Effectiveness of Yoga in Modulating Markers of Immunity and Inflammation: A Systematic Review and Meta-Analysis

Chronic inflammation is central to the pathogenesis of many chronic inflammatory conditions. This review aims to analyze whether the practice of yoga, or yogic meditation and breathing, has any effect on the levels of inflammatory cytokines and other inflammatory markers in patients with various chronic inflammatory diseases such as rheumatoid arthritis, neoplastic disorders, and asthma, as well as in healthy subjects, compared to usual care or sham interventions. A comprehensive search of databases (PubMed, CENTRAL, Embase, and CINAHL) was performed. Randomized controlled trials (RCTs) that evaluated the effects of yoga as an intervention on inflammatory markers were analyzed. A total of 26 studies were included. Only two studies had a low risk of bias (RoB); 24 other studies had a high RoB. Most studies (n=24) reported a favorable outcome with yoga, irrespective of the type of yoga used, the condition studied, and the duration of the intervention. The commonly reported inflammatory markers included IL-6 (n=17), tumor necrosis factor-alpha (TNF-a) (n=13), and C-reactive protein (CRP) (n=10). Most studies showed a significant reduction in inflammatory markers in the yoga group (YG) compared to the control group (CG). Few studies also showed significant improvement in markers of cellular immunity (interferon gamma (IFN-g), IL-10, and transforming growth factor-beta (TGF-b); n=2 each) and improved mucosal defense (IgA, IL-6, and IL-2; n=2 each). A meta-analysis of IL-6, TNF-a, and CRP showed yoga had a favorable effect on the levels of these markers, but it was not statistically significant. Current evidence suggests that yoga can be a complementary intervention for various chronic inflammatory conditions. However, the quality of the evidence is poor, along with considerable heterogeneity. In the future, investigators should describe the intervention better, with a uniform assortment of outcome measures and treatment conditions, to generate high-quality evidence.

Effectiveness of Telemedicine Interventions in Chronic Obstructive Pulmonary Disease (COPD) Management: A Randomized Controlled Trial Comparing Yoga Therapy and Pulmonary Rehabilitation Over Three Months

Background Pulmonary rehabilitation (PR) is an integral part of non-pharmacological therapy in chronic obstructive pulmonary disease (COPD). Yoga therapy (YT) has been shown to be beneficial in COPD, but the lack of large well-designed trials and standardized modules restricts its acceptability. This randomized control trial compares these two modalities in COPD patients via supervised tele-intervention. Objectives The primary objective of the study is to compare a 45-minute, five-days-per-week series of tele-YT (T-YT) with tele-PR (T-PR) for three months in terms of exercise capacity (6-Minute Walk Distance (6MWD)) in COPD patients. Methods COPD patients were randomly assigned (1:1) to T-YT or T-PR groups in a parallel-arm single-blinded controlled trial. The primary outcome is 6MWD recorded at baseline and after three months and secondary outcomes were symptom scores, Forced expiratory volume in the first second (FEV1), health-related quality of life (HrQoL), and depression and anxiety scores. Assessments were conducted at baseline and at the end of the three-month study period with a sample size of 75 in each group. Results A total of 150 consecutive patients with COPD were randomly assigned to either the T-YT (n = 75) or T-PR (n = 75) group. Their mean ± SD ages was 62.5 ± 7.0 years. The T-YT group had 55.5% males and 34.47% females, whereas the T-PR group had 44.5% males and 61.53% females. The trial was completed by 123 patients; 88% in the T-YT group and 76% in the T-PR group. Pre-intervention, the median (range) of 6MWD in T-YT and T-PR groups was 240 (120-600) m and 240 (120-660) m, respectively. There was statistically significant improvement in both groups respectively (p<0.001) post intervention from baseline but no significant intergroup difference (p = 0.486). A similar trend was seen in secondary outcomes with significant intragroup improvements and non-significant inter-group differences except FEV1%, which showed neither intragroup nor intergroup significant improvement. Conclusion Using a validated module, a three-month T-YT improves exercise capacity, symptom scores, HrQoL, and depression and anxiety scores similar to T-PR. T-YT is an acceptable alternative to T-PR in the management of COPD.

Cerebral Haemodynamic Changes in Type 2 Diabetes Mellitus Following a Three-Month Yoga Intervention: A Randomized Controlled Trial

Background and purpose Cerebral haemodynamics and cognitive performance may be adversely affected in type 2 diabetes mellitus (T2DM). Previous studies reported reduced cerebral blood flow (CBF) and altered cerebrovascular reactivity (CVR) in T2DM. Yoga, an ancient holistic health approach, is known to be beneficial for T2DM. We hypothesized that yoga practice may alter CBF and the flow resistance in the middle cerebral artery (MCA) and improve cognition in T2DM. Our secondary objective was to explore the relationship between changes in cerebral haemodynamics and cognition in T2DM. Materials and methods Participants were randomly allotted into the yoga and control groups based on the eligibility criteria. One hour of yoga intervention specific to type 2 diabetes was provided to the yoga group for three months, while conventional treatment was provided to the control group. A transcranial Doppler was used to evaluate longitudinal changes in cerebral haemodynamics in MCA. A Corsi block tapping test was used to assess visio-spatial working memory. Results There were 75 participants recruited, of whom 38 participated in yoga and 37 participated in a control group. Both intention to treat and per protocol analysis showed significant results. At day 90, intention-to-treat analysis showed significant changes in CBF velocities (mean difference -10.85%, 95% CI (-13.26, -6.15), p<0.001), cerebral vasodilatory reserve (mean difference -0.23%, 95% CI (-0.43, -0.03), p=0.02) and cognition (mean difference -12.13%, 95% CI (-17.48, -6.78), p≤0.001). There was no between-group effect. Also, the correlation between the CBF and cognition did not show any significant results. Conclusion The three-month yoga intervention was associated with an improvement in cerebral hemodynamics. The study also revealed an improvement in visio-spatial working memory among patients with T2DM. The study did not show any correlation between the improvement in cerebral haemodynamics and working memory. We recommend larger and longer studies on yoga intervention for T2DM patients to evaluate whether such benefits are sustained and improve their quality of life.

Patients' Choices for Yoga Therapy: An Exploratory Cross-Sectional, Convenience-Sampling Survey from India

In conventional healthcare, patients' preferences for their treatment are determined, though this practice has not been reported for yoga therapy. The present convenience sampling exploratory survey attempted to determine whether those seeking yoga therapy would report preferences for the way yoga therapy is implemented, the therapist's knowledge, and related aspects of yoga therapy. Responses from 426 people attending a yoga therapy institution in India were analyzed. Based on the chi-square test (p < 0.05) and Cramer's V (> 0.10), most people wished to receive yoga therapy in a group of others with a similar disease (42.25%), in a yoga institution (83.57%), and as in-person sessions (48.83%). Patients preferred yoga therapists to know about the principles of yoga (40.38%), to be well-informed generally (61.97%), and to be able to give suggestions for emotional well-being. For the majority of participants (59.4%), the reason for selecting yoga therapy was "a belief in yoga as therapy" (rather than as an add-on therapy or as a last resort). Patients' expectations of yoga therapy were positive, namely a cure of disease (79.34%) and improvement after 1 year (95.8%). Most patients (91.6%) wanted their conventional medicine practitioner to know that they were receiving yoga therapy. Although limited by the study design, survey design, and participant details available, overall results suggest that patients (1) reported specific preferences (for the implementation of yoga therapy and for yoga therapists' knowledge), (2) had expectations of yoga therapy, and (3) most often were interested in their conventional care physicians being informed about the yoga therapy they received.

Development and Validation of Wheelchair-Based Yoga Module for Individuals with Paraplegia

Spinal cord injury causes temporary or permanent loss of motor, sensory, or autonomic functions, leading to long-term impairments that are not only confined to physical attributes but also restrict individuals' participation in major domains of life. Around 60%-80% of individuals with spinal cord injuries depend on a wheelchair for mobility. Numerous studies have reported yoga's beneficial role in alleviating spinal cord injury symptoms; however, a validated wheelchair-based yoga module was unavailable. Thus, the present study aimed to develop and validate a wheelchair-based yoga module that comprises a printed protocol for individuals with paraplegia. The study was conducted in four phases: The first three phases were the steps for the formulation of a wheelchair-based yoga module, and in the last phase the content validity of the designed module was determined by a panel of 10 experts, who were asked to rate the preliminary module for its necessity and relevance using a Likert scale. A total of 17 yoga practices with high content validity were included in the final wheelchair-based yoga module, and 10 practices with lower content validity were excluded from the designed module. Data analysis revealed the mean content validation index of the designed module to be 0.81. This study concludes that the formulated wheelchair-based yoga module is valid for individuals with paraplegia. However, future studies need to be conducted to determine the protocol's feasibility and effectiveness.

Development and Implementation of a Flexible Yoga Therapy Protocol in the Group Acupuncture Therapy and Modified Yoga (GAPYOGA) Pilot Study

Chronic pain is the most common reason U.S. adults seek medical care. Acupuncture and yoga show effectiveness, and a recent study assessed the feasibility of these two modalities for chronic pain at federally qualified health centers. Yoga research is rarely individualized, which is important for chronic pain treatments. Six experienced yoga professionals drew on research and clinical experience to co-create a yoga therapy protocol standardized for replication with flexibility for individual care. Yoga therapy was to be combined with a previously developed flexible acupuncture intervention in a feasibility trial. Categories of practices were identified as relevant and appropriate for chronic pain management in a federally qualified health center. Within each category, specific practices were listed for each provider to select as appropriate. These were based on usefulness for chronic pain, safety, ease of teaching/learning, and cultural appropriateness. The final manual included: (1) stabilizing poses, (2) mobilizing poses, (3) breathing practices, (4) relaxation, (5) mental practices, and (6) applied philosophy. Each participant began with an intake to inform practice selection. Ten subsequent sessions were 30 minutes each, with 1-2 participants receiving simultaneous care. First sessions included diaphragmatic breathing and some physical postures. All practices were adapted. Over 10 sessions, at least one practice from each category was included. Participants were given instructions/images for home practice. Individual charting ensured continuity of care and consistency across sessions. In evidence-informed practice, there exists a tension between replicability and individualization. A flexible protocol allows both. Future application in research and clinical settings will help to determine feasibility and effectiveness.

A Systematic Review of Quantitative and Qualitative Results of Randomized Controlled Trials Assessing the Effect of Yoga in Adult Women With Post-traumatic Stress Disorder: What Is Known So Far

Yoga has been increasingly practiced in recent years, with many of its practitioners being female. Adults may seek a complementary and alternative medicine (CAM) modality, such as yoga, to attempt to alleviate symptoms related to mental health conditions such as post-traumatic stress disorder (PTSD). Our goal for this systematic review was to collect and analyze all available data from quantitative and qualitative reports of randomized controlled trials (RCTs) conducted over the past 10 years on the impact of yoga on women diagnosed with PTSD. We included RCTs with the adult female population in which yoga was practiced for more than one week. We searched the databases PubMed, PubMed Central (PMC), and MEDLINE on June 11, 2022, Embase on June 12, 2022, and Science Direct on June 13, 2022, to find relevant articles. With the Cochrane RoB2 tool and Critical Appraisal Skills Programme (CASP) criteria, we checked for their quality, after which we selected 13 high-quality reports comprising seven original study designs and a total of 496 women. Of the 13 reports, nine evaluated effectiveness, four assessed feasibility, three explored acceptability, and four identified qualitative themes. We compared the results based on the assessed themes. Our results found yoga effective, feasible, acceptable, and a viable interoceptive pathway for emotional and personal growth. Limitations in our study include insufficient papers with large sample sizes and not including papers other than RCTs. With our research, we hope to present healthcare providers with research-based data on the effects of yoga so that they may better navigate its role in therapy as the trend of seeing more patients taking an interest in such alternative approaches rises.

Effect of Yoga on Quality of Life in Patients with Pulmonary Tuberculosis: A Randomized Control Trial

Introduction

Yoga is emerging as one of the holistic approaches to respiratory diseases. The scope of yoga is expanding in communicable diseases with physical, mental, and societal benefits.

Aim and Objective

The present study aims to evaluate the effect of integrated yoga as an adjuvant therapy to the National Tuberculosis Elimination Programme (NTEP) on assessing health-related Quality of Life (QoL) in patients with pulmonary tuberculosis (PTB).

Setting and Design

A randomized controlled trail study was conducted in a tertiary care teaching hospital.

Methodology

The study screened 826 PTB patients; 72 patients were found suitable and agreed to participate. The PTB patients were randomly assigned to either a yoga group (n = 36) or a control group (n = 36) using the sequentially numbered opaque sealed envelope technique. The control group received standard-of-care treatment as per NTEP, and the yoga group practiced 45 min of integrated yoga for 8 weeks along with standard of care. The World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to collect the data at baseline and after 8 weeks of intervention.

Results

The results of within-group comparisons in both the groups showed that there was a significant improvement in physical (P < 0.01), psychological (P < 0.01), and social (P < 0.01), with P ≤ 0.05 being considered statistically significant except environmental domain. Between groups, analysis shows that in the preintervention, there was no difference between the yoga and control group as P > 0.05. After the yoga intervention, there was an enhancement in QoL scores with three domains except the environmental domain (P = 0.28).

Conclusion

The study evidence supports the use of yoga as a complementary therapy for the NTEP in patients with PTB may improve their QoL.

Long-term Add-on Yoga Therapy Modulates Oxidative Stress Pathway and Offers Clinical Benefits in Major Depressive Disorder: A Randomized Controlled Trial

Background

Yoga therapy (YT) as an adjunct treatment has reportedly been demonstrated to offer clinical benefits in major depressive disorder (MDD). Although a few biological pathways are suggested to mediate the effects of yoga, the precise mechanistic basis remains unknown. Oxidative stress pathway activation has consistently been linked to the pathobiology of MDD. Whether YT has a modulatory effect on the oxidative stress pathway in MDD is not adequately understood.

Aim and Objectives

In this study, we examined the impact of a course (3 months) of yoga as an add on therapy on the markers of the oxidative stress pathway in MDD patients.

Methods

Thirty-three MDD patients were randomized to the YT (n = 16) and waitlist control (WC) (n = 17) groups. Colorimetric estimation of the plasma malondialdehyde (MDA) and total antioxidant (AO) levels was performed in all the study participants using commercially available kits at the baseline and after 3 months.

Results

A significant reduction of plasma MDA levels was observed in MDD patients of YT group (P = 0.05) after 3 months of YT. Notably, the plasma MDA levels also decreased in MDD patients of WC group (P = 0.015) after the trial period. In addition, levels of total AO showed a trend toward significance only in MDD patients after 3 months of YT (P = 0.07). Conclusion: The current study suggests that the benefits of YT might be mediated through its modulatory role on the oxidative stress pathway in MDD.

Role of Alternate Therapies to Improve the Quality of Life in Menopausal Women: A Systematic Review

Middle aged women in majority undergoing menopausal symptoms are unaware of the physiological changes happening in their body, necessary lifestyle changes and alternate therapies to overcome the symptoms. All major electronic sources of relevant information were systematically searched and collected data were pooled under specific subheadings. From the reviewed papers, the awareness on symptoms and related complications of menopause in the middle aged women were consolidated. Studies helped to identify alternative therapies replacing or in parallel with the Hormone Replacement Therapy to overcome the menopausal symptoms. Reduced oestrogen and progesterone level causes physiological, psychological, and genitourinary symptoms. Prolonged consequences cause libido, osteoporosis, and cardio vascular diseases. Hypo-estrogenic status is well managed with alternative therapies including dietary intervention, acupuncture, aromatherapy, exercise, and yoga. Dietary interventions involving foods like Fennel, Soy, Black Cohash, St. John Wort, Red Clover and Date Pollen were found to be managing vasomotor symptoms and sexual dysfunction. Non-Hormonal and Non-Pharmacological impact behind acupuncture treatment was well accepted. Various studies proved inhaling and massaging with Lavender, Neroli oil, Fennel, Rose, and Geranium essential oils balance cortisol hormone and reduce stress and anxiety. Impact of yoga therapy on neurohormonal pathways reduce both psychological and physiological symptoms. Reviews summarizes various symptoms and complications during menopausal transition and alternate ways of better management with dietary intervention, yoga, exercise, aromatherapy, and acupuncture to improve the quality of menopausal women's life.

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study

Background

Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care.

Objective

To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings.

Methods

This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10 weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up.

Results

93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic.

Conclusions

Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.

Yoga Therapy in Cancer Care via Telehealth During the COVID-19 Pandemic

BACKGROUND

Yoga is an evidence-based mind-body practice known to improve physical and mental health in cancer patients. We report on the processes and patient-reported outcomes of one-on-one yoga therapy (YT) consultations delivered via telehealth.

METHODS

For patients completing a YT consultation between March 2020 and October 2021, we examined demographics, reasons for referral, and self-reported symptom burden before and after one YT session using the Edmonton Symptom Assessment Scale (ESAS). Changes in ESAS symptom and subscale scores [physical distress (PHS), psychological distress (PSS), and global distress (GDS)] were evaluated by Wilcoxon signed-rank test. Descriptive statistics summarized the data.

RESULTS

Ninety-seven initial YT consults were completed, with data evaluated for 95 patient encounters. The majority were women (83.2%) and white (75.8%), The mean age for females was 54.0 and for males was 53.4; the most common diagnosis was breast cancer (48%), 32.6% had metastatic disease, and nearly half (48.4%) were employed full-time. Mental health (43.0%) was the most common reason for referral, followed by fatigue (13.2%) and sleep disturbances (11.7%). The highest symptoms at baseline were sleep disturbance (4.3), followed by anxiety (3.7) and fatigue (3.5). YT lead to clinically and statistically significant reductions in PHS (mean change = -3.1, P < .001) and GDS (mean change = -5.1, P < .001) and significant reductions in PSS (mean change = -1.6, P < .001). Examination of specific symptom scores revealed clinically and statistically significant reductions in anxiety (mean change score -1.34, P < .001) and fatigue (mean change score -1.22, P < .001). Exploratory analyses of patients scoring ≥1 for specific symptoms pre-YT revealed clinically and statistically significant improvements in almost all symptoms and those scoring ≥4 pre-YT.

CONCLUSIONS

As part of an integrative oncology outpatient consultation service, a single YT intervention delivered via telehealth contributed to a significant improvement in global, physical, and psychosocial distress. Additional research is warranted to explore the long-term sustainability of the improvement in symptoms.

Mindfulness as an Antidote to Burnout for Nursing and Support Staff in an Oncological Intensive Care Unit: A Pilot Study

We set out to implement a pilot mindfulness-based intervention (MBI) to alleviate burnout, stress, anxiety, and depression in nursing and support staff of an oncological intensive care unit. We created an 8-week personalized yoga therapy MBI for nurses and patient care technicians in an oncological intensive care unit. Validated self-report scale tools were used to measure burnout, stress, anxiety, and depression in the intervention and control groups (Institutional Quality Improvement Registry no. 296, 2018). Changes in scores from baseline to postintervention were evaluated between groups. Forty-five staff, 21 in the control group and 24 in the intervention group, participated. Both groups at baseline had low prevalence of stress, anxiety, and depression (13% vs 36.8%, P = .11; 21.7% vs 52.6%, P = .17; 17.4% vs 26.3%, P = .48; respectively). Low rates of high emotional exhaustion, depersonalization, and low professional efficacy were observed for both groups (41.7% vs 35.0%, P = .65; 20.8% vs 15%, P = .71; 58.3% vs 50.0%, P = .58, respectively). Post-MBI, prevalence of depression, anxiety, stress, emotional exhaustion, and depersonalization remained low and similar between both groups. Notwithstanding, professional efficacy scores significantly improved in a between-group comparison (0.063 vs -0.25; P = .0336). We observed that burnout, stress, anxiety, and depression were remarkably low in our study relative to the literature. Implementation of the MBI faced many obstacles and had low compliance during participation. This presumably influenced results and should be addressed prior to any future intervention. Despite this, professional efficacy improved significantly.

TRIAL REGISTRATION

Approved by MD Anderson Cancer Center Quality Improvement Registry (no. 296, 2018).

"The Pain Left, I Was Off and Running": A Qualitative Analysis of Group Acupuncture and Yoga Therapy for Chronic Pain in a Low-Income and Ethnically Diverse Population

Introduction: Chronic pain and the current opioid epidemic are pressing public health concerns, especially in low-income and ethnically diverse communities. Nonpharmacologic therapies that are safe, effective, and acceptable for the treatment of chronic pain conditions may provide a solution for addressing this issue. This qualitative analysis explores the experience of study participants who received combined acupuncture and yoga therapy (YT) to treat chronic pain delivered in a primary care setting. Methods: The group acupuncture with yoga therapy for chronic neck, low back, and osteoarthritic pain trial (GAPYOGA) assessed the feasibility and effectiveness of group acupuncture (GA) combined with YT in a low-income, racial, and ethnically diverse population. Individual in-depth interviews were conducted with a subset of patients in the trial. Nineteen participants were interviewed for qualitative analysis of their experience. Using the immersion and crystallization method, transcribed interviews were analyzed for themes meaningfully representing participant experience. Results: The combined GA and YT resulted in significant pain relief and transformative healing experiences. Three themes emerged from participant narratives: (1) transformative engagement with self in the healing process through pain relief, psychological well-being, and self-efficacy; (2) therapeutic relationship with acupuncture and yoga providers; and (3) fostering relationships with fellow participants in the group. Discussion: In this study of a low-income and ethnically diverse population, the combination of acupuncture and YT was found to alleviate pain, improve function, promote psychological well-being, and engage participants in self-care practices in a transformative healing process-resulting in physical and psychological benefits.

Impact of an Integrated Yoga Therapy Protocol on Insulin Resistance and Glycemic Control in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

Diabetes mellitus (DM), characterized by chronic hyperglycemia, is attributed to relative insulin deficiency or resistance, or both. Studies have shown that yoga can modulate parameters of insulin resistance. The present study explored the possible beneficial effects of integrated yoga therapy with reference to glycemic control and insulin resistance (IR) in individuals with diabetes maintained on standard oral medical care with yoga therapy, compared to those on standard oral medical care alone.

METHODS

In this study, the subjects on yoga intervention comprised 35 type 2 diabetics, and an equal number of volunteers constituted the control group. Subjects ranged in age from 30 to 70 years, with hemoglobin A1c (HbA1c) test more than 7%, and were maintained on diabetic diet and oral hypoglycemic agents. Blood samples were drawn prior to and after 120 days of integrated yoga therapy intervention. Fasting blood glucose (FBG), post-prandial blood glucose (PPBG), HbA1c, insulin, and lipid profile were assessed in both the intervention and control groups.

RESULTS

The intervention group revealed significant improvements in body mass index (BMI) (0.7 kg/m² median decrease; P=0.001), FBG (20 mg/dL median decrease; P<0.001), PPBG (33 mg/dL median decrease; P<0.001), HbA1c (0.4% median decrease; P<0.001), homeostatic model assessment for insulin resistance (HOMA-IR) (1.2 median decrease; P<0.001), cholesterol (13 mg/dL median decrease, P=0.006), triacylglycerol (22 mg/dL median decrease; P=0.027), low-density lipoprotein (6 mg/dL median decrease; P=0.004), and very-low-density lipoprotein levels (4 mg/dL median decrease; P=0.032). Increases in high-density lipoprotein after 120 days were not significant (6 mg/dL median increase; P=0.15). However, when compared to changes observed in patients in the control group, all these improvements proved to be significant.

CONCLUSION

Administration of integrated yoga therapy to individuals with diabetes leads to a significant improvement in glycemic control, insulin resistance, and key biochemical parameters.

Coping and Adapting to Climate Change in Australia: Yoga Perspectives

Scientists caution against ignoring human-induced climate change and related health repercussions, with a growing body of literature highlighting the mental health effects of climate change and the importance of understanding coping and adaptation strategies. Less is known, however, about sustainable personal practices fortifying mental health in the context of climate change. The present study sought to investigate how long-term yoga practitioners (yoga therapists or yoga teachers) in Australia with a lived experience of climate change-related events are coping and adapting. The aim was to better understand participants' reports of climate change-related experiences and how yoga influences their mental health and choices in the face of climate change. Eleven in-depth telephone interviews were conducted and analyzed using an interpretive phenomenological methodology. Participants reported that their ongoing relationship with yoga influences how they cope with climate change-related stressors and their being-in-the-world, and how concern for all life bolsters their responses to climate change. The results illustrate the part yoga may play in supporting long-term practitioners to prepare for, cope with, and respond to climate change events and impacts. Offering inclusive, interdisciplinary yoga therapy and community-based networks fostering ethical living and response flexibility may prove beneficial not only for the mental health and coping ability of participants, but for the planet.

Effect of yoga on pulse rate and blood pressure among women

Objectives:

Change in the past few decades in human life style, nowadays international health organizations, i.e., World Health Organization are also focusing on prevention along with treatment aspect of chronic illness. Researches focus that women of age group 30–45 years are at increased risk for hypertension and heart disease due to increased weight. Yoga is an effective method to control our physiological variables like blood pressure (BP), pulse, etc. The main aim of this study was to identify the effects of yoga on physiological variables.

Methods:

The study was an experimental study with two group, pretest and posttest control group, design, which was conducted on 40 female participants. Pranayama and meditation for a period of 6 weeks was done by these women.

Results:

Yoga therapy significantly reduced the BP (0.000*) and pulse rate (0.000*) of women, which was also statistically proved.

Conclusions:

Yoga therapy can be an effective method to control BP and pulse rate of patients with chronic diseases.

Yoga complements cognitive behaviour therapy as an adjunct treatment for anxiety and depression: Qualitative findings from a mixed-methods study

OBJECTIVES

Cognitive behaviour therapy (CBT) is recommended for treating anxiety and depression, demonstrating good efficacy and moderate rates of engagement. To further improve outcomes and access to evidence-based treatments, researchers have sought to enhance CBT protocols with mindfulness-based approaches, such as yoga. This study aimed to examine whether yoga is an acceptable and complementary adjunct to CBT through exploring the lived experiences of adults with anxiety and depression who engaged in an adjunct therapeutic yoga programme alongside group CBT.

DESIGN

Single-group qualitative design with post-intervention and follow-up timepoints.

METHODS

Thirty-six adults with anxiety and depression self-selected into a therapeutic yoga programme as an adjunct to group CBT. Qualitative interviews were conducted with 27 participants immediately after the eight-week programme and again three months later. Thematic analysis was used to identify common themes from the lived experiences.

RESULTS

Three primary themes, with nine subthemes, were identified which reflect the experiences of the combined therapies, the complementary elements, and process of engagement over time. The adjunct yoga programme was highly acceptable to adults with anxiety and depression, enhancing engagement and perceived outcomes. Yoga was identified as providing a unique combination of elements that complemented processes of CBT, such as behavioural activation and thought disputation. Yoga practices represented mental health self-management tools that are accessible and available as relapse prevention strategies.

CONCLUSIONS

Therapeutic yoga warrants consideration as an adjunct treatment for anxiety and depression as it offers unique and complementary elements to CBT and can enhance engagement and perceived clinical outcomes.

PRACTITIONER POINTS

Adults with anxiety and depression experienced a therapeutic yoga programme as a suitable and appealing adjunct that enhanced engagement with psychological treatment. Yoga offers a unique combination of elements, including a values system, body-based mindfulness practices, and breathing techniques, that complement CBT processes, such as behavioural activation, awareness of maladaptive patterns, and thought disputation. A therapeutic yoga programme provides adults with anxiety and depression with an accessible and sustainable mental health self-management tool. Therapeutic yoga can be considered for integration to models of mental health service provision to enhance engagement and clinical outcomes for adults with anxiety and depression.

Yoga-Based Group Intervention for In-patients With Schizophrenia Spectrum Disorders-A Qualitative Approach

Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity. Nevertheless, participants encountered challenges; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation. YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.

Effect of Yoga Therapy on Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

The purpose of this study was to assess the effect of yoga therapy (YT) on health outcomes of women suffering from polycystic ovary syndrome (PCOS). Interventional studies, with postmenarchal and premenopausal females with PCOS who received YT, with any health outcome reported, were included. Scopus, Cochrane, PubMed, Embase, and Medline databases were electronically searched. Systematic review included 11 experimental studies, representing 515 participants with PCOS, out of which 2 randomized controlled trials (RCTs) were included for meta-analysis. Random effects model was applied using Review Manager Software version 5.4.1 and strength of evidence was assessed using GRADEpro Guideline Development Tool, 2020. Meta-analysis showed that YT may significantly decrease menstrual irregularity (MD -.41, 95% CI -.74 to -.08), clinical hyperandrogenism (MD -.70, 95% CI -1.15 to -.26), fasting blood glucose (MD -.22 mmol/L, 95% CI -.44 to -.01), fasting insulin (MD -28.21 pmol/L, 95% CI -43.79 to -12.63), and homeostatic model assessment-insulin resistance value (MD -.86, 95% CI -1.29 to -.43). Strength of evidence was "low." In conclusion, YT may have beneficial effects on health outcomes in women suffering from PCOS. However, low strength of evidence suggests need of conducting well-designed RCTs to assess the efficacy of YT for PCOS.

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.

'A tool to help me through the darkness': suffering and healing among teacher-practitioners of Ashtanga yoga

Yoga is widely regarded as beneficial for physical and emotional health, and as a safe ancillary intervention for managing a range of psychological conditions. Evidence of injury, harm, and abuse in yoga traditions is difficult to square with this emphasis on healing. Drawing mainly from on online memoirs by long-term practitioners of Ashtanga yoga, this paper examines the relationship between suffering and healing in yoga, showing how long-term abuse can be perpetuated and injury sustained in a system widely understood and labelled by its practitioners as therapeutic. The paper argues that elements of healing and harm are present in the rituals of practice, the concepts that support it, and the power structure of the Ashtanga system. The system's organizational dynamics together with a therapeutic discourse that links suffering to its transcendence enabled the same kinds of abuse and trauma that Ashtanga yoga is purported to heal. The analysis raises questions about the overarching narrative of yoga as safe and healthy, and about the connections between healing and harm within therapeutic traditions.

Effect of Yoga on Glucose Control and Quality of Life in Patients of Prediabetes

Objective: The objective of this study was to evaluate effect of yoga on fasting plasma glucose (FPG), postprandial plasma glucose, and hemoglobin A1C (HbA1C) and also on quality of life (QoL). Research Design and Methods: This was a cohort study in which 100 diagnosed cases of prediabetes were recruited for doing specific yoga, and they themselves act as control for the study. The measurement and comparison of FPG, prandial plasma glucose (PPG), and HbA1C were done at three different time intervals, that is, baseline, 3 months, and at 6 months. The assessment of QoL was done using SF-36 scale. Results: One hundred prediabetic cases were selected for the study in which impaired fasting glucose (IFG) was present more in younger population compared to impaired glucose tolerance (IGT) and IFG plus IGT both of which are more prevalent in middle age group. The yoga therapy was found to have favorable effect on FPG, PPG, and HbA1C along with various anthropometry measures studied in this study. After adjusting correlation coefficient for various anthropometry measures, yoga was found to be effective for controlling glycemic parameters in prediabetics. Conclusions: Yoga is a type of exercise known to improve glycemic control by changing anthropometry measures, but our study aids in knowledge about the beneficial effect beyond this known fact through other mechanisms yet to be explored.

Effect of Pranayama Techniques with Marmanasthanam Kriya as Yogic Relaxation on Biopsychosocial Parameters Prior to Endodontic Therapy: A Cross Sectional Study Design

Background:

The root canal treatment is one of the common dental or endodontic therapies associated with high levels of patient anxiety. Yoga therapy (YT) is reported in medical literature as an effective modality in bringing down anxiety in clinical scenarios; however, the reports of the same for dental settings are fewer. The current study aimed to evaluate the effect of YT on biopsychosocial parameters in patients undergoing root canal therapy.

Materials and Methods:

A cross sectional study was conducted on 50 participants who underwent dental root canal therapy. The sample was divided into two groups: Yoga group (Group A; n = 25) who received YT and control group (Group B; n = 25) who were subjected to self-relaxation during dental procedure. The state of anxiety was measured by a 5-point single-item Likert scale and the cardiovascular (CV) parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) and CV indices (pulse pressure [PP], mean arterial pressure [MAP], rate-pressure product [RPP], and double product [DoP]) were derived and compared between both the groups.

Results:

The intergroup comparison showed statistically significant differences in anxiety score (P < 0.001), SBP (P < 0.001), MAP (P < 0.001), RPP (P < 0.001), DoP (P < 0.001), HR (P < 0.029), DBP (P < 0.003), and PP (P < 0.116).

Conclusion:

A significant reduction was recorded in terms of anxiety and primary and derived CV parameters in the yoga group. The YT can be adopted as an interventional tool for anxiety management in patients indicated for dental root canal therapy.

Barriers and Facilitators to Implementing Bundled Acupuncture and Yoga Therapy to Treat Chronic Pain in Community Healthcare Settings: A Feasibility Pilot

Objective: To identify factors associated with implementing bundled group acupuncture and yoga therapy (YT) to treat underserved patients with chronic pain in community health center (CHC) settings. This is not an implementation science study, but rather an organized approach for identification of barriers and facilitators to implementing these therapies as a precursor to a future implementation science study. Design: This study was part of a single-arm feasibility trial, which aimed to test the feasibility of bundling GA and YT for chronic pain in CHCs. Treatment outcomes were measured before and after the 10-week intervention period. Implementation feasibility was assessed through weekly research team meetings, weekly yoga provider meetings, monthly acupuncture provider meetings, and weekly provider surveys. Settings: The study was conducted in New York City at two Montefiore Medical Group (MMG) sites in the Bronx, and one Institute for Family Health (IFH) site in Harlem. Subjects: Participants in the feasibility trial were recruited from IFH and MMG sites, and needed to have had lower back, neck, or osteoarthritis pain for >3 months. Implementation stakeholders included the research team, providers of acupuncture and YT, referring providers, and CHC staff. Results: Implementation of these therapies was assessed using the Consolidated Framework for Implementation Research. We identified issues associated with scheduling, treatment fidelity, communication, the three-way disciplinary interaction of acupuncture, yoga, and biomedicine, space adaptation, site-specific logistical and operational requirements, and patient-provider language barriers. Issues varied as to their frequency and resolution difficulty. Conclusions: This feasibility trial identified implementation issues and resolution strategies that could be further explored in future implementation studies. Clinical Trial Registration No.: NCT04296344.

An alternative yogic approach for cyclical mastalgia-A narrative review

Background

Mastalgia or breast pain common benign breast disorder in women in her reproductive life. Mastalgia estimate prevalence 41-71%. It affects to overall quality of life and associated with anxiety, stress, and other psychological factors.

Objective

The purpose of the study was to conduct a review of alternative therapy in the management of mastalgia.

Method

A review was conducted using search terms cyclical mastalgia (CM), yoga therapy, breast treatment, primrose oil, oestrogen, progesterone and all the probable term in national and international data repositories such as PubMed, Scopus, science direct, google scholar, web of science in English language.

Result

The review of alternative therapies in the management of CM suggests that most of the studies used primrose oil, vitamins, and physical activity. There are very few studies conducted in relation to yoga and cyclical mastalgia. Further, most of the studies explored effect of alternative therapies on psychological outcomes. None of the studies investigated efficacy of these therapies on hormonal changes.

Conclusion

Evidence suggests that biochemical clinical trial is effective with side effect, primrose oil and seeds treatment is less effective. One evidence-based study with integrated yoga therapy should be considered in the management of cyclical mastalgia. More high-quality trial with yogic approach needed to first line management of patients presenting with CM.

Sudarshan Kriya Yoga: A Breath of Hope during COVID-19 Pandemic

Important counter measures to combat an infectious disease pandemic include vaccination, antiviral therapy, and immunomodulation therapy. Vaccinations are disease specific and moreover strain specific, so the protection provided is also specific and limited. Antiviral therapies are costly and require bulk production of drugs, hence globally there is an increased interest toward low-risk, cost-effective complementary alternative therapies, such as Yoga and Ayurveda to tackle the infectious pandemic, coronavirus disease 2019 (COVID-19). There is clinical evidence available on the potential complementary role of yogic practices in the management of noncommunicable and communicable diseases. Various online databases were searched for articles published between 2000 and 2020. Databases explored were Medline, EMBASE, Indian Citation Index, PsycINFO, Index Medicus for South-East Asia Region, and Google Scholar. All search results were screened, and articles related to keywords such as COVID-19, yoga therapy, and Sudarshan Kriya Yoga (SKY) were selected for data extraction. Quality of the studies included was evaluated on the basis of the construct validity, content validity, relevance, bias, credibility relating to information, and data sources. SKY is a unique yogic practice that includes specific sequential breathing techniques. It balances the autonomic nervous system and thus can alleviate anxiety, routine stress, depression, stress-related medical disorders, and posttraumatic stress. It potentiates natural host immune defenses that are essential to tackle a plethora of microbial infections. This narrative review article provides an overview of potential therapeutic benefits that SKY can offer to the population at large during this COVID-19 pandemic.

Study of Additive Effect of Yoga and Physical Therapies to Standard Pharmacologic Treatment in Migraine

Objective  We aimed to evaluate and compare the effectiveness of physical and yoga therapies as an adjuvant therapy along with standard pharmacologic treatment in patients with migraine.

Materials and Methods  A total of 61 consenting patients diagnosed to have migraine were randomized into three groups to receive either standard treatment alone, physical therapy along with standard treatment, or yoga therapy along with standard treatment. The respective adjuvant intervention was taught to the respective group of patients and they were advised to perform it daily for 3 months with weekly telephonic reminders and review of their activity logs. Outcome measures assessed were headache frequency, Short-Form McGill Pain Questionnaire (SF-MPQ), and Headache Impact Test-6 (HIT-6) at recruitment and once every month for 3 months.

Statistical Analysis  Statistical analysis of the study was done by using Stata 14.1 software. All the descriptive statistics, paired t -test was used to compare the difference between pre and postintervention values of headache frequency, SF-MPQ, and HIT-6 score within all the three groups. Analysis of variance test and post hoc test were used to compare the differences between all groups for outcome measures ( p < 0.05).

Results  Headache frequency and the visual analog scale before intervention compared during each month intervals for 3 months in all the three groups were significantly decreased in all the three groups ( p < 0.005). Yoga or physical therapy as an adjuvant to standard treatment leads to a higher reduction in headache frequency and severity. Sensory and affective pain ratings of SF-MPQ and HIT-6 also showed a significant improvement at 1 to 3 months of treatment compared with baseline in all the three groups.

Conclusion  Either physical or yoga therapy as an adjuvant to standard pharmacologic treatment may further improve the quality of life and reduce headache frequency in patients with migraine.

White Paper: Yoga Therapy and Pain-How Yoga Therapy Serves in Comprehensive Integrative Pain Management, and How It Can Do More

This paper examines the role of yoga therapy in comprehensive integrative pain management (CIPM). The pain crisis is described, and how yoga therapists can contribute to its solution is explained. Yoga therapy can be an essential component of the multidisciplinary undertaking that will be required to improve patient outcomes and alter the trajectory of the global public health crisis constituted by an epidemic of poorly understood and inadequately addressed pain. Additional context and evidence are presented to document the effectiveness of yoga therapy interventions to support people living with pain. The white paper concludes by listing recommendations to providers, consumers, payers, and legislators, who together can address systemic and structural barriers to CIPM, as well as suggestions for enabling the yoga therapy profession to more fully participate in these solutions.

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot

Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less access to pain care, poorer outcomes, and higher risk of fatal opioid overdose. Acupuncture therapy is effective in treating chronic pain conditions including chronic low back pain, neck pain, shoulder pain, and knee pain from osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible and effective, and specifically so for underserved and diverse populations at risk for health outcome disparities. Acupuncture therapy also encourages patient engagement and activation. As chronic pain improves, there is a natural progression to want and need to increase activity and movement recovery. Diverse movement approaches are important for improving range of motion, maintaining gains, strengthening, and promoting patient engagement and activation. Yoga therapy is an active therapy with proven benefit in musculoskeletal pain disorders and pain associated disability. The aim of this quasi-experimental pilot feasibility trial is to test the bundling of these 2 effective care options for chronic pain, to inform both the design for a larger randomized pragmatic effectiveness trial as well as implementation strategies across underserved settings.

Characteristics of Clients Seeking Yoga Therapy in a University-Based Student Clinic

Yoga therapy is an emerging profession with recent development of educational competencies, training program accreditation, and practitioner certification. In the United States, most yoga therapy training programs are studio-based and data on mentored clinical encounters are lacking. This study aimed to characterize the client population in a university-based mentored student clinic. As part of a larger feasibility study, data were collected at all clinic visits for 70 consenting clients. Data collected included demographic characteristics, reasons for pursuing care, use of other healthcare approaches, and the Patient-Reported Outcomes Measurement Information System (PROMIS) for physical and mental health. Participants were mostly middle-aged, White, and highly educated. Common reasons for pursuing care were pain and mental health. Most used multiple healthcare approaches. Average scores for most patient-reported outcomes fell within normal range at baseline. Future studies are needed to better characterize yoga therapy users and to expand access for populations in whom the modality is underutilized despite emerging evidence of relevance.

Changes in Heart Rate Variability after Yoga are Dependent on Heart Rate Variability at Baseline and during Yoga: A Study Showing Autonomic Normalization Effect in Yoga-Naïve and Experienced Subjects

Background:

Yoga therapy is widely applied to the maintenance of health and to treatment of various illnesses. Previous researches indicate the involvement of autonomic control in its effects, although the general agreement has not been reached regarding the acute modulation of autonomic function.

Aim:

The present study aimed at revealing the acute effect of yoga on the autonomic activity using heart rate variability (HRV) measurement.

Methods:

Twenty-seven healthy controls participated in the present study. Fifteen of them (39.5 ± 8.5 years old) were naïve and 12 (45.1 ± 7.0 years old) were experienced in yoga. Yoga skills included breath awareness, two types of asana, and two types of pranayama. HRV was measured at the baseline, during yoga, and at the resting state after yoga.

Results:

In both yoga-naïve and experienced participants, the changes in low-frequency (LF) component of HRV and its ratio to high-frequency (HF) component (LF/HF) after yoga were found to be correlated negatively with the baseline data. The changes in LF after yoga were also correlated with LF during yoga. The changes in HF as well as the raw HRV data after yoga were not related to the baseline HRV or the HRV during yoga.

Conclusion:

The results indicate that yoga leads to an increase in LF when LF is low and leads to a decrease in LF when it is high at the baseline. This normalization of LF is dependent on the autonomic modulation during yoga and may underlie the clinical effectiveness of yoga therapy both in yoga-naïve and experienced subjects.

Effectiveness of Adjuvant Yoga Therapy in Diabetic Lung: A Randomized Control Trial

Context

Recent studies provide ample evidence of the benefits of yoga in various chronic disorders. Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia and Sandler coined the term "Diabetic Lung" for the abnormal pulmonary function detected in diabetic patients due underlying pulmonary dysfunction. Yoga therapy may help in achieving better pulmonary function along with enhanced glycaemic control and overall health benefits.

Aim

To study the effect of adjuvant yoga therapy in diabetic lung through spirometry.

Settings and Design

Randomized control trial was made as interdisciplinary collaborative work between departments of Yoga Therapy, Pulmonary Medicine and Endocrinology, of MGMC & RI, Sri Balaji Vidyapeeth Puducherry.

Materials and Methods

72 patients of diabetic lung as confirmed by spirometry (<70% of expected) were randomized into control group (n=36) who received only standard medical treatment and yoga group (n=36) who received yoga training thrice weekly for 4 months along with standard medical management. Yoga therapy protocol included yogic counseling, preparatory practices, Asanas or static postures, Pranayama or breathing techniques and relaxation techniques. Hathenas of the Gitananda Yoga tradition were the main practices used. Spirometry was done at the end of the study period. Data was analyzed by Student's paired and unpaired 't' test as it passed normality.

Results

There was a statistically significant (P < 0.05) reduction in weight, and BMI along with a significant (P < 0.01) improvement in pulmonary function (FEV₁, FVC) in yoga group as compared to control group where parameters worsened over study period.

Conclusion

It is concluded from the present RCT that yoga has a definite role as an adjuvant therapy as it enhances standard medical care and hence is even more significant in routine clinical management of diabetes, improving physical condition and pulmonary function.

The Elephant in the Room: The Need for Increased Integrative Therapies in Conventional Medical Settings

Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion of integrative therapies in an effort to promote best practice and holistic care. The main methods applied in this article are vignettes that illustrate how the integrative therapies in a metropolitan academic hospital successfully treat the patient by complementing conventional medicine. This leads to comprehensive care. The central finding of the article proposes viable solutions to increase interdisciplinary collaboration both internally within the institution and externally. Integrative therapists detail how they were able to increase visibility and yield best practice through increased educational initiatives and interdisciplinary collaboration.

Yoga Therapy in the German Healthcare System

An estimated 15.7 million Germans are currently practicing yoga or are at least interested in starting to practice, and they often perceive yoga as a therapeutic approach. From a healthcare system perspective, the situation is less clear. Here, yoga is only recognized as a recreational or preventive activity. When yoga teachers fulfill specific qualifications, their preventive yoga classes are covered by the statutory health insurances. Only those with additional qualifications in medicine or psychotherapy, however, can independently use and promote "yoga therapy." The general perception of yoga in Germany as a preventive practice is reflected in the professional organization of yoga providers. Most providers are considered to be yoga teachers rather than yoga therapists and are organized mainly in yoga teacher associations. Despite the uncertain legal framework, yoga is now considered in a number of medical guidelines; in a number of hospitals, yoga is part of multimodal inpatient treatment programs and is delivered by physical therapists or members of other health professions. An increasing number of yoga therapy clinical trials are conducted in Germany, and efforts are underway to establish yoga therapy as an accepted adjunct treatment approach for selected medical conditions within the German healthcare system.

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience

Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks-one based in neurophysiology and the other in an ancient wisdom tradition-highlight yoga therapy's promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts.

Bridging Body and Mind: Considerations for Trauma-Informed Yoga

Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphasize beneficial practices (e.g., diaphragmatic breath and restorative postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender- and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice.

Yoga for Heart Failure: A Review and Future Research

Background:

Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients.

Aim:

The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients.

Methods:

The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies.

Conclusions:

Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.

Yoga as a Therapeutic Intervention in the Management of Dysfunctional Uterine Bleeding: A Controlled Pilot Study

BACKGROUND

Dysfunctional uterine bleeding (DUB) is one of the most common gynecological disorders encountered in women during the reproductive age. Yoga therapy has shown promising benefits in several gynecological disorders.

METHODS

Thirty women between the ages of 20 and 40 years with primary DUB were randomly assigned to a yoga (n = 15) and a waitlist control group (n = 15). Participants in the yoga group received a 3-month yoga module and were assessed for hemoglobin values, endometrial thickness (ET), pictorial blood loss assessment chart (PBAC), State-Trait Anxiety Inventory, perceived stress scale, and Pittsburgh Sleep Quality Index (PSQI) before and after a 3-month follow-up period.

RESULTS

At the end of 3 months of intervention, the yoga group, unlike the control group, reported a significant reduction in the anxiety scores (P < 0.05) and perceived stress (P < 0.05). The PSQI scores indicated a reduction in sleep disturbances (P < 0.001) and the need for sleep medications (P < 0.01) and higher global scores (P < 0.001). However, there were no changes in PBAC and ET in both the groups.

CONCLUSION

The results indicate that yoga therapy positively impacts the outcome of DUB by reducing the perceived stress and state anxiety and improving the quality of sleep. This warrants larger clinical trials to validate the findings of this pilot study.

Aligning Yoga With Its Evolving Role in Health Care: Comments on Yoga Practice, Policy, Research

Evidence is accumulating that suggests that yoga has beneficial effects in mitigating the impact of certain diseases. As a result, efforts are being made to medicalize yoga and use it within integrative medicine as a therapy. However, there are substantial shortcomings in the practice, policy, and research of yoga that undermine its optimal use. Yoga as a modality functions within a context. Therefore, it is important to occasionally step back and examine the entirety of the context from a high vantage to assess whether the tactical and programmatic endeavors are aligned with the strategic intended purpose. This commentary discusses a few policy issues relevant to some key stakeholders. It suggests that yoga therapists need to calibrate their model of yoga by reducing emphasis on postures and increasing it on meditation and breathing exercises while catering to clients with chronic conditions. It recommends that yoga research should be more critical in evaluating yoga's fundamental tenets and use reductionist approach to do so. It proposes that autonomous regulators should extricate injury prone postures from the body of yoga practice for regulatory purposes, rather than regulate yoga summarily. It is suggested that payers should pay for yoga. However, they should use payment model as it is used for vaccination, instead of paying as it is done for physiotherapy. It concludes that yoga can help, but before it can help it needs help itself, and the various stakeholders need to reflect on the big picture so that they can collaborate on these improvements.

Decline in the Use of Medicalized Yoga Between 2002 and 2012 While the Overall Yoga Use Increased in the United States: A Conundrum

We analyzed the National Health Institute Survey Alternative Medicine supplement yoga data for 2002, 2007, and 2012 to answer the following questions: (1) Do the claims about increase in the use of yoga hold true at the level of specific health problems? (2) Do trends support a proposition that yoga is believed to be helpful in amelioration of disease conditions? (3) Do the prescribing patterns of health care providers correspond with the increasing popularity of yoga? Data were analyzed using SAS software, version 9.4. Response percentages were compared using chi-square test after adjusting for age. Between 2002 and 2012, use of yoga increased but adherence failed to increase, and use for specific health problems and for back pain declined; use of health care providers’ referral–driven yoga declined between 2007 and 2012. All results were statistically significant. Our results suggest that the use of medicalized yoga declined between 2002 and 2012.

Effect of a 12-week yoga therapy program on mental health status in elderly women inmates of a hospice

Aim and Objectives:

This study was undertaken to evaluate the effectiveness of yoga on the mental health status of elderly women inmates residing in a hospice in Puducherry.

Materials and Methods:

Forty elderly women were randomly divided into yoga and wait-listed control group. A yoga therapy program of 60 min was given twice a week for 12 weeks. This protocol was specially designed for senior citizens, keeping in mind their health status and physical limitations that included simple warm-up and breath-body movement coordination practices (jathis and kriyas), static stretching postures (asanas), breathing techniques (pranayamas), and relaxation. Hamilton anxiety scale for measuring anxiety, Hamilton rating scale for depression, and Rosenberg self-esteem scale to measure self-esteem were administered to both groups before and after the 12-week study period. Data were assessed for normality, and appropriate parametric and nonparametric statistical methods were applied for intra- and inter-group comparisons.

Results:

Overall, intra- and inter-group comparison of prepost data showed statistically significant (P < 0.001) differences for all three parameters. There was an overall improvement in the scores indicating decreased levels of depression and anxiety coupled with an increase in the level of self-esteem after the yoga therapy program.

Discussion:

The influence of yoga in the reduction of depression and anxiety scores and improvement in self-esteem scores in elderly women subjects is evident from this study. As reported in earlier studies, this may be attributed to changes in central neurotransmitters such as gamma-aminobutyric-acid coupled with increased parasympathetic tone and decreased sympatho-adrenal activity.

Conclusion:

It is recommended that yoga should be a part of health-care facilities for elderly as it can enhance the quality of life by improving their overall mental health status. It could provide a healthy and positive alternative from depressing negative thoughts, and give them a sense of purpose and hope.

A National Survey of Yoga Instructors and their Delivery of Yoga Therapy

Yoga therapy may improve a variety of symptoms and health conditions, but little is known about how yoga therapy is being delivered in the real world. The purpose of this study was to describe the delivery of yoga therapy by yoga instructors across the U.S. In this cross-sectional survey, certified instructors were recruited from the Iyengar Yoga National Association, United States (IYNAUS) (n = 966) via an email that contained a link to an anonymous online survey that collected information on demographics, their delivery of yoga therapy, and the health conditions and symptoms seen and records kept by the instructors. A total of 487 instructors (50.4%) completed the surve y. Instructors ranged from 28 to 82 years in age (m = 56.4 ± 10.1 years) and had been teaching for 17.0 ± 10.0 years. The majority (n = 384, 81.4%) reported teaching some form of therapeutic yoga either in groups (n = 261, 55%) and/or privately (n = 340, 73.4%). All instructors (100%) reported modifying poses in their regular yoga classes for students because of health conditions or symptoms. Other than attendance, the majority (n = 255, 57.3%) reported keeping no records on their sessions. Students came to instructors for help with over 54 health conditions, most commonly musculoskeletal conditions and injuries (n = 267, 62.8%), followed by pregnancy (n = 56, 13.2%) and hypertension (n = 22, 5.2%). Nearly all (n = 373, 85.6%) reported pain to be the symptom that brought students to yoga therapy most frequently. Whereas yoga in randomized controlled trials typically is delivered to individuals in large, homogenous groups, the instructors reported that most yoga therapy is being provided individually or in small, general therapeutic classes that include a variety of health conditions. Research is needed to examine the effectiveness of yoga therapy under such conditions. A clear set of guidelines for assessing and documenting the effectiveness of yoga therapy using standardized, valid, and reliable methods is needed, particularly for pain-related conditions.

INDIVIDUALIZED YOGA FOR REDUCING DEPRESSION AND ANXIETY, AND IMPROVING WELL-BEING: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND

Depression and anxiety are leading causes of disability worldwide. Current treatments are primarily pharmaceutical and psychological. Questions remain about effectiveness and suitability for different people. Previous research suggests potential benefits of yoga for reducing depression and anxiety. The aim of this study is to investigate the effects of an individualized yoga intervention.

METHODS

A sample of 101 people with symptoms of depression and/or anxiety participated in a randomized controlled trial comparing a 6-week yoga intervention with waitlist control. Yoga was additional to usual treatment. The control group was offered the yoga following the waitlist period. Measures included Depression Anxiety Stress Scale (DASS-21), Kessler Psychological Distress Scale (K10), Short-Form Health Survey (SF12), Scale of Positive and Negative Experience (SPANE), Flourishing Scale (FS), and Connor-Davidson Resilience Scale (CD-RISC2).

RESULTS

There were statistically significant differences between yoga and control groups on reduction of depression scores (-4.30; 95% CI: -7.70, -0.01; P = .01; ES -.44). Differences in reduced anxiety scores were not statistically significant (-1.91; 95% CI: -4.58, 0.76; P = .16). Statistically significant differences in favor of yoga were also found on total DASS (P = .03), K10, SF12 mental health, SPANE, FS, and resilience scores (P < .01 for each). Differences in stress and SF12 physical health scores were not statistically significant. Benefits were maintained at 6-week follow-up.

CONCLUSION

Yoga plus regular care was effective in reducing symptoms of depression compared with regular care alone. Further investigation is warranted regarding potential benefits in anxiety. Individualized yoga may be particularly beneficial in mental health care in the broader community.

Effect of yoga therapy on physical and psychological quality of life of perimenopausal women in selected coastal areas of Karnataka, India

BACKGROUND

Perimenopausal period is characterized by a continuous decline in ovarian function due to which women are vulnerable to various physical and psychological symptoms affecting their quality of life. Currently these symptoms are managed by hormone replacement therapy. However, hormonal therapy can cause complications including malignancy which has resulted in search for various alternative therapies to improve the quality of life (QOL). Yoga is one such alternative therapy shown to enhance the QOL at all stages of human life associated with the chronic illness. There are very few scientific studies regarding the effect of yoga on perimenopause and in this study we investigated the effects of yoga therapy on physical and psychological symptoms using the standardized questionnaire.

OBJECTIVE

To study the effect of yoga therapy on physical, psychological, vasomotor and sexual symptoms of perimenopause.

MATERIALS AND METHODS

It is a prospective non-randomized control study of 216 perimenopausal women with 12 weeks of intervention. The subjects were divided in two groups with either yoga therapy [n = 111] or exercise [n = 105] as the interventional tool. The symptoms control and QOL before and after intervention in both the groups were assessed by using the menopausal QOL questionnaire.

RESULTS

The perimenopausal symptoms in all the four domains were improved by yoga therapy, thus significantly improving the overall QOL compared to the control group.

CONCLUSION

This study clearly demonstrates the effectiveness of yoga therapy in managing the distressing perimenopausal symptoms. It is easy, safe, non-expensive alternative therapy helping the well-being of perimenopausal women and must be encouraged in the regular management of perimenopausal symptoms.

A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure

AIMS

The purpose of this study was to evaluate whether yoga training in addition to standard medical therapy can improve cardiac function and reduce N terminal pro B-type natriuretic peptide (NT pro BNP) in heart failure (HF).

METHODS

130 patients were recruited and randomized into two groups: Control Group (CG) (n = 65), Yoga Group (YG). In YG, 44 patients and in CG, 48 patients completed the study. Cardiac function using left ventricular ejection fraction (LVEF), myocardial performance index (Tei index), and NT pro BNP, a biomarker of HF, was assessed at baseline and after 12 weeks.

RESULT

Improvement in LVEF, Tei index, and NT pro BNP were statistically significant in both the groups. Furthermore, when the changes in before and after 12 weeks were in percentage, LVEF increased 36.88% in the YG and 16.9% in the CG, Tei index was reduced 27.87% in the YG and 2.79% in the CG, NT pro BNP was reduced 63.75% in the YG and 10.77% in the CG. The between group comparisons from pre to post 12 weeks were significant for YG improvements (LVEF, P < 0.01, Tei index, P < 0.01, NT pro BNP, P < 0.01).

CONCLUSION

These results indicate that the addition of yoga therapy to standard medical therapy for HF patients has a markedly better effect on cardiac function and reduced myocardial stress measured using NT pro BNP in patients with stable HF.

Serum mineral status and climacteric symptoms in perimenopausal women before and after Yoga therapy, an ongoing study

BACKGROUND

Many women report an increased level of anxiety, irritability and mood swings during their perimenopausal state. Studies show that physically active people can reduce their anxiety and depression by practicing yoga. Serum minerals such as calcium, copper and magnesium and the ferro-oxidase, ceruloplasmin play an important role in the body during the perimenopausal period.

OBJECTIVE

The objective of this study is to assess the serum mineral status, anthropometric parameters and climacteric symptoms in perimenopausal women before and after yoga intervention.

SUBJECTS AND METHODS

A total of 30 subjects with perimenopausal symptoms, aged between 40 and 60 years (49.43 ± 6.15) were included in the study. Yoga intervention was given on a daily basis (45 min duration) for 12 weeks. The climacteric symptoms were assessed by Greene's climacteric scale and biochemical parameters were analyzed spectrophotometrically.

RESULTS

A significant decrease in the waist hip ratio (P < 0.036) and body mass index (P < 0.036) was observed after yoga intervention. Systolic (P < 0.064) and diastolic (P < 0.082) blood pressure (BP) showed marginal decrease after yoga therapy. Climacteric symptoms improved significantly (P < 0.001) after yoga intervention. A significant increase (P < 0.001) in serum calcium and copper and a marked decrease in serum magnesium (P < 0.05) and ceruloplasmin (P < 0.028) levels was observed, post yoga therapy. Serum magnesium negatively correlated (r = -0.467, P < 0.035) with systolic BP after yoga intervention.

CONCLUSION

The overall changes observed in the mineral status and climacteric symptoms suggest that yoga therapy protocol can be effectively used to improve the quality of life in perimenopausal women.

A process evaluation of the art of yoga project mentor program for incarcerated teenage girls

Returning to the community upon release from custody is a difficult process to navigate, and there are scant resources available to juvenile female offenders, in particular. Comprehensive wraparound aftercare and mentor services are a central component of successful community reentry, and the well-established unique characteristics of juvenile girls make it necessary to create programs catered specifically to them. The present study employed a case study design to describe and evaluate the Art of Yoga Project's Mentor Program. Eight girls and their mentors were followed for a period of 12 months after the girls' release from custody. Preliminary results from qualitative content analysis suggest that the program was valuable for the girls who participated.

Accepted Common Interest Community (CIC) Proposals

These are the 18 accepted proposals for the three Common Interest Community (CIC) sessions at IAYT's Symposium on Yoga Therapy and Research (SYTAR), June 5-8, 2014, in Austin, Texas and published in the Final Program Guide and CIC Works for SYTAR 2014. The sessions were CIC#1 Rehab Professionals: Bridging the Past with the Future and CIC#2a & CIC#2b Mental, Emotional and Spiritual Health.

Joint ventures: helping those with rheumatoid arthritis live well

OBJECTIVES

Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory disorder that causes pain, swelling, stiffness, loss of joint function, and reduced quality of life. Yoga therapy may help individuals with RA manage stress and increase well-being. This study focused on the identification of therapeutic objectives and a methodology to achieve symptom relief, regain function, and enhance quality of life for individuals with RA.

METHODS

Four women with RA participated in private yoga therapy sessions for 2.5 months. Assessment based, tailored home practices were developed and modified to address participant - identified goals.

RESULTS

Participants reported decreased pain, fatigue, swelling, and flares; increased energy; pain-free range of motion and strength around affected joints; and a heightened sense of well-being.

CONCLUSIONS

Tailored yoga therapy that emphasizes stress reduction may be beneficial for individuals with RA.