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1.  “Now I see a brighter day”: expectations and perceived benefits of an Iyengar yoga intervention for young patients with rheumatoid arthritis 
Rheumatoid arthritis (RA) is a chronic disease characterized by inflammation of joints and associated fatigue, deteriorated range of motion, and impaired psychosocial functioning. Young adults with RA are at a particular risk for compromised health-related quality of life, and there is a need for safe, effective complementary treatment in addition to traditional medical approaches. The aim of the present study was to use face-to-face participant interviews, conducted before and after an Iyengar yoga (IY) program, to examine mechanisms through which yoga may be beneficial to young adults with RA.
This pilot study utilized a single-arm design where all participants received the intervention. Classes were taught twice per week (1.5 hours each) for 6 weeks by an IY teacher qualified in therapeutics. Interview themes included participants’ baseline expectations about yoga and viewpoints as to how their functioning had been impacted by the IY intervention were examined. Five young adults with RA aged 24–31 years (mean = 28; 80% female) completed the yoga intervention. Participants consistently reported that yoga helped with energy, relaxation and mood and they discussed perceived mechanisms for how yoga impacted well-being. Mechanisms included physical changes such as range of motion and physiological awareness, and psychospiritual developments such as acceptance, coping, self-efficacy and mindfulness. Though the study is limited, participants’ responses provide compelling evidence that IY for RA patients is an intervention worthy of further exploration. The mechanisms and outcomes reported by participants support a biopsychosocial model, which proposes that yoga benefits patients through both physiological and psychospiritual changes.
doi:10.4172/2157-7595.1000101
PMCID: PMC3493157  PMID: 23145356
Iyengar yoga; Rheumatoid arthritis; Qualitative data
2.  Impact and Outcomes of an Iyengar Yoga Program in a Cancer Centre 
Current Oncology  2008;15(Suppl 2):s109.es72-s109.es78.
Background
Individuals have increasingly sought complementary therapies to enhance health and well-being during cancer, although little evidence of their effect is available.
Objectives
We investigated how an Iyengar yoga program affects the self-identified worst symptom in a group of participants. whether quality of life, spiritual well-being, and mood disturbance change over the Iyengar yoga program and at 6 weeks after the program. how, from a participant’s perspective, the Iyengar yoga program complements conventional cancer treatment.
Patients and Methods
This pre–post instrumental collective case study used a mixed methods design and was conducted at a private Iyengar yoga studio. The sample consisted of 24 volunteers (23 women, 1 man; 88% Caucasian; mean age: 49 years) who were currently on treatment or who had been treated for cancer within the previous 6 months, and who participated in ten 90-minute weekly Iyengar yoga classes.
The main outcome measures were most-bothersome symptom (Measure Your Medical Outcome Profile 2 instrument), quality of life and spiritual well-being (Functional Assessment of Chronic Illness Therapy–General subscale and Spiritual subscale), and mood disturbance (Profile of Mood States–Short Form). Participant perspectives were obtained in qualitative interviews.
Results
Statistically significant improvements were reported in most-bothersome symptom (t(23) = 5.242; p < 0.001), quality of life (F(2,46) = 14.5; p < 0.001), spiritual well-being (F(2,46) = 14.4; p < 0.001), and mood disturbance (F(2,46) = 10.8; p < 0.001) during the program. At follow-up, quality of life (t(21) = −3.7; p = 0.001) and mood disturbance (t(21) = 2.4; p = 0.025) significantly improved over time. Categorical aggregation of the interview data showed that participants felt the program provided them with various benefits not included on the outcomes questionnaires.
Conclusions
Over the course of the Iyengar Yoga for Cancer program, participants reported an improvement in overall well-being. The program was also found to present participants with a holistic approach to care and to provide tools to effectively manage the demands of living with cancer and its treatment.
PMCID: PMC2528557  PMID: 18769575
Iyengar yoga; cancer; complementary and alternative medicine; integrative oncology; mixed methodology
3.  Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis 
The Clinical journal of pain  2013;29(11):988-997.
Objective
Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health related quality of life (HRQOL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga (IY) program on HRQOL of young adults with RA compared to a usual-care waitlist control group.
Method
The program was designed to improve the primary outcome of HRQOL including pain, as well as disability and psychological functioning in patients. Assessments were collected pre, post, and at 2-months following treatment. Weekly ratings of anxiety, depression, pain and sleep were also recorded. A total of 26 participants completed the intervention (yoga = 11; usual care waitlist = 15). All participants were female (mean age =28 years).
Results
Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQOL, pain disability, general health, mood, fatigue, acceptance of chronic pain and self-efficacy regarding pain at post treatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQOL general health, pain disability and weekly ratings of pain, anxiety and depression that maintained at follow-up.
Conclusion
The findings suggest a brief IY intervention is a feasible and safe adjunctive treatment for young people with RA, leading to health related quality of life (HRQOL), pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability and mood persisted at the 2-month follow-up.
doi:10.1097/AJP.0b013e31827da381
PMCID: PMC3644391  PMID: 23370082
Yoga; arthritis; young adults
4.  Iyengar Yoga for Distressed Women: A 3-Armed Randomized Controlled Trial 
Distress is an increasing public health problem. We aimed to investigate the effects of an Iyengar yoga program on perceived stress and psychological outcomes in distressed women and evaluated a potential dose-effect relationship. Seventy-two female distressed subjects were included into a 3-armed randomized controlled trial and allocated to yoga group 1 (n = 24) with twelve 90 min sessions over 3 months, yoga group 2 (n = 24) with 24 sessions over 3 months, or a waiting list control group (n = 24). The primary outcome was stress perception, measured by Cohen Stress Scale; secondary outcomes included state trait anxiety, depression, psychological and physical quality of life (QOL), profile of Mood States, well being, and bodily complaints. After three months, women in the yoga groups showed significant improvements in perceived stress (P = 0.003), state trait anxiety (P = 0.021 and P = 0.003), depression (P = 0.008), psychological QOL (P = 0.012), mood states being (P = 0.007), and bodily complaints well(P = 0.012) when compared to controls. Both yoga programs were similarly effective for these outcomes; however, compliance was better in the group with fewer sessions (yoga group 1). Dose effects were seen only in the analysis of group-independent effects for back pain, anxiety, and depression. These findings suggest that Iyengar yoga effectively reduces distress and improves related psychological and physical outcomes. Furthermore, attending twice-weekly yoga classes was not superior to once-weekly classes, as a result of limited compliance in the twice-weekly group.
doi:10.1155/2012/408727
PMCID: PMC3463199  PMID: 23049608
5.  Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial 
Cancer  2011;118(15):3766-3775.
Background
Cancer-related fatigue afflicts up to one-third of breast cancer survivors, yet there are no empirically-validated treatments for this symptom.
Methods
We performed a two-group RCT to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer patients who had completed cancer treatments (other than endocrine therapy) at least 6 months prior to enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent to treat analyses were conducted with all randomized participants using linear mixed models.
Results
Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3 month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group showed significant increases in vigor relative to controls (P = .011). Both groups showed positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed.
Conclusions
A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.
doi:10.1002/cncr.26702
PMCID: PMC3601551  PMID: 22180393
6.  “More than I Expected”: Perceived Benefits of Yoga Practice among Older Adults at Risk for Cardiovascular Disease 
Objective
This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program.
Design
This study used a constructivist-interpretive approach to naturalistic inquiry.
Setting
A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study.
Intervention
The 8-week Iyengar yoga program included two 90-minute yoga classes and five 30-minute home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study.
Main Outcome Measures
Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process.
Results
Four broad themes emerged from content analysis: Practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants).
Conclusions
These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease.
doi:10.1016/j.ctim.2012.11.001
PMCID: PMC3564012  PMID: 23374201
7.  National Survey of Yoga Practitioners: Mental and Physical Health Benefits 
Summary
Objectives
to describe yoga practice and health characteristics of individuals who practice yoga, and to explore their beliefs regarding the effects of their yoga practice on their health.
Design
a cross-sectional design with anonymous online surveys
Setting
4307 randomly selected individuals from 15 US Iyengar yoga studios (n = 18,160), representing 41 states; 1087 individuals responded, with 1045 (24.3%) surveys completed.
Outcome Measures
Freiberg Mindfulness Inventory, Mental Health Continuum (subjective well-being), Multi-factor Screener (diet), PROMIS sleep disturbance, fatigue, and social support, International Physical Activity Questionnaire.
Results
Age: 19 to 87 years (M = 51.7 ± 11.7), 84.2% female, 89.2% white, 87.4% well educated (≥ bachelor’s degree). Mean years of yoga practice = 11.4 (± 7.5). BMI = 12.1–49.4 (M = 23.1 ± 3.9). Levels of obesity (4.9%), smoking (2%), and fruit and vegetable consumption (M = 6.1 ± 1.1) were favorable compared to national norms. 60% reported at least one chronic/serious health condition, yet most reported very good (46.3%) or excellent (38.8%) general health. Despite high levels of depression (24.8 %), nearly all were moderately mentally healthy (55.2%) or flourishing (43.8%). Participants agreed yoga improved: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57.3%), and beliefs did not differ substantially according to race or gender. The more they practiced yoga, whether in years or in amount of class or home practice, the higher their odds of believing yoga improved their health.
Conclusions
Individuals who practice yoga are not free of health concerns, but most believe their health improved because of yoga. Yoga might be beneficial for a number of populations including elderly women and those with chronic health conditions.
doi:10.1016/j.ctim.2013.04.001
PMCID: PMC3721070  PMID: 23876562
8.  Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study 
International Journal of Yoga  2014;7(1):48-53.
Background:
Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP.
Aim of the Study:
To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL in nonspecific chronic low back pain.
Materials and Methods:
Experimental study with random sampling technique.
Subjects/Intervention:
Sixty subjects who fulfilled the selection criteria were randomly assigned to Iyengar yoga (yoga group, n = 30) and control group (exercise group, n = 30). Participants completed low back pain evaluation form and HRQOL-4 questionnaire before their intervention and again 4 weeks and 6 month later. Yoga group underwent 29 yogic postures training and exercise group had undergone general exercise program for 4 weeks.
Statistics:
Repeated measures analysis of variance (ANOVA) was used to analyze group differences over time, while controlling for baseline differences.
Results:
Patients in both groups experienced significant reduction in pain and improvement in HRQOL. In visual analogue scale (VAS) yoga group showed reduction of 72.81% (P = 0.001) as compared to exercise group 42.50% (P = 0.001). In HRQOL, yoga group showed reduction of 86.99% (P = 0.001) as compared to exercise group 67.66% (P = 0.001).
Conclusion:
These results suggest that Iyengar yoga provides better improvement in pain reduction and improvement in HRQOL in nonspecific chronic back pain than general exercise.
doi:10.4103/0973-6131.123481
PMCID: PMC4097916  PMID: 25035607
Health related quality of life; Iyengar yoga; nonspecific chronic low back pain; visual analog scale
9.  A randomized trial of yoga for adolescents with irritable bowel syndrome 
BACKGROUND:
Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind-body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients.
OBJECTIVE:
To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS.
METHODS:
Twenty-five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then received the yoga intervention and four weeks later completed an additional set of questionnaires.
RESULTS:
Adolescents in the yoga group reported lower levels of functional disability, less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre- and postintervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS.
CONCLUSIONS:
Yoga holds promise as an intervention for adolescents with IBS.
PMCID: PMC2673138  PMID: 17149454
Adolescents; Irritable bowel syndrome (IBS); Mind-body; Recurrent abdominal pain; Yoga
10.  Clinical Applications of Yoga for the Pediatric Population: A Systematic Review 
Academic pediatrics  2009;9(4):212-220.e1-9.
Objective
Evaluate the evidence for clinical applications of yoga among the pediatric population.
Methods
We conducted an electronic literature search including CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO, and manual search of retrieved articles from inception of database until December 2008. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) were selected including yoga or yoga-based interventions for individuals aged from 0 to 21 years of age. Data were extracted and articles critically reviewed utilizing a modified Jadad score and descriptive methodological criteria with summarization in tables.
Results
Thirty four controlled studies were identified published from 1979 to 2008, with 19 RCTS and 15 NRCTs. Many studies were of low methodological quality. Clinical areas for which yoga has been studied include physical fitness, cardio-respiratory effects, motor skills/strength, mental health and psychological disorders, behavior and development, irritable bowel syndrome, and birth outcomes following prenatal yoga. No adverse events were reported in trials reviewed. While a large majority of studies were positive, methodological limitations such as randomization methods, withdrawal/dropouts, and details of yoga intervention preclude conclusive evidence.
Conclusions
There are limited data on the clinical applications of yoga among the pediatric population. Most published controlled trials were suggestive of benefit, but results are preliminary based on low quantity and quality of trials. Further research of yoga for children utilizing a higher standard of methodology and reporting is warranted.
doi:10.1016/j.acap.2009.04.002
PMCID: PMC2844096  PMID: 19608122
yoga; complementary and alternative medicine (CAM); behavioral medicine; pediatric; children
11.  Efficacy of an Eight-Week Yoga Intervention on Symptoms of Restless Legs Syndrome (RLS): A Pilot Study 
Abstract
Background
Restless legs syndrome (RLS) is a common and highly burdensome sleep disorder. While relaxation therapies, including yoga, are often recommended for RLS management, rigorous supporting research is sparse. The goal of this preliminary study was to assess the effects of yoga on RLS symptoms and related outcomes in women with RLS.
Methods
Participants were 13 nonsmoking women with moderate to severe RLS, who did not have diabetes, sleep apnea, or other serious concomitant chronic conditions, and who were not pregnant. The intervention was a gentle, 8-week Iyengar yoga program. Core outcomes assessed pre- and post-treatment were RLS symptoms and symptom severity (International RLS Scale [IRLS] and RLS ordinal scale), sleep quality (Medical Outcomes Study Sleep Scale), mood (Profile of Mood States), and perceived stress (Perceived Stress Scale). Participants also completed yoga logs and a brief exit questionnaire regarding their experience with the study.
Results
Ten (10) women, aged 32–66 years, completed the study. Participants attended an average 13.4±0.5 (of 16 possible) classes, and completed a mean of 4.1±0.3 (of 5 possible) homework sessions/week. At follow-up, participants demonstrated striking reductions in RLS symptoms and symptom severity, with symptoms decreasing to minimal/mild in all but 1 woman and no participant scoring in the severe range by week 8. Effect sizes (Cohen's d) were large: 1.6 for IRLS total, and 2.2 for RLS ordinal scale. IRLS scores declined significantly with increasing minutes of homework practice per session (r=0.70, p=0.025) and total homework minutes (r=0.64, p<0.05), suggesting a possible dose–response relation. Participants also showed significant improvements in sleep, perceived stress, and mood (all p's≤0.02), with effect sizes ranging from 1.0 to 1.6.
Conclusions
These preliminary findings suggest that yoga may be effective in attenuating RLS symptoms and symptom severity, reducing perceived stress, and improving sleep and mood in women with RLS.
doi:10.1089/acm.2012.0330
PMCID: PMC3673587  PMID: 23270319
12.  Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial 
Trials  2010;11:36.
Background
Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.
Methods/Design
A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors.
Conclusions
This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.
Trial registration
This trial is registered in ClinicalTrials.gov, with the ID number of NCT00447668.
doi:10.1186/1745-6215-11-36
PMCID: PMC2864260  PMID: 20356395
13.  Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review 
Considerable amount of money spent in health care is used for treatments of lifestyle related, chronic health conditions, which come from behaviors that contribute to morbidity and mortality of the population. Back and neck pain are two of the most common musculoskeletal problems in modern society that have significant cost in health care. Yoga, as a branch of complementary alternative medicine, has emerged and is showing to be an effective treatment against nonspecific spinal pain. Recent studies have shown positive outcome of yoga in general on reducing pain and functional disability of the spine. The objective of this study is to conduct a systematic review of the existing research within Iyengar yoga method and its effectiveness on relieving back and neck pain (defined as spinal pain). Database research form the following sources (Cochrane library, NCBI PubMed, the Clinical Trial Registry of the Indian Council of Medical Research, Google Scholar, EMBASE, CINAHL, and PsychINFO) demonstrated inclusion and exclusion criteria that selected only Iyengar yoga interventions, which in turn, identified six randomized control trials dedicated to compare the effectiveness of yoga for back and neck pain versus other care. The difference between the groups on the postintervention pain or functional disability intensity assessment was, in all six studies, favoring the yoga group, which projected a decrease in back and neck pain. Overall six studies with 570 patients showed, that Iyengar yoga is an effective means for both back and neck pain in comparison to control groups. This systematic review found strong evidence for short-term effectiveness, but little evidence for long-term effectiveness of yoga for chronic spine pain in the patient-centered outcomes.
doi:10.4103/0973-6131.146046
PMCID: PMC4278133  PMID: 25558128
Back pain; complementary alternative medicine; effectiveness; Iyengar yoga; neck pain; randomized control trials; spine pain
14.  A pilot study of yoga as self-care for arthritis in minority communities 
Background
While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis.
Methods/design
In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months.
Discussion
There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis.
Trial registration
ClinicalTrials.gov: NCT01617421
doi:10.1186/1477-7525-11-55
PMCID: PMC3637098  PMID: 23548052
Yoga; Complementary and alternative medicine; Minority; Osteoarthritis; Rheumatoid arthritis; Self-efficacy
15.  PA03.08. A clinical study on the effect of yoga in Udavartini Vyapad w.s.r. to primary dysmenorrhoea 
Ancient Science of Life  2013;32(Suppl 2):S77.
Purpose:
1. To evaluate the role of yoga in the prevention of Udavarthini Yonivyapad 2. To observe other relative benefits after the intervention with yoga.?
Method:
It is a clinical study with a pretest and posttest design in three groups, each group comprising of 10 patients. Group A (medicine group) Group B (yoga group) Group C (yoga + medicine group) The yoga practice consisted of selected yogasanas, pranayama techniques and meditation with 2030 minutes duration for a period of 3 months with monthly assessment of improvement?.
Result:
Yoga practice has shown good results in reducing the intensity of pain by 38.24%. The other benefits observed with yoga practice were on regularizing the menstrual cycle by 43.75%. Associated symptoms of primary dysmenorrhoea got reduced by 57.14% and the premenstrual syndrome by 71.43%.?
Conclusion:
Pain was reduced markedly in yoga group when compaired to the medicine group and yoga+medicine group. The results are suggesting that efficacy in yoga group got increased in every follow up, indicating the need for continuous practice. Yoga practice regularizes the menstural cycle and also decreases the intensity of premenstural symptoms.?
doi:10.4103/0257-7941.123900
PMCID: PMC4147551
16.  A Comparative Randomised Controlled Trial of the Effects of Brain Wave Vibration Training, Iyengar Yoga, and Mindfulness on Mood, Well-Being, and Salivary Cortisol 
This randomised trial compared the effects of Brain Wave Vibration (BWV) training, which involves rhythmic yoga-like meditative exercises, with Iyengar yoga and Mindfulness. Iyengar provided a contrast for the physical components and mindfulness for the “mental” components of BWV. 35 healthy adults completed 10 75-minute classes of BWV, Iyengar, or Mindfulness over five weeks. Participants were assessed at pre- and postintervention for mood, sleep, mindfulness, absorption, health, memory, and salivary cortisol. Better overall mood and vitality followed both BWV and Iyengar training, while the BWV group alone had improved depression and sleep latency. Mindfulness produced a comparatively greater increase in absorption. All interventions improved stress and mindfulness, while no changes occurred in health, memory, or salivary cortisol. In conclusion, increased well-being followed training in all three practices, increased absorption was specific to Mindfulness, while BWV was unique in its benefits to depression and sleep latency, warranting further research.
doi:10.1155/2012/234713
PMCID: PMC3246835  PMID: 22216054
17.  A randomized controlled trial examining Iyengar yoga for young adults with rheumatoid arthritis: a study protocol 
Trials  2011;12:19.
Background
Rheumatoid arthritis is a chronic, disabling disease that can compromise mobility, daily functioning, and health-related quality of life, especially in older adolescents and young adults. In this project, we will compare a standardized Iyengar yoga program for young people with rheumatoid arthritis to a standard care wait-list control condition.
Methods/Design
Seventy rheumatoid arthritis patients aged 16-35 years will be randomized into either the 6-week Iyengar yoga program (12 - 1.5 hour sessions twice weekly) or the 6-week wait-list control condition. A 20% attrition rate is anticipated. The wait-list group will receive the yoga program following completion of the first arm of the study. We will collect data quantitatively, using questionnaires and markers of disease activity, and qualitatively using semi-structured interviews. Assessments include standardized measures of general and arthritis-specific function, pain, mood, and health-related quality of life, as well as qualitative interviews, blood pressure/resting heart rate measurements, a medical exam and the assessment of pro-inflammatory cytokines. Data will be collected three times: before treatment, post-treatment, and two months following the treatment.
Discussion
Results from this study will provide critical data on non-pharmacologic methods for enhancing function in rheumatoid arthritis patients. In particular, results will shed light on the feasibility and potential efficacy of a novel intervention for rheumatoid arthritis symptoms, paving the way for a larger clinical trial.
Trial Registration
ClinicalTrials.gov NCT01096823
doi:10.1186/1745-6215-12-19
PMCID: PMC3033352  PMID: 21255431
18.  Yoga Therapy Decreases Dyspnea-Related Distress and Improves Functional Performance in People with Chronic Obstructive Pulmonary Disease: A Pilot Study 
Background
There has been limited study of yoga training as a complementary exercise strategy to manage the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD).
Purpose
The primary purpose of this pilot study was to evaluate a yoga program for its safety, feasibility, and efficacy for decreasing dyspnea intensity (DI) and dyspnea-related distress (DD) in older adults with COPD.
Methods
Clinically stable patients with COPD (n = 29; age 69.9 ± 9.5; forced expiratory volume in 1 second (FEV1) 47.7 ± 15.6% predicted; female = 21) were randomized to a 12-week yoga program specifically designed for people with COPD or usual-care control (UC). The twice-weekly yoga program included asanas (yoga postures) and visama vritti pranayama (timed breathing). Safety measure outcomes included heart rate, oxygen saturation, dyspnea, and pain. Feasibility was measured by patient-reported enjoyment, difficulty, and adherence to yoga sessions. At baseline and at 12 weeks, DI and DD were measured during incremental cycle ergometry and a 6-minute walk (6MW) test. Secondary efficacy outcomes included physical performance, psychologic well-being, and health-related quality of life (HRQoL).
Results
Yoga training was safe and feasible for patients with COPD. While yoga training had only small effects on DI after the 6MW test (effect size [ES], 0.20; p = 0.60), there were greater reductions in DD in the yoga group compared to UC (ES, 0.67; p = 0.08). Yoga training also improved 6MW distance (+71.7 ± 21.8 feet versus −27.6 ± 36.2 feet; ES = 0.78, p = 0.04) and self-reported functional performance (ES = 0.79, p = 0.04) compared to UC. There were small positive changes in muscle strength and HRQoL.
Conclusions
Elderly patients with COPD participated safely in a 12-week yoga program especially designed for patients with this chronic illness. After the program, the subjects tolerated more activity with less DD and improved their functional performance. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.
doi:10.1089/acm.2008.0389
PMCID: PMC3051406  PMID: 19249998
19.  Yoga Therapy Decreases Dyspnea-Related Distress and Improves Functional Performance in People with Chronic Obstructive Pulmonary Disease: A Pilot Study 
Abstract
Background
There has been limited study of yoga training as a complementary exercise strategy to manage the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD).
Purpose
The primary purpose of this pilot study was to evaluate a yoga program for its safety, feasibility, and efficacy for decreasing dyspnea intensity (DI) and dyspnea-related distress (DD) in older adults with COPD.
Methods
Clinically stable patients with COPD (n = 29; age 69.9 ± 9.5; forced expiratory volume in 1 second (FEV1) 47.7 ± 15.6% predicted; female = 21) were randomized to a 12-week yoga program specifically designed for people with COPD or usual-care control (UC). The twice-weekly yoga program included asanas (yoga postures) and visama vritti pranayama (timed breathing). Safety measure outcomes included heart rate, oxygen saturation, dyspnea, and pain. Feasibility was measured by patient-reported enjoyment, difficulty, and adherence to yoga sessions. At baseline and at 12 weeks, DI and DD were measured during incremental cycle ergometry and a 6-minute walk (6MW) test. Secondary efficacy outcomes included physical performance, psychologic well-being, and health-related quality of life (HRQoL).
Results
Yoga training was safe and feasible for patients with COPD. While yoga training had only small effects on DI after the 6MW test (effect size [ES], 0.20; p = 0.60), there were greater reductions in DD in the yoga group compared to UC (ES, 0.67; p = 0.08). Yoga training also improved 6MW distance (+71.7 ± 21.8 feet versus −27.6 ± 36.2 feet; ES = 0.78, p = 0.04) and self-reported functional performance (ES = 0.79, p = 0.04) compared to UC. There were small positive changes in muscle strength and HRQoL.
Conclusions
Elderly patients with COPD participated safely in a 12-week yoga program especially designed for patients with this chronic illness. After the program, the subjects tolerated more activity with less DD and improved their functional performance. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.
doi:10.1089/acm.2008.0389
PMCID: PMC3051406  PMID: 19249998
20.  Predictors of adherence to an Iyengar yoga program in breast cancer survivors 
Context:
Despite the known health benefits of physical activity, participation rates in cancer survivor groups remain low. Researchers have attempted to identify alternative modes of nontraditional physical activities that may increase participation and adherence rates. This study investigated the determinants of yoga in breast cancer survivors.
Aim:
To examine predictors of Iyengar yoga adherence in breast cancer survivors using the theory of planned behaviour. Settings and Design: Classes were held either in Campus Recreation facilities or at the Behavioral Medicine Fitness Center at the University of Alberta in Edmonton, Canada. The study was an evaluation of an existing yoga program.
Materials and Methods:
Twenty-three post adjuvant therapy breast cancer survivors participating in a community-based, twice weekly, 12 week Iyengar yoga program were asked to complete baseline measures of the theory of planned behavior, demographic, medical, health/fitness, and psychosocial variables. Adherence was measured by objective attendance to the classes.
Statistical Analysis:
We analyzed univariate associations between predictors and yoga adherence with independent t-tests.
Results:
Adherence to the Iyengar yoga program was 63.9% and was predicted by stronger intention (P<0.001), greater self-efficacy (P=0.003), more positive instrumental attitude (Ps=0.025), higher disease stage (P=0.018), yoga experience in the past year, (P=0.044), diagnosis of a second cancer (P=0.008), lower fatigue (P=0.037), and greater happiness (P=0.023).
Conclusions:
Adherence to Iyengar yoga in breast cancer survivors was strongly related to motivational variables from the theory of planned behaviour. Researchers attempting to improve yoga adherence in breast cancer survivors may benefit from targeting the key constructs in the theory of planned behaviour.
doi:10.4103/0973-6131.91693
PMCID: PMC3276930  PMID: 22346059
Iyengar yoga; breast cancer; survivorship; correlates; adherence; theory of planned behavior
21.  Reducing the Symptomatology of Panic Disorder: The Effects of a Yoga Program Alone and in Combination with Cognitive-Behavioral Therapy 
Introduction: Yoga is a holistic system of different mind–body practices that can be used to improve mental and physical health. It has been shown to reduce perceived stress and anxiety as well as improve mood and quality of life. Research documenting the therapeutic benefits of yoga has grown progressively for the past decades and now includes controlled trials on a variety of mental health conditions such as depression, anxiety, and panic disorder.
Objectives: The primary goal of this study was to investigate the effects of yoga in patients suffering from panic disorder. We aimed at observing the efficacy of yoga techniques on reducing the symptomatology of panic disorder (anxiety and agoraphobia), compared to a combined intervention of yoga and psychotherapy.
Method: Twenty subjects previously diagnosed with panic disorder were selected. Subjects were randomly assigned to both experimental groups: Group 1 (G1-Yoga: 10 subjects) attended yoga classes and Group 2 (G2-CBT + Yoga: 10 subjects) participated in a combined intervention of yoga practice followed by a cognitive-behavioral therapy (CBT) session. Both interventions occurred weekly for 100 min and lasted 2 months. Subjects were evaluated two times during the study: pre-test and post-test. Psychometric tools included the Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HAM-A), The Panic Beliefs Inventory (PBI), and Body Sensations Questionnaire (BSQ).
Results: Statistical analysis showed significant reductions in anxiety levels associated with panic disorder (G1: BAI – p = 0.035, HAM-A – p = 0.000; G2: BAI – p = 0.002, HAM-A – p = 0.000), panic-related beliefs (G1: PBI – p = 0.000; G2: PBI – p = 0.000) and panic-related body sensations (G1: BSQ – p = 0.000; G2: BSQ – p = 0.000) both in G1 and G2. However, the combination of yoga and CBT (G2) showed even further reductions in all observed parameters (mean values).
Conclusion: This study observed significant improvement in panic symptomatology following both the practice of yoga and the combination of yoga and psychotherapy. While contemplative techniques such as yoga promote a general change in dealing with private events, CBT teaches how to modify irrational beliefs and specific cognitive distortions. The results observed in G2 might indicate that the techniques complemented each other, increasing the intervention efficacy. These findings are in agreement with many investigations found in the literature which observed improvements in different mental health parameters after the practice of contemplative techniques alone or combined to psychotherapy. Future research joining psychological and physiological variables could help better elucidate the mechanisms through which mind-body practices work to improve mental health.
doi:10.3389/fpsyt.2014.00177
PMCID: PMC4259001  PMID: 25538634
anxiety; cognitive-behavioral therapy; contemplative practice; panic disorder; yoga
22.  Yoga in adult cancer: a pilot survey of attitudes and beliefs among oncologists 
Current Oncology  2015;22(1):13-19.
Background
Depending on interest, knowledge, and skills, oncologists are adapting clinical behaviour to include integrative approaches, supporting patients to make informed complementary care decisions. The present study sought to improve the knowledge base in three ways: Test the acceptability of a self-reported online survey for oncologists.Provide preliminary data collection concerning knowledge, attitudes, beliefs, and current referral practices among oncologists with respect to yoga in adult cancer.List the perceived benefits of and barriers to yoga intervention from a clinical perspective.
Methods
A 38-item self-report questionnaire was administered online to medical, radiation, and surgical oncologists in British Columbia.
Results
Some of the 29 oncologists who completed the survey (n = 10) reported having recommended yoga to patients to improve physical activity, fatigue, stress, insomnia, and muscle or joint stiffness. Other responding oncologists were hesitant or unlikely to suggest yoga for their patients because they had no knowledge of yoga as a therapy (n = 15) or believed that scientific evidence to support its use is lacking (n = 11). All 29 respondents would recommend that their patients participate in a clinical trial to test the efficacy of yoga. In qualitative findings, oncologists compared yoga with exercise and suggested that it might have similar psychological and physical health benefits that would improve patient capacity to endure treatment. Barriers to and limitations of yoga in adult cancer are also discussed.
Conclusions
An online self-report survey is feasible, but has response rate limitations. A small number of oncologists are currently recommending yoga to improve health-related outcomes in adult cancer. Respondents would support clinical yoga interventions to improve the evidence base in cancer patients, including men and women in all tumour groups.
doi:10.3747/co.22.2129
PMCID: PMC4324339
Yoga; oncologists; surveys; cam
23.  Predictors of yoga use among internal medicine patients 
Background
Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients.
Methods
A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors.
Results
Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50–64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated with yoga use.
Conclusion
Yoga was used for their primary medical complaint by 12.19% of an internal integrative medicine patient population and was commonly perceived as beneficial. Yoga use was not associated with the patients’ specific diagnosis but with sociodemographic factors, mental health, and health locus of control. To improve adherence to yoga practice, it should be considered that male, younger, and anxious patients and those with low internal health locus of control might be less intrinsically motivated to start yoga.
doi:10.1186/1472-6882-13-172
PMCID: PMC3717114  PMID: 23849549
Yoga; Complementary therapies; Internal medicine
24.  Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome 
Preliminary findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission. The purpose of this article is to present further data on the intervention, focusing on individual differences in psychological, emotional and biological processes affecting treatment outcome. Twenty-seven women and 10 men were enrolled in the study, of whom 17 completed the intervention and pre- and post-intervention assessment data. The intervention consisted of 20 classes led by senior Iyengar yoga teachers, in three courses of 20 yoga classes each. All participants were diagnosed with unipolar major depression in partial remission. Psychological and biological characteristics were assessed pre- and post-intervention, and participants rated their mood states before and after each class. Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability in the 17 completers. Eleven out of these completers achieved remission levels post-intervention. Participants who remitted differed from the non-remitters at intake on several traits and on physiological measures indicative of a greater capacity for emotional regulation. Moods improved from before to after the yoga classes. Yoga appears to be a promising intervention for depression; it is cost-effective and easy to implement. It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study. The physiological methods are especially useful as they provide objective markers of the processes and effectiveness of treatment. These observations may help guide further clinical application of yoga in depression and other mental health disorders, and future research on the processes and mechanisms.
doi:10.1093/ecam/nel114
PMCID: PMC2176141  PMID: 18227917
anger; anxiety; baroreflex sensitivity; heart rate variability; unipolar major depression
25.  Complementary and alternative medicine for treatment of irritable bowel syndrome 
Canadian Family Physician  2009;55(2):143-148.
Abstract
OBJECTIVE
To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS).
QUALITY OF EVIDENCE
MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions.
MAIN MESSAGE
Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses.
CONCLUSION
Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.
PMCID: PMC2642499  PMID: 19221071

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