Yoga: A tool for improving the quality of life in chronic pancreatitis

Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach

BACKGROUND

Pancreatitis is a common surgical emergency, associated with pain and poor quality of life for patients. However, assessment of patient-reported outcome measures in these patients is unclear. This study aimed to identify and evaluate the methodological quality of the health-related quality of life instruments used for patients with acute or chronic pancreatitis.

METHODS

Prospective studies that evaluated health-related quality of life in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 28th June 2023 (PROSPERO: CRD42021274743). Instrument characteristics were extracted, and methodological quality assessed using COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) guidelines and GRADE approach. Narrative synthesis was conducted, with recommendations for use based on COSMIN criteria, evaluated according to World Health Organisation (WHO) quality of life domains.

RESULTS

From 3850 records screened, 41 quality of life instruments were identified across 138 studies included. The majority (69.8%, n = 26) were designed to assess general health-related quality of life, whereas the remainder were abdominal-specific (n = 5) or pancreas-specific (n = 10). Only ten instruments (24.3%) demonstrated sufficient content validity, incorporating items in ≥5 WHO quality of life domains. However, only nine instruments (21.9%) incorporated public and patient involvement. Only the Gastrointestinal Quality of Life Index and PAN-PROMISE met the criteria to be recommended for use based on COSMIN methodological assessment.

CONCLUSION

There is significant heterogeneity in instruments used to assess quality of life after pancreatitis, with almost all instruments considered insufficient. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve quality of life for these patients.

Post-pancreatitis diabetes mellitus: insight on optimal management with nutrition and lifestyle approaches

Pancreatitis is the leading gastrointestinal cause of hospitalizations. There are multiple short- and long-term complications associated with pancreatitis. Post-pancreatitis diabetes mellitus (PPDM) is one of the less explored complications of pancreatitis. Nonetheless, it has attracted considerable attention during the last decade. PPDM is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM. However, there exists a knowledge gap amongst practitioners regarding diagnosis, complications, and management of PPDM. In this narrative, we aim to provide a brief review regarding risks, diagnosis and management of PPDM with a special focus on dietary and lifestyle management strategies.KEY MESSAGESPost-pancreatitis diabetes mellitus (PPDM) is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM.New-onset diabetes in patients with pancreatitis could also be an early marker of occult pancreatic malignancy.Management of PPDM is complex and requires a team-based approach including gastroenterologists, endocrinologists, primary care physicians, nutritionists, and behavioural health specialists.

AGA-PancreasFest Joint Symposium on Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency (EPI) is a clinically defined syndrome based on the physician's assessment of a patient's maldigestion. However, current clinical definitions are inadequate in determining (1) the threshold of reduced pancreatic digestive enzyme secretion that determines "pancreatic insufficiency" in an individual patient; (2) the role of pancreatic function tests; (3) effects of differing metabolic needs, nutrition intake, and intestinal function/adaptation (4) when pancreatic enzyme replacement therapy is needed; and (5) how to monitor and titrate multiple therapies. Experts and key opinion leaders were invited to PancreasFest 2021 to discuss and help clarify mechanistic issues critical to defining EPI and to address misconceptions and barriers limiting advancements in patient care. Clinically EPI is defined as inadequate delivery of pancreatic digestive enzymes to meals to meet nutritional needs and is reversed with appropriate treatment. A new mechanistic definition of EPI was proposed that includes the disorders essence and character: (1) EPI is a disorder caused by failure of the pancreas to deliver a minimum/threshold level of specific pancreatic digestive enzymes to the intestine in concert with ingested nutrients, followed by enzymatic digestion of a series of individual snacks and meals over time to meet nutritional and metabolic needs, given (a) the specific macronutritional and micronutritional needs; (b) nutrient intake; (c) exocrine pancreatic function; and (d) intestinal anatomy, function, diseases, and adaptative capacity. (2) EPI is characterized by variable deficiencies in micronutrients and macronutrients, especially essential fats and fat-soluble vitamins, by gastrointestinal symptoms of nutrient maldigestion and by improvement or correction of nutritional state with lifestyle changes, disease treatment, optimized diet, dietary supplements, and/or administration of adequate pancreatic enzyme replacement therapy. EPI is complex and individualized and multidisciplinary approaches are needed to optimize therapy. Better pancreas function tests and biomarkers are needed to diagnose EPI and guide treatment.

Efecto del ejercicio físico sobre la aptitud física y estrés en pacientes por consumo de sustancias psicoactivas

El ejercicio físico (EF) regular tiene beneficios en la salud; además, es recomendado como estrategia útil en el tratamiento por consumo de sustancias psicoactivas (SPA). Se estudiaron diferencias y efecto del EF sobre la aptitud física y estrés en sujetos drogodependientes. El diseño pre-experimental pretest-postest con un solo grupo conformado por (n=4, Medad=22.0, DE=5.3), evaluados y elegibles según el autoreporte PAR-Q & YOU y el inventario IDARE. Los resultados mostraron que la resistencia muscular de miembros superiores e inferiores obtuvieron diferencias significativas (p< 0.03, y 0.00), aunque el tamaño del efecto no evidenció valores positivos (d = -1.79 y -6.00); la capacidad aeróbica, resistencia muscular abdominal y flexibilidad no reportaron significación estadística y el tamaño del efecto fue negativo; el estrés mostró diferencias significativas. Los hallazgos revelan que el EF puede generar cambios positivos en algunos componentes de la aptitud física en los pacientes. Se debe seguir investigando esta línea de trabajo. Regular physical activity (PE) has positive health effects, and it is also suggested as a helpful tactic in the management of psychoactive substance use (PAS). Study individuals who were drug addicted looked at differences and the impact of PE on stress and physical fitness. The pre-experimental pretest-posttest design included a single group of (n=4, Mage=22.0, SD=5.3) individuals who were evaluated and eligible based on the PAR-Q & YOU self-report and the IDARE inventory. The results showed that the muscular resistance of the upper and lower limbs had significant differences (p 0.03, and 0.00), but the effect size was negative (d = -1.79 and -6.00); aerobic capacity, abdominal muscular resistance, and flexibility did not show statistical significance, and the effect size was negative; stress showed significant differences. The findings show that PE can improve some aspects of physical fitness in patients. This area of research should be looked into further.  

Physical activity for chronic pancreatitis: a systematic review

BACKGROUND

Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. Sarcopenia is a degenerative loss of skeletal muscle mass, quality, and strength and is commonly associated with chronic pancreatitis. Regular physical activity and adequate functional fitness have been found to ameliorate the risk and effects of sarcopenia in other chronic diseases. The objective of this systematic review was to collate all the published evidence which has examined any type of physical activity as an intervention in the chronic pancreatitis patient population.

METHODS

This systematic review was conducted in accordance with the PRISMA guidelines. The search strategy was designed by the medical librarian (DM) for Embase and then modified for the other search platforms. Two of the researchers (BM) and (AM) then performed the literature search using the databases Embase, Medline, CINAHL, and Web of Science.

RESULTS

An electronic identified a total of 571 references imported to Covidence as 420 when the duplicates (151) were removed. 420 titles were screened and 390 were removed as not relevant from their titles. 30 full text papers were selected and from these, only one full text paper was deemed suitable for inclusion.

CONCLUSIONS

There is currently insufficient evidence to advise physical activity in the chronic pancreatitis population. However, given the evidence to support physical activity in many other chronic diseases this review highlights the need for urgent investigation of physical activity as an intervention on this specific patient population.

Outpatient Pain Management in Children With Chronic Pancreatitis: A Scoping Systematic Review

OBJECTIVES

Although pain management is central to pediatric chronic pancreatitis (CP) care, no evidence-based guidelines exist. In this scoping systematic review, we sought promising strategies for CP pain treatment in children.

METHODS

We systematically reviewed literature on pain management in children and adults with CP, and 2 conditions with similar pain courses: juvenile idiopathic arthritis and sickle cell disease.

RESULTS

Of 8997 studies identified, 287 met inclusion criteria. There are no published studies of analgesic medications, antioxidants, dietary modification, integrative medicine, or regional nerve blocks in children with CP. In adults with CP, studies of nonopioid analgesics, pancreatic enzymes, and dietary interventions have mixed results. Retrospective studies suggest that endoscopic retrograde cholangiopancreatography and surgical procedures, most durably total pancreatectomy with islet autotransplant, improve pain for children with CP. Follow-up was short relative to a child's life. Large studies in adults also suggest benefit from endoscopic therapy and surgery, but lack conclusive evidence about optimal procedure or timing. Studies on other painful pediatric chronic illnesses revealed little generalizable to children with CP.

CONCLUSIONS

No therapy had sufficient high-quality studies to warrant untempered, evidence-based support for use in children with CP. Multicenter studies are needed to identify pain management "best practices."

Effects of yoga in inflammatory bowel diseases and on frequent IBD-associated extraintestinal symptoms like fatigue and depression

Quality of life (QoL) of persons with inflammatory bowel diseases (IBD) is often impaired by symptoms that do not primarily relate to intestinal inflammation. Among the most challenging extraintestinal symptoms are depression and fatigue, which are also frequent in other chronic diseases like multiple sclerosis, rheumatoid arthritis and cancer. Yoga as an ancient Indian tradition containing postures, breathing exercises and meditation may positively influence those symptoms. This review evaluates the current literature with regard to the effect of yoga-based interventions in persons with IBD and with regard to QoL, depression and fatigue in other somatic disorders. A systematic literature search yielded three trials examining the effects of yoga in patients with IBD and 37 trials addressing depressive syndromes or fatigue in somatic disorders. In summary, both in-person and video-based yoga classes are feasible, acceptable and safe as complementary treatment in patients with IBD and significantly improve anxiety and impaired quality of life. Current literature does not provide information on the effect of yoga on depression and fatigue in patients with IBD, but research from other somatic disorders or patients with depressive disorders implies the potential of yoga in this regard for persons with IBD. This should be specifically addressed in interventional trials with standardized yoga modules including patients with IBD suffering from fatigue, depression and/or impaired QoL.

The Benefits of Physical Exercise on Mental Disorders and Quality of Life in Substance Use Disorders Patients. Systematic Review and Meta-Analysis

Physical exercise seems to have a promising effect on numerous variables related to the recovery of drug-dependent patients. However, some contradictions are found in the literature. The aim of this study was to perform a systematic review and meta-analysis in order to identify the effect of physical exercise on mental disorders, quality of life, abstinence, and craving, and make a comparison of the effect of exercise depending on the type of program. A search for articles was conducted using PubMed, Web of Science, and Scopus databases. Studies were selected that measured the acute effects or long-term effect (≥2 weeks) of exercise in patients who met criteria for alcohol use disorders or substance use disorders. A total of 59 studies were included. An effect of exercise on quality of life and mental disorders was identified. Subgroup analysis revealed an effect of exercise on stress (SMD = 1.11 (CI: 0.31, 1.91); z = 2.73; p = 0.006), anxiety (SMD = 0.50 (CI: 0.16, 0.84); z = 2.88; p = 0.004) and depression (SMD = 0.63 (CI: 0.34, 0.92); z = 4.31; p < 0.0001), and an effect of exercise on the eight variables included in the SF36 test. The results also showed a trend towards a positive effect on craving (SMD = 0.89 (CI: −0.05, 1.82); z = 1.85, p = 0.06). Body-mind activities and programs based on improving physical conditions produced similar results in mental disorders and quality of life. Available evidence indicates that physical exercise, both body-mind and physical fitness programs, can be effective in improving mental disorders, craving, and quality of life in drug-dependent patients.

Is Exercise a Useful Intervention in the Treatment of Alcohol Use Disorder? Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review and meta-analysis examined the effects of exercise on individuals with alcohol use disorders (AUDs) across multiple health outcomes.

DATA SOURCES

PubMed, Medline, Web of Science, Scopus, Academic Search complete, Sport Discuss, and ERIC databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

Interventional studies published between 2000 and 2018 focused on evaluating the effectiveness of exercise interventions in adults with AUD.

DATA EXTRACTION

This protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols standard and the Meta-Analyses and Systematic Reviews of Observational Studies guidelines.

DATA SYNTHESIS

Physical activity levels/fitness [VO₂ max (Oxygen Uptake) and HRmax (Maximum Heart Rate)], levels of depression, anxiety, self-efficacy, quality of life, and alcohol consumption (number of standard drinks consumed per day and per week).

RESULTS

The findings indicated that exercise significantly improved physical fitness as assessed by VO₂ max (standardized mean difference [SMD]: 0.487, P < .05) and HRmax (SMD: 0.717, P < .05). Similarly, exercise significantly improved mental health as assessed by quality of life (SMD: 0.425, P < .05), but levels of depression, anxiety, self-efficacy, and alcohol consumption did not change significantly. Aerobic exercise alleviated depression and anxiety symptoms more than that of yoga and mixed types. Duration of exercise also had a similar effect on anxiety and depression.

CONCLUSIONS

Exercise can be an effective and persistent adjunctive treatment for individuals with AUDs.

Clinical impact of physical exercise on sleep disorder as assessed by actigram in patients with chronic pancreatitis: a study protocol for a randomised controlled trial

Introduction

In most chronic pancreatitis (CP) cases, malabsorption, pain, and weight loss are the leading clinical symptoms, which significantly worsen the quality of life (QOL) and decreased QOL in patients with CP can cause sleep disorder. There is a growing body of evidence that recognises the favourable effects of physical exercise (PE), however, there are limited data currently available concerning patients with CP undergoing PE. Actigram is a device for gathering objective sleep/awake data in the natural sleeping surroundings over an extended time period. In this study, we will aim to prospectively investigate the effect of PE on sleep disorder as assessed by actigram in patients with CP.

Methods and analysis

This study is a non-double-blind randomised controlled trial. Study participants will be randomised into the PE group and the control group. When registering patients, precise assessment for nutritional status and daily physical activities will be undertaken in each study patient. In the PE group, physical activities equal to or higher than walking for 60 min/day should be strongly recommended. Sleep quality using actigram will be prospectively compared in the two groups. The primary endpoint is the activity index in actigram at 12 weeks.

Ethics and dissemination

Ethical approval for the study was granted by the Institutional Review Board at Hyogo College of Medicine (approval number 2767). Results will be presented at relevant conferences and submitted to an appropriate journal following trial closure and analysis.

Trial registration number

UMIN000029265 (https://upload.umin.ac.jp/); Pre-results.

Effects of Maharishi Yoga Asanas on Mood States, Happiness, and Experiences during Meditation

Context/Background

Many studies showed positive effects of Yoga Asanas. There is no study on Maharishi Yoga Asanas yet. This research replicated and expanded observed improvements on the profile of mood states (POMS) as a result of 2-week Maharishi Yoga Asanas course. Thirteen college students taking part in a 4-week course on Maharishi Yoga Asanas were matched with 13 students taking other courses at the university.

Aims and Objective

The main objective of the study was to assess the effects of Maharishi Yoga Asanas on mood states, degree of happiness, and experiences in Transcendental Meditation (TM) practice.

Methods

All students were given two psychological tests and additional question before and after their 4-week course: POMS, Meditation Depth Questionnaire, and question about the degree of happiness.

Results

Repeated measure MANOVA showed the 4-week Maharishi Yoga Asanas course resulted in significant increase in happiness during the day and significant improvements in (1) sense of personal self, (2) transpersonal qualities, and (3) transpersonal self during their TM practice.

Conclusion

This research shows that Maharishi Yoga Asanas affect more than body and mind. Rather they influence much deeper levels of one's subjectivity including one's transpersonal self.

Yoga and substance use disorders: A narrative review

Yoga has been utilized for promotion of health and alleviating distress. It has also been used as a therapeutic measure in the field of mental health, including substance use disorders. This narrative review discusses the literature pertaining to use of yoga in the treatment of substance use disorders. The evidence base especially with regards to randomized trials is presented. The possible mechanisms how yoga might be helpful in the treatment of substance use disorders are explored. Subsequently, implications of yoga in clinical practice are elaborated, followed by examination of the issues in interpretation of the literature of published yoga related studies.

Effects of Modified Hatha Yoga in Industrial Rehabilitation on Physical Fitness and Stress of Injured Workers

PURPOSE

The purpose of this study was to assess the effects of 8 weeks of modified hatha yoga training on physical fitness and stress level in injured workers.

METHODS

Eighteen male and female injured workers, age between 18 and 55 years, participated in this study. They were divided into two groups: an additive hatha yoga training to routine industrial rehabilitation program group (HYG: n = 9) and a control group with no yoga training (CG: n = 9). A modified hatha yoga protocol was designed for this population by two certified yoga instructors, approved by a physical therapist, and conducted for 1 h, three times weekly for 8 weeks. Physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and lung capacity and scores of sensitivity to stress were evaluated at the time of recruitment and after 8 weeks of intervention.

RESULTS

The values of all physical fitness variables and stress scores were no significant difference between the two groups at baseline. Significant post-yoga improvements for HYG group were noted in flexibility, hand grip strength, and vital capacity (p < 0.05). In contrast, there was no significant change in the CG group. Stress scores did not change as a result of hatha yoga training.

CONCLUSION

An 8-week modified hatha yoga training experience exerted therapeutic effects on physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and vital capacity, but not on stress level in injured workers. These findings indicate that hatha yoga can be a beneficial adjunct to routine physical therapy treatment in industrial rehabilitation programs.

Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study

With limited efficacy of medications for symptom relief, non-medication treatments may play an important role in the treatment of irritable bowel syndrome (IBS), the most common functional gastrointestinal (GI) disorder. This study aimed to evaluate the efficacy of two self-regulation strategies for symptom relief and mood management in IBS patients. Thirty-five adult participants meeting ROME III criteria for IBS were enrolled, 27 of the 35 participants (77%) completed treatment and pre- and post-treatment visits (89% women, 11% men; M (SD) age = 36 (13)), and 20 of the 27 (74%) completed a 6-month follow-up. Participants were randomly assigned to 16 biweekly group sessions of Iyengar yoga or a walking program. Results indicated a significant group by time interaction on negative affect with the walking treatment showing improvement from pre- to post-treatment when compared to yoga (p < .05). There was no significant group by time effect on IBS severity. Exploratory analyses of secondary outcomes examined change separately for each treatment condition. From pre- to post-treatment, yoga showed significant decreases in IBS severity measures (p < .05), visceral sensitivity (p < .05), and severity of somatic symptoms (p < .05). Walking showed significant decreases in overall GI symptoms (p < .05), negative affect (p < .05), and state anxiety (p < .05). At 6-month follow-up, overall GI symptoms for walking continued to significantly decline, while for yoga, GI symptoms rebounded toward baseline levels (p < .05). When asked about self-regulated home practice at 6 months, significantly more participants in walking than in yoga practiced at least weekly (p < .05). In sum, results suggest that yoga and walking as movement-based self-regulatory behavioral treatments have some differential effects but are both beneficial for IBS patients, though maintenance of a self-regulated walking program may be more feasible and therefore more effective long term.

The impact of yoga on quality of life and psychological distress in caregivers for patients with cancer

PURPOSE/OBJECTIVES

To assess the effects of a six-week Vinyasa yoga (VY) intervention on caregivers' overall quality of life (QOL) and psychological distress.

DESIGN

A single-group, pre- and post-test pilot study.

SETTING

University public recreational facility.

SAMPLE

12 informal caregivers for patients with cancer.

METHODS

Caregivers participated in a six-week VY intervention and completed measures of QOL and psychological distress pre- and postintervention. Program satisfaction was measured with open-ended survey questions.

MAIN RESEARCH VARIABLES

QOL, psychological distress, and program satisfaction.

FINDINGS

Significant improvements were found in the mental component score of overall QOL and in overall psychological distress. Several subdomains of QOL and psychological distress were also improved significantly. Open-ended survey question responses revealed participants perceived physical and mental benefit from the intervention, highlighting improvements in flexibility, core and upper-body strength, balance, breathing, and energy.

CONCLUSIONS

Informal caregivers may benefit mentally and physically from participating in VY.

IMPLICATIONS FOR NURSING

Caregivers of patients with cancer characterize a group worthy of attention, research, and interventions focusing on their healthcare needs.

Impact of physical exercise on substance use disorders: a meta-analysis

OBJECTIVE

The goal of this meta-analysis was to examine whether long-term physical exercise could be a potential effective treatment for substance use disorders (SUD).

METHODS

The PubMed, Web of Science, Elsevier, CNKI and China Info were searched for randomized controlled trials (RCT) studies in regards to the effects of physical exercise on SUD between the years 1990 and 2013. Four main outcome measures including abstinence rate, withdrawal symptoms, anxiety, and depression were evaluated.

RESULTS

Twenty-two studies were integrated in the meta-analysis. The results indicated that physical exercise can effectively increase the abstinence rate (OR = 1.69 (95% CI: 1.44, 1.99), z = 6.33, p < 0.001), ease withdrawal symptoms (SMD = -1.24 (95% CI: -2.46, -0.02), z = -2, p<0.05), and reduce anxiety (SMD = -0.31 (95% CI: -0.45, -0.16), z  =  -4.12, p < 0.001) and depression (SMD  =  -0.47 (95% CI: -0.80, -0.14), z = -2.76, p<0.01). The physical exercise can more ease the depression symptoms on alcohol and illicit drug abusers than nicotine abusers, and more improve the abstinence rate on illicit drug abusers than the others. Similar treatment effects were found in three categories: exercise intensity, types of exercise, and follow-up periods.

CONCLUSIONS

The moderate and high-intensity aerobic exercises, designed according to the Guidelines of American College of Sports Medicine, and the mind-body exercises can be an effective and persistent treatment for those with SUD.

Comparison groups in yoga research: a systematic review and critical evaluation of the literature

OBJECTIVES

Comparison groups are essential for accurate testing and interpretation of yoga intervention trials. However, selecting proper comparison groups is difficult because yoga comprises a very heterogeneous set of practices and its mechanisms of effect have not been conclusively established.

METHODS

We conducted a systematic review of the control and comparison groups used in published randomized controlled trials (RCTs) of yoga.

RESULTS

We located 128 RCTs that met our inclusion criteria; of these, 65 included only a passive control and 63 included at least one active comparison group. Primary comparison groups were physical exercise (43%), relaxation/meditation (20%), and education (16%). Studies rarely provided a strong rationale for choice of comparison. Considering year of publication, the use of active controls in yoga research appears to be slowly increasing over time.

CONCLUSIONS

Given that yoga has been established as a potentially powerful intervention, future research should use active control groups. Further, care is needed to select comparison conditions that help to isolate the specific mechanisms of yoga's effects.

Characteristics of randomized controlled trials of yoga: a bibliometric analysis

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

Effect of 12 weeks of yoga training on the somatization, psychological symptoms, and stress-related biomarkers of healthy women

Background

Previous studies have shown that the practice of yoga reduces perceived stress and negative feelings and that it improves psychological symptoms. Our previous study also suggested that long-term yoga training improves stress-related psychological symptoms such as anxiety and anger. However, little is known about the beneficial effects of yoga practice on somatization, the most common stress-related physical symptoms, and stress-related biomarkers. We performed a prospective, single arm study to examine the beneficial effects of 12 weeks of yoga training on somatization, psychological symptoms, and stress-related biomarkers.

Methods

We recruited healthy women who had no experience with yoga. The data of 24 participants who were followed during 12 weeks of yoga training were analyzed. Somatization and psychological symptoms were assessed before and after 12 weeks of yoga training using the Profile of Mood State (POMS) and the Symptom Checklist-90-Revised (SCL-90-R) questionnaires. Urinary 8-hydroxydeoxyguanosine (8-OHdG), biopyrrin, and cortisol levels were measured as stress-related biomarkers. The Wilcoxon signed-rank test was used to compare the stress-related biomarkers and the scores of questionnaires before and after 12 weeks of yoga training.

Results

After 12 weeks of yoga training, all negative subscale scores (tension-anxiety, depression, anger-hostility, fatigue, and confusion) from the POMS and somatization, anxiety, depression, and hostility from the SCL-90-R were significantly decreased compared with those before starting yoga training. Contrary to our expectation, the urinary 8-OHdG concentration after 12 weeks of yoga training showed a significant increase compared with that before starting yoga training. No significant changes were observed in the levels of urinary biopyrrin and cortisol after the 12 weeks of yoga training.

Conclusions

Yoga training has the potential to reduce the somatization score and the scores related to mental health indicators, such as anxiety, depression, anger, and fatigue. The present findings suggest that yoga can improve somatization and mental health status and has implications for the prevention of psychosomatic symptoms in healthy women.

Trial registration

University Hospital Medical Information Network (UMIN CTR) UMIN000007868.

Iyengar yoga and the use of props for pediatric chronic pain: a case study

Iyengar yoga uses postures and props to support the body so that practitioners can engage in poses that would otherwise be more difficult. This type of yoga may be useful in treating children and adolescents who have chronic pain and disability. In this case study, the authors discuss a 14-y-old girl who had two surgeries for gastro-esophageal reflux disease (GERD) and who had continued chest and abdominal pain, as well as vomiting, difficulty eating, weight loss, and anxiety. Having significantly impaired functioning, she was unable to attend school, sleep, socialize, or eat, and she had become wheelchair-bound. Despite evaluations and treatments by specialists over an extended period of time, her symptoms had not improved. This case history describes how the authors used a 4-mo treatment of Iyengar yoga to help the adolescent resume activities and re-engage with her environment. The authors intend this report to stimulate scientific study of this form of treatment for children and adolescents with chronic pain.

Quality of life among alcohol-dependent patients: how satisfactory are the available instruments? A systematic review

AIM

The purpose of this systematic review was to compare quality-of-life instruments used as outcome measures in randomized clinical trials for alcohol-dependence treatment.

METHODS

Randomized controlled clinical trials, indexed in the EMBASE, PubMed and PsycINFO databases since 1981, which aimed at improving the quality of life in alcohol-dependent patients and used as instrument to measure the quality of life, as specifically designated by the authors, were included.

RESULTS

Of the 331 articles screened, 18 studies were included in the review. Eight different quality-of-life instruments were used as outcome measures. Twenty-seven life domains were explored. Between-scale heterogeneity was high. The scale most frequently used was the medical outcomes study 36-item short-form health survey (SF-36). Only 1 clinical trial demonstrated a significant difference between intervention groups at all endpoints, using the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q).

CONCLUSION

Because many different instruments were used, it is difficult to compare quality-of-life improvement between trials. The most frequently used instrument was a generic health status measure that may not be well suited as a quality-of-life measure for subjects with alcohol dependence. The construction and validation of a specific patient-reported outcome based on alcohol-dependent patients' concerns would effectively contribute to the assessment of treatment efficacy.

Effects of yoga interventions on fatigue: a meta-analysis

Background. Researchers aimed at systematically reviewing and meta-analyzing the effectiveness of yoga interventions for fatigue. Methods. PubMed/Medline was searched until January 2012 for controlled clinical studies. Two reviewers independently extracted the data. The methodological quality of the studies was assessed. A meta-analysis was performed. Results. Nineteen clinical studies (total n = 948) were included in this review. Investigated yoga styles included Hatha, Iyengar, Asanas, Patanjali, Sahaja, and Tibetan yoga. Participants were suffering from cancer, multiple sclerosis, dialysis, chronic pancreatitis, fibromyalgia, asthma, or were healthy. Yoga had a small positive effect on fatigue (SMD = 0.27, 59% CI = 0.23–0.31). Seven studies received 4 points on the Jadad score. There were baseline differences in at least 5 studies. Conclusion. Overall, the effects of yoga interventions on fatigue were only small, particularly in cancer patients. Although yoga is generally a safe therapeutic intervention and effective to attenuate other health-related symptoms, this meta-analysis was not able to define the powerful effect of yoga on patients suffering from fatigue. Treatment effects of yoga could be improved in well-designed future studies. According to the GRADE recommendations assessing the overall quality of evidence, there is a moderate effect of the confidence placed in the estimates of the effects discussed here.

Modern treatment of patients with chronic pancreatitis

CP remains a challenging disease. Endoscopic and surgical management, along with antioxidants, have helped in reducing chronic pain. Management of exocrine and endocrine insufficiency forms the cornerstone for improving nutrition in these patients. Newer therapeutic targets that will transcend the management of CP beyond just pain control and enzyme supplementation are required in the future.

Assessment of quality of life in patients with chronic pancreatitis

BACKGROUND

Quality of life (QOL) has increasingly become a factor in management decisions in patients with chronic diseases. Chronic pancreatitis (CP) is a debilitating disorder that causes not only pain and endo/exocrine insufficiency but is also connected with some social issues. The aim of this study was to assess QOL in patients with chronic pancreatitis in correlation with the disease activity or the environmental/social factors that can influence their well-being.

MATERIAL/METHODS

The study group comprised 43 patients with CP: M/F 37/6; mean age 47.9 ± 8.6; range: 30-74 yrs. The control group consisted of 40 healthy volunteers of comparable demographics. Different degrees of CP activity were defined using the Cambridge classification. Pain intensity and frequency were assessed using a pain index. QOL was assessed using the Short-Form-36 questionnaire.

RESULTS

Mean QOL scores in CP were lower compared to the control group in all SF-36 domains, particularly in general health perception, physical functioning, role-physical (p<0.001) and vitality (p<0.05). We observed correlation of QOL results and pain index in all domains, and number of the disease relapses and body weight in 5 out of 8 domains (p<0.001 and p<0.05, respectively). The worst QOL scores were obtained in retired patients, as well as in unemployed persons in almost all SF-36 domains (p<0.001).

CONCLUSIONS

Chronic pancreatitis significantly impairs patients' quality of life. Severity of abdominal pain, low body weight, and loss of work were the factors most closely associated with poor health status perception.

Here and now: Yoga in Israeli schools

Context:

In the aftermath of the Second Lebanon War, a project was initiated and designed to reduce tension in the children living in the area under bombardment.

Aims:

To assess the impact of yoga intervention in a group of Israeli school children residing in the region affected by the Second Lebanon War.

Settings and Design:

The study population included 122 school children aged 8–12 years in two elementary schools in Safed (n=55 and n=67, respectively) and their teachers (n=6). The children attended the third grade (n=28), fourth grade (n=42) and sixth grade (n=52).

Inclusion in the study was based on the school principal’s consent to participate in the program.

Materials and Methods:

Assessment was conducted using three questionnaires that have been previously validated in international studies and translated to Hebrew.

Statistical Analysis Used:

Statistical analysis of the results included Wilcoxon Signed Ranked Tests for pre- and post-intervention comparisons and the Kruskall–Wallis test for teacher and child cross-comparisons.

Results:

Based on the questionnaires completed by the children and their teachers, we found that the teachers reported many statistically significant improvements in the children’s concentration, mood and ability to function under pressure, although the children themselves were unaware of any change in their behavior. Enjoyment was reported by all participants, and almost all expressed an interest in continuing to practice yoga during school hours. We conclude that participation in yoga classes may be both enjoyable and beneficial to children living in stressful conditions.

Conclusions:

The study indicates that yoga may be beneficial as an intervention for children in postwar stress situations.

Profile of mood states and stress-related biochemical indices in long-term yoga practitioners

Background

Previous studies have shown the short-term or intermediate-term practice of yoga to be useful for ameliorating several mental disorders and psychosomatic disorders. However, little is known about the long-term influences of yoga on the mental state or stress-related biochemical indices. If yoga training has a stress-reduction effect and also improves an individual's mental states for a long time, long-term yoga practitioners may have a better mental state and lower stress-related biochemical indices in comparison to non-experienced participants. This study simultaneously examined the differences in mental states and urinary stress-related biochemical indices between long-term yoga practitioners and non-experienced participants.

Methods

The participants were 38 healthy females with more than 2 years of experience with yoga (long-term yoga group) and 37 age-matched healthy females who had not participated in yoga (control group). Their mental states were assessed using the Profile of Mood States (POMS) questionnaire. The level of cortisol, 8-hydroxydeoxyguanosine (8-OHdG) and biopyrrin in urine were used as stress-related biochemical indices.

Results

The average self-rated mental disturbance, tension-anxiety, anger-hostility, and fatigue scores of the long-term yoga group were lower than those of the control group. There was a trend toward a higher vigor score in the long-term yoga group than that in the control group. There were no significant differences in the scores for depression and confusion in the POMS between the two groups. The urine 8-OHdG concentration showed a trend toward to being lower in the long-term yoga group in comparison to the control group. There were no significant differences in the levels of urine biopyrrin or cortisol.

Conclusions

The present findings suggest that long-term yoga training can reduce the scores related to mental health indicators such as self-rated anxiety, anger, and fatigue.

Development of the beliefs about yoga scale

Beliefs about yoga may influence participation in yoga and outcomes of yoga interventions. There is currently no scale appropriate for assessing these beliefs in the general U.S. population. This study took the first steps in developing and validating a Beliefs About Yoga Scale (BAYS) to assess beliefs about yoga that may influence people's engagement in yoga interventions. Items were generated based on previously published research about perceptions of yoga and reviewed by experts within the psychology and yoga communities. 426 adult participants were recruited from an urban medical center to respond to these items. The mean age was 40.7 (SD=13.5) years. Participants completed the BAYS and seven additional indicators of criterion-related validity. The BAYS demonstrated internal consistency (11 items; α=0.76) and three factors emerged: expected health benefits, expected discomfort, and expected social norms. The factor structure was confirmed: x2 (41, n=213)=72.06, p<.001; RMSEA=06, p=.23. Criterion-related validity was supported by positive associations of the BAYS with past experiences and future intentions related to yoga. This initial analysis of the BAYS demonstrated that it is an adequately reliable and valid measure of beliefs about yoga with a three-factor structure. However, the scale may need to be modified based on the population to which it is applied.

Subjective Sleep Quality and hormonal modulation in long-term yoga practitioners

Yoga represents a fascinating mind-body approach, wherein body movements (asana), breathing exercises (pranayama) and meditation are integrated into a single multidimensional practice. Numerous beneficial mental and physical effects have been classically ascribed to this holistic ancient method. The purpose of the present study has been to examine the effects of long-term yoga practice on Subjective Sleep Quality (SSQ) and on several hormonal parameters of the hypothalamus-pituitary-adrenal (HPA) axis. Twenty-six subjects (16 experimental and 10 controls) were recruited to be part of the study. Experimental subjects were regular yoga practitioners with a minimum of 3 years of practice. Blood samples for the quantification of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEA-S) were drawn from all subjects. Likewise, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess SSQ. As statistical analysis, Mann-Whitney U-test was performed. The yoga group displayed lower PSQI scores and higher blood cortisol levels than control subjects. Therefore, it can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol. These preliminary results suggest interesting clinical implications which should be further researched.