1 613 144 DEVELOPMENT OF A YOGA PROGRAM FOR TYPE-2 DIABETES PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE IN INDIA. INTRODUCTION: MANY INDIANS ARE AT HIGH-RISK OF TYPE-2 DIABETES MELLITUS (T2DM). YOGA IS AN ANCIENT INDIAN MIND-BODY DISCIPLINE, THAT HAS BEEN ASSOCIATED WITH IMPROVED GLUCOSE LEVELS AND CAN HELP TO PREVENT T2DM. THE STUDY AIMED TO SYSTEMATICALLY DEVELOP A YOGA PROGRAM FOR T2DM PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE IN INDIA USING A COMPLEX INTERVENTION DEVELOPMENT APPROACH. MATERIALS AND METHODS: AS PART OF THE INTERVENTION, WE DEVELOPED A BOOKLET AND A HIGH-DEFINITION VIDEO FOR PARTICIPANTS AND A MANUAL FOR YOGA-DP INSTRUCTORS. A SYSTEMATIC ITERATIVE PROCESS WAS FOLLOWED TO DEVELOP THE INTERVENTION AND INCLUDED FIVE STEPS: (I) A SYSTEMATIC REVIEW OF THE LITERATURE TO GENERATE A LIST OF YOGIC PRACTICES THAT IMPROVES BLOOD GLUCOSE LEVELS AMONG ADULTS AT HIGH-RISK OF OR WITH T2DM, (II) VALIDATION OF IDENTIFIED YOGIC PRACTICES BY YOGA EXPERTS, (III) DEVELOPMENT OF THE INTERVENTION, (IV) CONSULTATION WITH YOGA, EXERCISE, PHYSICAL ACTIVITY, DIET, BEHAVIOR CHANGE, AND/OR DIABETES EXPERTS ABOUT THE INTERVENTION, AND (V) PRETEST THE INTERVENTION AMONG YOGA PRACTITIONERS AND LAY PEOPLE (THOSE AT RISK OF T2DM AND HAD NOT PRACTICED YOGA BEFORE) IN INDIA. RESULTS: YOGA-DP IS A STRUCTURED LIFESTYLE EDUCATION AND EXERCISE PROGRAM, PROVIDED OVER A PERIOD OF 24 WEEKS. THE EXERCISE PART IS BASED ON YOGA AND INCLUDES SHITHILIKARANA VYAYAMA (LOOSENING EXERCISES), SURYA NAMASKAR (SUN SALUTATION EXERCISES), ASANA (YOGIC POSES), PRANAYAMA (BREATHING PRACTICES), AND DHYANA (MEDITATION) AND RELAXATION PRACTICES. ONCE PARTICIPANTS COMPLETE THE PROGRAM, THEY ARE STRONGLY ENCOURAGED TO MAINTAIN A HEALTHY LIFESTYLE IN THE LONG-TERM. CONCLUSIONS: WE SYSTEMATICALLY DEVELOPED A NOVEL YOGA PROGRAM FOR T2DM PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE IN INDIA. A MULTI-CENTER FEASIBILITY RANDOMIZED CONTROLLED TRIAL IS IN PROGRESS IN INDIA. 2020 2 2764 77 YOGA PROGRAMME FOR TYPE-2 DIABETES PREVENTION (YOGA-DP) AMONG HIGH RISK PEOPLE IN INDIA: A MULTICENTRE FEASIBILITY RANDOMISED CONTROLLED TRIAL PROTOCOL. INTRODUCTION: A HUGE POPULATION IN INDIA IS AT HIGH RISK OF TYPE-2 DIABETES (T2DM). PHYSICAL ACTIVITY AND A HEALTHY DIET (HEALTHY LIFESTYLE) IMPROVE BLOOD GLUCOSE LEVELS IN PEOPLE AT HIGH RISK OF T2DM. HOWEVER, AN UNHEALTHY LIFESTYLE IS COMMON AMONG INDIANS. YOGA COVERS PHYSICAL ACTIVITY AND A HEALTHY DIET AND CAN HELP TO PREVENT T2DM. THE RESEARCH QUESTION TO BE ADDRESSED BY THE MAIN RANDOMISED CONTROLLED TRIAL (RCT) IS WHETHER A YOGA PROGRAMME FOR T2DM PREVENTION (YOGA-DP) IS EFFECTIVE IN PREVENTING T2DM AMONG HIGH RISK PEOPLE IN INDIA AS COMPARED WITH ENHANCED STANDARD CARE. IN THIS CURRENT STUDY, WE ARE DETERMINING THE FEASIBILITY OF UNDERTAKING THE MAIN RCT. INTERVENTION: YOGA-DP IS A STRUCTURED LIFESTYLE EDUCATION AND EXERCISE PROGRAMME. THE EXERCISE PART IS BASED ON YOGA AND INCLUDES SHITHILIKARANA VYAYAMA (LOOSENING EXERCISES), SURYA NAMASKAR (SUN SALUTATION EXERCISES), ASANA (YOGIC POSES), PRANAYAMA (BREATHING PRACTICES) AND DHYANA (MEDITATION) AND RELAXATION PRACTICES. METHODS AND ANALYSIS: THIS IS A MULTICENTRE, TWO-ARM, PARALLEL-GROUP, FEASIBILITY RCT WITH BLINDED OUTCOME ASSESSMENT AND INTEGRATED MIXED-METHODS PROCESS EVALUATION. ELIGIBLE PARTICIPANTS SHOULD BE AGED 18-74 YEARS, AT HIGH RISK OF T2DM (FASTING PLASMA GLUCOSE LEVEL 5.6-6.9 MMOL/L) AND SAFE TO PARTICIPATE IN PHYSICAL ACTIVITIES. AT LEAST 64 PARTICIPANTS WILL BE RANDOMISED TO INTERVENTION OR CONTROL GROUP WITH FINAL FOLLOW-UP AT 6 MONTHS. IMPORTANT PARAMETERS, NEEDED TO DESIGN THE MAIN RCT, WILL BE ESTIMATED, SUCH AS SD OF THE OUTCOME MEASURE (FASTING PLASMA GLUCOSE LEVEL AT 6-MONTH FOLLOW-UP), RECRUITMENT, INTERVENTION ADHERENCE, FOLLOW-UP, POTENTIAL CONTAMINATION AND TIME NEEDED TO CONDUCT THE STUDY. SEMISTRUCTURED QUALITATIVE INTERVIEWS WILL BE CONDUCTED WITH UP TO 20-30 PARTICIPANTS, A SAMPLE OF THOSE DECLINING TO PARTICIPATE, FOUR YOGA-DP INSTRUCTORS AND AROUND EIGHT STUDY STAFF TO EXPLORE THEIR PERCEPTIONS AND EXPERIENCES OF TAKING PART IN THE STUDY AND OF THE INTERVENTION, REASONS BEHIND NON-PARTICIPATION, EXPERIENCES OF DELIVERING THE INTERVENTION AND RUNNING THE STUDY, RESPECTIVELY. ETHICS AND DISSEMINATION: ETHICS APPROVAL HAS BEEN OBTAINED FROM THE FOLLOWING RESEARCH ETHICS COMMITTEES: FACULTY OF MEDICINE AND HEALTH SCIENCES, UNIVERSITY OF NOTTINGHAM (UK); CENTRE FOR CHRONIC DISEASE CONTROL (CCDC, INDIA); BAPU NATURE CURE HOSPITAL AND YOGASHRAM (BNCHY, INDIA) AND SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA (S-VYASA, INDIA). THE RESULTS WILL BE WIDELY DISSEMINATED AMONG KEY STAKEHOLDERS THROUGH VARIOUS AVENUES. TRIAL REGISTRATION NUMBER: CTRI/2019/05/018893. 2020 3 2763 42 YOGA PROGRAM FOR TYPE 2 DIABETES PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE: QUALITATIVE STUDY TO EXPLORE REASONS FOR NON-PARTICIPATION IN A FEASIBILITY RANDOMIZED CONTROLLED TRIAL IN INDIA. BACKGROUND: YOGA-BASED INTERVENTIONS CAN BE EFFECTIVE IN PREVENTING TYPE 2 DIABETES MELLITUS (T2DM). WE DEVELOPED A YOGA PROGRAM FOR T2DM PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE AND CONDUCTED A FEASIBILITY RANDOMIZED CONTROLLED TRIAL (RCT) IN INDIA. THE OBJECTIVE OF THIS STUDY WAS TO IDENTIFY AND EXPLORE WHY POTENTIAL PARTICIPANTS DECLINED TO PARTICIPATE IN THE FEASIBILITY RCT. METHODS: AN EXPLORATORY QUALITATIVE STUDY, USING SEMI-STRUCTURED INTERVIEWS, WAS CONDUCTED AT A YOGA CENTER IN NEW DELHI, INDIA. FOURTEEN PEOPLE (10 WOMEN AND FOUR MEN) WHO DECLINED TO PARTICIPATE IN THE FEASIBILITY RCT WERE INTERVIEWED, AND 13 OF THEM COMPLETED THE NON-PARTICIPANT QUESTIONNAIRE, WHICH CAPTURED THEIR SOCIO-DEMOGRAPHICS, DIETS, PHYSICAL ACTIVITIES, AND REASONS FOR DECLINING. RESULTS: THREE TYPES OF BARRIERS WERE IDENTIFIED AND EXPLORED WHICH PREVENTED PARTICIPATION IN THE FEASIBILITY RCT: (1) PERSONAL BARRIERS, SUCH AS LACK OF TIME, PERCEIVED SUFFICIENCY OF KNOWLEDGE, PREFERENCES ABOUT SELF-MANAGEMENT OF HEALTH, AND TRUST IN OTHER TRADITIONAL AND ALTERNATIVE THERAPIES; (2) CONTEXTUAL BARRIERS, SUCH AS SOCIAL INFLUENCES AND LACK OF AWARENESS ABOUT PREVENTIVE CARE; AND (3) STUDY-RELATED BARRIERS, SUCH AS LACK OF STUDY INFORMATION, POOR ACCESSIBILITY TO THE YOGA SITE, AND LACK OF TRUST IN THE STUDY METHODS AND INTERVENTION. CONCLUSIONS: WE IDENTIFIED AND EXPLORED PERSONAL, CONTEXTUAL, AND STUDY-RELATED BARRIERS TO PARTICIPATION IN A FEASIBILITY RCT IN INDIA. THE FINDINGS WILL HELP TO ADDRESS RECRUITMENT CHALLENGES IN FUTURE YOGA AND OTHER RCTS. CLINICAL TRIAL REGISTRATION:WWW.CLINICALTRIALS.GOV, IDENTIFIER: CTRI/2019/05/018893. 2021 4 1251 45 FEASIBILITY TRIAL OF YOGA PROGRAMME FOR TYPE 2 DIABETES PREVENTION (YOGA-DP) AMONG HIGH-RISK PEOPLE IN INDIA: A QUALITATIVE STUDY TO EXPLORE PARTICIPANTS' TRIAL- AND INTERVENTION-RELATED BARRIERS AND FACILITATORS. YOGA-BASED INTERVENTIONS CAN BE EFFECTIVE IN PREVENTING TYPE 2 DIABETES MELLITUS (T2DM). WE DEVELOPED A YOGA PROGRAMME FOR T2DM PREVENTION (YOGA-DP) AND CONDUCTED A FEASIBILITY RANDOMISED CONTROLLED TRIAL (RCT) AMONG HIGH-RISK PEOPLE IN INDIA. THIS QUALITATIVE STUDY'S OBJECTIVE WAS TO IDENTIFY AND EXPLORE PARTICIPANTS' TRIAL- AND INTERVENTION-RELATED BARRIERS AND FACILITATORS. THE FEASIBILITY TRIAL WAS CONDUCTED AT TWO YOGA CENTRES IN NEW DELHI AND BENGALURU, INDIA. IN THIS QUALITATIVE STUDY, 25 TRIAL PARTICIPANTS (13 INTERVENTION GROUP, 12 CONTROL GROUP) WERE RECRUITED FOR SEMI-STRUCTURED INTERVIEWS. DATA WERE ANALYSED USING DEDUCTIVE LOGIC AND AN INTERPRETATIVE PHENOMENOLOGICAL APPROACH. AMONGST INTERVENTION AND CONTROL PARTICIPANTS, KEY BARRIERS TO TRIAL PARTICIPATION WERE INADEQUATE INFORMATION ABOUT RECRUITMENT AND RANDOMISATION PROCESSES AND THE NEGATIVE INFLUENCE OF NON-PARTICIPANTS. FREE BLOOD TESTS TO AID T2DM PREVENTION, SITE STAFF'S FRIENDLY BEHAVIOUR AND FRIENDS' POSITIVE INFLUENCE FACILITATED TRIAL PARTICIPATION. AMONGST INTERVENTION PARTICIPANTS, READABILITY AND UNDERSTANDING OF THE PROGRAMME BOOKLETS, DISLIKE OF THE YOGA DIARY, POOR QUALITY YOGA MATS, DIFFICULTY IN USING THE PROGRAMME VIDEO, HOUSEHOLD COMMITMENT DURING HOME SESSIONS, UNPLANNED TRAVEL, DIFFICULTY IN PRACTISING YOGA POSES, HESITATION IN ATTENDING PROGRAMME SESSIONS WITH THE YOGA-DP INSTRUCTOR OF THE OPPOSITE SEX AND MIXED-SEX GROUP PROGRAMME SESSIONS WERE KEY BARRIERS TO INTERVENTION PARTICIPATION. ADEQUATE INFORMATION WAS PROVIDED ON T2DM PREVENTION AND SELF-CARE, GOOD VENUE AND OTHER SUPPORT PROVIDED FOR PROGRAMME SESSIONS, YOGA-DP INSTRUCTORS' POSITIVE BEHAVIOUR AND IMPROVEMENTS IN PHYSICAL AND MENTAL WELL-BEING FACILITATED INTERVENTION PARTICIPATION. IN CONCLUSION, WE IDENTIFIED AND EXPLORED PARTICIPANTS' TRIAL- AND INTERVENTION-RELATED BARRIERS AND FACILITATORS. WE IDENTIFIED AN ALMOST EQUAL NUMBER OF BARRIERS (N = 12) AND FACILITATORS (N = 13); HOWEVER, INTERVENTION-RELATED BARRIERS AND FACILITATORS WERE GREATER THAN FOR PARTICIPATING IN THE TRIAL. THESE FINDINGS WILL INFORM THE DESIGN OF THE PLANNED DEFINITIVE RCT DESIGN AND INTERVENTION AND CAN ALSO BE USED TO DESIGN OTHER YOGA INTERVENTIONS AND RCTS. 2022 5 103 42 A PILOT CROSS-SECTIONAL SURVEY ON AWARENESS AND PRACTICE REGARDING TYPE 2 DIABETES MELLITUS AND ITS MANAGEMENT WITH YOGA. DIABETES MELLITUS IS A METABOLIC DISORDER OF MULTIPLE ETIOLOGY, CHARACTERIZED BY CHRONIC HYPERGLYCAEMIA WITH DISTURBANCE OF CARBOHYDRATE, FAT, AND PROTEIN METABOLISM RESULTING FROM DEFECT IN INSULIN SECRETION, INSULIN ACTION OR BOTH. IMPROPER LIFESTYLE CONTRIBUTES TO THE INCREASING NUMBER OF PEOPLE AFFECTED WITH TYPE 2 DIABETES MELLITUS (T2DM). SYSTEMATIC REVIEWS ON THE MANAGEMENT OF T2DM IN ADULTS THROUGH YOGA REPORTED SIGNIFICANT IMPROVEMENTS IN MULTIPLE MODIFIABLE INDICES OF DIABETES MELLITUS MANAGEMENT INCLUDING GLYCEMIC CONTROL, LIPID LEVELS, AND BODY COMPOSITION. AWARENESS LEVELS OF A CONDITION AMONG THE POPULATION PLAY A CRITICAL ROLE IN BEHAVIOUR CHANGE. HOWEVER, STUDIES RELATED TO ASSESSING THE AWARENESS AND PRACTICE OF YOGA FOR MANAGING DISEASES ARE LIMITED. HENCE, THIS STUDY WAS FORMULATED WITH THE OBJECTIVE OF ASSESSING THE AWARENESS LEVEL AND EXTENT OF KNOWLEDGE ABOUT DIABETES MELLITUS AND ITS MANAGEMENT THROUGH YOGA. A CROSS-SECTIONAL SURVEY WITH A SAMPLE SIZE OF 317 WAS CONDUCTED USING A STRUCTURED QUESTIONNAIRE AT 5 DISTRICTS IN TAMIL NADU AND KERALA. 95% OF THE STUDY POPULATION WERE AWARE OF DIABETES MELLITUS WHILE 61.2% RESPONDED THAT DIABETES CAN BE PREVENTED BY REGULAR EXERCISE AND HEALTHY DIET. 62.4% PEOPLE PERCEIVED THAT YOGA PRACTICES CAN PREVENT DIABETES MELLITUS AND 59% MENTIONED THAT REGULAR YOGA PRACTICE CAN HELP IN CONTROLLING DIABETES AND PREVENT FURTHER COMPLICATIONS. ONLY 13% REPORTED TO PRACTICE YOGA REGULARLY AT LEAST THREE DAYS A WEEK. IDENTIFYING A QUALIFIED YOGA TRAINER WAS REPORTED TO BE A LIMITING FACTOR FOR REGULAR YOGA PRACTICE. THE STUDY SUGGESTED THAT THERE IS A NEED TO INCREASE THE ACCESS TO QUALIFIED YOGA PROFESSIONALS AT COMMUNITY LEVEL. FURTHER LARGE SCALE STUDIES WITH RANDOM SAMPLING METHOD TO ASSESS THE AWARENESS LEVEL AND PRACTICE OF YOGA IN DIFFERENT SETTINGS IS INDICATED. 2020 6 606 31 DEVELOPMENT AND VALIDATION OF YOGA PROGRAM FOR PATIENTS WITH TYPE 2 DIABETES MELLITUS (T2DM). THIS STUDY WITH AIM OF DEVELOPMENT AND VALIDATION OF A YOGA PROGRAM FOR PATIENTS WITH T2DM WAS CARRIED IN VIEW OF EMERGING EVIDENCE OF YOGA AS AN ALTERNATIVE AND/OR COMPLEMENTARY TREATMENT. CLASSICAL AND CONTEMPORARY YOGA TEXTS WERE REVIEWED FOR IDENTIFICATION OF YOGA PRACTICES. AFTER REVIEWING RESEARCH PAPERS AND YOGA TEXTS A THREE-STEP YOGA PROGRAM, IN ORDER OF INCREASING DIFFICULTY LEVEL FOR T2DM WAS PREPARED. FOR VALIDATION OF YOGA PROGRAM, MIXED METHODS APPROACH INTEGRATING QUALITATIVE AND QUANTITATIVE INPUTS WAS CONSIDERED. EIGHTEEN EXPERTS OVER THREE ROUNDS OF ITERATION CONTRIBUTED TOWARD VALIDATION OF YOGA PROGRAM. A FINAL SET OF THREE-STEP YOGA PROGRAM WAS OBTAINED WHICH FURTHER NEEDS TO BE TESTED IN STANDARDIZED RANDOMIZED CONTROLLED TRIALS.TRIAL REGISTRATION WITH INDIAN COUNCIL OF MEDICAL RESEARCH: CLINICAL TRIAL REGISTRY OF INDIA; ICMR-CTRI: DEVELOPMENT AND VALIDATION STUDY: CTRI/2013/11/004163. 2022 7 549 22 CONTEXTUALIZING THE EFFECTS OF YOGA THERAPY ON DIABETES MANAGEMENT: A REVIEW OF THE SOCIAL DETERMINANTS OF PHYSICAL ACTIVITY. THIS ARTICLE PROVIDES A REVIEW OF LITERATURE BOTH TO IDENTIFY THE EFFECTS OF YOGA-BASED THERAPY ON THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS AND TO EXAMINE THE SOCIAL CONTEXT OF PHYSICAL ACTIVITY. FINDINGS FROM THE REVIEW INDICATE THAT YOGA HAS A POSITIVE SHORT-TERM EFFECT ON MULTIPLE DIABETES-RELATED OUTCOMES; HOWEVER, LONG-TERM EFFECTS OF YOGA THERAPY ON DIABETES MANAGEMENT REMAIN UNCLEAR. THE CONTEXT OF THE SOCIAL ENVIRONMENT, INCLUDING INTERPERSONAL RELATIONSHIPS, COMMUNITY CHARACTERISTICS, AND DISCRIMINATION, INFLUENCES THE ADOPTION AND MAINTENANCE OF HEALTH BEHAVIORS SUCH AS PHYSICAL ACTIVITY, INCLUDING YOGA PRACTICE. FURTHER RESEARCH IS NECESSARY TO DETERMINE THE EXTENT OF THIS INFLUENCE. 2008 8 2452 45 YOGA AS A COMPLEMENTARY THERAPY FOR ADULTS WITH TYPE 2 DIABETES: DESIGN AND RATIONALE OF THE HEALTHY, ACTIVE, AND IN CONTROL (HA1C) STUDY. DIABETES IS THE SEVENTH LEADING CAUSE OF DEATH IN THE UNITED STATES. FOR MOST PATIENTS, MEDICATION ALONE IS NOT SUFFICIENT TO ACHIEVE GLYCEMIC CONTROL; ATTENTION MUST ALSO BE PAID TO MULTIPLE HEALTHY BEHAVIORS INCLUDING DIET, REGULAR PHYSICAL ACTIVITY, AND STRESS MANAGEMENT. YOGA, A MINDFULNESS PRACTICE WITH EMPHASIS ON RELAXATION, MEDITATION, AND DEEP BREATHING, MAY HAVE SPECIAL RELEVANCE TO PEOPLE WITH TYPE 2 DIABETES MELLITUS (T2DM). YOGA PRACTICE MAY POSITIVELY AFFECT STRESS AND OTHER SELF-CARE TASKS THAT WILL CONTRIBUTE TO IMPROVED GLYCEMIC CONTROL. THE HEALTHY, ACTIVE, AND IN CONTROL (HA1C) STUDY IS DESIGNED TO EXAMINE THE FEASIBILITY AND ACCEPTABILITY OF YOGA AMONG ADULT PATIENTS WITH T2DM. IN THIS PILOT RANDOMIZED CONTROLLED TRIAL, ADULTS WITH T2DM WERE RANDOMLY ASSIGNED TO EITHER A 12-WEEK IYENGAR YOGA INTERVENTION GIVEN TWICE WEEKLY, OR A TWICE-WEEKLY 12-WEEK PROGRAM OF TRADITIONAL EXERCISE (E.G., WALKING, STATIONARY CYCLING). ASSESSMENTS ARE CONDUCTED AT THE END OF TREATMENT (12 WEEKS) AND AT 3 AND 6 MONTHS POSTINTERVENTION. THE HA1C STUDY WILL ASSESS FEASIBILITY AND ACCEPTABILITY (E.G., ATTENDANCE/RETENTION RATES, SATISFACTION WITH PROGRAM), GLYCEMIC OUTCOMES (E.G., HBA1C, FASTING BLOOD GLUCOSE, POSTPRANDIAL BLOOD GLUCOSE), AND CHANGES IN PHYSIOLOGICAL (E.G., SALIVARY CORTISOL) AND BEHAVIORAL FACTORS (E.G., PHYSICAL ACTIVITY, DIET) RELEVANT TO THE MANAGEMENT OF T2DM. FOCUS GROUPS ARE CONDUCTED AT THE END OF THE INTERVENTION TO EXPLORE PARTICIPANTS' EXPERIENCE WITH THE PROGRAM AND THEIR PERCEPTION OF THE POTENTIAL UTILITY OF YOGA FOR DIABETES MANAGEMENT. 2018 9 1303 31 HATHA YOGA PRACTICE FOR TYPE 2 DIABETES MELLITUS PATIENTS: A PILOT STUDY. OBJECTIVE: THIS STUDY WAS CONDUCTED TO EXAMINE THE IMPACT OF HATHA YOGA ON GLYCEMIC CONTROL, PSYCHOLOGICAL AND PHYSIOLOGICAL STRESS, AND SELF-CARE FOR INDIVIDUALS WITH TYPE 2 DIABETES MELLITUS (T2DM). METHODS: TEN SEDENTARY INDIVIDUALS WITH T2DM WHO WERE NON-INSULIN DEPENDENT, FREE OF DIABETES-RELATED COMPLICATIONS, AND HAD NO PREVIOUS YOGA EXPERIENCE COMPLETED THERAPEUTIC YOGA CLASSES FOR 6 WEEKS, 3 TIMES PER WEEK . GLYCEMIC CONTROL MEASURES INCLUDED FASTING BLOOD GLUCOSE, GLYCATED HEMOGLOBIN, AND FASTING INSULIN. THE STATE-TRAIT ANXIETY INVENTORY, PERCEIVED STRESS SCALE, AND SALIVARY CORTISOL WERE USED TO ASSESS LEVELS OF STRESS, AND THE SUMMARY OF DIABETES SELF-CARE ACTIVITIES QUESTIONNAIRE WAS USED TO ASSESS REGIMEN ADHERENCE. RESULTS: NO SIGNIFICANT CHANGES IN GLUCOSE CONTROL OR PHYSIOLOGICAL STRESS WERE FOUND; HOWEVER, SIGNIFICANT CHANGES IN PERCEIVED STRESS, STATE ANXIETY, AND SELF-CARE BEHAVIORS WERE DETECTED. CONCLUSIONS: PRELIMINARY FINDINGS SUPPORT FURTHER INVESTIGATION OF THE BENEFITS OF HATHA YOGA AS A COMPLEMENTARY THERAPY FOR THOSE WITH T2DM. 2013 10 1661 34 NARRATIVE REVIEW OF YOGA INTERVENTION CLINICAL TRIALS INCLUDING WEIGHT-RELATED OUTCOMES. CONTEXT: MEDICAL AUTHORITIES HAVE IDENTIFIED OBESITY AS A CAUSAL FACTOR IN THE DEVELOPMENT OF DIABETES, HYPERTENSION, AND CARDIOVASCULAR DISEASE (CVD), AND MORE BROADLY, OF METABOLIC SYNDROME/INSULIN RESISTANCE SYNDROME. TO PROVIDE SOLUTIONS THAT CAN MODIFY THIS RISK FACTOR, RESEARCHERS NEED TO IDENTIFY METHODS OF EFFECTIVE RISK REDUCTION AND PRIMARY PREVENTION OF OBESITY. RESEARCH ON THE EFFECTIVENESS OF YOGA AS A TREATMENT FOR OBESITY IS LIMITED, AND STUDIES VARY IN OVERALL QUALITY AND METHODOLOGICAL RIGOR. OBJECTIVE: THIS NARRATIVE REVIEW ASSESSED THE QUANTITY AND QUALITY OF CLINICAL TRIALS OF YOGA AS AN INTERVENTION FOR WEIGHT LOSS OR AS A MEANS OF RISK REDUCTION OR TREATMENT FOR OBESITY AND DISEASES IN WHICH OBESITY IS A CAUSAL FACTOR. THIS REVIEW SUMMARIZED THE STUDIES' RESEARCH DESIGNS AND EVALUATED THE EFFICACY OF YOGA FOR WEIGHT LOSS VIA THE CURRENT EVIDENCE BASE. DESIGN: THE RESEARCH TEAM EVALUATED PUBLISHED STUDIES TO DETERMINE THE APPROPRIATENESS OF RESEARCH DESIGNS, COMPARABILITY OF PROGRAMS' INTERVENTION ELEMENTS, AND STANDARDIZATION OF OUTCOME MEASURES. THE RESEARCH TEAM'S LITERATURE SEARCH USED THE KEY TERMS YOGA AND OBESITY OR YOGA AND WEIGHT LOSS IN THREE PRIMARY MEDICAL-LITERATURE DATABASES (PUBMED, PSYCHINFO, AND WEB OF SCIENCE). THE STUDY EXCLUDED CLINICAL TRIALS WITH NO QUANTITATIVE OBESITY RELATED MEASURE. EXTRACTED DATA INCLUDED EACH STUDY'S (1) DESIGN; (2) SETTING AND POPULATION; (3) NATURE, DURATION, AND FREQUENCY OF INTERVENTIONS; (4) COMPARISON GROUPS; (5) RECRUITMENT STRATEGIES; (6) OUTCOME MEASURES; (7) DATA ANALYSIS AND PRESENTATION; AND (8) RESULTS AND CONCLUSIONS. THE RESEARCH TEAM DEVELOPED AN OVERALL EVALUATION PARAMETER TO COMPARE DISPARATE TRIALS. OUTCOME MEASURES: THE RESEARCH TEAM REVIEWED EACH STUDY TO DETERMINE ITS KEY FEATURES, EACH WORTH A SPECIFIED NUMBER OF POINTS, WITH A MAXIMUM TOTAL OF 20 POINTS. THE FEATURES INCLUDED A STUDY'S (1) DURATION, (2) FREQUENCY OF YOGA PRACTICE, (3) INTENSITY OF (LENGTH OF) EACH PRACTICE, (4) NUMBER OF YOGIC ELEMENTS, (5) INCLUSION OF DIETARY MODIFICATION, (6) INCLUSION OF A RESIDENTIAL COMPONENT, (7) THE NUMBER OF WEIGHT-RELATED OUTCOME MEASURES, AND (8) A DISCUSSION OF THE DETAILS OF THE YOGIC ELEMENTS. RESULTS: OVERALL, THERAPEUTIC YOGA PROGRAMS ARE FREQUENTLY EFFECTIVE IN PROMOTING WEIGHT LOSS AND/OR IMPROVEMENTS IN BODY COMPOSITION. THE EFFECTIVENESS OF YOGA FOR WEIGHT LOSS IS RELATED TO THE FOLLOWING KEY FEATURES: (1) AN INCREASED FREQUENCY OF PRACTICE; (2) A LONGER INTERVENTION DURATION (3) A YOGIC DIETARY COMPONENT; (4) A RESIDENTIAL COMPONENT; (5) THE COMPREHENSIVE INCLUSION OF YOGIC COMPONENTS; (5) AND A HOME-PRACTICE COMPONENT. CONCLUSIONS: YOGA APPEARS TO BE AN APPROPRIATE AND POTENTIALLY SUCCESSFUL INTERVENTION FOR WEIGHT MAINTENANCE, PREVENTION OF OBESITY, AND RISK REDUCTION FOR DISEASES IN WHICH OBESITY PLAYS A SIGNIFICANT CAUSAL ROLE. 2013 11 1707 37 PATTERNS OF YOGA PRACTICE AND PHYSICAL ACTIVITY FOLLOWING A YOGA INTERVENTION FOR ADULTS WITH OR AT RISK FOR TYPE 2 DIABETES. BACKGROUND: THE CURRENT STUDY DESCRIBED PATTERNS OF YOGA PRACTICE AND EXAMINED DIFFERENCES IN PHYSICAL ACTIVITY OVER TIME BETWEEN INDIVIDUALS WITH OR AT RISK FOR TYPE 2 DIABETES WHO COMPLETED AN 8-WEEK YOGA INTERVENTION COMPARED WITH CONTROLS. METHODS: A LONGITUDINAL COMPARATIVE DESIGN MEASURED THE EFFECT OF A YOGA INTERVENTION ON YOGA PRACTICE AND PHYSICAL ACTIVITY, USING DATA AT BASELINE AND POSTINTERVENTION MONTHS 3, 6, AND 15. RESULTS: DISPARATE PATTERNS OF YOGA PRACTICE OCCURRED BETWEEN INTERVENTION AND CONTROL PARTICIPANTS OVER TIME, BUT THE SUBJECTIVE DEFINITION OF YOGA PRACTICE LIMITS INTERPRETATION. MULTILEVEL MODEL ESTIMATES INDICATED THAT TREATMENT GROUP DID NOT HAVE A SIGNIFICANT INFLUENCE IN THE RATE OF CHANGE IN PHYSICAL ACTIVITY OVER THE STUDY PERIOD. WHILE AGE AND EDUCATION WERE NOT SIGNIFICANT INDIVIDUAL PREDICTORS, THE INCLUSION OF THESE VARIABLES IN THE MODEL DID IMPROVE FIT. CONCLUSIONS: FINDINGS INDICATE THAT AN 8-WEEK YOGA INTERVENTION HAD LITTLE EFFECT ON PHYSICAL ACTIVITY OVER TIME. FURTHER RESEARCH IS NECESSARY TO EXPLORE THE INFLUENCE OF YOGA ON BEHAVIORAL HEALTH OUTCOMES AMONG INDIVIDUALS WITH OR AT RISK FOR TYPE 2 DIABETES. 2012 12 2353 40 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. 2011 13 204 32 A REVIEW OF YOGA PROGRAMS FOR FOUR LEADING RISK FACTORS OF CHRONIC DISEASES. YOGA, A FORM OF PHYSICAL ACTIVITY, IS RAPIDLY GAINING IN POPULARITY AND HAS MANY HEALTH BENEFITS. YET HEALTHCARE PROVIDERS HAVE BEEN SLOW TO RECOGNIZE YOGA FOR ITS ABILITY TO IMPROVE HEALTH CONDITIONS, AND FEW INTERVENTIONS HAVE BEEN DEVELOPED THAT TAKE FULL ADVANTAGE OF ITS BENEFITS. THE PURPOSE OF THIS ARTICLE IS TO REVIEW PUBLISHED STUDIES USING YOGA PROGRAMS AND TO DETERMINE THE EFFECT OF YOGA INTERVENTIONS ON COMMON RISK FACTORS OF CHRONIC DISEASES (OVERWEIGHT, HYPERTENSION, HIGH GLUCOSE LEVEL AND HIGH CHOLESTEROL). A SYSTEMATIC SEARCH YIELDED 32 ARTICLES PUBLISHED BETWEEN 1980 AND APRIL 2007. THE STUDIES FOUND THAT YOGA INTERVENTIONS ARE GENERALLY EFFECTIVE IN REDUCING BODY WEIGHT, BLOOD PRESSURE, GLUCOSE LEVEL AND HIGH CHOLESTEROL, BUT ONLY A FEW STUDIES EXAMINED LONG-TERM ADHERENCE. ADDITIONALLY, NOT ENOUGH STUDIES INCLUDED DIVERSE POPULATIONS AT HIGH RISK FOR DIABETES AND ITS RELATED COMMON HEALTH PROBLEMS. 2007 14 2025 29 SYSTEMATIC REVIEW OF YOGA INTERVENTIONS TO PROMOTE CARDIOVASCULAR HEALTH IN OLDER ADULTS. THE BENEFITS OF PHYSICAL ACTIVITY ARE WELL ESTABLISHED, YET FEW OLDER ADULTS ENGAGE IN ADEQUATE PHYSICAL ACTIVITY TO OPTIMIZE HEALTH. WHILE YOGA MAY REDUCE THE RISK OF CARDIOVASCULAR DISEASE, FEW STUDIES HAVE FOCUSED ON THE EFFICACY OF YOGA-BASED PHYSICAL ACTIVITY TO PROMOTE CARDIOVASCULAR HEALTH IN OLDER ADULTS. THE OBJECTIVE OF THIS REVIEW IS TO PROVIDE AN EVALUATION OF YOGA INTERVENTIONS TO REDUCE CARDIOVASCULAR RISK IN OLDER ADULTS. FOUR DATABASES WERE SEARCHED FOR RANDOMIZED CONTROLLED TRIALS OF YOGA INTERVENTIONS IN OLDER ADULTS. STUDIES WITH CARDIOVASCULAR OUTCOMES WERE INCLUDED. LITERATURE SEARCHES IDENTIFIED NINE ARTICLES ELIGIBLE FOR REVIEW. SIGNIFICANT HEALTH BENEFITS WERE REPORTED, INCLUDING FAVORABLE CHANGES IN BLOOD PRESSURE, BODY COMPOSITION, GLUCOSE, AND LIPIDS. YOGA PRACTICES, PARTICIPANT CHARACTERISTICS, AND OUTCOME MEASURES WERE VARIABLE. THERE WAS LIMITED USE OF THEORY. YOGA IS SAFE AND FEASIBLE IN OLDER ADULTS; ADDITIONAL RESEARCH IS WARRANTED TO EXAMINE THE SPECIFIC COMPONENTS OF YOGA INTERVENTIONS ESSENTIAL TO REDUCING CARDIOVASCULAR RISK. 2016 15 1370 41 IMPACT OF A STRUCTURED YOGA PROGRAM ON BLOOD PRESSURE REDUCTION AMONG HYPERTENSIVE PATIENTS: STUDY PROTOCOL FOR A PRAGMATIC RANDOMIZED MULTICENTER TRIAL IN PRIMARY HEALTH CARE SETTINGS IN NEPAL. BACKGROUND: HYPERTENSION CONTROL REMAINS A MAJOR GLOBAL CHALLENGE. THE BEHAVIORAL APPROACHES RECOMMENDED FOR BLOOD PRESSURE REDUCTION ARE STRESS REDUCTION, INCREASED EXERCISE AND HEALTHY DIETARY HABITS. SOME STUDY FINDINGS SUGGEST THAT YOGA HAS A BENEFICIAL EFFECT IN REDUCING BLOOD PRESSURE. HOWEVER, THE ROLE OF YOGA ON BLOOD PRESSURE HAS RECEIVED LITTLE ATTENTION IN EXISTING HEALTH CARE PRACTICES IN DEVELOPING COUNTRIES. THIS STUDY WILL BE CONDUCTED IN PRIMARY HEALTH CARE FACILITIES IN NEPAL TO ASSESS THE EFFECTIVENESS OF A PRAGMATIC YOGA INTERVENTION TO COMPLEMENT STANDARD PRACTICE IN FURTHER REDUCING BLOOD PRESSURE. METHODS: THIS WILL BE MULTICENTRIC, TWO ARMS, RANDOMIZED, NONBLINDED, PRAGMATIC TRIAL. IT WILL BE CONDUCTED IN SEVEN DISTRICT AYURVEDA HEALTH CENTERS (DAHCS) IN NEPAL BETWEEN JULY 2017 AND JUNE 2018. THE STUDY PARTICIPANTS WILL CONSIST OF HYPERTENSIVE PATIENTS WITH OR WITHOUT ANTIHYPERTENSIVE MEDICATION ATTENDING TO THE OUTPATIENT DEPARTMENT (OPD). ONE HUNDRED AND FORTY PARTICIPANTS WILL BE RANDOMIZED TO TREATMENT OR CONTROL GROUPS BY USING A STRATIFIED BLOCK RANDOMIZATION. AT THE STUDY SITE, THE TREATMENT ARM PARTICIPANTS WILL RECEIVE AN INTERVENTION CONSISTING OF FIVE DAYS OF STRUCTURED YOGA TRAINING AND PRACTICE OF THE SAME PACKAGE AT HOME WITH A RECOMMENDATION OF FIVE DAYS A WEEK FOR THE FOLLOWING 90 DAYS. BOTH THE INTERVENTION AND CONTROL GROUPS WILL RECEIVE TWO HOURS OF HEALTH EDUCATION ON LIFESTYLE MODIFICATIONS. THE PRIMARY OUTCOME OF THIS TRIAL WILL BE THE CHANGE IN SYSTOLIC BLOOD PRESSURE AND IT WILL BE ASSESSED AFTER 90 DAYS OF THE INTERVENTION. DISCUSSION: THIS STUDY WILL ESTABLISH THE EXTENT TO WHICH A YOGA INTERVENTION PACKAGE CAN HELP REDUCE BLOOD PRESSURE IN HYPERTENSIVE PATIENTS. IF PROVEN EFFECTIVE, STUDY FINDINGS MAY BE USED TO RECOMMEND THE GOVERNING BODIES AND OTHER STAKEHOLDERS FOR THE INTEGRATION OF YOGA IN THE NATIONAL HEALTHCARE SYSTEM FOR THE TREATMENT AND CONTROL OF HYPERTENSION. TRIAL REGISTRATION: CLINICAL TRIAL REGISTRY- INDIA (CTRI); CTRI REG. NO- CTRI/2017/02/007822 . REGISTERED ON 10/02/2017. 2018 16 2416 30 YOGA AND MEDITATION IN CARDIOVASCULAR DISEASE. YOGA IS A HOLISTIC MIND-BODY INTERVENTION AIMED AT PHYSICAL, MENTAL, EMOTIONAL AND SPIRITUAL WELL BEING. SEVERAL STUDIES HAVE SHOWN THAT YOGA AND/OR MEDITATION CAN CONTROL RISK FACTORS FOR CARDIOVASCULAR DISEASE LIKE HYPERTENSION, TYPE II DIABETES AND INSULIN RESISTANCE, OBESITY, LIPID PROFILE, PSYCHOSOCIAL STRESS AND SMOKING. SOME RANDOMIZED STUDIES SUGGEST THAT YOGA/MEDITATION COULD RETARD OR EVEN REGRESS EARLY AND ADVANCED CORONARY ATHEROSCLEROSIS. A RECENT STUDY SUGGESTS THAT TRANSCENDENTAL MEDITATION MAY BE EXTREMELY USEFUL IN SECONDARY PREVENTION OF CORONARY HEART DISEASE AND MAY REDUCE CARDIOVASCULAR EVENTS BY 48% OVER A 5-YEAR PERIOD. ANOTHER SMALL STUDY SUGGESTS THAT YOGA MAY BE HELPFUL IN PREVENTION OF ATRIAL FIBRILLATION. HOWEVER, MOST STUDIES HAVE SEVERAL LIMITATIONS LIKE LACK OF ADEQUATE CONTROLS, SMALL SAMPLE SIZE, INCONSISTENCIES IN BASELINE AND DIFFERENT METHODOLOGIES, ETC. AND THEREFORE LARGE TRIALS WITH IMPROVED METHODOLOGIES ARE REQUIRED TO CONFIRM THESE FINDINGS. HOWEVER, IN VIEW OF THE EXISTING KNOWLEDGE AND YOGA BEING A COST-EFFECTIVE TECHNIQUE WITHOUT SIDE EFFECTS, IT APPEARS APPROPRIATE TO INCORPORATE YOGA/MEDITATION FOR PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE. 2014 17 501 48 COMMUNITY BASED YOGA CLASSES FOR TYPE 2 DIABETES: AN EXPLORATORY RANDOMISED CONTROLLED TRIAL. BACKGROUND: YOGA IS A POPULAR THERAPY FOR DIABETES BUT ITS EFFICACY IS CONTESTED. THE AIM OF THIS STUDY WAS TO EXPLORE THE FEASIBILITY OF RESEARCHING COMMUNITY BASED YOGA CLASSES IN TYPE 2 DIABETES WITH A VIEW TO INFORMING THE DESIGN OF A DEFINITIVE, MULTI-CENTRE TRIAL METHODS: THE STUDY DESIGN WAS AN EXPLORATORY RANDOMISED CONTROLLED TRIAL WITH IN-DEPTH PROCESS EVALUATION. THE SETTING WAS TWO MULTI-ETHNIC BOROUGHS IN LONDON, UK; ONE WITH AVERAGE AND ONE WITH LOW MEAN SOCIO-ECONOMIC DEPRIVATION SCORE. CLASSES WERE HELD AT A SPORTS CENTRE OR GP SURGERY. PARTICIPANTS WERE 59 PEOPLE WITH TYPE 2 DIABETES NOT TAKING INSULIN, RECRUITED FROM GENERAL PRACTICE LISTS OR OPPORTUNISTICALLY BY GENERAL PRACTICE STAFF. THE INTERVENTION GROUP WERE OFFERED 12 WEEKS OF A TWICE-WEEKLY 90-MINUTE YOGA CLASS; THE CONTROL GROUP WAS A WAITING LIST FOR THE YOGA CLASSES. BOTH GROUPS RECEIVED ADVICE AND LEAFLETS ON HEALTHY LIFESTYLE AND WERE ENCOURAGED TO EXERCISE. PRIMARY OUTCOME MEASURE WAS HBA1C. SECONDARY OUTCOME MEASURES INCLUDED ATTENDANCE, WEIGHT, WAIST CIRCUMFERENCE, LIPID LEVELS, BLOOD PRESSURE, UKPDS CARDIOVASCULAR RISK SCORE, DIABETES-RELATED QUALITY OF LIFE (ADDQOL), AND SELF-EFFICACY. PROCESS MEASURES WERE ATTENDANCE AT YOGA SESSIONS, SELF-REPORTED FREQUENCY OF PRACTICE BETWEEN TAUGHT SESSIONS, AND QUALITATIVE DATA (INTERVIEWS WITH PATIENTS AND THERAPISTS, ETHNOGRAPHIC OBSERVATION OF THE YOGA CLASSES, AND ANALYSIS OF DOCUMENTS INCLUDING MINUTES OF MEETINGS, CORRESPONDENCE, AND EXERCISE PLANS). RESULTS: DESPITE BROAD INCLUSION CRITERIA, AROUND TWO-THIRDS OF THE PATIENTS ON GP DIABETIC REGISTERS PROVED INELIGIBLE, AND 90% OF THE REMAINDER DECLINED TO PARTICIPATE. MEAN AGE OF PARTICIPANTS WAS 60 +/- 10 YEARS. ATTENDANCE AT YOGA CLASSES WAS AROUND 50%. NOBODY DID THE EXERCISES REGULARLY AT HOME. YOGA TEACHERS FELT THAT MOST PARTICIPANTS WERE UNSUITABLE FOR 'STANDARD' YOGA EXERCISES BECAUSE OF LIMITED FLEXIBILITY, LACK OF BASIC FITNESS, CO-MORBIDITY, AND LACK OF CONFIDENCE. THERE WAS A SMALL FALL IN HBA1C IN THE YOGA GROUP WHICH WAS NOT STATISTICALLY SIGNIFICANT AND WHICH WAS NOT SUSTAINED SIX MONTHS LATER, AND NO SIGNIFICANT CHANGE IN OTHER OUTCOME MEASURES. CONCLUSION: THE BENEFITS OF YOGA IN TYPE 2 DIABETES SUGGESTED IN SOME PREVIOUS STUDIES WERE NOT CONFIRMED. POSSIBLE EXPLANATIONS (APART FROM LACK OF EFFICACY) INCLUDE RECRUITMENT CHALLENGES; PRACTICAL AND MOTIVATIONAL BARRIERS TO CLASS ATTENDANCE; PHYSICAL AND MOTIVATIONAL BARRIERS TO ENGAGING IN THE EXERCISES; INADEQUATE INTENSITY AND/OR DURATION OF YOGA INTERVENTION; AND INSUFFICIENT PERSONALISATION OF EXERCISES TO INDIVIDUAL NEEDS. ALL THESE FACTORS SHOULD BE CONSIDERED WHEN DESIGNING FUTURE TRIALS. TRIAL REGISTRATION: NATIONAL RESEARCH REGISTER (1410) AND CURRENT CONTROLLED TRIALS (ISRCTN63637211). 2009 18 1552 36 LIFESTYLE MODIFICATION IN BLOOD PRESSURE STUDY II (LIMBS): STUDY PROTOCOL OF A RANDOMIZED CONTROLLED TRIAL ASSESSING THE EFFICACY OF A 24 WEEK STRUCTURED YOGA PROGRAM VERSUS LIFESTYLE MODIFICATION ON BLOOD PRESSURE REDUCTION. HYPERTENSION IS A MAJOR PUBLIC HEALTH ISSUE AFFECTING 68 MILLION ADULTS IN THE UNITED STATES. LIFESTYLE MODIFICATIONS INCLUDING COMPLEMENTARY THERAPIES SUCH AS THE MOVEMENT BASED MIND BODY PRACTICE OF YOGA HAVE BECOME INCREASINGLY POPULAR IN THE UNITED STATES AND HAVE BEEN CONSIDERED AS A POTENTIAL ALTERNATIVE TO MEDICATION IN BLOOD PRESSURE REDUCTION. WE COMPLETED A PILOT STUDY IN 2009 WHICH SHOWED MEANINGFUL DECREASES IN 24-HOUR AMBULATORY BLOOD PRESSURE READINGS AFTER A 12 WEEK PERIOD OF YOGA PARTICIPATION. BASED ON DATA FROM OUR PILOT STUDY WE ARE NOW COMPLETING THE LIFESTYLE MODIFICATION AND BLOOD PRESSURE STUDY (LIMBS II) WHICH IS A PHASE 2 RANDOMIZED CONTROLLED TRIAL DESIGNED TO DETERMINE THE EFFECTS OF YOGA THERAPY AND ENHANCED LIFESTYLE MODIFICATION ON LOWERING BLOOD PRESSURE IN PRE-HYPERTENSIVE AND STAGE 1 HYPERTENSIVE SUBJECTS. USING 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING, LIMBS II AIMS TO COMPARE THE EFFECTS ON BLOOD PRESSURE REDUCTION IN SUBJECTS RANDOMIZED FOR 24 WEEKS TO ONE OF THE THREE FOLLOWING GROUPS: YOGA THERAPY VERSUS BLOOD PRESSURE EDUCATION PROGRAM (SODIUM RESTRICTION AND WALKING PROGRAM) VERSUS A COMBINATION PROGRAM THAT INVOLVES COMPONENTS OF BOTH GROUPS. LIMBS II WILL ALSO EXAMINE THE IMPACT THAT CHANGES IN BLOOD PRESSURE HAVE ON CEREBRAL BLOOD FLOW. IF SUCCESSFUL, THE LIMBS STUDY WILL DETERMINE IF YOGA THERAPY COMBINED WITH ENHANCED LIFESTYLE MODIFICATION WILL RESULT IN CLINICALLY MEANINGFUL DECREASES IN BLOOD PRESSURE AND THUS CAN BE IMPLEMENTED AS AN ALTERNATIVE TO DRUG THERAPY FOR PATIENTS WITH PREHYPERTENSION AND STAGE 1 HYPERTENSION. 2013 19 2742 38 YOGA PRACTICE FOR THE MANAGEMENT OF TYPE II DIABETES MELLITUS IN ADULTS: A SYSTEMATIC REVIEW. THE EFFECT OF PRACTICING YOGA FOR THE MANAGEMENT OF TYPE II DIABETES WAS ASSESSED IN THIS SYSTEMATIC REVIEW THROUGH SEARCHING RELATED ELECTRONIC DATABASES AND THE GREY LITERATURE TO THE END OF MAY 2007 USING OVID. ALL RANDOMIZED CONTROLLED CLINICAL TRIALS (RCTS) COMPARING YOGA PRACTICE WITH OTHER TYPE OF INTERVENTION OR WITH REGULAR PRACTICE OR BOTH, WERE INCLUDED REGARDLESS OF LANGUAGE OR TYPE OF PUBLICATION. EACH STUDY WAS ASSESSED FOR QUALITY BY TWO INDEPENDENT REVIEWERS. MEAN DIFFERENCE WAS USED FOR SUMMARIZING THE EFFECT OF EACH STUDY OUTCOMES WITH 95% CONFIDENCE INTERVALS. POOLING OF THE STUDIES DID NOT TAKE PLACE DUE TO THE WIDE CLINICAL VARIATION BETWEEN THE STUDIES. PUBLICATION BIAS WAS ASSESSED BY STATISTICAL METHODS. FIVE TRIALS WITH 363 PARTICIPANTS MET THE INCLUSION CRITERIA WITH MEDIUM TO HIGH RISK OF BIAS AND DIFFERENT INTERVENTION CHARACTERISTICS. THE STUDIES' RESULTS SHOW IMPROVEMENT IN OUTCOMES AMONG PATIENTS WITH DIABETES TYPE II. THESE IMPROVEMENTS WERE MAINLY AMONG SHORT TERM OR IMMEDIATE DIABETES OUTCOMES AND NOT ALL WERE STATISTICALLY SIGNIFICANT. THE RESULTS WERE INCONCLUSIVE AND NOT SIGNIFICANT FOR THE LONG-TERM OUTCOMES. NO ADVERSE EFFECTS WERE REPORTED IN ANY OF THE INCLUDED STUDIES. SHORT-TERM BENEFITS FOR PATIENTS WITH DIABETES MAY BE ACHIEVED FROM PRACTICING YOGA. FURTHER RESEARCH IS NEEDED IN THIS AREA. FACTORS LIKE QUALITY OF THE TRIALS AND OTHER METHODOLOGICAL ISSUES SHOULD BE IMPROVED BY LARGE RANDOMIZED CONTROL TRIALS WITH ALLOCATION CONCEALMENT TO ASSESS THE EFFECTIVENESS OF YOGA ON DIABETES TYPE II. A DEFINITIVE RECOMMENDATION FOR PHYSICIANS TO ENCOURAGE THEIR PATIENTS TO PRACTICE YOGA CANNOT BE REACHED AT PRESENT. 2010 20 178 48 A RANDOMIZED CONTROLLED TRIAL OF THE EFFECT OF YOGA AND PEER SUPPORT ON GLYCAEMIC OUTCOMES IN WOMEN WITH TYPE 2 DIABETES MELLITUS: A FEASIBILITY STUDY. BACKGROUND: TYPE TWO DIABETES IS A COMPLEX AND DEMANDING CHRONIC DISEASE AND ITS IMPACT IN A STATE (KERALA) WHICH LEADS INDIA IN TERMS OF THE NUMBER OF PEOPLE WITH DIABETES IS PROFOUND. THOUGH THE MALE TO FEMALE RATIO AMONG THE PEOPLE WITH DIABETES IS ROUGHLY EQUAL, WOMEN ARE UNIQUELY AND MORE SEVERELY AFFECTED. MANAGEMENT OF TYPE TWO DIABETES REQUIRES CONSIDERABLE DEXTERITY ON THE PART OF THE PATIENT TO MANAGE DRUGS, DIET AND EXERCISE. THEREFORE, IN A LOW MIDDLE-INCOME COUNTRY LIKE INDIA IT IS NECESSARY TO LOOK AT LOW COST INTERVENTIONS THAT CAN EMPOWER THE PATIENT AND BUILD ON AVAILABLE RESOURCES TO HELP MANAGE DIABETES. HENCE, WE STUDIED THE FEASIBILITY AND EFFECT OF TWO LOW COST INTERVENTIONS; YOGA AND PEER SUPPORT ON GLYCAEMIC AND OTHER OUTCOMES AMONG WOMEN WITH TYPE TWO DIABETES. METHODS: AN OPEN LABEL PARALLEL THREE ARMED RANDOMIZED CONTROL TRIAL WAS CONDUCTED AMONG 124 RECRUITED WOMEN WITH DIABETES FOR THREE MONTHS. BLOCK RANDOMIZATION WITH A BLOCK LENGTH OF SIX WAS CARRIED OUT WITH EACH GROUP HAVING AT LEAST 41 WOMEN. IN THE YOGA ARM, SESSIONS BY AN INSTRUCTOR, CONSISTING OF A GROUP OF POSTURES COORDINATED WITH BREATHING WERE CONDUCTED FOR AN HOUR, TWO DAYS A WEEK. IN THE PEER SUPPORT ARM EACH PEER MENTOR AFTER TRAINING VISITED 13-14 WOMEN WITH DIABETES EVERY WEEK FOLLOWED BY A PHONE CALL. THE MEETING WAS ABOUT APPLYING DISEASE MANAGEMENT OR PREVENTION PLANS IN DAILY LIFE. RESULTS: THERE WAS A TREND IN DECLINE OF FASTING PLASMA GLUCOSE IN THE PEER AND YOGA GROUP AND OF GLYCOSYLATED HAEMOGLOBIN (HBA1C) IN THE YOGA GROUP ONLY, THOUGH NOT SIGNIFICANT. A SIGNIFICANT DECREASE WAS OBSERVED IN DIASTOLIC BLOOD PRESSURE AND HIP CIRCUMFERENCE IN THE YOGA GROUP. THE PROCESS INDICATED THAT MOST (80%) OF THE WOMEN IN THE YOGA GROUP ATTENDED CLASSES REGULARLY AND 90% OF THE WOMEN IN THE PEER GROUP REPORTED THAT PEER MENTORING WAS USEFUL. CONCLUSION: THE EFFECT OF YOGA AND PEER SUPPORT ON GLYCAEMIC OUTCOMES WAS INCREMENTAL. LONGER TERM STUDIES ARE NECESSARY TO ASCERTAIN THE BENEFITS SHOWN BY THIS FEASIBILITY STUDY. TRIAL REGISTRATION: CTRI/2011/12/002227 DATED 14/12/2011. 2017