported variables in women with abdominal obesity. Yoga is safe in this population and can be recommended as a technique for combating abdominal obesity in women.

Associations between yoga/meditation use, body satisfaction, and weight management methods: Results of a national cross-sectional survey of 8009 Australian women

OBJECTIVES

To analyze whether yoga or meditation use is associated with body (dis)satisfaction and weight control methods in Australian women.

METHODS

Women ages 34 to 39 y from the Australian Longitudinal Study on Women's Health were surveyed regarding body satisfaction, weight control behaviors, and yoga and meditation practice. Associations of body satisfaction and weight control methods with yoga/meditation practice were analyzed using chi-squared tests and multiple logistic regression modelling.

RESULTS

Of the 8009 women, 49% were overweight or obese. Sixty-five percent of women with normal body mass index (BMI) and approximately 95% of women with overweight/obesity wanted to lose weight. At least one in four women with normal BMI was dissatisfied with body weight and shape, as were more than two in three women with overweight/obesity. The most common weight control methods included exercising (82.7%), cutting down meal sizes (76.8%), and cutting down sugars or fats (71.9%). Yoga/meditation was practiced frequently by 688 women (8.6%) and occasionally by 1176 women (14.7%). Yoga/meditation users with normal BMI were less likely dissatisfied with body weight and shape. All yoga/meditation users more likely exercised and followed a low glycemic diet or diet books; and women with obesity occasionally using yoga/meditation also more likely used fasting or smoking to lose weight.

CONCLUSION

Yoga/meditation users with normal BMI appear to be more satisfied with their body weight and shape than non-yoga/meditation users. While women with normal BMI or overweight tend to rely on healthy weight control methods, women with obesity occasional using yoga/meditation may more likely utilize unhealthy weight control methods.

Yoga Research and Public Health: Is Research Aligned With The Stakeholders' Needs?

Research on yoga is witnessing an unprecedented proliferation currently, partly because of great interest in yoga's health utility. However, yoga research does not seem to be sufficiently public health oriented, or its quality corresponding to its quantity. Yoga research is falling short to enable key stakeholders like end users, prescribers, and payers to meaningfully, confidently, and fruitfully answer the questions like: Is it generalizable? Is it standardizable? Which yoga style should be used/recommended/paid for? Or will it be worth the money? Therefore, it is important to examine the alignment to purpose or value of yoga research from a public health point of view so as to make it more practical. The issues such as lack of clear definition of yoga, wide variation in its dosage, cacophony of lineage-based styles, no data about comparative effectiveness between the yoga components, confounders and biases clouding the evidence regarding its benefits, too little data on long-term adherence, equivocal results about its cost effectiveness, discussions lacking embrace of better methods in research, and absence of a theory of yoga are examined. This is not a detailed discussion of every issue yoga research faces, but a high-level overview of those that have direct practical bearing. In the end, a few pragmatic approaches are offered. The article suggests that yoga-component analysis, development of a theory of yoga, adoption of a health-aligned functional typology of yoga, development and testing of a simple universal basic prototype of yoga intervention, emphasis on research about long-term adherence, and discouragement for mere proof of concept research might make yoga research serve the stakeholders better. It urges the research community to practice "context cognizant scholarship" to disentangle health compatible yoga from its historical-cultural-social body before examining it for health or medical application.