Neurophysiological and neurocognitive mechanisms underlying the effects of yoga-based practices: towards a comprehensive theoretical framework

Evaluating the Impact of the Nirvana Fitness and Functional Training Programs on Young Women's State Body Appreciation and Its Correlates

This study examined the effects of the Nirvana Fitness (NF) program on state body appreciation (BA) and its correlates, as well as the mechanisms that could explain these changes. The study participants were allocated to NF (n = 21) and functional training (control, n = 22) groups and participated in an 8-week exercise intervention. The mean age was 24.4 ± 6.7. The participants filled out online questionnaires on state measures of BA, body surveillance (BS), functionality appreciation, body-mind connection, mindfulness in physical activity (SMS-PA), intrinsic exercise motivation (IM), satisfaction of basic psychological needs, and perceived physical fitness (PPF) immediately after the first and last sessions. The results revealed a significant improvement in state BA and its correlates in both groups, with no changes in PPF in the NF group or IM in either group. An interaction between group and time effects was revealed in a change of relatedness, indicating a stronger effect in the NF group. Positive changes in SMS-PA, BS, and satisfaction of the need for relatedness significantly predicted improvement in state BA. These findings highlight the importance of targeting mindfulness, body surveillance, and relatedness during physical activity in interventions aimed at promoting positive body image in university-aged women.

Effect of a single session of yoga and meditation on stress reactivity: A systematic review

This systematic review synthesises the evidence for the effectiveness of a single session of yoga or its components including meditation and breathing techniques in reducing acute stress reactivity in healthy adults. Following the PRISMA guidelines, we searched Medline, EMBASE, Cochrane, CINAHL, and PsycINFO on 30th July 2023 for randomised controlled or crossover trials of yoga components and reporting physiological and/or psychological outcome measure(s) related to stress reactivity. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Data were synthesised narratively. Twenty-one out of 28 eligible studies (n = 2574) relating to 31 interventions (meditation [n = 22], breathing [n = 4] and yoga [n = 5]) reported outcomes in favour of the intervention. Stress reactivity was reported to be reduced by 71% of studies measuring physiological outcomes and 65% of studies measuring psychological outcomes. These studies show that a single session of yoga components is effective in reducing acute stress reactivity in adults and could be recommended for stress management. Future studies with larger populations and a more equal representation of genders and age groups are warranted.

The Effects of Tele-Yoga in Ankylosing Spondylitis Patients: A Randomized Controlled Trial

Objective: This randomized controlled trial aimed at investigating the effects of tele-yoga on physical function, disease activity, spinal mobility, flexibility, muscular endurance, exercise capacity, balance, sleep quality, stress, depression, anxiety, quality of life (QoL), and mindfulness in patients with ankylosing spondylitis (AS). Methods: Sixty patients with AS were randomly assigned to the tele-yoga group (TYG) or wait-list control group (CG). In addition to their medical treatments, TYG participants attended online yoga classes three times per week for 8 weeks. The CG continued their standard medical treatment. Data were collected at baseline and after 8 weeks. The primary outcome measure was physical function as assessed by the Bath AS Functional Index (BASFI). Secondary outcome measures included the Bath AS Disease Activity Index (BASDAI), Bath AS Patient Global Score (BAS-G), Assessment of SpondyloArthritis International Society Health Index (ASAS HI), Bath AS Metrology Index (BASMI), sit-and-reach test, sit-up test, push-up test, incremental shuttle walk test, Balance Master test, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), 36-Item Short Form Health Survey (SF-36), and Mindful Attention Awareness Scale (MAAS). Results: Compared with the CG (n = 27), participants in the TYG (n = 28) demonstrated significant improvements in BASFI (p = 0.001). The TYG also showed significant improvements in disease activity, spinal mobility, flexibility, muscular endurance, balance, sleep quality, stress, depression, and QoL compared with the CG (p < 0.05). Conclusions: Tele-yoga practice appears to be a safe and promising intervention for patients with AS and should be considered as a part of holistic disease management because of its potential physical and psychological benefits. Clinical Trial Registration: NCT04803383.

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.

Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions

In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.

'It stretches your body but makes you feel good too': A qualitative study exploring young people's perceptions and experiences of yoga

Whilst research suggests that yoga can positively impact physical and psychological wellbeing, understanding of youth's experiences is limited with no non-clinical studies in the UK. Ten focus groups explored perceptions and experiences of yoga among 35 youth (10-18 years). Inductive thematic analysis revealed that yoga was viewed as a holistic mind-body practice cultivating greater awareness and enhanced physical performance. Youth described yoga as providing tools that developed confidence, stress-management and emotional self-regulation. Social and relational impacts of yoga were highly valued. Despite the perceived biopsychosocial benefits of yoga, gendered and media representations of yoga may serve as a barrier to uptake.

Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up

BACKGROUND

Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation.

AIMS AND OBJECTIVES

To assess the feasibility of the SBTs protocol, eligibility criteria, randomization, and dropout rates. To quantify the changes in patient outcome measures and choose the most relevant measure for larger-scale study. To quantify self-adherence levels to home exercise and monitor and record possible pain medication and other treatment modality usage, and adverse events during exercise.

DESIGN

A parallel randomised analyst-blinded feasibility trial with two-month follow-up.

OUTCOME MEASURES

Feasibility related to aims and objectives. Multiple pain- and health-related patient-reported outcome measures of pain intensity, disability, central sensitization, anxiety, kinesiophobia, catastrophising, self-efficacy, sleep quality, quality of life, and health and well-being status. Exercise adherence, pain medication and other treatment modality usage, and possible adverse events related to exercises will be monitored and recorded.

METHODS

Thirty participants will be randomized to movement control exercise with SBTs (15 subjects in experimental group) or movement control exercise without SBTs (15 subjects in control group) in private chiropractic practice setting with two-month follow-up. Trial registration number; NCT05268822.

DISCUSSION

The clinical difference in effectiveness between practically identical exercise programs in uniform study settings with or without SBTs has not been studied before. This study aims to inform feasibility and help determine whether progression to a full-scale trial is worthwhile.

Effects of Yoga and Aerobic Exercise on Verbal Fluency in Physically Inactive Older Adults: Randomized Controlled Trial (FitForAge)

Purpose

To compare the effects on verbal fluency of a supported yoga-based exercise intervention to an aerobic exercise intervention and a wait-list control group.

Participants and Methods

Eighty-two physically-inactive but otherwise healthy adults (mean age 72.5 years, range 65-85, 77% female) were recruited into a 12-week, three-group, parallel randomized controlled trial. Participants were supported to complete ≥3 Hatha yoga classes per/week or ≥3 structured aerobic exercise sessions/week. A wait-list control group continued usual daily activities only. Verbal fluency, including total-FAS, animals, and verbs, was assessed before and after interventions. Group effects were assessed using analysis of covariance (ANCOVA).

Results

Twenty-seven participants were randomized to yoga, 29 to aerobic exercise and 26 to a waitlist. At 12-week follow-up, compared to baseline, there were increases in mean total-FAS in the yoga (+5.0 words, p=0.002) and aerobic exercise groups (+6.6 words, p=0.004). Mean total-FAS in the wait-list control group remained stable (-0.5 words, p=0.838). There were medium-magnitude estimated treatment effects on total-FAS for yoga versus wait-list control and aerobic exercise versus wait-list control: Hedges' g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. In addition, small-to-medium magnitude estimated treatment effects were seen on animals and verbs for yoga versus wait-list control and aerobic exercise versus wait-list control: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.

Conclusion

Participation in yoga or aerobic exercise was associated with estimated improvements in verbal fluency compared to a non-active control group. Yoga and aerobic exercise may be promising approaches by which to promote cognitive function among older adults.

Trial Registration

DRKS00015093, U1111-1217-4248.

Reduction of anxiety and pain in primigravida mothers with modified Iyengar yoga: A clinical study

BACKGROUND

In primigravidas, childbirth, although physiological can be a frightening event. Two factors that accompany labor are anxiety and pain. This study aims to investigate the benefits of Iyengar yoga for anxiety and labor pain in primigravida women.

MATERIAL AND METHODS

The study involved 59 female primigravida subjects, which were divided into 29 controls (without the provision of yoga exercises) and 30 people who received Iyengar yoga exercise. Anxiety and the degree of labor pain will be measured using the Hamilton Scale Rating for Anxiety (HSRA) and visual analog scale (VAS), respectively.

RESULTS

Iyengar yoga significantly reduced VAS and HARS values compared to controls (p < 0.05).

CONCLUSION

It was concluded that Iyengar yoga in primigravida women was beneficial in reducing labor pain and anxiety. Thus, the Iyengar yoga technique can be a method for supporting the success and safety of labor.

"A source of empowerment and well-being": Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders

Background

Functional abdominal pain disorders are common among children and adolescents worldwide and effective treatments are needed to alleviate suffering for these children and their families. This study aimed to explore the experience of participating in a combined dance and yoga intervention from the perspectives of girls aged 9-13 years with functional abdominal pain disorders.

Materials and Methods

A randomized controlled trial called Just in TIME (Try, Identify, Move and Enjoy) recruited 121 girls aged 9-13 years with functional abdominal pain disorders. The eight-month intervention combined dance and yoga twice a week, focusing on enjoyment, socialization and playful creativity in an undemanding and non-judgemental environment. The intervention group comprised 64 girls, of whom 25 were purposefully selected for this qualitative interview study. Semi-structured interviews were conducted and analysed using qualitative content analysis with an inductive approach.

Results

The girls' experiences of the Just in TIME intervention can be described as "A source of empowerment and well-being which facilitated personal growth and new ways of engaging in life". The main category was derived from six generic categories: "A sense of belonging", "Joy and emotional expression through movement", "Relief from pain", "More self-confident", "More active in daily life" and "A sense of calm."

Conclusions

Regular participation in an eight-month intervention with combined dance and yoga in a supportive and non-judgemental atmosphere can ease pain and strengthen inner resources, resulting in empowerment, well-being and a more active life for girls with functional abdominal pain disorders.

Trial registration

The Just in TIME study is available online at clinicaltrials.gov, ID: NCT02920268.

Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization

Background

While there is recognition by the greater medical community and physical therapists to address the biopsychosocial needs of people with chronic, persistent pain, there are challenges in implementation and delivery including wide variability in interventions, lack of clear rationale, and absence of clinical models that are feasible and acceptable on a large scale. Important components for psychologically informed physical therapy (PiPT) for pain care include behavioral approaches (e.g., Acceptance and Commitment Therapy), mindfulness, pain neuroscience education, motivational interviewing (MI), and interoceptive skills-building. The Empower Veterans Program (EVP) Mindful Movement framework blends these components and emphasizes a mindfulness and self-compassion approach with MI and body-based experiential learning. This program was offered in-person at the Atlanta and Maryland VA Health Care Centers with published positive Patient Reported Outcomes (PRO) pre-COVID 19 crisis and shifted to entirely remote delivery in March 2020.

Objective

This paper offers an evidence-based and theory driven framework to operationalize a remotely delivered group-based psychologically informed mindful movement physical therapy intervention as part of an interdisciplinary pain care program.

Methods

Since 2021 PRO and demographics are collected using a survey administered through Qualtrics over a 12-month period at baseline, immediately post TelePain EVP, at 6 months, and at 12 months, with findings forthcoming.

Discussion/Results

Tele-pain EVP offers 6-9 groups a week with 7-9 veterans from Atlanta based team and 3-4 groups a week with 5-9 veterans from Maryland based team. Adaptations for remote delivery optimized mindfulness and active learning strategies including interoceptive skills-building and use of MI to support self-efficacy to trust, restore a sense of safety in the body, and explore adaptations for safe movement.

Conclusion

TelePain-EVP Mindful Movement provides a framework for other programs to translate for their populations and systems to further develop best practices in PiPT for pain care and integration into interdisciplinary care.

Evaluation of the effectiveness of yoga in management of premenstrual syndrome: a systematic review and meta-analysis

Aim: The management of Premenstrual Syndrome (PMS) is still evolving due to the modest effect sizes of the available treatment modalities. Yoga as therapeutic intervention in PMS has been gathering interest amongst researchers. The current manuscript reviews the evidence surrounding yoga in PMS.Methods: This manuscript was a systematic review and meta-analysis evaluating the effectiveness of yoga on the total scores and sub-domains of PMS after studies were identified using a pre-defined selection criterion after a search in PubMed, Google Scholar, Scopus and Web of Science. Both quantitative and qualitative analysis of the accumulated data was performed. Overall, 14 studies were identified for the review, 11 of which were used for the purpose of quantitative analysis.Results: The studies were heterogenous in terms of the design, yoga regimes, nature of interventions and tools used for outcome measures. It was found that yoga was beneficial in the management of PMS. This benefit was also seen when all the sub-domains of PMS were individually examined except physical sub-domain.Conclusion: Though there were certain limitations in our review like heterogeneity in studies, possibility of publication bias and restrictive selection criterion; it supported that yoga can be beneficial in patients with PMS.

Digitally distributed Yoga Intervention in Breast Cancer Rehabilitation (DigiYoga CaRe): protocol for a randomised controlled trial

INTRODUCTION

Breast cancer is the most prevalent cancer among women. The treatment is extensive; in addition to surgery, various combinations of radiation therapy, chemotherapy and antibody and endocrine treatment can be applied. Cancer-related fatigue (CRF) is high in patients with breast cancer, peaking during chemotherapy, but may persist for several years. Physical activity has proven to be effective in reducing CRF in breast cancer rehabilitation, but many patients tend to be less active after the diagnosis. Yoga has a previously demonstrated effect on energy levels and digitally distributed yoga intervention can potentially increase accessibility in pandemic times and facilitate participation for patients susceptible to infection and those living far from organised rehabilitation opportunities. The purpose of this study, Digital Yoga Intervention in Cancer Rehabilitation (DigiYoga CaRe) is to investigate whether a 12-week digitally distributed yoga intervention can reduce CRF and stress, improve health-related quality of life (HRQL) and affect pro-inflammatory and metabolic markers in patients with breast cancer.

METHODS AND ANALYSIS

This multicentre study will adopt a randomised controlled design including 240 persons after their breast cancer surgery. They will be randomised to a 12-week digitally distributed yoga intervention or to a control group. The intervention group practice yoga two times a week, one yoga class live-streamed to the patient's computer or mobile device and one prerecorded video class for self-training. The controls receive standardised care, gift cards for flowers and access to yoga video links after the data collection has ended. The primary analysis will be performed following the principle of intention to treat. Data will be collected by questionnaires, blood samples, accelerometers and interviews.

ETHICS AND DISSEMINATION

The DigiYoga CaRe study was approved by the Regional Ethical Review Board in Lund. The final results of this study will be disseminated to conference, patient and public involvements and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04812652.

Embodied Cognition in Meditation, Yoga, and Ethics-An Experimental Single-Case Study on the Differential Effects of Four Mind-Body Treatments

Yoga is an embodied contemplative practice considered as a path toward long-term well-being, which fosters an integrated processing of bodily and emotional stimuli. However, little is known about how the different components of yoga contribute to these processes. This was the aim of this single-case multiple-baseline study. Herein, we explored how different yoga components affect body awareness, emotion regulation, affectivity, self-compassion, and distress tolerance. Forty-two randomly assigned participants (from initially fifty-seven) completed one of four 8-week treatments: Mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). Participants had no prior regular yoga or meditation practice. Data were analyzed using visual inspection, effect size estimation, and multilevel modeling. Surprisingly, all four treatments similarly improved body awareness (Tau-UMA = 0.21 to Tau-UMY = 0.49), emotion regulation (Tau-UMYE = -0.43 to Tau-UME = -0.52), self-compassion (η2 = 0.08), and distress tolerance (η2 = 0.13). These effects were maintained until follow-up at 2 and 12 months after the study, even though home practice declined. The MA condition had the least favorable effect on affective experience (Tau-UMA = -0.14 and 0.07), while the ME condition enhanced valence the most (Tau-UME = 0.10) and the MY condition was the most effective in preventing negative affective responses. Although mantra meditation on its own negatively influenced daily affect, it can be assumed as the driving force behind the improvement in the other variables. This points to the central role of meditation in increasing interoception, self-awareness, and embodied processing.

Acute physical-activity related increases in interoceptive ability are not enhanced with simultaneous interoceptive attention

Interoception, the sense of the internal body, is proposed to support self-regulation, and consequently influence mental health. Researchers have therefore shown interest in improving the ability to accurately monitor internal signals (i.e., interoceptive accuracy, IAcc). Research suggests that cardiac IAcc is modifiable by both manipulations of interoceptive attention (guided attention towards the internal body), and interoceptive exposure (strategically inducing somatic signals e.g., via physical activity). Whilst successful in isolation, it is unclear whether a combined approach (i.e., directing attention towards the internal body when signals are more salient) could elicit greater benefits. In a 2 × 2 within-subject design, 48 healthy adults (M_age = 25.98 ± 4.73 years, 50% female) completed four 20-min conditions varying in both attentional focus (interoceptive vs exteroceptive) and physical activity (active vs rest), with cardiac IAcc measured immediately after. Results revealed a main effect for physical activity (p < 0.001), however, there was no effect for attentional focus (p = 0.397), and no interaction effect (p = 0.797). Differential analyses showed that a higher sporting background increased sensitivity to physical activity-related increases in cardiac IAcc (p = 0.031). Findings indicate that (irrespective of attentional focus) moderate-vigorous physical activity-based interventions have the potential to increase cardiac IAcc, with certain individuals potentially benefiting more.

PE augmented mindfulness: A neurocognitive framework for research and future healthcare

Various well-controlled studies have suggested that practitioners in mindfulness can be prone to patient drop-out (e.g., due to chronic stress, pathology, cognitive reactivity), despite researchers having identified the underlying mechanisms that link mindfulness to mental health. In this article, a framework for physical exercise (PE) augmented mindfulness is proposed, which posits that consistently practiced PE before meditation can support (early-stage) mindfulness. Neurocognitive research shows PE (aerobic exercises or yoga) and mindfulness to impact similar pathways of stress regulation that involve cognitive control and stress regulation, thereby supporting the proposed synergistic potential of PE augmented mindfulness. Research focused on the psychophysiological impact of PE, showed its practice to promote short-term neurocognitive changes that can promote both cognitive control and the attainment of mindful awareness (MA). In order to chart dose responses required for protocol development, further research will be presented. Together these findings are discussed in light of future research on this multidisciplinary topic, protocol development, mindful walking, and further application in healthcare and beyond.

Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments

Mind-Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients.

Do Physical Therapy and Yoga Improve Pain and Disability through Psychological Mechanisms? A Causal Mediation Analysis of Adults with Chronic Low Back Pain

OBJECTIVE

To investigate whether indirect effects via psychological mechanisms explain the effects of physical therapy (PT) or yoga versus education on back-related outcomes.

DESIGN

Mediation analyses using data from a randomized controlled trial of PT, yoga, and education interventions for chronic low back pain.

METHODS

Primary outcomes were changes in back-related pain on the 11-point numeric rating scale and disability on the modified 23-point Roland-Morris Disability Questionnaire, measured at 52 weeks after randomization. Hypothesized mediators were 12-week changes in pain self-efficacy, fear-avoidance beliefs, depression, anxiety, perceived stress, and sleep quality. We used causal mediation analysis to estimate the total effect, direct effect, indirect effect, and proportion mediated.

RESULTS

We analyzed data from 230 adults (mean age = 46.2 years, 69.6% female, 79.6% non-White). In the PT-versus-education model, when the mediator was perceived stress, the total effect on disability was 2.6 points (95% confidence interval [CI]: 0.3, 4.9) and decomposed into a direct effect of 1.7 points (95% CI: -0.4, 3.8) and an indirect effect 0.9 points (95% CI: 0.1, 2.0; proportion mediated, 34%). No other psychological construct was a significant mediator.

CONCLUSION

Improvements in perceived stress mediated improvements in disability after PT treatment compared to education. Other psychological outcomes did not mediate the effect of yoga or PT on pain or disability outcomes compared to education. J Orthop Sports Phys Ther 2022;52(7):470-483. Epub: 18 May 2022. doi:10.2519/jospt.2022.10813.

Heartfulness Meditation: A Yogic and Neuroscientific Perspective

Today, as research into the contemplative sciences is being widely referenced, the research community would benefit from an understanding of the Heartfulness method of meditation. Heartfulness offers an in-depth experiential practice focused on the evolution of human consciousness using the ancient technique of Pranahuti (yogic Transmission) during Meditation, in combination with the more active mental practice of “Cleaning.” Both are enabled by initiation into the Heartfulness practices. These unique features distinguish Heartfulness from other paths that have been described in the scientific literature thus far. In this introductory paper, we present the Heartfulness practices, the philosophy upon which the practices are based, and we reflect on the putative mechanisms through which Heartfulness could exert its effects on the human body and mind in the light of scientific research that has been done in other meditation systems. We conclude with suggestions for future research on the Heartfulness way of meditation.

Comparing Types of Yoga for Chronic Low Back and Neck Pain in Military Personnel: A Feasibility Randomized Controlled Trial

Background

Chronic low back pain (cLBP) and chronic neck pain (cNP) are highly prevalent conditions and common reasons for disability among military personnel. Yoga and other mind-body interventions have been shown to safely decrease pain and disability in persons with cLBP and/or cNP but have not been adequately studied in active duty military personnel. The objective of this study was to examine the feasibility and acceptability of delivering 2 types of yoga (hatha and restorative) to a sample of active-duty military personnel with cLBP/cNP.

Methods

Military personnel with cLBP and/or cNP (n = 49; 59% men) were randomized to either hatha or restorative yoga interventions. Interventions consisted of in-person yoga 1-2x weekly for 12 weeks. Feasibility and acceptability were measured by rates of recruitment, intervention attendance, attrition, adverse events, and satisfaction ratings. Health outcomes including pain and disability were measured at baseline, 12 weeks, and 6 months. Means and effect sizes are presented.

Results

Recruitment was completed ahead of projections. Over 90% of participants agreed or strongly agreed that they enjoyed participation, liked the instructor, and would like to continue yoga. Retention rates were 86% and 80% at 12 week and 6 month assessments, respectively. Intervention attendance was adequate but lower than expected. There were small to moderate reductions in back-pain related disability, pain severity and pain interference, and improvements in quality of life, grip strength, and balance. In general, effects were larger for those who attended at least 50% of intervention classes. Participants with cNP tended to have smaller outcome improvements, but conclusions remain tentative given small sample sizes.

Conclusions

Results demonstrate feasibility for conducting a randomized controlled comparative effectiveness trial of yoga for cLBP and cNP among active duty military personnel. Acceptability was also established. Ongoing work will enhance the intervention for cNP and establish feasibility at another military facility in preparation for a fully-powered comparative effectiveness trial.ClinicalTrials #NCT03504085; registered April 20, 2018.

A Systematic Review of a Polyvagal Perspective on Embodied Contemplative Practices as Promoters of Cardiorespiratory Coupling and Traumatic Stress Recovery for PTSD and OCD: Research Methodologies and State of the Art

Baseline respiratory sinus arrhythmia (RSA) has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies, and a reliable association between PTSD, OCD and lower resting RSA was found. Contemplative practices have been linked to the activation of the vagus as well as to an increased RSA that, according to the polyvagal theory, reflects the activation of the ventral vagal complex (VVC) and may promote PTSD and OCD recovery. PubMed and Scopus databases were selected to conduct a search following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines, and A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality for this systematic review. Six articles met the inclusion criteria (one cross-sectional study, one study with pre-post measurements, two cohort studies and two RCT studies). Mindfulness-related interventions promoted parasympathetic activity, an increased vagal tone and improvements in PTSD and OCD symptoms. According to the polyvagal theory, mindfulness-related and compassion-related meditations would be conceptualized as neural exercises expanding the capacity of the ventral vagal complex to regulate the present state and to promote resilience. Clinical and methodological issues are discussed.

Is Weekly Frequency of Yoga Practice Sufficient? Physiological Effects of Hatha Yoga Among Healthy Novice Women

Beneficial physical and physiological health outcomes of yoga practice are well-supported by empirical data. However, whether weekly frequency of training is sufficient to evoke positive changes, is still an open question. The present intervention study investigated the effects of 10 weekly sessions of beginner level hatha yoga with respect to indicators of physical fitness and physiological markers. 82 young women (mean age of 22.0 ± 3.83 years) participated in the study. The yoga group (N = 49) attended a yoga course consisting of 10 sessions (1.5 h each) on a weekly basis. The control group (N = 33) did not receive any intervention. BMI, body fat percentage, balance (one-leg-stand test with open and closed eyes, functional reach test), flexibility (side bend test, modified sit and reach test) core muscle strength (plank test) as well as resting heart rate (HR), and heart rate variability (HRV) were assessed 1 week before and after the course. Both frequentist and Bayesian analysis showed an improvement in flexibility and balance in the yoga group compared to the control group. The yoga group showed also increased core muscle strength. No changes with respect to BMI, body fat percentage, resting HR and HRV were found. Ninety minute beginner level hatha yoga classes were characterized by 93.39 HR and 195 kcal energy consumption on average. The present findings suggest that weekly setting of a 10-session long hatha yoga training leads to improvements in balance, flexibility and core muscle strength among healthy young women. However, for changes in BMI, body fat percentage, resting HR and HRV longer, and/or more intense interventions are needed.

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.

Mindfulness practice during COVID-19 crisis: Implications for confinement, physical inactivity, and sedentarism

COVID-19 pandemic has radically impacted and altered the lives of billions of people around the world. Due to strict government policies, most individuals now find themselves confined at home with limited movement permissible. Although these measures are enforced to help abate the rate of infection, such restrictions have huge implications for the psychophysiological health, lifestyle, and overall well-being of individuals. The COVID-19 confined circumstances, coupled with the gradually declining levels of physical activity and rising levels of sedentarism that is prevalent in the modern society, can have deleterious effect on the psychological, physical, and social health of individuals. This paper argues for essential alternative measures to be introduced that would not only assuage the detrimental effects of COVID-19 confinement, physical inactivity, and sedentarism in the short-term, but also promote psychophysiological health and well-being in the long-term. In particular, this paper recommends the practice of mindfulness as a viable option under the current circumstances. This paper further outlines the health benefits of mindfulness practice and illustrates two effective and efficient practices — mindful breathing and mantram chanting — that could be suitably utilized under the current altered and confined COVID-19 arrangement by individuals across the life span. Potential benefits, recommendations, and risks have also been addressed.

Differential Effects of Ethical Education, Physical Hatha Yoga, and Mantra Meditation on Well-Being and Stress in Healthy Participants-An Experimental Single-Case Study

Traditionally, yoga is a multicomponent practice consisting of postures, breathing techniques, meditation, mantras, and ethics. To date, only a few studies have tried to dismantle the effects of each of these components and their combinations. To fill this gap, we examined the incremental effects of ethical education and physical Hatha yoga on mantra meditation using a single-case multiple-baseline design. This study was part of a project evaluating the new mind-body program Meditation-Based Lifestyle Modification. Fifty-seven healthy participants with no regular yoga or meditation practice were randomly assigned to three baselines (7, 14, and 21 days) and four conditions using a random number generator. The conditions were mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). All the interventions lasted for 8 weeks and were run consecutively according to baseline length. During the baseline and treatment phases, participants received daily questionnaires measuring their well-being (WHO-5 Well-Being Index), stress (Perceived Stress Scale), and subjective experiences. Forty-two participants completed the treatment and were entered in the analyses. We analyzed our data using visual inspection, effect size estimation (Tau-U), and multilevel modeling. Almost all participants showed a longitudinal increase in well-being. Regarding between-group differences, participants who received ethical education exhibited the largest increases in well-being (Tau-U = 0.30/0.23 for ME/MYE), followed by participants in the MY condition (Tau-U = 0.12). Conversely, participants in the MA condition showed no change (Tau-U = 0.07). There was a tendency for the combined treatments to decrease stress. This tendency was strongest in the MY condition (Tau-U = -0.40) and reversed in the MA condition (Tau-U = 0.17). These results emphasize the incremental and differential effects of practicing meditation in combination with other practices from the eight-fold yoga path. This approach is valuable for better understanding the multifaceted practice of yoga. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04252976.

The health imaginary of postural yoga

This paper explores the capacity of yoga narratives and practices to contribute to and relate ideas about health. It adds theoretically to existing literature on yoga by introducing the concept of the 'health imaginary' as an analytic lens for considering yoga discourses in late modern times, where personal health care and spiritual ambitions are once again becoming blurred. With this perspective, the paper provides a thorough analysis of how yoga postures (asanas) are conceived to work therapeutically, in yoga's recent history and in present-day yoga therapy. Taking case studies from India and Germany, it is shown empirically how the application of asanas is rationalized differently in specific geographical and therapeutic environments - particularly regarding the presumed theory of the body. Thus, the concept of the health imaginary not only provides analytic space to explore the implicit logics and goals of healing in different contexts, but also offers clues about the distinct social, cultural/religious, and local influences that draw people into yoga and contribute to its selective appropriation across the globe.

Feasibility and outcome of an online streamed yoga intervention on stress and wellbeing of people working from home during COVID-19

BACKGROUND

The outbreak of COVID-19 and its associated measures has resulted in a sizeable working population transitioning to working from home (WFH), bringing additional challenges, and increasing work-related stress. Research has indicated that yoga has promising potential in reducing stress in the workplace. However, there are very few studies exploring the impact of online streamed yoga on stress management for people-WFH.

OBJECTIVE

To investigate the feasibility and outcome of an online streamed yoga intervention on stress and wellbeing of people-WFH during COVID-19.

METHODS

A six-week pilot randomized controlled trial (RCT) yoga intervention was designed with yoga (n = 26) and a wait-list control group (n = 26). A mixed two-way ANOVA was used to assess changes in standardised outcome measures at baseline and post-intervention. Likert and open-ended questions assessed enjoyment, acceptability and perceived benefits of the program, which were analysed thematically.

RESULTS

Compared with the control, the yoga group reported significant improvements in perceived stress, mental wellbeing, depression and coping self-efficacy, but not stress and anxiety. Participants experienced physical and mental health benefits and reported high acceptability and enjoyment of the intervention.

CONCLUSIONS

An online yoga intervention can help people WFH manage stress and enhance wellbeing and coping abilities.

Feasibility and effects of a chair-based yoga program for adults with neurodisability

Purpose: This study focuses on exploring the feasibility and the effects of practicing chair-based yoga for 10 weeks on health-related quality of life (HRQoL) and interoceptive body awareness (BA) in adults with neurodisability and moderate to severe physical dependence.Materials and Methods: A pre- and post-testing control group design was followed. Participants were 34 service users at a rehabilitation center. The intervention group (IG, n = 17, 53% men, mean age of 48.6 ± 11.4 years) took part in the 10-week chair-based yoga program. The control group (CG, n = 17, 53% men, mean age of 53.1 ± 11.0 years) received usual care. The outcome measures were feasibility (recruitment rate, attrition, completion rate, adherence, participation, safety and tolerability), HRQoL (WHOQoL-BREF questionnaire), and BA (the Multidimensional Assessment of Interoceptive Awareness, MAIA). Participants in the IG completed a questionnaire to measure their personal experience of participating in the program.Results and Conclusions: This study provides implications for a 10-week chair-based yoga program as a feasible, well-tolerated, and safe intervention, reinforced by the participants' retrospective judgment. Compared to the CG, the program produced statistically significant improvements over BA, such as subscales of MAIA Noticing (p = .031, Hedges g_s = 0.76), Emotional Awareness (p < .001, Hedges g_s = 1.68), and Trusting (p = .036, Hedges g_s = 0.74), but not HRQoL, for the IG. Chair-based yoga programs could be a rehabilitation strategy in the socio-health care of a varied population with physical mobility impairments leading to wheelchair use.Implications for RehabilitationA 10-week chair-based yoga intervention was shown to be a feasible, well-tolerated, and safe therapy which allowed people of varying abilities to participate equitable.Chair-based yoga can help people with moderate to severe physical dependence due to neurodisability to improve their interoceptive body awareness.Chair-based yoga does not have a significant impact on the health-related quality of life of this sample of participants.

Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials

We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies ( = k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.

Yoga, Dance, Team Sports, or Individual Sports: Does the Type of Exercise Matter? An Online Study Investigating the Relationships Between Different Types of Exercise, Body Image, and Well-Being in Regular Exercise Practitioners

Physical activity, specifically exercising, has been suggested to improve body image, mental health, and well-being. With respect to body image, previous findings highlight a general benefit of exercise. This study investigates whether the relationship between exercising and body image varies with the type of exercise that individuals preferentially and regularly engage in. In addition, physical efficacy was explored as a potential psychological mediator between type of exercise and body image. Using a cross-sectional design, healthy regular exercise practitioners of yoga, ballroom dance, team sports, or individual sports as well as healthy adults reporting no regular exercising were surveyed. Body image and its different facets were assessed by a set of standardized self-report questionnaires, covering perceptual, cognitive, and affective body image dimensions particularly related to negative body image. In addition, participants were questioned with regard to mental health. Participants were 270 healthy adults. Descriptive statistics, measures of variance (ANOVA), and multiple linear regression analysis with orthogonal contrasts were performed to investigate differences between the different exercise and non-exercise groups in the variables of interest. In line with the hypotheses and previous findings, the statistic comparisons revealed that body dissatisfaction (as one important factor of negative body image) was most pronounced in the non-exercise group compared to all exercise groups [contrast: no exercise versus exercise (all groups taken together)]. Physical efficacy, as assessed with a standardized questionnaire, mediated the difference between type of exercise (using contrasts) and body image including perceptual, cognitive, and affective body image dimensions. The findings shed light on so far less systematically investigated questions regarding the relationship between types of exercise, like yoga and ballroom dance, and body image. The results underscore the relevance of considering possible influencing factors in exercise research, such as the perception of one's physical efficacy as a mediator of this relationship.

Feasibility, Acceptability, and Outcomes of a Yoga-Based Meditation Intervention for Hospice Professionals to Combat Burnout

(1) Background. This research examined the feasibility, acceptability and outcomes of delivering a 6-week yoga-based meditation intervention to clinical teams of hospice professionals (HPs) at a large non-profit hospice organization. The intervention was designed to increase mind-body integration and combat burnout. This article was written for different audiences, including research scientists who study interoception, burnout, meditation, or yoga, designers of meditation interventions, and hospice organizations looking for ways to mitigate HP burnout. (2) Methods. The intervention was launched within clinical teams, beginning with a half-hour online introduction to the program and exposure to the week 1 meditation at each team's monthly all-staff meeting. Throughout the program, HPs could access the meditations on their own via their workplace computers, tablets, and smartphones. Online pre- and post-intervention surveys were submitted by 151 HPs, 76 of whom were exposed to the intervention and completed both surveys. The surveys assessed burnout using the Professional Fulfillment Index and mind-body integration using the Multidimensional Assessment of Interoceptive Awareness scales. (3) Results. Two-thirds of HPs who were present at a staff meeting where the program was introduced went on to do a meditation on their own at least once. Half of HPs expressed a desire to continue with access to the meditations after the 6-week program ended. Due to COVID-19 work from home restrictions, three-fourth of HPs did a meditation at home, 29% in a car between patient visits (not while driving), and 23% at the office. Higher interoceptive awareness was significantly related to lower burnout, particularly lower work exhaustion. Meditation frequency was significantly related to higher interoceptive awareness but not to burnout. Interpersonal disengagement was rare and temporary. (4) Conclusions. Findings showed that the yoga-based meditation intervention was feasible and acceptable and associated with higher interoceptive awareness. The results point to a role for interoceptive awareness in reducing the risk for burnout.

A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery

BACKGROUND AND OBJECTIVES

Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change.

METHODS

Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15-20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up.

PROJECTED OUTCOMES

This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery.

An Intervention With Dance and Yoga for Girls With Functional Abdominal Pain Disorders (Just in TIME): Protocol for a Randomized Controlled Trial

BACKGROUND

Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus.

OBJECTIVE

This study aims to evaluate the effects of a dance and yoga intervention among girls aged 9 to 13 years with FAPDs.

METHODS

The study is a prospective randomized controlled trial among girls aged 9 to 13 years with functional abdominal pain, irritable bowel syndrome, or both. The target sample size was 150 girls randomized into 2 arms: an intervention arm that receives dance and yoga sessions twice weekly for 8 months and a control arm that receives standard care. Outcomes will be measured at baseline and after 4, 8, 12, and 24 months, and long-term follow-up will be conducted 5 years from baseline. Questionnaires, interviews, and biomarker measures, such as cortisol in saliva and fecal microbiota, will be used. The primary outcome is the proportion of girls in each group with reduced pain, as measured by the faces pain scale-revised in a pain diary, immediately after the intervention. Secondary outcomes are gastrointestinal symptoms, general health, mental health, stress, and physical activity. The study also includes qualitative evaluations and health economic analyses. This study was approved by the Regional Ethical Review Board in Uppsala (No. 2016/082 1-2).

RESULTS

Data collection began in October 2016. The intervention has been performed in 3 periods from 2016 through 2019. The final 5-year follow-up is anticipated to be completed by fall 2023.

CONCLUSIONS

Cost-effective and easily accessible interventions are warranted to reduce the negative consequences arising from FAPDs in young girls. Physical activity is an effective strategy, but intervention studies are needed to better understand what types of activities facilitate regular participation in this target group. The Just in TIME (Try, Identify, Move, and Enjoy) study will provide insights regarding the effectiveness of dance and yoga and is anticipated to contribute to the challenging work of reducing the burden of FAPDs for young girls.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02920268); https://clinicaltrials.gov/ct2/show/NCT02920268.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19748.

Mitigating the Antecedents of Sports-related Injury through Yoga

Context:

Injury risk among athletes is an epidemic. The psychological and physical loads imposed on athletes through psychosocial stressors and training regimens significantly increase athletes' injury risk.

Aims:

This feasibility study assessed whether a 10-week yoga intervention could be implemented successfully and mitigated antecedents of sports injury.

Methods:

Using a prospective, nonexperimental design, 31 male soccer players attending a college in the Pacific Northwest enrolled in the yoga intervention. The Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) was completed at three time-points before and after the yoga intervention. The RESTQ-Sport scales, identified as strongest predictors for injury, were hypothesized to be mitigated through yoga.

Results:

Two stress-related scales were significant in the hypothesized direction: injury and fatigue. The general recovery scale, General Well-Being, was significant at one time-point, but in the opposite direction as hypothesized.

Conclusions:

Positive findings are discussed and explanations for unexpected changes are explored, along with study limitations. Results suggest that yoga can be successfully integrated into the athletic program of soccer players and provisionally support the potential of a yoga intervention to mitigate two significant antecedents of injury, namely, perception of propensity to sustain injury and generalized fatigue.

The impact of a yoga-based physical therapy group for individuals with traumatic brain injury: results from a pilot study

OBJECTIVE

To compare the impacts of yoga-based physical therapy versus a seated rest within the context of standard rehabilitation practice on sleep, heart rate variability (HRV), anxiety, and fatigue during acute traumatic brain injury (TBI) rehabilitation.

METHODS

Eleven individuals participated in this crossover study involving the following interventions in a randomized order: group yoga-based physical therapy (YPT), conventional physical therapy (CPT), and group seated rest in a relaxing environment (SR). HRV and self-reported anxiety and fatigue were measured immediately before and after each group, and sleep after each condition and at baseline. Data was analyzed using generalized linear mixed models with repeated measures.

RESULTS

The interaction between time and treatment was statistically significant (p = .0203). For the SR treatment, wake after sleep onset (WASO) rate was reduced from 14.99 to 10.60 (IRR = 0.71; p = .006). Time and treatment were not found to be statistically significantly associated with any of the secondary outcomes.

CONCLUSION

Yoga-based physical therapy is feasible and safe in the inpatient rehabilitation setting following TBI. Sleep quality improved following the addition of a one-hour seated rest in a relaxing environment to a standard rehabilitation daily schedule, suggesting that structured rest time may be beneficial to sleep hygiene during inpatient rehabilitation following TBI. ClinicalTrials.Gov Registration Number: NCT03701594.

Mindfulness Training for Improving Attention Regulation in University Students: Is It Effective? and Do Yoga and Homework Matter?

The present study examined the effects of mindfulness training on attention regulation in university students and whether the potential benefits of implementation are influenced by the yoga component of mindfulness-based interventions (MBIs) and/or by MBI homework practice. In a non-randomized trial with pre- and post-assessments, n = 180 university students were allocated to either mindfulness training (experimental groups), awareness activities (active control group), or no training (passive control group). Mindfulness was taught through two MBIs, one including yoga and the other excluding yoga. Attention regulation was operationalized via behavioral indicators, namely sustained attention, cognitive flexibility, cognitive inhibition, and data-driven information processing. With the exception of speed in a cognitive flexibility task, the results indicated no systematic or differential advantage arising from mindfulness training, with or without yoga, regarding the aspects of attention regulation. There was no consistent influence of homework quantity or quality. The implications for mindfulness training in academic contexts are discussed.

The Shape of Water: How Tai Chi and Mental Imagery Effect the Kinematics of a Reach-to-Grasp Movement

The aim of the present study was to investigate the effect of Tai Chi (TC) and mental imagery (MI) on motor performance. MI is the ability of representing different types of images and it can be improved through constant practice (e.g., of TC). The majority of previous literature has mainly investigated the impact of this mental factor by means of qualitative indexes, whereas studies considering more rigorous measures such as kinematic parameters are rare. In this vein, little is known about how MI can affect reach-to-grasp, one of the most studied models in kinematic research. The present study attempts to fill that gap by investigating the relationship between MI and motor performance in TC, a practice that largely promotes the adoption of mental training. One TC master, four instructors, ten apprentices and fifteen untrained participants were requested to reach toward and grasp an object while mentally representing one out of five different images related to water with an increasing degree of dynamicity and expansion (i.e., still water, flowing water, wave, whirlpool, and opening water flower). Kinematic profiles of movements were recorded by means of six infra-red cameras using a 3-D motion analysis system. We tested whether: (i) focusing on MI during the task would help in optimizing motor efficiency, and (ii) expertise in TC would be reflected in higher flexibility during the task. The results indicate that kinematics is highly sensitive to MI and TC practice. In particular, our main finding suggests a statistically significant general improvement in motor efficiency for the TC group and a beneficial effect for all the participants when focusing on the most expansive image (i.e., opening water flower). Moreover, regression analysis indicates that MI and TC practice make online control more flexible in an experience-based way. These results have important implications for the use of mental imagery and TC in the retraining of motor function in people with physical disabilities.

Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration

Traumatic psychoemotional experiences often manifest in hypersympathetic states of excitement or in immobilization and withdrawal behaviors. A person with this kind of traumatic background may present with an autonomic response consistently maintained in the defensive state, which over time becomes a stressor. In this article, the authors discuss an osteopathic approach to psychoemotional trauma by means of bifocal integration, with an emphasis on promoting a relaxed body and mind by actively involving the patient in the healing process. They briefly discuss the role of mind-body therapies in treatment, considering the popular polyvagal theory and other neuropsychophysiological frameworks. The authors also focus on clinical practice, introducing the reader to the different elements of the osteopathic treatment, including the acknowledgement and integration of top-down and bottom-up dynamics in diagnosis and therapy.

Exploring how different types of yoga change psychological resources and emotional well-being across a single session

OBJECTIVES

Yoga demonstrates beneficial effects in many populations, yet our understanding of how yoga brings about these effects is quite limited. Among the proposed mechanisms of yoga are increasing psychological resources (mindfulness, body consciousness, self-transcendence, spiritual peace, and social connectedness) that may bring about salutary effects on emotional wellbeing. Further, yoga is a complex practice comprising meditation, active and restorative postures, and breathwork; however little is known about how different components may affect mechanisms. We aimed to determine how an acute session of yoga (and its specific components) related to pre- to post- session changes in proposed mechanisms (psychological resources) and whether those changes were associated with positive changes in emotions.

DESIGN

144 regular yoga practitioners completed measures of mindfulness, body consciousness, self-transcendence, social connectedness, spiritual peace, and exercise-induced emotions (positive engagement, revitalization, tranquility, exhaustion) immediately before and after a yoga session (N = 11 sessions, each a different type of yoga). Perceived properties of each yoga session, exercise exertion and engagement with the yoga teacher were assessed immediately following the session.

RESULTS

Pre-to post- yoga, levels of positive emotions (engagement, tranquility and revitalization) increased while exhaustion decreased. Further, all psychological resources increased and closely tracked improved emotions. Additionally, aspects of the yoga session correlated with changes in psychological resources (mechanisms) and emotions.

CONCLUSIONS

Yoga may influence multiple psychological mechanisms that influence emotional well-being. Further, different types of yoga may affect different mechanisms. Results can inform yoga interventions aiming to optimize effects through specific mechanisms such as mindfulness or spirituality.

Effect of Meditative Movement on Affect and Flow in Qigong Practitioners

Qigong is a Meditative Movement exercise that consists of mindful movements, regulation of breathing and attentional control. In this study we investigated whether Qigong practice might be associated with the affect and flow of its practitioners during the exercise. Although practitioners of Meditative Movement anecdotally describe flow-like experiences and strong effects on affect there are only a few empirical studies that focus on acute effects of Qigong practice on affect, and to our knowledge none on flow. Understanding these phenomena could shed new light on the interrelationship between body movement and the embodied mind. Self-reported affect and flow of qigong practitioners (N = 19) was probed in four qigong sessions, 1 week apart, each lasting about an hour. We used the PANAS (Positive And Negative Affect Schedule) to measure self-reported affect pre- and post-session. Additionally, open-ended questions were used to further inquire the specific quality of the post-session affect. Flow was measured using the Flow Short Scale, twice during each Qigong session and once after it. Our results confirm previous studies that Qigong practice shifts affect toward positive valence. Content analysis of the open-ended questions further revealed that the resulting experience can be described as restful, relaxed, happy, balanced, and clear. Although the lack of a control group/condition preclude drawing firm causal conclusions, our results indicate that Qigong practice produced flow already 20 min into the session, and that flow state intensified at 40 and 60 min. Future directions for studying affect and flow in meditative exercise are discussed.

Mindfulness, Interoception, and the Body: A Contemporary Perspective

Mindfulness is often used as an umbrella term to characterize a large number of practices, processes, and characteristics. Critics argue that this broad definition has led to misinformation, misunderstanding, and a general lack of methodologically rigorous research. Some of the confusion surrounding mindfulness is also believed to stem from an undifferentiated use of the term mindfulness and meditation. Mindfulness and all other forms of meditation have been shown to modulate the insula, which is the primary hub for interoception. Some have argued that interoception is foundational to mindfulness and may be the primary mechanism by which one benefits from the practice. However, much like the mindfulness literature, interoception remains broadly defined often without precision and with domain-specific meanings and implications. Research demonstrates that the insula and surrounding neural circuits are believed to be responsible for a number of other functions beyond interoception including attention, awareness, and all subjective experiences, much of which has been linked to the mindfulness literature. It has been assumed that mindfulness produces these neuroplasticity and functional effects. There is evidence that mindfulness and some of its benefits may be better described as increased interoception as a result of the neuroplasticity changes in the insula, and the development of the insula and surrounding neural circuits may cultivate dispositional mindfulness. The purposes of this article are to (1) highlight that it may be more accurate to link many of the identified benefits in the mindfulness literature to interoception and its neurological correlates and (2) propose attentional style as a means to clarify some of the confusion surrounding mindfulness, interoception, and meditation. Different meditations require different attentional styles. Attention can be analogous to a focal point with each focal point providing a unique perspective. Given that all meditative techniques modulate the insula, each meditation can provide a unique perspective from which to investigate complex interoceptive signals that may be unavailable from other meditative traditions. It may prove more useful to anchor scientific findings in the concrete body as a means to investigate those rather than a set of abstract, broadly defined meditative techniques.

Improving emotion regulation and mood in teacher trainees: Effectiveness of two mindfulness trainings

BACKGROUND/OBJECTIVE

The present research investigated potential effects of mindfulness training on emotion regulation and mood of future schoolteachers in a nonrandomized pre-post design, and whether these are influenced by the yoga component of mindfulness-based stress reduction (MBSR) and/or by homework practice.

METHOD

N = 169 university students received either mindfulness training (experimental groups), awareness activities (active control group), or no training (passive control group), in the context of university seminars. Allocation to groups was bound by the seminar chosen by participants, and in that sense was self-selected. Mindfulness was trained in two adapted MBSR courses, one of which including yoga, and the other excluding yoga.

RESULTS

Specific benefits of both mindfulness training groups were observed for emotion regulation in terms of an increase in cognitive reappraisal and a reduction in symptom-focused rumination as well as depressive mood. No benefits of mindfulness training were observed for reductions in expressive suppression, self-focused rumination, anxious, and negative mood or an increase in distraction and positive mood respectively. Mindfulness training with and without yoga was mostly equally effective. Outcomes were largely not moderated by practice quantity or quality, but reductions in depressive mood were mediated by gains in reappraisal and distraction.

CONCLUSIONS

Mindfulness training can be implemented in the context of university seminars to foster advantageous emotion regulation strategies and lower depressive mood in future schoolteachers. Discontinuing yoga within mindfulness interventions does not seem to reduce training benefits.

How Does Exercise Improve Implicit Emotion Regulation Ability: Preliminary Evidence of Mind-Body Exercise Intervention Combined With Aerobic Jogging and Mindfulness-Based Yoga

Purpose: The primary aim of the present study is to examine the effect of 8-week mind-body exercise intervention combining aerobic jogging and mindfulness-based yoga on implicit emotion regulation ability. The secondary aim is to explore the specific potential pathways by which the mind-body exercise intervention fosters implicit emotion regulation. This may help us to understand how the key components of exercise intervention contribute to emotional benefits.

Methods: Sixty participants were randomly allocated to one of two parallel groups: (1) the intervention group (n = 29) and (2) the waitlist control group (n = 31). Participants were asked to fill out scales measuring mindfulness and instructed to complete an emotion regulation task to assess implicit emotion regulation ability as well as the PWC 170 Test to evaluate aerobic fitness before and after the intervention.

Results: The results of the two-way repeated ANOVA revealed that 8 weeks of intervention improved implicit emotion regulation, mindfulness, and aerobic fitness levels. Path analysis showed that only improved aerobic fitness mediated the intervention effect on implicit emotion regulation ability, controlling for change in negative affect. Notably, the relationship between the effects on implicit emotion regulation ability and aerobic fitness was moderated by improved mindfulness.

Conclusion: Eight weeks of mind-body exercise intervention improves implicit emotion regulation ability. The aerobic fitness may be an essential pathway which mediates the efficacy on implicit emotion regulation ability. Furthermore, different components, such as aerobic fitness and mindfulness, may interactively contribute to such emotional benefits.

What are the known effects of yoga on the brain in relation to motor performances, body awareness and pain? A narrative review

OBJECTIVE

The current body of literature was reviewed to evaluate the effects of yoga on the brain in relation to motor performance, body awareness and pain.

BACKGROUND

Yoga has been increasingly popular in the Western countries especially for its unique integration of the mind and body. Yoga has been studied more intensely in the last decade. Although it has been shown to improve cognitive functions, few studies have looked into the effects of yoga on improving motor performance, body awareness or pain and the possible underlying brain mechanisms associated with them.

METHODS

A search of the current literature was made using keywords such as: "yoga brain motor", "yoga brain pain", "effects yoga brain" and "effects yoga brain motor performance". The findings were then discussed in relation to motor performance, body awareness and pain and their reported mechanisms of action on the brain.

RESULTS

A total of 61 articles were selected, out of which 29 were excluded because they did not meet our criteria. A total of thirty-two articles were included in this review, which we further subdivided by focus: motor performance (n = 10), body awareness (n = 14) and pain (n = 8).

DISCUSSION

Our review shows that yoga has a positive effect on learning rate, speed and accuracy of a motor task by increasing attention and decreasing stress through a better control of sensorimotor rhythms. Yoga also seems to improve sensory awareness and interoception, regulate autonomic input, increase parasympathetic activity and promote self-regulation. Yoga was also shown to reduce the threat signal, increase pain tolerance, decrease pain unpleasantness and decrease the anxiety and distress associated with pain. Those changes are associated with the recruitment of specific brain areas such as the insula, the amygdala and the hippocampus.

CONCLUSION

Based on the studies reviewed in this report, we found that the practice of yoga seems to facilitate motor learning, to increase body awareness and to decrease pain. These are associated with a wide variety of changes in terms of brain activity and structure. Further studies are necessary to reveal its precise mechanism of action on the brain and to validate its wider application in clinical settings.

Detecting Mind Wandering: An Objective Method via Simultaneous Control of Respiration and Fingertip Pressure

Mind wandering happens when one train of thought, related to a current undertaking, is interrupted by unrelated thoughts. The detection and evaluation of mind wandering can greatly help in understanding the attention control mechanism during certain focal tasks. Subjective assessments such as random thought-probe and spontaneous self-report are the ways previous research has assessed mind wandering. Here we propose a task in which participants are asked to simultaneously control respiration and fingertip pressure. They are instructed to click a force sensor at the exact moment of inhalation and exhalation of their respiration. The temporal synchronization between the respiratory signals and the fingertip force pulses offers an objective index to detect mind wandering. Twelve participants engaged in the proposed task in which self-reports of mind wandering are compared with the proposed objective index. The results show that the participants reported significantly more mind-wandering episodes during the trials with a larger temporal synchronization than they did during those trials with a smaller temporal synchronization. The findings suggest that the temporal synchronization might be used as an objective marker of mind wandering in attention training and exploration of the attention control mechanism.

Yoga Practitioners Uniquely Activate the Superior Parietal Lobule and Supramarginal Gyrus During Emotion Regulation

Chronic stress contributes to both mental and physical illness. A high prevalence and cost of stress-related illnesses North America warrants investigation into alternative or complementary therapies which may help reduce adverse reactions to stressful stimuli. Emotion regulation is the process of monitoring and adjusting emotional responses to environmental stimuli and stressors. Individuals who participate in physical activity are less likely to have adverse responses to potentially stressful situations, potentially due to adaptions in emotion regulation. Yoga is a form of physical activity involving stretching exercises and meditation, that may lessen individuals’ levels of stress and anxiety and improve emotion regulation. High-frequency heart rate variability (HF-HRV) is considered a measure of parasympathetic nervous system (PNS) activity during the emotion regulation. Measuring HRV and brain activity using functional magnetic resonance imaging (fMRI) offers a useful, noninvasive approach to evaluating “neurovisceral” components of emotion regulation. We aimed to determine whether yoga practitioners (YP) exhibit different patterns of brain activation compared to recreational athletes (RA) without current yoga experience, while viewing emotionally arousing visual stimuli. Our secondary aim was to examine potential differences across groups in HRV throughout the presentation of these stimuli. Analysis of fMRI data during exposure to emotion-evoking (EE) stimuli revealed that the YP group activated two unique brain areas, namely the superior parietal lobule and the supramarginal gyrus. These areas have been associated with attentional awareness and reduced egocentric bias, processes that have been implicated in emotion regulation by others. The RA group activated the inferior middle frontal cortex, an area associated with cognitive reappraisal during emotion regulation. The YP group also demonstrated a trend towards a higher ratio of low- to high-frequency HRV compared to the RA group. The present findings support the presence of experience-dependent neurovisceral mechanisms associated with emotion regulation. Individuals who practice yoga regulate their neurovisceral responses to potentially stressful external stimuli in a different manner than recreational athletes who do not engage in yoga practice. The present study had a small sample size (RA: n = 12; YP: n = 19), which should be taken into account when interpreting the results.

Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity

Contemplative practices, such as meditation and yoga, are increasingly popular among the general public and as topics of research. Beneficial effects associated with these practices have been found on physical health, mental health and cognitive performance. However, studies and theories that clarify the underlying mechanisms are lacking or scarce. This theoretical review aims to address and compensate this scarcity. We will show that various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline in turn could parsimoniously explain the physical and mental benefits of contemplative activities through changes in autonomic balance. We propose a neurophysiological model that explains how these specific respiration styles could operate, by phasically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation (rVNS). The vagal nerve, as a proponent of the parasympathetic nervous system (PNS), is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition. We will discuss implications and limitations of our model.