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1.  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
2.  “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
3.  A pragmatic multi-centred randomised controlled trial of yoga for chronic low back pain: Trial protocol 
A systematic review revealed three small randomised controlled trials of yoga for low back pain, all of which showed effects on back pain that favoured the yoga group. To build on these studies a larger trial, with longer term follow-up, and a number of different yoga teachers delivering the intervention is required. This study protocol describes the details of a randomised controlled trial (RCT) to determine the effectiveness and cost-effectiveness of Yoga for chronic Low Back Pain, which is funded by Arthritis Research Campaign (arc) and is being conducted by the University of York. 262 patients will be recruited from GP practices in 5 centres in England. Patients will be randomised to receive usual care or 12 weekly classes of yoga. A yoga programme will be devised that can be delivered by yoga teachers of the two main national yoga organisations in the UK (British Wheel of Yoga and Iyengar Yoga Association (UK)).
Trial registration: Current controlled trials registry ISRCTN81079604 (date registered 30/03/2007).
doi:10.1016/j.ctcp.2009.09.010
PMCID: PMC2856861  PMID: 20347837
Randomised; Trial; RCT; Yoga; Back; Pain
4.  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
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.  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
7.  Yoga for Persistent Fatigue in Breast Cancer Survivors: Results of a Pilot Study 
Approximately one-third of breast cancer survivors experiences persistent fatigue for months or years after successful treatment completion. There is a lack of evidence-based treatments for cancer-related fatigue, particularly among cancer survivors. This single-arm pilot study evaluated the feasibility and preliminary efficacy of a yoga intervention for fatigued breast cancer survivors based on the Iyengar tradition. Iyengar yoga prescribes specific poses for individuals with specific medical problems and conditions; this trial emphasized postures believed to be effective for reducing fatigue among breast cancer survivors, including inversions and backbends performed with the support of props. Twelve women were enrolled in the trial, and 11 completed the full 12-week course of treatment. There was a significant improvement in fatigue scores from pre- to post-intervention that was maintained at the 3-month post-intervention followup. Significant improvements were also observed in measures of physical function, depressed mood, and quality of life. These results support the acceptability of this intervention and suggest that it may have beneficial effects on persistent post-treatment fatigue. However, results require replication in a larger randomized controlled trial.
doi:10.1155/2011/623168
PMCID: PMC3026999  PMID: 21274288
8.  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
9.  “I Could Move Mountains” 
The Diabetes educator  2010;36(6):965-975.
Purpose
The purpose of this study was to describe firsthand experiences with yoga as shared by adults with or at risk for type 2 diabetes and to examine their beliefs regarding maintenance of yoga practice over time.
Methods
In this qualitative study, 13 adults with or at risk for type 2 diabetes described their experiences with yoga and their beliefs regarding maintenance of yoga practice over time. Semistructured interviews occurred 16 to 20 months after completion of an 8-week yoga-based clinical trial.
Results
Themes of readiness for continuing yoga, environmental support for yoga, and integrating yoga emerged through data analysis.
Conclusions
Findings indicate that yoga is appealing to some individuals with diabetes, but maintaining yoga practice over time is a challenge. Diabetes educators may be able to support maintenance by discussing specific strategies with individuals who express interest in yoga practice.
doi:10.1177/0145721710381802
PMCID: PMC3141226  PMID: 20847193
10.  Effects of Yoga Interventions on Fatigue: A Meta-Analysis 
Background. Researchers aimed at systematically reviewing and meta-analyzing the effectiveness of yoga interventions for fatigue. Methods. PubMed/Medline was searched until January 2012 for controlled clinical studies. Two reviewers independently extracted the data. The methodological quality of the studies was assessed. A meta-analysis was performed. Results. Nineteen clinical studies (total n = 948) were included in this review. Investigated yoga styles included Hatha, Iyengar, Asanas, Patanjali, Sahaja, and Tibetan yoga. Participants were suffering from cancer, multiple sclerosis, dialysis, chronic pancreatitis, fibromyalgia, asthma, or were healthy. Yoga had a small positive effect on fatigue (SMD = 0.27, 59% CI = 0.23–0.31). Seven studies received 4 points on the Jadad score. There were baseline differences in at least 5 studies. Conclusion. Overall, the effects of yoga interventions on fatigue were only small, particularly in cancer patients. Although yoga is generally a safe therapeutic intervention and effective to attenuate other health-related symptoms, this meta-analysis was not able to define the powerful effect of yoga on patients suffering from fatigue. Treatment effects of yoga could be improved in well-designed future studies. According to the GRADE recommendations assessing the overall quality of evidence, there is a moderate effect of the confidence placed in the estimates of the effects discussed here.
doi:10.1155/2012/124703
PMCID: PMC3443845  PMID: 22991569
11.  Utilization of 3-Month Yoga Program for Adults at High Risk for Type 2 Diabetes: A Pilot Study 
Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.
doi:10.1093/ecam/nep117
PMCID: PMC3096458  PMID: 19690044
12.  PA01.21. Effect of short term yoga practice on weight and blood pressure - An observational study 
Ancient Science of Life  2012;32(Suppl 1):S71.
Purpose:
Adult hood attained with paradogmic shift in life style and its own stress leading to birth of many ailments of chronic nature. Hypertension and obesity considered to trigger many fatal diseases. Yoga can be implemented as non pharmacological intervention in these problems. So to evaluate effect of yoga during short term yoga program on semi urban school teachers was carried out.
Objectives:
To assess effect of yoga techniques on body weight, systolic and diastolic blood pressure during short term practice.
Method:
55 Semi urban school teachers between age group 20 to 55 years were subjected to one week Yoga program. Yoga training was given for 2 hrs from 6am to 8am. Yoga session included ASANAS and PRANAYAM, QUICK RELAXATION TECHNIQUE (Q.R.T). Weight, Blood Pressure was recorded before yoga session on first day and on last day after yoga performance. The results were statistically analyzed.
Result:
During the study, significant result in Weight with t value 2.506 and Systolic Blood pressure with t value 2.214 at P>0.05. But no significant result in Diastolic Blood pressure was observed at P>0.05 with t value 0.413.
Discussion:
Asana like Surya Namaskara, Ardha kati chakrasana, Paada Hastasana etc may regulate lipid metabolism, calorie expenditure by muscles and soft tissue and also reduced fat accumulation may attributed to Weight reduction. Significant Drop in both systolic and diastolic blood pressure was may be due to Pranayama and Quick Relaxation Technique which helped in reducing stress and increase mental relaxation.
Conclusion:
1. Even short term yoga practice has its beneficial effect on weight and blood pressure. 2. Hence yoga therapy can be considered as potential alternative approach for the management of weight and blood pressure.
PMCID: PMC3800952
13.  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
14.  Yoga for Youth in Pain 
Holistic nursing practice  2012;26(5):262-271.
Children, adolescents, and young adults do not typically feature in clinics, studies, and mainstream notions of chronic pain. Yet many young people experience debilitating pain for extended periods of time. Chronic pain in these formative years may be especially important to treat in order for young patients to maintain life tasks and to prevent protracted disability. The Pediatric Pain Program at the University of California, Los Angeles, is a multidisciplinary treatment program designed for young people with chronic pain and their families. We offer both conventional and complementary medicine to treat the whole individual. This article describes the work undertaken in the clinic and our newly developed Yoga for Youth Research Program. The clinical and research programs fill a critical need to provide service to youth with chronic pain and to scientifically study one of the more popular complementary treatments we offer, Iyengar yoga.
doi:10.1097/HNP.0b013e318263f2ed
PMCID: PMC3493178  PMID: 22864296
chronic pain; complementary medicine; pediatrics; yoga
15.  Frequency of Yoga Practice Predicts Health: Results of a National Survey of Yoga Practitioners 
Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits.
doi:10.1155/2012/983258
PMCID: PMC3425136  PMID: 22927885
16.  YOGA FOR CHRONIC LOW BACK PAIN IN A PREDOMINANTLY MINORITY POPULATION: A PILOT RANDOMIZED CONTROLLED TRIAL 
Background
Several studies suggest yoga may be effective for chronic low back pain; however, trials targeting minorities have not been conducted.
Primary Study Objectives
Assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain. Collect preliminary data to plan a larger powered study.
Study Design
Pilot randomized controlled trial.
Setting
Two community health centers in a racially diverse neighborhood of Boston, Massachusetts.
Participants
Thirty English-speaking adults (mean age 44 years, 83% female, 83% racial/ethnic minorities; 48% with incomes ≤$30000) with moderate-to-severe chronic low back pain.
Interventions
Standardized series of weekly hatha yoga classes for 12 weeks compared to a waitlist usual care control.
Outcome Measures
Feasibility measured by time to complete enrollment, proportion of racial/ethnic minorities enrolled, retention rates, and adverse events. Primary efficacy outcomes were changes from baseline to 12 weeks in pain score (0=no pain to 10=worst possible pain) and back-related function using the modified Roland-Morris Disability Questionnaire (0–23 point scale, higher scores reflect poorer function). Secondary efficacy outcomes were analgesic use, global improvement, and quality of life (SF-36).
Results
Recruitment took 2 months. Retention rates were 97% at 12 weeks and 77% at 26 weeks. Mean pain scores for yoga decreased from baseline to 12 weeks (6.7 to 4.4) compared to usual care, which decreased from 7.5 to 7.1 (P=.02). Mean Roland scores for yoga decreased from 14.5 to 8.2 compared to usual care, which decreased from 16.1 to 12.5 (P=.28). At 12 weeks, yoga compared to usual care participants reported less analgesic use (13% vs 73%, P=.003), less opiate use (0% vs 33%, P=.04), and greater overall improvement (73% vs 27%, P=.03). There were no differences in SF-36 scores and no serious adverse events.
Conclusion
A yoga study intervention in a predominantly minority population with chronic low back pain was moderately feasible and may be more effective than usual care for reducing pain and pain medication use.
PMCID: PMC2792123  PMID: 19943573
17.  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
18.  P03.05. The Yoga Empowers Seniors Study (YESS) 
Focus Area: Integrative Approaches to Care
The Yoga Empowers Seniors Study (YESS) was an intervention development study (IDS) that used biomechanical investigation (high-speed cameras, force platforms, and musculoskeletal modeling) to quantify the physical demands of yoga performance by older adults. Secondarily, the YESS used physical-performance testing, muscle-performance testing, and flexibility and balance assessments to quantify the efficacy and safety of a 32-week yoga program for ambulatory seniors. The yoga program was divided into introductory and intermediate phases, each lasting 16 weeks. The participants (N=24; mean 70.7 years of age) learned the associated yoga poses (asanas) from a yoga instructor with expertise working with seniors. In order to quantify the physical demands of the program, the participants performed the asanas at the termination of each phase while instrumented for biomechanical analysis. Follow-up physical performance and balance assessments were conducted at the end of each phase in order to determine the efficacy of the program. Outcome measures included biomechanical indices of the physical demands associated with yoga (joint range-of-motion, joint moments), measures of muscular and functional performance (stair climb, chair stand, gait, strength, and static and dynamic balance), adherence, and safety. Data from the IDS will be used to develop evidenced-based yoga prescriptions, which we postulate will be associated with fewer musculoskeletal side effects compared to non–evidence-based yoga programs. We also postulate that evidenced-based tailoring of yoga for seniors will enhance adherence and efficacy.
doi:10.7453/gahmj.2013.097CP.P03.05
PMCID: PMC3875008
19.  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
20.  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
21.  Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial 
The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY) has been purported to reduce blood pressure (BP) though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC) (based on individual dietary adjustment) on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P < .05), but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05). 24 h DBP (P < .01) and MAP (P < .05) decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.
doi:10.1093/ecam/nep130
PMCID: PMC3145370  PMID: 19734256
22.  An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia 
Journal of Pain Research  2011;4:189-201.
Objectives:
Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, depression, and hypocortisolism. To date, published studies have not investigated the effects of yoga on cortisol in FM. This pilot study used a time series design to evaluate pain, psychological variables, mindfulness, and cortisol in women with FM before and after a yoga intervention.
Methods:
Participants (n = 22) were recruited from the community to participate in a 75 minute yoga class twice weekly for 8 weeks. Questionnaires concerning pain (intensity, unpleasantness, quality, sum of local areas of pain, catastrophizing, acceptance, disability), anxiety, depression, and mindfulness were administered pre-, mid- and post-intervention. Salivary cortisol samples were collected three times a day for each of two days, pre- and post-intervention.
Results:
Repeated measures analysis of variance (ANOVA) revealed that mean ± standard deviation (SD) scores improved significantly (p < 0.05) from pre- to post-intervention for continuous pain (pre: 5.18 ± 1.72; post: 4.44 ± 2.03), pain catastrophizing (pre: 25.33 ± 14.77; post: 20.40 ± 17.01), pain acceptance (pre: 60.47 ± 23.43; post: 65.50 ± 22.93), and mindfulness (pre: 120.21 ± 21.80; post: 130.63 ± 20.82). Intention-to-treat analysis showed that median AUC for post-intervention cortisol (263.69) was significantly higher (p < 0.05) than median AUC for pre-intervention levels (189.46). Mediation analysis revealed that mid-intervention mindfulness scores significantly (p < 0.05) mediated the relationship between pre- and post-intervention pain catastrophizing scores.
Discussion:
The results suggest that a yoga intervention may reduce pain and catastrophizing, increase acceptance and mindfulness, and alter total cortisol levels in women with FM. The changes in mindfulness and cortisol levels may provide preliminary evidence for mechanisms of a yoga program for women with FM. Future studies should use an RCT design with a larger sample size.
doi:10.2147/JPR.S22761
PMCID: PMC3160832  PMID: 21887116
fibromyalgia; pain; cortisol; yoga; psychological variables
23.  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
24.  Development of the Beliefs About Yoga Scale 
Beliefs about yoga may influence participation in yoga and outcomes of yoga interventions. There is currently no scale appropriate for assessing these beliefs in the general U.S. population. This study took the first steps in developing and validating a Beliefs About Yoga Scale (BAYS) to assess beliefs about yoga that may influence people’s engagement in yoga interventions. Items were generated based on previously published research about perceptions of yoga and reviewed by experts within the psychology and yoga communities. 426 adult participants were recruited from an urban medical center to respond to these items. The mean age was 40.7 (SD = 13.5) years. Participants completed the BAYS and seven additional indicators of criterion-related validity. The BAYS demonstrated internal consistency (11 items; α = 0.76) and three factors emerged: expected health benefits, expected discomfort, and expected social norms. The factor structure was confirmed: χ2 (41, n = 213) = 72.06, p < .001; RMSEA =.06, p = .23. Criterion-related validity was supported by positive associations of the BAYS with past experiences and future intentions related to yoga. This initial analysis of the BAYS demonstrated that it is an adequately reliable and valid measure of beliefs about yoga with a three-factor structure. However, the scale may need to be modified based on the population to which it is applied.
PMCID: PMC3360551  PMID: 22398348
yoga; mind-body therapies; health; self-efficacy; behavior change; social norms
25.  Is yoga a suitable treatment for rheumatoid arthritis: current opinion 
We reviewed published literature regarding the use of yoga for managing rheumatoid arthritis to determine whether adequate evidence exists to suggest its usefulness as a therapy. A search for previous studies involving yoga and rheumatoid arthritis in PubMed yielded eight reports. These studies reported the benefits of yoga in the physical and mental health of patients with rheumatoid arthritis (RA), suggesting that yoga is a useful add-on therapy for RA patients. However, all studies showed limitations with respect to sample size, study design, description and duration of yoga intervention, and assessment tools and statistical methods used. Additionally, the studies did not attempt to understand the mechanisms underlying observed benefits. Hence, evidence suggests a definite role of yoga in RA improvement, reducing pain, improving function, and creating a positive mental state. However, detailed analysis and additional studies are necessary to verify these observations.
doi:10.2147/OAJSM.S25707
PMCID: PMC3781903  PMID: 24198591
bibliographic database search; PubMed; rheumatoid arthritis; yoga

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