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1.  Effect of 12 weeks of yoga training on the somatization, psychological symptoms, and stress-related biomarkers of healthy women 
Background
Previous studies have shown that the practice of yoga reduces perceived stress and negative feelings and that it improves psychological symptoms. Our previous study also suggested that long-term yoga training improves stress-related psychological symptoms such as anxiety and anger. However, little is known about the beneficial effects of yoga practice on somatization, the most common stress-related physical symptoms, and stress-related biomarkers. We performed a prospective, single arm study to examine the beneficial effects of 12 weeks of yoga training on somatization, psychological symptoms, and stress-related biomarkers.
Methods
We recruited healthy women who had no experience with yoga. The data of 24 participants who were followed during 12 weeks of yoga training were analyzed. Somatization and psychological symptoms were assessed before and after 12 weeks of yoga training using the Profile of Mood State (POMS) and the Symptom Checklist-90-Revised (SCL-90-R) questionnaires. Urinary 8-hydroxydeoxyguanosine (8-OHdG), biopyrrin, and cortisol levels were measured as stress-related biomarkers. The Wilcoxon signed-rank test was used to compare the stress-related biomarkers and the scores of questionnaires before and after 12 weeks of yoga training.
Results
After 12 weeks of yoga training, all negative subscale scores (tension-anxiety, depression, anger-hostility, fatigue, and confusion) from the POMS and somatization, anxiety, depression, and hostility from the SCL-90-R were significantly decreased compared with those before starting yoga training. Contrary to our expectation, the urinary 8-OHdG concentration after 12 weeks of yoga training showed a significant increase compared with that before starting yoga training. No significant changes were observed in the levels of urinary biopyrrin and cortisol after the 12 weeks of yoga training.
Conclusions
Yoga training has the potential to reduce the somatization score and the scores related to mental health indicators, such as anxiety, depression, anger, and fatigue. The present findings suggest that yoga can improve somatization and mental health status and has implications for the prevention of psychosomatic symptoms in healthy women.
Trial registration
University Hospital Medical Information Network (UMIN CTR) UMIN000007868.
doi:10.1186/1751-0759-8-1
PMCID: PMC3892034  PMID: 24383884
Yoga; Somatization; Psychological symptom; Stress; Biomarker; Anxiety; Depression; Anger; Hostility; Fatigue
2.  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
3.  Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial 
Biopsychosocial Medicine  2014;8(1):27.
Background
Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments.
Methods
This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n = 15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions (yoga group, n = 15) for approximately two months. The short-term effect of isometric yoga on fatigue was assessed by administration of the Profile of Mood Status (POMS) questionnaire immediately before and after the final 20-minute session with the instructor. The long-term effect of isometric yoga on fatigue was assessed by administration of the Chalder’s Fatigue Scale (FS) questionnaire to both groups before and after the intervention. Adverse events and changes in subjective symptoms were recorded for subjects in the yoga group.
Results
All subjects completed the intervention. The mean POMS fatigue score decreased significantly (from 21.9 ± 7.7 to 13.8 ± 6.7, P < 0.001) after a yoga session. The Chalder’s FS score decreased significantly (from 25.9 ± 6.1 to 19.2 ± 7.5, P = 0.002) in the yoga group, but not in the control group. In addition to the improvement of fatigue, two patients with CFS and fibromyalgia syndrome in the yoga group also reported pain relief. Furthermore, many subjects reported that their bodies became warmer and lighter after practicing isometric yoga. Although there were no serious adverse events in the yoga group, two patients complained of tiredness and one of dizziness after the first yoga session with the instructor.
Conclusions
Isometric yoga as an add-on therapy is both feasible and successful at relieving the fatigue and pain of a subset of therapy-resistant patients with CFS.
Trial registration
University Hospital Medical Information Network (UMIN CTR) UMIN000009646.
doi:10.1186/s13030-014-0027-8
PMCID: PMC4269854  PMID: 25525457
Chronic fatigue syndrome; Isometric yoga; Fatigue; Treatment; Fibromyalgia
4.  Effect of integrated yoga practices on immune responses in examination stress – A preliminary study 
International Journal of Yoga  2011;4(1):26-32.
Background:
Stress is often associated with an increased occurrence of autonomic, cardiovascular, and immune system pathology. This study was done to evaluate the impact of stress on psychological, physiological parameters, and immune system during medical term -academic examination and the effect of yoga practices on the same.
Materials and Methods:
The study was carried out on sixty first-year MBBS students randomly assigned to yoga group and control group (30 each). The yoga group underwent integrated yoga practices for 35 minutes daily in the presence of trained yoga teacher for 12 weeks. Control group did not undergo any kind of yoga practice or stress management. Physiological parameters like heart rate, respiratory rate, and blood pressure were measured. Global Assessment of Recent Stress Scale and Spielbergers State Anxiety score were assessed at baseline and during the examination. Serum cortisol levels, IL-4, and IFN-γ levels were determined by enzyme-linked immunosorbent assay technique.
Result:
In the yoga group, no significant difference was observed in physiological parameters during the examination stress, whereas in the control group, a significant increase was observed. Likewise, the indicators of psychological stress showed highly significant difference in control group compared with significant difference in yoga group. During the examination, the increase in serum cortical and decrease in serum IFN-γ in yoga group was less significant (P<0.01) than in the control group (P<0.001). Both the groups demonstrated an increase in serum IL-4 levels, the changes being insignificant for the duration of the study.
Conclusion:
Yoga resists the autonomic changes and impairment of cellular immunity seen in examination stress.
doi:10.4103/0973-6131.78178
PMCID: PMC3099098  PMID: 21654972
Cell-mediated immune responses; IL-4; IFN-γ; state anxiety score; stress; yoga
5.  Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study 
European Spine Journal  2010;20(3):408-413.
The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case–control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A validated grading scale was used to grade the condition of cervical and lumbar discs seen in magnetic resonance imaging of the spine, and the resulting data analyzed statistically. The mean number of years of yoga practice for the yoga group was 12.9 ± 7.5. The overall (cervical + lumbar) disc scores of the yoga group were significantly lower (indicating less degenerative disc disease) than those of the control group (P < 0.001). The scores for the cervical vertebral discs of the yoga group were also significantly lower than those of the control group (P < 0.001), while the lower scores for the yoga group in the lumbar group approached, but did not reach, statistical significance (P = 0.055). The scores for individual discs of yoga practitioners showed significantly less degenerative disease at three disc levels, C3/C4, L2/L3 and L3/L4 (P < 0.05). Magnetic resonance imaging showed that the group of long-term practitioners of yoga studied had significantly less degenerative disc disease than a matched control group.
doi:10.1007/s00586-010-1547-y
PMCID: PMC3048237  PMID: 20711844
Yoga; Disc degenerative disease (DDD); Neck pain; Low back pain; MRI
6.  Effect of yoga on mental health: Comparative study between young and senior subjects in Japan 
Background:
Japan has a large number of senior citizens. Yoga can be wisely applied in old age care. There is no any age restriction to practice yoga. The effect may differ by age. There is a need to study the mechanism of action of yoga with respect to age.
Aim:
This study was conducted in Japan to find the effect of yoga on mental health between young and senior people.
Materials and Methods:
Twenty-five normal healthy volunteers of both sexes were divided into two groups according to age. Fifteen participants of the age group between 65 to 75 years and 10 participants of the age group between 20 to 30 years were selected. This study was approved by the ethical committee of Kawasaki University of Medical Welfare. Selected individuals were subjected to 90 min of yoga classes once or twice a week for a month. Salivary amylase activity was assessed before and after yoga practice. State Trait Anxiety Inventory (STAI) was given before yoga on the first day and after one month of practice to assess the change in State anxiety and Trait anxiety.
Results
Senior group – Salivary amylase activity decreased from 111.2±42.7 to 83.48±39.5 kU/L [average±standard deviation]. Younger group – Salivary amylase activity reduced from 60.74±31.8 to 42.39±24 kU/L. Senior group – State anxiety score decreased from 41.13 ±8.43 to 30.8±6.49, Trait anxiety score reduced from 45.66±7.5 to 40.73±8.3. Younger group – State anxiety score reduced from 38.7±4.8 to 30.8±4.1,Trait anxiety score reduced from 46.2±7.9 to 42.9±9.1. Changes were statistically significant with P<0.05.
Conclusion:
Decrease in Salivary amylase activity may be due to reduction in sympathetic response. Reduction in State and Trait anxiety score signifies that yoga has both immediate as well as long-term effect on anxiety reduction. Thus yoga helps to improve the mental health in both the groups.
doi:10.4103/0973-6131.78173
PMCID: PMC3099103  PMID: 21654969
Salivary amylase activity; state trait anxiety inventory; stress; yoga
7.  Effects of Yoga Interventions on Fatigue in Cancer Patients and Survivors: A Systematic Review of Randomized Controlled Trials 
Explore (New York, N.Y.)  2013;9(4):232-243.
Background
Fatigue is one of the most frequently reported, distressing side effects reported by cancer survivors and often has significant long-term consequences. Research indicates that yoga can produce invigorating effects on physical and mental energy, and thereby may improve levels of fatigue. The objective of this systematic review was to examine the literature that reports the effects of randomized, controlled yoga interventions on self-reported fatigue in cancer patients and survivors. The online electronic databases, PubMed and PsycINFO, were used to search for peer-reviewed research articles studying the effects of yoga interventions on fatigue in cancer survivors. Combinations of yoga, cancer, and fatigue-related search terms were entered simultaneously to obtain articles that included all three elements. Studies were included if they met the following inclusion criteria: participants were male or female cancer patients or survivors participating in randomized, controlled yoga interventions. The main outcome of interest was change in fatigue from pre- to post-intervention. Interventions of any length were included in the analysis. Risk of bias using the format of the Cochrane Collaboration’s tool for assessing risk of bias was also examined across studies.
Results
Ten articles met inclusion criteria and involved a total of 583 participants who were predominantly female, breast cancer survivors. Four studies indicated that the yoga intervention resulted in significant reductions in self-reported fatigue from pre- to post-intervention. Three of the studies reported that there were significant reductions of fatigue among participants who attended a greater number of yoga classes. Risk of bias was high for areas of adequate selection, performance, detection, and patient-reported bias and mixed for attrition and reporting bias. Risk of bias was uniformly low for other forms of bias, including financial conflicts of interest.
Conclusions
Results of the studies included in this review suggest that yoga interventions may be beneficial for reducing cancer-related fatigue in women with breast cancer; however, conclusions should be interpreted with caution as a result of levels of bias and inconsistent methods used across studies. More well-constructed randomized controlled trials are needed to determine the impact of yoga interventions on fatigue in cancer patients and survivors.
doi:10.1016/j.explore.2013.04.005
PMCID: PMC3781173  PMID: 23906102
Yoga; cancer; fatigue
8.  Increased Hatha yoga experience predicts lower body mass index and reduced medication use in women over 45 years 
International Journal of Yoga  2011;4(2):77-86.
Background:
Yoga has been shown to have many short-term health benefits, but little is known about the extent to which these benefits accrue over a long time frame or with frequent practice.
Aims:
The purpose of this study was to examine the extent to which body mass index (BMI) and medication use in a sample of female yoga practitioners over 45 years varied according to the length and frequency of yoga practice.
Materials and Methods:
We administered online surveys to 211 female yoga practitioners aged 45 to 80 years. We used regression analyses to evaluate the relationship of extent of yoga experience to both BMI and medication use after accounting for age and lifestyle factors. We also conducted comparisons with 182 matched controls.
Results:
Participants had practiced yoga for as long as 50 years and for up to 28 hours per week. There were significant inverse relationships between yoga experience and both BMI and medication load. These significant relationships remained after accounting for age and lifestyle factors. When we computed yoga experience in terms of total calendar years, without accounting for hours of practice, significant relationships did not remain. However, there was no obesity in the 49 participants with more than 25 years of yoga practice. Yoga practitioners were less likely than non-practitioners to use medication for metabolic syndrome, mood disorders, inflammation, and pain.
Conclusions:
A long-term yoga practice was associated with little or no obesity in a non-probability sample of women over 45 years. Relationships showed a dose-response effect, with increased yoga experience predicting lower BMI and reduced medication use.
doi:10.4103/0973-6131.85490
PMCID: PMC3193658  PMID: 22022126
Yoga; medication use; aging; healthy aging; women; body mass index
9.  Yoga in Australia: Results of a national survey 
International Journal of Yoga  2012;5(2):92-101.
Introduction:
The therapeutic benefits of yoga and meditation are well documented, yet little is known about the practice of yoga in Australia or elsewhere, whether as a physical activity, a form of therapy, a spiritual path or a lifestyle.
Materials and Methods:
To investigate the practice of yoga in Australia, a national survey of yoga practitioners was conducted utilizing a comprehensive web-based questionnaire. Respondents were self-selecting to participate. A total of 3,892 respondents completed the survey. Sixty overseas respondents and 1265 yoga teachers (to be reported separately) were excluded, leaving 2,567 yoga practitioner respondents.
Results:
The typical yoga survey respondent was a 41-year-old, tertiary educated, employed, health-conscious female (85% women). Asana (postures) and vinyasa (sequences of postures) represented 61% of the time spent practicing, with the other 39% devoted to the gentler practices of relaxation, pranayama (breathing techniques), meditation and instruction. Respondents commonly started practicing yoga for health and fitness but often continued practicing for stress management. One in five respondents practiced yoga for a specific health or medical reason which was seen to be improved by yoga practice. Of these, more people used yoga for stress management and anxiety than back, neck or shoulder problems, suggesting that mental health may be the primary health-related motivation for practicing yoga. Healthy lifestyle choices were seen to be more prevalent in respondents with more years of practice. Yoga-related injuries occurring under supervision in the previous 12 months were low at 2.4% of respondents.
Conclusions:
Yoga practice was seen to assist in the management of specific health issues and medical conditions. Regular yoga practice may also exert a healthy lifestyle effect including vegetarianism, non-smoking, reduced alcohol consumption, increased exercise and reduced stress with resulting cost benefits to the community.
doi:10.4103/0973-6131.98217
PMCID: PMC3410203  PMID: 22869991
Australia; cardiovascular; exercise; health; injuries; injury; medical; meditation; mental health; musculoskeletal; quality of life; survey; therapy; women's health; yoga
10.  Yoga based cardiac rehabilitation after coronary artery bypass surgery: One-year results on LVEF, lipid profile and psychological states – A randomized controlled study 
Indian Heart Journal  2014;66(5):490-502.
Objective
To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors.
Methods
In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35–65 years) who satisfied the selection criteria and consented were randomized into two groups.
Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively.
Results
Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (≥23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ≥110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety.
Conclusion
Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence.
doi:10.1016/j.ihj.2014.08.007
PMCID: PMC4223225  PMID: 25443601
Yoga; Physiotherapy; Cardiac rehabilitation; LVEF; Risk factors
11.  Can yoga practices benefit health by improving organism regulation? Evidence from electrodermal measures of acupuncture meridians 
International Journal of Yoga  2014;7(1):32-40.
Objectives:
To document and explain Yoga's effects on acupuncture meridian energies. To understand mechanisms behind Yoga's efficacy by testing links between yoga and traditional Chinese medicine.
Materials and Methods:
The study compared two groups of yoga practitioners: Novice and experienced. Novices consisted of 33 volunteers from a Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) yoga instructor training module and the experienced practitioners were 20 resident SVYASA students. The intervention was 3 weeks of a yoga training program, new for the novices, but the lifestyle of the experienced group, who were therefore assessed only once. Novices were assessed on day 2 and 23 of their program at SVYASA's Yoga Medicine Hospital, making their data a pre-post, self-as-control, prospective study. Main outcome measures were mean acumeridian energy levels assessed by AcuGraph3 measures of electrodermal resistance at acupoints; additionally, gender differences, standard deviations (SDs) of all measures, and comparison of post and experienced group data.
Results:
Averaged energy levels significantly improved in all 24 meridians (maximum P = 0.032, 4-P < 0.01, and 19-P < 0.001). Females improved more than males (P < 0.05), both ending at similar levels to experienced practitioners, whose SDs were lower than novices on 19/24 meridians (mean F = 3.715, P = 0.0022), and 4/5 average variables.
Conclusions:
AcuGraph3 electrodermal measures contain substantial information, P << 0.00001. Yoga-lifestyle practice can increase and balance acumeridian energies; long-term practice decreases group SD's. These three suggest reasons why yoga practice impacts health: One, increased prana levels are important; two and three, improved physiological regulation is the key. Further studies relating traditional Indian and Chinese medical systems are needed.
doi:10.4103/0973-6131.123477
PMCID: PMC4097913  PMID: 25035605
AcuGraph3; energy balance; energy regulation; Jing-Well points; prana; yoga
12.  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
13.  A Phase I Feasibility Study of Yoga on the Physical Health and Coping of Informal Caregivers 
Family and friends who provide unpaid care to an individual with a disease or disability (known as informal caregivers) experience numerous threats to their physical health as a result of providing care. In spite of evidence that participation in physical and leisure activities can be health promoting, informal caregivers have reported diminished or completely absent leisure participation. Hatha yoga has documented therapeutic benefits, including reduced anxiety, as well as improved muscle strength and endurance and flexibility. The purpose of this study was to determine the feasibility of conducting an 8-week yoga program with informal caregivers, and to gather pilot data on the effects of yoga on the physical fitness and coping of informal caregivers. Caregivers were randomized into a yoga intervention (n = 8) or control group (n = 9). The yoga sessions were 2.5 hours/week for 8 weeks and consisted of a variety of pranayama (breathing) and asana (postures) activities and were led by a certified yoga instructor. Four caregivers (two in each group) dropped out of the study. After the conclusion of the 8-week yoga program, lower body strength increased significantly for those in the yoga group and other notable trends occurred in terms of coping, upper body strength and aerobic endurance. Caregivers in the control group experienced an unexpected increase in lower body flexibility. These findings indicate that caregivers in a yoga program may receive some benefits. Future studies are encouraged to test the efficacy of yoga as an intervention for caregivers.
doi:10.1093/ecam/nem075
PMCID: PMC2176147  PMID: 18227920
yoga; informal caregivers; physical health; coping; pilot study
14.  Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial 
Background
Osteoarthritis (OA) is a common problem in older women that is associated with pain and disabilities. Although yoga is recommended as an exercise intervention to manage arthritis, there is limited evidence documenting its effectiveness, with little known about its long term benefits. This study’s aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA.
Methods
Eligible participants (N = 36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control. The yoga intervention program was developed by a group of yoga experts (N = 5). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks. The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey. Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks.
Results
The recruitment target was met, with study retention at 95%. Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3 [.67], 5.8 [.67]; p = .01), stiffness (4.7 [.28], 3.4 [.28]; p = .002) and SPPB (repeated chair stands) (2.0 [.23], 2.8 [.23]; p = .03) at 8 weeks. Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4 [.54]; p = .03), function (24.5 [1.8], 19.9 [1.6]; p = .01) and total scores (35.4 [2.3], 28.6 [2.1]; p = .01) from 4 to 20 weeks. Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks. Changes in BMI and QOL were not significant. No yoga related adverse events were observed.
Conclusions
A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits.
Trial registration
ClinicalTrials.gov: NCT01832155
doi:10.1186/1472-6882-14-160
PMCID: PMC4038088  PMID: 24886638
Yoga; Knee osteoarthritis; Symptom management; Older women
15.  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
16.  Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial 
Thorax  2002;57(2):110-115.
Background: Sahaja Yoga is a traditional system of meditation based on yogic principles which may be used for therapeutic purposes. A study was undertaken to assess the effectiveness of this therapy as an adjunctive tool in the management of asthma in adult patients who remained symptomatic on moderate to high doses of inhaled steroids.
Methods: A parallel group, double blind, randomised controlled trial was conducted. Subjects were randomly allocated to Sahaja yoga and control intervention groups. Both the yoga and the control interventions required the subjects to attend a 2 hour session once a week for 4 months. Asthma related quality of life (AQLQ, range 0–4), Profile of Mood States (POMS), level of airway hyperresponsiveness to methacholine (AHR), and a diary card based combined asthma score (CAS, range 0–12) reflecting symptoms, bronchodilator usage, and peak expiratory flow rates were measured at the end of the treatment period and again 2 months later.
Results: Twenty one of 30 subjects randomised to the yoga intervention and 26 of 29 subjects randomised to the control group were available for assessment at the end of treatment. The improvement in AHR at the end of treatment was 1.5 doubling doses (95% confidence interval (CI) 0.0 to 2.9, p=0.047) greater in the yoga intervention group than in the control group. Differences in AQLQ score (0.41, 95% CI –0.04 to 0.86) and CAS (0.9, 95% CI –0.9 to 2.7) were not significant (p>0.05). The AQLQ mood subscale did improve more in the yoga group than in the control group (difference 0.63, 95% CI 0.06 to 1.20), as did the summary POMS score (difference 18.4, 95% CI 0.2 to 36.5, p=0.05). There were no significant differences between the two groups at the 2 month follow up assessment.
Conclusions: This randomised controlled trial has shown that the practice of Sahaja yoga does have limited beneficial effects on some objective and subjective measures of the impact of asthma. Further work is required to understand the mechanism underlying the observed effects and to establish whether elements of this intervention may be clinically valuable in patients with severe asthma.
doi:10.1136/thorax.57.2.110
PMCID: PMC1746263  PMID: 11828038
17.  A yoga intervention for type 2 diabetes risk reduction: a pilot randomized controlled trial 
Background
Type 2 diabetes is a major health problem in many countries including India. Yoga may be an effective type 2 diabetes prevention strategy in India, particularly given its cultural familiarity.
Methods
This was a parallel, randomized controlled pilot study to collect feasibility and preliminary efficacy data on yoga for diabetes risk factors among people at high risk of diabetes. Primary outcomes included: changes in BMI, waist circumference, fasting blood glucose, postprandial blood glucose, insulin, insulin resistance, blood pressure, and cholesterol. We also looked at measures of psychological well-being including changes in depression, anxiety, positive and negative affect and perceived stress. Forty-one participants with elevated fasting blood glucose in Bangalore, India were randomized to either yoga (n = 21) or a walking control (n = 20). Participants were asked to either attend yoga classes or complete monitored walking 3–6 days per week for eight weeks. Randomization and allocation was performed using computer-generated random numbers and group assignments delivered in sealed, opaque envelopes generated by off-site study staff. Data were analyzed based on intention to treat.
Results
This study was feasible in terms of recruitment, retention and adherence. In addition, yoga participants had significantly greater reductions in weight, waist circumference and BMI versus control (weight −0.8 ± 2.1 vs. 1.4 ± 3.6, p = 0.02; waist circumference −4.2 ± 4.8 vs. 0.7 ± 4.2, p < 0.01; BMI −0.2 ± 0.8 vs. 0.6 ± 1.6, p = 0.05). There were no between group differences in fasting blood glucose, postprandial blood glucose, insulin resistance or any other factors related to diabetes risk or psychological well-being. There were significant reductions in systolic and diastolic blood pressure, total cholesterol, anxiety, depression, negative affect and perceived stress in both the yoga intervention and walking control over the course of the study.
Conclusion
Among Indians with elevated fasting blood glucose, we found that participation in an 8-week yoga intervention was feasible and resulted in greater weight loss and reduction in waist circumference when compared to a walking control. Yoga offers a promising lifestyle intervention for decreasing weight-related type 2 diabetes risk factors and potentially increasing psychological well-being.
Trial registration
ClinicalTrials.gov Identified NCT00090506.
doi:10.1186/1472-6882-14-212
PMCID: PMC4096416  PMID: 24980650
Yoga; Prediabetes; Type 2 diabetes; India; Randomized controlled pilot
18.  Long-term effect of yogic practices on diurnal metabolic rates of healthy subjects 
International Journal of Yoga  2008;1(1):27-32.
Background:
The metabolic rate is an indicator of autonomic activity. Reduced sympathetic arousal probably resulting in hypometabolic states has been reported in several yogic studies.
Aim:
The main objective of this study was to assess the effect of yoga training on diurnal metabolic rates in yoga practitioners at two different times of the day (at 6 a.m. and 9 p.m.).
Materials and Methods:
Eighty eight healthy volunteers were selected and their metabolic rates assessed at 6 a.m. and 9 p.m. using an indirect calorimeter at a yoga school in Bangalore, India. Results and conclusions: The results show that the average metabolic rate of the yoga group was 12% lower than that of the non-yoga group (P < 0.001) measured at 9 p.m. and 16% lower at 6 a.m. (P < 0.001). The 9 p.m. metabolic rates of the yoga group were almost equal to their predicted basal metabolic rates (BMRs) whereas the metabolic rate was significantly higher than the predicted BMR for the non-yoga group. The 6 a.m. metabolic rate was comparable to their predicted BMR in the non-yoga group whereas it was much lower in the yoga group (P < 0.001). The lower metabolic rates in the yoga group at 6 a.m. and 9 p.m. may be due to coping strategies for day-to-day stress, decreased sympathetic nervous system activity and probably, a stable autonomic nervous system response (to different stressors) achieved due to training in yoga.
doi:10.4103/0973-6131.36761
PMCID: PMC3144606  PMID: 21829281
Basal Metabolic Rate (BMR); decreased arousal response; yoga; yoga training
19.  Cortisol and antidepressant effects of yoga 
Indian Journal of Psychiatry  2013;55(Suppl 3):S405-S408.
Context:
Hypercortisolemia is well-known in depression and yoga has been demonstrated earlier to reduce the parameters of stress, including cortisol levels.
Aim:
We aimed to find the role of yoga as an antidepressant as well as its action on lowering the serum cortisol levels.
Settings and Design:
An open-labeled study consisting of three groups (yoga alone, yoga along with antidepressant medication and antidepressant medication alone) was conducted at a tertiary care psychiatry hospital.
Methodology:
Out-patient depressives who were not suicidal were offered yoga as a possible antidepressant therapy. A validated yoga module was used as therapy taught over a month and to be practiced at home daily. Patients were free to choose the drugs if their psychiatrist advised. Patients (n=54) were rated on Hamilton Depression Rating Scale (HDRS) with serum cortisol measurements at baseline and after 3 months. In 54 patients, assessments and blood test results were both available. 19 each received yoga alone or with drugs and 16 received drugs only. Healthy comparison subjects (n=18) too underwent morning cortisol measurements once.
Results:
Serum cortisol was higher in depressives compared with controls. In the total sample, the cortisol level dropped significantly at the end of treatment. More patients in the yoga groups had a drop in cortisol levels as compared to drug-only group. In the yoga-only group, the cortisol drop correlated with the drop in HDRS score (antidepressant effect).
Conclusion:
The findings support that yoga may act at the level of the hypothalamus by its ‘anti-stress’ effects (reducing the cortisol), to bring about relief in depression.
doi:10.4103/0019-5545.116315
PMCID: PMC3768222  PMID: 24049209
Cortisol; depression; hypercortisolemia; stress; yoga
20.  “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
21.  Randomized Controlled Clinical Trial of Yoga in the Treatment of Eating Disorders 
Purpose
This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (Anorexia Nervosa, Bulimia Nervosa, Eating Disorder Not Otherwise Specified).
Methods
50 girls and 4 boys, aged 11–21 years were randomized to an 8 week trial of standard care versus individualized yoga plus standard care. 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician/dietician appointments) was required to meet ethical guidelines. The control group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and one month follow-up included: Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State Trait Anxiety Inventory, and Food Preoccupation questionnaire.
Results
The yoga group demonstrated greater decreases in eating disordered symptoms. Specifically, the EDE scores decreased over time in the yoga group, while the control group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and dropped significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time.
Conclusions
Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately following yoga sessions. Yoga treatment did not have a negative impact on BMI. Results suggest individualized yoga therapy holds promise as adjunctive therapy to standard care.
doi:10.1016/j.jadohealth.2009.08.007
PMCID: PMC2844876  PMID: 20307823
22.  Yoga experience as a predictor of psychological wellness in women over 45 years 
International Journal of Yoga  2013;6(1):11-19.
Background:
Although high levels of subjective well-being (SWB) are common in old age, a subset of older individuals is disproportionately vulnerable to negative affect. Yoga has been shown to have many short-term benefits, but researchers have not determined whether a long-term or frequent yoga practice increasingly protects older women from low levels of psychological well-being.
Aims:
The purpose of this study was to examine the extent to which psychological attitudes, transcendence, mental mastery, and subjective vitality in a sample of female yoga practitioners over 45 years varied according to the length and frequency of yoga practice.
Materials and Methods:
We administered online surveys to a non-probability sample of 211 female yoga practitioners 45 to 80. We used weighted least squares regression analyses to evaluate the relationship of extent of yoga experience to the outcome variables after accounting for age and lifestyle factors.
Results:
Participants had practiced yoga for as long as 50 years and for up to 28 h per week. There were significant positive relationships between yoga experience and all outcome variables. These significant relationships remained after accounting for age and lifestyle factors. When we computed yoga experience in terms of total calendar years, without accounting for hours of practice, significant relationships did not remain. Transcendence of the ordinary was the most strongly associated with current yoga practice frequency, and positive psychological attitudes were the most strongly associated with total lifetime hours of practice.
Conclusions:
Among a non-probability sample of female yoga practitioners between 45 and 80 years, increased yoga experience predicted increased levels of psychological well-being. Results showed a dose-response effect, with yoga experience exercising an increasingly protective effect against low levels of SWB and vitality.
doi:10.4103/0973-6131.105937
PMCID: PMC3573537  PMID: 23440029
Aging; vitality; well-being; women; yoga
23.  Yoga for breast cancer patients and survivors: a systematic review and meta-analysis 
BMC Cancer  2012;12:412.
Background
Many breast cancer patients and survivors use yoga to cope with their disease. The aim of this review was to systematically assess and meta-analyze the evidence for effects of yoga on health-related quality of life and psychological health in breast cancer patients and survivors.
Methods
MEDLINE, PsycInfo, EMBASE, CAMBASE, and the Cochrane Library were screened through February 2012. Randomized controlled trials (RCTs) comparing yoga to controls were analyzed when they assessed health-related quality of life or psychological health in breast cancer patients or survivors. Risk of bias was assessed using the Cochrane risk of bias tool. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.
Results
Twelve RCTs with a total of 742 participants were included. Seven RCTs compared yoga to no treatment; 3 RCTs compared yoga to supportive therapy; 1 RCT compared yoga to health education; and 1 RCT compared a combination of physiotherapy and yoga to physiotherapy alone. Evidence was found for short-term effects on global health-related quality of life (SMD = 0.62 [95% CI: 0.04 to 1.21]; P = 0.04), functional (SMD = 0.30 [95% CI: 0.03 to 0.57), social (SMD = 0.29 [95% CI: 0.08 to 0.50]; P < 0.01), and spiritual well-being (SMD = 0.41 [95% CI: 0.08; 0.74]; P = 0.01). These effects were, however, only present in studies with unclear or high risk of selection bias. Short-term effects on psychological health also were found: anxiety (SMD = −1.51 [95% CI: -2.47; -0.55]; P < 0.01), depression (SMD = −1.59 [95% CI: -2.68 to −0.51]; P < 0.01), perceived stress (SMD = −1.14 [95% CI:-2.16; -0.12]; P = 0.03), and psychological distress (SMD = −0.86 [95% CI:-1.50; -0.22]; P < 0.01). Subgroup analyses revealed evidence of efficacy only for yoga during active cancer treatment but not after completion of active treatment.
Conclusions
This systematic review found evidence for short-term effects of yoga in improving psychological health in breast cancer patients. The short-term effects on health-related quality of life could not be clearly distinguished from bias. Yoga can be recommended as an intervention to improve psychological health during breast cancer treatment.
doi:10.1186/1471-2407-12-412
PMCID: PMC3527138  PMID: 22988934
Breast neoplasms; Yoga; Complementary therapies; Quality of life; Psychological health; Meta-analysis; Review
24.  The effect of long term combined yoga practice on the basal metabolic rate of healthy adults 
Background
Different procedures practiced in yoga have stimulatory or inhibitory effects on the basal metabolic rate when studied acutely. In daily life however, these procedures are usually practiced in combination. The purpose of the present study was to investigate the net change in the basal metabolic rate (BMR) of individuals actively engaging in a combination of yoga practices (asana or yogic postures, meditation and pranayama or breathing exercises) for a minimum period of six months, at a residential yoga education and research center at Bangalore.
Methods
The measured BMR of individuals practicing yoga through a combination of practices was compared with that of control subjects who did not practice yoga but led similar lifestyles.
Results
The BMR of the yoga practitioners was significantly lower than that of the non-yoga group, and was lower by about 13 % when adjusted for body weight (P < 0.001). This difference persisted when the groups were stratified by gender; however, the difference in BMR adjusted for body weight was greater in women than men (about 8 and 18% respectively). In addition, the mean BMR of the yoga group was significantly lower than their predicted values, while the mean BMR of non-yoga group was comparable with their predicted values derived from 1985 WHO/FAO/UNU predictive equations.
Conclusion
This study shows that there is a significantly reduced BMR, probably linked to reduced arousal, with the long term practice of yoga using a combination of stimulatory and inhibitory yogic practices.
doi:10.1186/1472-6882-6-28
PMCID: PMC1564415  PMID: 16945127
25.  Effect of yoga on quality of life of CLBP patients: A randomized control study 
International Journal of Yoga  2010;3(1):10-17.
Context:
In two of the earlier Randomized Control Trials on yoga for chronic lower back pain (CLBP), 12 to 16 weeks of intervention were found effective in reducing pain and disability.
Aim:
To study the efficacy of a residential short term intensive yoga program on quality of life in CLBP.
Materials and Methods:
About 80 patients with CLBP (females 37) registered for a week long treatment at SVYASA Holistic Health Centre in Bengaluru, India. They were randomized into two groups (40 each). The yoga group practiced a specific module for CLBP comprising of asanas (physical postures), pranayama (breathing practices), meditation and lectures on yoga philosophy. The control group practiced physical therapy exercises for back pain.
Perceived stress scale (PSS) was used to measure baseline stress levels. Outcome measures were WHOQOL Bref for quality of life and straight leg raising test (SLR) using a Goniometer.
Results:
There were significant negative correlations (Pearson’s, P<0.005, r>0.30) between baseline PSS with all four domains and the total score of WHOQOLBref. All the four domains’ WHOQOLBref improved in the yoga group (repeated measures ANOVA P=0.001) with significant group*time interaction (P<0.05) and differences between groups (P<0.01). SLR increased in both groups (P=0.001) with higher increase in yoga (31.1 % right, 28.4 % left) than control (18.7% right, 21.5 % left) group with significant group*time interaction (SLR right leg P=0.044).
Conclusion:
In CLBP, a negative correlation exists between stress and quality of life. Yoga increases quality of life and spinal flexibility better than physical therapy exercises.
doi:10.4103/0973-6131.66773
PMCID: PMC2952119  PMID: 20948896
Chronic low back pain; flexibility; quality of life; stress; yoga

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