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Dhali B, Chatterjee S, Sundar Das S, Cruz MD. Effect of Yoga and Walking on Glycemic Control for the Management of Type 2 Diabetes: A Systematic Review and Meta-analysis. J ASEAN Fed Endocr Soc 2023; 38:113-122. [PMID: 38045671 PMCID: PMC10692414 DOI: 10.15605/jafes.038.02.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/18/2023] [Indexed: 12/05/2023] Open
Abstract
Background A daily habit of yogic practice or walking, along with an oral hypoglycemic agent (OHA) could be beneficial for better control of type 2 diabetes mellitus (T2DM). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to find out the efficiency of yoga or walking on glycemic control in T2DM. Methodology The present systematic review and meta-analysis were completed according to the PRISMA guidelines. The risk of bias in included studies was evaluated, by using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was implemented using RevMan software. Forest plots were used to illustrate the study findings and meta-analysis results. Results Sixteen studies were included in this systematic review, where 1820 participants were allocated to one of the following interventions: yoga, walking, and without any regular exercise (control group). Participants were between 17-75 years of age. Compared to the control group, the yoga group had a significant reduction in fasting blood glucose (FBG) by 31.98 mg/dL (95% CI = -47.93 to -16.03), postprandial blood glucose (PPBG) by 25.59 mg/dL (95% CI = -44.00 to -7.18], glycosylated hemoglobin (HbAlc) by 0.73% (95% CI = -1.24 to -0.22), fasting insulin by 7.19 μIU/mL (95% CI = -12.10 to -2.28), and homeostatic model assessment for insulin resistance (HOMA-IR) by 3.87 (95% CI = -8.40 to -0.66). Compared to the control group, the walking group had a significant reduction in FBG by 12.37 mg/dL (95% CI = -20.06 to -4.68) and HbA1c by 0.35% (95% CI = -0.70 to -0.01). Compared to the walking group, the yoga group had a significant reduction in FBG by 12.07 mg/dL (95% CI = -24.34 to - 0.20), HbA1c by 0.20% (95% CI = -0.37 to -0.04), fasting insulin by 10.06 μIU/mL (95% CI = -23.84 to 3.71) and HOMA-IR by 5.97 (95% CI = -16.92 to 4.99). Conclusions Yoga or walking with OHA has positive effects on glycemic control. For the management of T2DM, yoga has relatively more significant effects on glycemic control than walking.Review registration number: PROSPERO registration number CRD42022310213.
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Affiliation(s)
- Biswajit Dhali
- Department of Physical Education, Jadavpur University, Kolkata, India
| | - Sridip Chatterjee
- Department of Physical Education, Jadavpur University, Kolkata, India
| | - Sudip Sundar Das
- Department of Physical Education, Jadavpur University, Kolkata, India
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Kaur N, Majumdar V, Nagarathna R, Malik N, Anand A, Nagendra HR. Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes: a randomized controlled trial from Northern India. Diabetol Metab Syndr 2021; 13:149. [PMID: 34949227 PMCID: PMC8696241 DOI: 10.1186/s13098-021-00761-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/17/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To study the effectiveness of diabetic yoga protocol (DYP) against management of cardiovascular risk profile in a high-risk community for diabetes, from Chandigarh, India. METHODS The study was a randomized controlled trial, conducted as a sub study of the Pan India trial Niyantrita Madhumeha Bharath (NMB). The cohort was identified through the Indian Diabetes Risk Scoring (IDRS) (≥ 60) and a total of 184 individuals were randomized into intervention (n = 91) and control groups (n = 93). The DYP group underwent the specific DYP training whereas the control group followed their daily regimen. The study outcomes included changes in glycemic and lipid profile. Analysis was done under intent-to-treat principle. RESULTS The 3 months DYP practice showed diverse results showing glycemic and lipid profile of the high risk individuals. Three months of DYP intervention was found to significantly reduce the levels of post-prandial glucose levels (p = 0.035) and LDL-c levels (p = 0.014) and waist circumference (P = 0.001). CONCLUSION The findings indicate that the DYP intervention could improve the metabolic status of the high-diabetes-risk individuals with respect to their glucose tolerance and lipid levels, partially explained by the reduction in abdominal obesity. The study highlights the potential role of yoga intervention in real time improvement of cardiovascular profile in a high diabetes risk cohort. TRIAL REGISTRATION CTRI, CTRI/2018/03/012804. Registered 01 March 2018-Retrospectively registered, http://www.ctri.nic.in/ CTRI/2018/03/012804.
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Affiliation(s)
- Navneet Kaur
- Department of Physical Education, Panjab University, Chandigarh, 160014, India
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vijaya Majumdar
- Division of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsathana, Bengaluru, Karnataka, 560106, India
| | - Raghuram Nagarathna
- Division of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsathana, Bengaluru, Karnataka, 560106, India.
| | - Neeru Malik
- Dev Samaj College of Education, Sector 36B, Chandigarh, 160036, India
| | - Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Dutta D, Bhattacharya S, Sharma M, Khandelwal D, Surana V, Kalra S. Effect of yoga on glycemia and lipid parameters in type-2 diabetes: a meta-analysis. J Diabetes Metab Disord 2021; 20:349-367. [PMID: 34178843 PMCID: PMC8212260 DOI: 10.1007/s40200-021-00751-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Prior systematic reviews on yoga and diabetes have given conflicting results. They have been limited by inclusion of uncontrolled unblinded single group observational studies. No reviews are available which have used the Cochrane methodology and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. This meta-analysis evaluated the efficacy of yoga on glycaemia and lipids in T2DM using the Cochrane methodology and GRADE approach. METHODS Major repositories were searched to pick randomized controlled trials involving T2DM patients receiving yoga. Primary outcome was to evaluate changes in fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c). Secondary outcomes were to evaluate changes in post-prandial plasma glucose (PPG), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Sub-group analysis involving people undergoing structured exercise regimen (SER) versus those undergoing standard diabetes care in controls was done. RESULTS Data from 13 studies involving 1440 patients were analysed. Compared to controls, individuals doing yoga had significantly lower FPG [mean difference (MD) -17.22 mg/dl (95% CI: -26.19 - -8.26 mg/dl); p < 0.01; considerable heterogeneity (CH); low certainty of evidence (LCE)], PPG [MD -27.77 mg/dl (95% CI: -35.73 - -19.81 mg/dl); p < 0.01; low heterogeneity; moderate certainty of evidence (MCE)], TC [MD -19.48 mg/dl (95% CI: -31.97 - -6.99 mg/dl); p < 0.01; CH; LCE], triglycerides [MD -12.99 mg/dl (95% CI: -23.74 - -2.25 mg/dl); p < 0.01; CH; LCE], LDL-C [MD -11.71 mg/dl (95% CI: -17.49 - -5.93 mg/dl); p < 0.01; I2 = 69% CH; LCE] and significantly higher HDL-C [MD 4.58 mg/dl (95% CI: 3.98-5.18 mg/dl); p < 0.01; low heterogeneity; MCE]. On sub-group analysis, where yoga was compared to SER, FPG was significantly lower in yoga group. CONCLUSION Yoga improves glycaemia and lipid parameters in T2DM with additional benefits seen both in people doing/not doing structured exercise. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-021-00751-0.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis & Rheumatism (CEDAR) Super-speciality Clinics, Dwarka, New Delhi, 110075 India
| | | | - Meha Sharma
- Department of Rheumatology, CEDAR Superspeciality Clinics, Dwarka, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaj Agrasen Hospital, New Delhi, India
| | - Vineet Surana
- Department of Endocrinology, Manipal Hospitals, Dwarka, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospitals, Karnal, India
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Chattopadhyay K, Mishra P, Manjunath NK, Harris T, Hamer M, Greenfield SM, Wang H, Singh K, Lewis SA, Tandon N, Kinra S, Prabhakaran D. Development of a Yoga Program for Type-2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India. Front Public Health 2020; 8:548674. [PMID: 33313032 PMCID: PMC7706999 DOI: 10.3389/fpubh.2020.548674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Many Indians are at high-risk of type-2 diabetes mellitus (T2DM). Yoga is an ancient Indian mind-body discipline, that has been associated with improved glucose levels and can help to prevent T2DM. The study aimed to systematically develop a Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India using a complex intervention development approach. Materials and Methods: As part of the intervention, we developed a booklet and a high-definition video for participants and a manual for YOGA-DP instructors. A systematic iterative process was followed to develop the intervention and included five steps: (i) a systematic review of the literature to generate a list of Yogic practices that improves blood glucose levels among adults at high-risk of or with T2DM, (ii) validation of identified Yogic practices by Yoga experts, (iii) development of the intervention, (iv) consultation with Yoga, exercise, physical activity, diet, behavior change, and/or diabetes experts about the intervention, and (v) pretest the intervention among Yoga practitioners and lay people (those at risk of T2DM and had not practiced Yoga before) in India. Results: YOGA-DP is a structured lifestyle education and exercise program, provided over a period of 24 weeks. The exercise part is based on Yoga and includes Shithilikarana Vyayama (loosening exercises), Surya Namaskar (sun salutation exercises), Asana (Yogic poses), Pranayama (breathing practices), and Dhyana (meditation) and relaxation practices. Once participants complete the program, they are strongly encouraged to maintain a healthy lifestyle in the long-term. Conclusions: We systematically developed a novel Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India. A multi-center feasibility randomized controlled trial is in progress in India.
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Affiliation(s)
- Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, Nottingham, United Kingdom
| | | | | | - Tess Harris
- Population Health Research Institute, St. George's University of London, London, United Kingdom
| | - Mark Hamer
- Division of Surgery and Interventional Science, Institute Sport Exercise and Health, University College London, London, United Kingdom
| | | | - Haiquan Wang
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, Nottingham, United Kingdom
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Sarah Anne Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Nikhil Tandon
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Xia T, Yang Y, Li W, Tang Z, Huang Q, Li Z, Guo Y. Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5745013. [PMID: 32089725 PMCID: PMC7016481 DOI: 10.1155/2020/5745013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/28/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Physical activity plays a specific role in the fundamental aspect of diabetes care. It is necessary to develop exercise programs for these patients. The aim of this systematic review is to summarize current evidence regarding the effectiveness of meditative movement in patients with type 2 diabetes. METHODS The following databases were searched: PubMed, CENTRAL, Web of Science, Ovid LWW, and EMBASE. Two independent investigators searched and screened the studies by finding duplications, excluding irrelevant titles and abstracts, and then selecting eligible studies by reviewing full texts. 21 studies fulfilled the inclusion criteria. Meta-analyses were performed on glycated hemoglobin (HbA1c), fasting blood glucose (FBG) and postprandial blood glucose (PPBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI). RESULTS Meta-analyses showed that meditative movements significantly improved FBG, HbA1c, PPBG, TC, LDL-C, and HDL-C. No improvement was found in BMI. CONCLUSIONS The results demonstrated a favorable effect or tendency of meditative movements to improve blood glucose and blood lipid levels in patients with type 2 diabetes mellitus. The special effects of meditative movements in type 2 diabetes mellitus patients need further research.
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Affiliation(s)
- Tingwei Xia
- Chengdu University of TCM, Chengdu, Sichuan Province, China
| | - Yue Yang
- Department of TCM, Qingyang District People's Hospital, Chengdu, Sichuan Province, China
| | - Weihong Li
- Chengdu University of TCM, Chengdu, Sichuan Province, China
| | - Zhaohui- Tang
- Chengdu University of TCM, Chengdu, Sichuan Province, China
| | - Qingsong Huang
- Chengdu University of TCM, Chengdu, Sichuan Province, China
| | - Zongrun Li
- Chengdu University of TCM, Chengdu, Sichuan Province, China
| | - Yongsong Guo
- Chengdu University of TCM, Chengdu, Sichuan Province, China
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Ramamoorthi R, Gahreman D, Skinner T, Moss S. The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: A systematic review and meta-analysis. PLoS One 2019; 14:e0221067. [PMID: 31618207 PMCID: PMC6795440 DOI: 10.1371/journal.pone.0221067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
A systematic review and meta-analysis was conducted to investigate the effects of yoga on glycemic control, lipid profiles, body composition and blood pressure in people in the pre-diabetic state. Studies on the effectiveness of yoga on population groups under high risk for diabetes, called prediabetic or suffering from metabolic syndromes were extracted from a thorough search of PubMed, Scopus, Cochrane Library, EBSCO and IndMED databases. Both Randomised Controlled Trial (RCT) and non-RCT studies were included in the systematic review and meta-analysis. Studies published between Jan 2002 and Dec 2018 were included. Studies were considered for evaluation if they investigated a yoga intervention to prevent T2DM, against a control group, while also reporting glycemic control and other health parameters of T2DM management. Summary effect sizes and 95% confidence intervals (CI) were calculated using the Comprehensive Meta-Analysis software in addition to publication bias. Of the 46,500 identified studies, 14 studies with 834 participants of whom were 50% women, were found to be eligible for inclusion in our systematic review. Our quantitative synthesis included 12 randomized control trials and 2 non-randomized control trials, with the follow-up period ranging from 4 to 52 weeks. Compared to controls, yoga intervention improved fasting blood glucose (FBG) [Standard Mean Difference (SMD -0.064 mg/dL (95% CI -0.201 to 0.074)]; low density lipoprotein (LDL) [SMD-0.090 mg/dL (95% CI -0.270 to 0.090)]; triglycerides [SMD -0.148 mg/dL (95% CI -0.285 to -0.012)]; total cholesterol [SMD -0.058 mg/dL (95% CI -0.220 to 0.104)] and systolic blood pressure [SMD -0.058 mm Hg (95% CI -0.168 to 0.053)]. This meta-analysis uncovered clinically improved effects of yoga intervention on glycemic control, lipid profiles and other parameters of T2DM management in prediabetic population. These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM. Further adequately powered, well designed RCTs are needed to support our findings and investigate the long-term effects of yoga in T2DM patients.
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Affiliation(s)
- Ramya Ramamoorthi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Timothy Skinner
- Københavns Universitet, Institut for Psykologi, Center for Sundhed og Samfund, Københavns Universitet, København K, Denmark
| | - Simon Moss
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
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