Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis-Related Disability: A Pilot Study

Yoga vs Physical Therapy in Multiple Sclerosis: Results of Randomized Controlled Trial and the Training Protocol

Background

Yoga originated in the territory of modern India more than 3,000 years ago uses techniques for working with the musculoskeletal system, cardiorespiratory system, and attention. Currently, the effectiveness and safety of yoga in patients with various neurological disorders, including multiple sclerosis (MS), is of interest to many scientists and clinicians.

Purpose

The main aim of this study is to examine the effect of yoga on symptoms and quality of life in patients with MS vs physical therapy (exercise therapy) and no exercise.

Methods

The patients were randomly assigned to three groups (yoga, physical therapy (PT), or waiting list). After 12 weeks of regular exercises (or the absence of them), the effect of yoga and PT on the functional status and quality of life of patients were evaluated. The data were collected during the patients' two visits to the study center - before the start of the study and at the end of the 12-week period. The in-person examination included a doctor's assessment of the Expanded Disability Status Scale (EDSS), the SF-36 quality of life questionnaire, the fatigue scale, the Berg balance scale, and the 6-min walking test.

Results

A total of 36 patients finished the clinical study: thirty women and six men. There was no statistically significant difference between the groups in terms of improvement in MS symptoms as measured by the balance, walking test, and fatigue scales. However, in the analysis of eight criteria of SF-36 quality-of-life questionnaire by the covariation analysis, statistically significant differences were found in favor of the yoga group in terms of physical functioning (PF) (p = .003), life activity (VT) (p < .001), mental health (MH) (p = 013), and social functioning (SF) (p = .028).

Conclusion

Thus, regular yoga classes under the guidance of qualified staff are a promising method of non-drug rehabilitation of patients with MS with motor disorders.

A crossover pilot trial of the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga for community-dwelling adults with multiple sclerosis

BACKGROUND AND PURPOSE

Among people with multiple sclerosis (MS), yoga has potential to improve fatigue and other symptoms that undermine quality of life. The aim of this study was to assess the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga, a six-week yoga with psychoeducation program, on fatigue and other health-related outcomes among people with MS in a rural, community-based setting in the United States.

METHODS

This non-randomized 2x2 crossover pilot trial compared LoveYourBrain Yoga to a control among 15 people with MS. People were eligible if they were adults with MS (EDSS score ≤6), English-speaking, and ambulatory. Paired t-tests and Wilcoxon signed rank sum analyses assessed mean differences in PROMIS-Fatigue_MS, Multiple Sclerosis Impact Scale, Symbol Digit Modalities Test, NIH Neuro-QoL measures, and Liverpool Self-Efficacy scale. We assessed feasibility using recruitment and retention rates, mean attendance, fidelity, and acceptability using satisfaction measures.

RESULTS

Significant improvements in fatigue (MD -4.34, SD 5.26, p = 0.012), positive affect and wellbeing (MD 2.76, SD 3.99, p = 0.028), and anxiety (MD -4.42, SD 5.36, p = 0.012) were found after LoveYourBrain Yoga compared to the control. Participants reported high satisfaction (M 9.5, SD 1.4) and a majority (92.3%) reported 'Definitely, yes' to recommending it to a friend or family.

CONCLUSION

LoveYourBrain Yoga is feasible and acceptable when implemented in a rural, community-based setting for people with MS. It may improve a range of MS symptoms and offer a means for acquiring new skills for stress reduction, anxiety management, and overall wellbeing.

Yoga Interventions Used for the Rehabilitation of Stroke, Parkinson's Disease, and Multiple Sclerosis: A Scoping Review of Clinical Research

Objectives: The current body of literature was reviewed to compile and describe yoga interventions that have been applied in clinical research and neurologic rehabilitation settings with patients affected by stroke, Parkinson's disease (PD), and multiple sclerosis (MS). Design: Available literature on yoga therapy (YT) was mapped following a five-stage framework to identify key concepts, knowledge gaps, and evidence to inform practice. Publications were identified through Medline, CINAHL, EMBASE, and PsycINFO. Selected studies required subjects with a clinical diagnosis of stroke, PD, and MS to participate in a yoga intervention and have physical, cognitive, and/or psychosocial outcome measures assessed. Results: A total of 50 studies were included in this review. Study characteristics, patient demographics, description of the yoga intervention, reported outcome measures and the main findings were extracted from the studies. Conclusion: Implementing YT in neurorehabilitation can help health care professionals integrate a more holistic approach that addresses the fundamental physical and psychological challenges of living with a chronic and debilitating neurologic disorder. The included studies described yogic interventions consisting of group or individual therapy sessions lasting 60-75 min that were carried out one to three times per week for 8-12 consecutive weeks across all three conditions. All studies described in this scoping review used different yoga protocols confirming the lack of specific interventional parameters available for implementing yoga into the rehabilitation of individuals affected by stroke, PD, or MS.

Postural stability is a valid and meaningful disability metric in progressive MS with potential for use in neuroprotective therapy trials

BACKGROUND

Balance impairment is observed in up to 70% of people with MS (pwMS) and worsens with disease progression. Posturography using a force platform is the current gold standard in the measurement of balance. However, posturography has not been adequately studied or widely accepted for use as a disability outcome measure for pwMS. Importantly, the recent emergence of both successful and failed neuroprotective therapy trials in progressive MS has emphasised the need for new disability outcome measures for people with progressive MS. The main objectives of this study were to evaluate the clinical validity, reliability and feasibility of posturography as a disability metric in progressive MS.

METHODS

This was a prospective cross-sectional study. We recruited 73 people with progressive MS (age 18-65 years, EDSS 3.5-6.0). Participants stood in the centre of a force platform, feet comfortably apart, under various conditions: (i) eyes open (EO), (ii) eyes closed (EC) - a single task, each lasting ninety seconds; and simultaneous EO with a cognitive test: (iii) N-Back, a three-minute test whereby participants were instructed to click the mouse when two identical letters were displayed consecutively on a screen, (iv) Sustained Attention Response Task, a five-minute test whereby participants were instructed to click the mouse for every number "1″ to "9″ except "3″ - i.e., dual-tasks. Additionally, we performed a battery of validated physical and cognitive outcome measures. Posturographic data was processed using Matlab. Statistical analysis was performed using SPSS version 26. We used multiple linear regression modelling to determine whether significant univariate correlations between posturography and clinical metrics were independent of covariates that may influence the associations seen. A two-tailed significance level of 0.05 was used.

RESULTS

Of 73 participants, mean age 52.4 (8.5) years, mean MS disease duration 13.8 (10.3) years, median EDSS 5.0 (IQR 4.0-6.0), 44 (60.4%) were female. EO-Path-Length independently predicted upper extremity function (9-Hole-Peg-Test) with a larger effect size (adjusted R²=20.0%, p = 0.001) than that for walking measures (Timed 25-Foot Walk, adjusted R²=1.6%, p = 0.01; Two-Minute Walk Test, adjusted R²=7.2%, p = 0.002), while controlling for age, disease duration, height, weight, and sex. The addition of EO-Mediolateral-Displacement to the MS Functional Composite (MSFC) created a four-component z-score that increased the variance explained for quality of life (QOL) by 62.1%. Postural stability was significantly lower with mediolateral vs anteroposterior direction of sway, removal of vision, increased body weight, male sex, and fampridine use. Postural stability improved during dual-tasks compared to EO single task. Posturography detected significant worsening of balance over a single prolonged stance.

CONCLUSION

Postural stability independently predicted a wide range of clinical metrics including upper extremity function, walking ability, cognition and QOL, therefore establishing construct and concurrent validity as a disability outcome measure for people with progressive MS. Additionally, posturography is a quantitative, non-invasive, quick-and-easy-to-administer, and highly sensitive device, demonstrating its high feasibility for use as a time- and resource-efficient disability metric in neuroprotective therapy trials for progressive MS.

Caregivers of People With Disabilities: A Program to Enhance Wellness Self-Care

Caregivers are a source of support for family members with disabilities. However, caregivers are at risk for caregiver burden, which can erode self-care skills and lead to poor physical and mental health outcomes. Caregiver Wellness Self-Care, developed to address that risk, is a 5-week group program in which participants learn about strategies that cultivate their inner resources, while connecting with others for support. Wellness, self-care, mindfulness, and yoga-based information and practices are taught in the sessions and included in participant handouts. Self-reflection and planning activities with facilitated discussions further support awareness and personal transformation. Designed by and for people providing care to an adult family member with a mental health disorder and a developmental/intellectual disability, the program was piloted three times. The current article describes the development of the program through caregiver involvement, participant and facilitator feedback, and implications for future efforts to build caregiver wellness self-care skills. Implications for nurses are highlighted. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 25-32.].

Realizing Yoga's all-access pass: a social justice critique of westernized yoga and inclusive embodiment

In the 21^st century, the ancient mind-body practice of yoga has surged in popularity among western enthusiasts for its numerous health benefits. Particularly, a growing evidence base supports yoga for cultivating positive embodiment and reducing risk for disordered eating. Nevertheless, amidst its rise are concerns about yoga's departure from its spiritual foundations and increasing assimilation into the appearance- and commercial-driven exercise and fitness culture. Consequently, an exclusionary identity has been perpetuated in shaping norms surrounding who can and does practice yoga, which contradicts earlier egalitarian visions of a yoga for all. Therefore, we adopt a social justice lens in offering a focused analysis of the intersection of yoga, embodiment, and inclusion for select marginalized social identities typically underrepresented among yoga practitioners and in yoga scholarship. Data are synthesized from both qualitative and quantitative sources and integrate an understanding of how confined media representations of "the yoga body" and other practical constraints may undermine the perceived access to the practice for members of diverse groups. We conclude with inviting future considerations towards fostering more interdisciplinary community-based research partnerships among the variety of stakeholders invested in advancing the accessibility and inclusion of yoga and positive embodiment for all bodies.

Medical Therapeutic Yoga for multiple sclerosis: examining self-efficacy for physical activity, motivation for physical activity, and quality of life outcomes

Purpose: Multiple Sclerosis (MS) is an incurable neurodegenerative disease that results in deficits in physical and cognitive function, and often fosters low levels of self-efficacy for physical activity, motivation for physical activity, and quality of life [1]. Drug therapies, physical therapy rehabilitation, and lifestyle modifications such as increased physical activity are standard protocol for symptom management, yet persons with MS tend to be physically inactive [2,3]. Additionally, single-modality interventions do not inherently address the challenges faced concurrently by individuals with MS [4,5].Methods: This project examined the effects of a 5-week holistic biopsychosocial Medical Therapeutic Yoga program on physical activity behavior outcomes in individuals diagnosed with MS. A mixed-methods approach was used to examine self-efficacy for physical activity, motivation for physical activity, and quality of life outcomes in 15 participants.Results: Quantitative measures demonstrated increased self-efficacy (t(14) = -2.23, p = 0.042), and emotional quality of life (t(14) = -2.66, p = 0.019). Responses to an open-ended written questionnaire and follow-up interviews indicated overall positive response to the program including increases in self-efficacy for physical activity, motivation for physical activity, and quality of life. These results may help future holistic programming for individuals with MS incorporate behavioral interventions with therapeutic rehabilitation to increase physical activity adherence.IMPLICATIONS FOR REHABILITATIONMultiple sclerosis is a neurological disease impacting physical and cognitive functioning that may be managed with a combination of drug therapies, rehabilitation, and physical activity.Individuals diagnosed with multiple sclerosis tend to be physically inactive and physical inactivity is a challenge for optimal disease management.Medical Therapeutic Yoga offers an interdisciplinary biopsychosocial framework to simultaneously address the behavioral challenges and physical impairments facing individuals diagnosed with multiple sclerosis.Health care providers should consider developing programs that use a biopsychosocial framework to aid in developing long-term adherence in health behaviors such as physical activity participation.

Center-Based Group and Home-Based Individual Exercise Programs Have Similar Impacts on Gait and Balance in People With Multiple Sclerosis: A Randomized Trial

BACKGROUND

Group and home-based exercises to improve function in people with multiple sclerosis (MS) are common but have little underpinning evidence.

OBJECTIVE

To determine the comparative effectiveness of a center-based group versus home-based individual 8-week exercise program to improve gait and balance in people with MS.

DESIGN

Prospective, randomized controlled trial.

SETTING

Community center-based and home-based exercise program.

PARTICIPANTS

Fifty people with MS were randomized and completed allocated intervention (n = 26 center, n = 24 home), 47 completed post-assessment and 44 follow-up assessment.

METHODS

The center- and home-based groups completed an 8-week progressive functional and balance training exercise program. The center-based groups of four to six were supervised by a physiotherapist. The home-based group was provided with telephone support.

MAIN OUTCOME MEASUREMENTS

The primary outcome was gait speed (10-meter walk test). Secondary outcomes were gait endurance (6-minute walk test) and balance (Berg Balance Scale). Outcome assessments were conducted at baseline, immediately postintervention and at 8-week follow-up.

RESULTS

There was no statistically significant difference between groups in gait speed post training, with a mean difference of 0.01 m/s, 95% CI -0.36 to 0.37. There were no group effects, time effects, or interactions for gait speed, endurance, or balance. In both groups, gait speed improved to a level that met minimal clinically important differences.

CONCLUSIONS

Gait speed, endurance, and balance did not statistically improve in either group; however, gait speed changes met minimally important differences.

Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes among People Living with HIV: A Randomized Controlled Pilot Trial

The purpose of this pilot randomized controlled trial is to assess the feasibility and impact of a triweekly 12-week yoga intervention among people living with HIV (PLWH). Additional objectives included evaluating cognition, physical function, medication adherence, health-related quality of life (HRQoL), and mental health among yoga participants versus controls using blinded assessors. We recruited 22 medically stable PLWH aged ≥35 years. A priori feasibility criteria were ≥70% yoga session attendance and ≥70% of participants satisfied with the intervention using a postparticipation questionnaire. Two participants withdrew from the yoga group. Mean yoga class attendance was 82%, with 100% satisfaction. Intention-to-treat analyses (yoga n = 11, control n = 11) showed no within- or between-group differences in cognitive and physical function. The yoga group improved over time in HRQoL cognition (P = .047) with trends toward improvements in HRQoL health transition (P =.063) and depression (P = .055). This pilot study provides preliminary evidence of feasibility and benefits of yoga for PLWH.

Yoga as an intervention to manage multiple sclerosis symptoms

Multiple sclerosis (MS) is an autoimmune, demyelinating, inflammatory disease of central nervous system (CNS) which is characterized by spasticity, fatigue, depression, anxiety, bowel and bladder dysfunction, impaired mobility, cognitive impairment etc. and affects approximately 2.5 million people worldwide. Disease modifying therapies for MS which help in preventing accumulation of lesions in white matter of CNS are costly and have significant adverse effects. Therefore, patients with MS are using complementary and alternative medicine (CAM) and Yoga is one of the most popular form of CAM which is being used immensely to reduce or overcome the symptoms of MS. In the current review attempted to present the potential impact of yoga practices on reducing MS related symptoms.

Yoga's Biophysiological Effects on Lower Urinary Tract Symptoms: A Scoping Review

BACKGROUND AND OBJECTIVES

Yoga is a mind and body practice that includes relaxation, meditation, breathing exercises, and body postures. It can be effective in enhancing the functioning of several body systems, including the lower urinary tract. Normal lower urinary tract functioning depends in part on the coordination of the bladder, urethra, pelvic floor and other muscles, and the nerves that control them. Lower urinary tract dysfunction can lead to symptoms, that is, stress urinary incontinence (UI), urinary frequency, nocturia, urinary urgency with and without incontinence, and mixed UI. Recent evidence suggests that yoga can improve lower urinary tract symptoms (LUTS). Thus, we performed a scoping review of the literature with regard to the evidence for the effects of yoga on LUTS and factors that may mediate yoga's effects on LUTS with the goal to identify gaps in knowledge regarding the relationship between yoga practice and LUTS.

METHODS

The authors employed the PRISMA extension for Scoping Reviews (PRISMA-ScR) methodological approach, proposed by Tricco et al., by searching the electronic databases, PubMed, Embase, and PsycINFO, for articles using the following keywords: yoga, urinary incontinence, urinary tract, bladder, and urethra. We assessed the quality of the studies using the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

Of the 172 articles we found, 8 articles met the inclusion criteria and were reviewed. We found that, despite the use of different protocols, yoga may reduce certain LUTS by increasing the strength of pelvic floor muscle and/or regulating the autonomic nervous system and activating the central nervous system.

CONCLUSIONS

Yoga is a noninvasive practice that may improve some LUTS. Rigorous studies are needed to determine the specific mechanisms through which yoga may affect LUTS.

Yoga is for Every (Able) Body: A Content Analysis of Disability Themes within Mainstream Yoga Media

Yoga is increasingly being recommended as a health self-management strategy for people with a range of disabilities. Mainstream yoga media have been criticized for limited representation of racial/ethnic, gender, age, and body size diversity within their publications; however, it is not known how these media outlets include visual representations of or textual information relevant for people with disabilities (PWDs). The purpose of this research was to understand if and how mainstream yoga media visually represent and include information for PWDs. We conducted a content analysis of the “Yogapedia” section of each Yoga Journal magazine published in 2015 and 2016 (n = 17). Two independent coders rated all of the images and text in these sections. Data were analyzed using a thematic approach informed by a prominent theoretical model of disablement. Results suggest that images contained no representation of disability. In contrast, magazine text included an abundance of references to disability; however, these mentions predominately aligned with constructs found early in the disablement process and strongly focused on physical and mobility limitations. These findings expand upon previous research examining the underrepresentation of marginalized groups within yoga media and illuminate a paucity of relevant information for individuals with disabilities who are interested in and may benefit from yoga practice.

Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations

BACKGROUND

Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier.

METHODS

Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test.

RESULTS

Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not.

CONCLUSIONS

Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.

Understanding leisure-time physical activity: Voices of people with MS who have moderate-to-severe disability and their family caregivers

Background

Physical activity (PA) is beneficial for all people, yet people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with the disease who have moderate‐to‐severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care‐recipient dyads with moderate‐to‐severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial.

Objective

We explored shared experiences of caregiver/care‐recipient dyads affected by moderate‐to‐severe MS about PA and directions for intervention.

Methods

Six focus groups with 23 people with moderate‐to‐severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach.

Results

Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines.

Conclusion

This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care‐recipient dyad with moderate‐to‐severe MS as a focus for PA intervention.