Impact of a structured yoga program on blood pressure reduction among hypertensive patients: study protocol for a pragmatic randomized multicenter trial in primary health care settings in Nepal

Delivering yoga to people with hypertension in the UK: A qualitative study to explore yoga providers' knowledge, experiences, and attitudes

Background and Aims

Yoga has become increasingly popular in the world and the UK for improving health and well-being. A growing body of research suggests that yoga could be used to improve the management of hypertension in addition to current management strategies. Previous cross-sectional studies have also reported that hypertension is one of the most commonly disclosed health conditions in yoga sessions in the United Kingdom. Therefore, semi-structured qualitative interviews were conducted with yoga providers in the United Kingdom (n = 19) to explore their knowledge, experiences, and attitudes toward delivering yoga to people with hypertension.

Methods

Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

Results

Eight themes were identified. Yoga providers were generally aware of the health conditions of their attendees, and they had a reasonable knowledge of the causes, signs and symptoms, and management of hypertension. While most had received some information about hypertension as part of their initial yoga teaching training, this was generally felt to be limited. They mentioned the biopsychosocial benefits of yoga on hypertension but also expressed their concerns about the lack of regulation, the wide disparity in what is being delivered under the label of yoga, and the competency of some yoga providers.

Conclusion

The findings suggest that yoga provision in the United Kingdom should be regulated with a better link with health service providers. A manual and training for yoga providers in the United Kingdom for managing hypertension using yoga would be helpful to address the training needs of yoga providers. However, there is a need for more robust studies before recommending the implementation of yoga in the management of hypertension in the United Kingdom.

Characteristics of Yoga Providers and Their Sessions and Attendees in the UK: A Cross-Sectional Survey

Yoga is an ancient Indian philosophy and way of life that is being used as a method of improving health and wellbeing. Evidence shows that yoga has several health benefits, such as managing many noncommunicable diseases, such as hypertension, and improving mental health. The popularity of yoga is growing in the UK, but it is mostly unregulated with little information available about yoga providers and their sessions and attendees. This study aimed to explore who is providing yoga; what sessions are available, where, and at what cost; and who attends these sessions in the UK and whether yoga providers were aware of health conditions in their sessions. A cross-sectional survey was undertaken among yoga providers in the UK. They were approached through four major UK yoga associations. In total, 407 yoga providers participated. Most providers were aged 45–64 years (69%), female (93%), and white (93%). The median number of group sessions and one-to-one sessions delivered per week was four and two, respectively. The most common styles were Hatha (28%), Iyengar (26%), and Vinyasa (15%). Sessions had a varying emphasis on different yogic practices, but 59% of providers allocated most time to yogic poses (asana), 18% to breathing practices (pranayama), and 12% to meditation (dhyana) and relaxation practices. Most (73%) reported that their attendees disclosed their health conditions to them, most commonly mental health issues (41%), hypertension (25%), and heart diseases (9%). This study showed that yoga sessions are widely available in the UK, often provided and practiced by women, and concentrate on yogic poses. Sessions concentrate on the asana and tend not to include many of the more holistic aspects of yoga that are practiced in South Asian countries. Yoga providers are often aware of health conditions but may benefit from training to deliver sessions suitable for specific health conditions.

Yoga for hypertensive patients: a study on barriers and facilitators of its implementation in primary care

Background

International guidelines for hypertension treatment recommend the use of yoga, particularly among low-risk patients. However, evidence is lacking on the implementation potential of health-worker-led yoga interventions in low-resource, primary care settings.

Objective

To assess barriers to and facilitators of the implementation of a yoga intervention for hypertensive patients in primary care in Nepal.

Methods

The study was conducted using focus group discussions, in-depth interviews, key informant interviews, and telephone interviews. Data were collected from the ‘Yoga and Hypertension’ (YoH) trial participants, YoH intervention implementers, and officials from the Ministry of Health and Population in Nepal.

Results

Most YoH trial participants stated that: (1) it was easy to learn yoga during a five-day training period and practise it for three months at home; (2) practising yoga improved their health; and (3) group yoga sessions in a community centre would help them practise yoga more regularly. Most YoH intervention implementers stated that: (1) they were highly motivated to implement the intervention; (2) the cost of implementation was acceptable; (3) they did not need additional staff to effectively implement the intervention; (4) providing remuneration to the staff involved in the intervention would increase their motivation; and (5) the yoga programme was ‘simple and easy to follow’ and ‘easily performed by participants of any age’. The government officials stated that: (1) yoga is considered as a key health promotional activity in Nepal; and (2) the integration of the yoga intervention into the existing health care programme would not be too challenging, because the existing personnel and other resources can be utilised.

Conclusion

While there is a good potential that a yoga intervention can be implemented in primary care, capacity development for health workers and the involvement of community yoga centres in the delivery of the interventions may be required to facilitate this implementation.

CLARIFY 2021: explanation and elaboration of the Delphi-based guidelines for the reporting of yoga research

BACKGROUND

Reporting of yoga research often lacks the detail required for clinical application, study replication, summary research and comparative effectiveness studies.

METHODS

To improve the transparency of reporting yoga interventions, and building on the development of previous reporting guidelines, a group of international yoga research stakeholders developed the consensus-based CheckList stAndardising the Reporting of Interventions For Yoga (CLARIFY) guidelines.

RESULTS

The 21-item CLARIFY checklist outlines the minimum details considered necessary for high-quality reporting of yoga research. This paper provides a detailed explanation of each of the 21 items of the CLARIFY checklist, together with model examples of how to integrate each item into publications of yoga research. The CLARIFY guideline serves as an extension for existing research reporting guidelines, and is flexible for use across all study designs.

CONCLUSION

We strongly encourage the uptake of these reporting guidelines by researchers and journals, to facilitate improvements in the transparency and utility of yoga research.

Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting

Background

Hypertension control remains a major challenge globally. A recent systematic review suggested that yoga has beneficial effects on reducing blood pressure. However, the role of yoga in hypertension management in primary health care has received little attention, and no studies have evaluated the impact of a yoga program fully delivered by health care staff on hypertension. This study, therefore, assessed the effects of a health worker-led yoga intervention on blood pressure reduction among hypertensives patients in the primary care setting.

Methods

This was a multicentric, two-arm, randomised trial conducted among hypertensive patients in seven Ayurveda Health Centres in Nepal between March 2017 and June 2018. One hundred and twenty-one participants who were on or without medications were randomised to intervention (n = 61) and wait-list control (n = 60) groups using stratified block randomisation. Participants in the intervention arm received an intervention consisting of an initial five-day structured yoga training at the centres and then a further home-based practice of yoga for five days a week for the following 90 days. Both intervention and control groups also participated in a 2-h health education session. The primary outcome of this trial was systolic blood pressure at 90-day follow-up. Data were analysed on an intention-to-treat basis using linear mixed-effects regression models.

Results

We included all 121 study participants (intervention/control = 61/60) in the primary analysis (52.1% males; mean ± SD age = 47.8 ± 10.8 years). The difference in systolic blood pressure between the intervention group and the control group was − 7.66 mmHg (95% CI: − 10.4, − 4.93). For diastolic blood pressure, the difference was − 3.86 mmHg (95% CI: − 6.65, − 1.06). No adverse events were reported by the participants.

Conclusions

A yoga program for hypertensive patients consisting of a five-day training in health centres and 90 days of practice at home is effective for reducing blood pressure. Significant benefits for hypertensive patients could be expected if such programmes would become a part of the standard treatment practice.

Trial registration

This trial was prospectively registered with the Clinical Trial Registry of India [CTRI/2017/02/007822] on 10/02/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10528-y.