1 2857 175 YOGA-BASED CARDIAC REHABILITATION AFTER ACUTE MYOCARDIAL INFARCTION: A RANDOMIZED TRIAL. BACKGROUND: GIVEN THE SHORTAGE OF CARDIAC REHABILITATION (CR) PROGRAMS IN INDIA AND POOR UPTAKE WORLDWIDE, THERE IS AN URGENT NEED TO FIND ALTERNATIVE MODELS OF CR THAT ARE INEXPENSIVE AND MAY OFFER CHOICE TO SUBGROUPS WITH POOR UPTAKE (E.G., WOMEN AND ELDERLY). OBJECTIVES: THIS STUDY SOUGHT TO EVALUATE THE EFFECTS OF YOGA-BASED CR (YOGA-CARE) ON MAJOR CARDIOVASCULAR EVENTS AND SELF-RATED HEALTH IN A MULTICENTER RANDOMIZED CONTROLLED TRIAL. METHODS: THE TRIAL WAS CONDUCTED IN 24 MEDICAL CENTERS ACROSS INDIA. THIS STUDY RECRUITED 3,959 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH A MEDIAN AND MINIMUM FOLLOW-UP OF 22 AND 6 MONTHS. PATIENTS WERE INDIVIDUALLY RANDOMIZED TO RECEIVE EITHER A YOGA-CARE PROGRAM (N = 1,970) OR ENHANCED STANDARD CARE INVOLVING EDUCATIONAL ADVICE (N = 1,989). THE CO-PRIMARY OUTCOMES WERE: 1) FIRST OCCURRENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) (COMPOSITE OF ALL-CAUSE MORTALITY, MYOCARDIAL INFARCTION, STROKE, OR EMERGENCY CARDIOVASCULAR HOSPITALIZATION); AND 2) SELF-RATED HEALTH ON THE EUROPEAN QUALITY OF LIFE-5 DIMENSIONS-5 LEVEL VISUAL ANALOGUE SCALE AT 12 WEEKS. RESULTS: MACE OCCURRED IN 131 (6.7%) PATIENTS IN THE YOGA-CARE GROUP AND 146 (7.4%) PATIENTS IN THE ENHANCED STANDARD CARE GROUP (HAZARD RATIO WITH YOGA-CARE: 0.90; 95% CONFIDENCE INTERVAL [CI]: 0.71 TO 1.15; P = 0.41). SELF-RATED HEALTH WAS 77 IN YOGA-CARE AND 75.7 IN THE ENHANCED STANDARD CARE GROUP (BASELINE-ADJUSTED MEAN DIFFERENCE IN FAVOR OF YOGA-CARE: 1.5; 95% CI: 0.5 TO 2.5; P = 0.002). THE YOGA-CARE GROUP HAD GREATER RETURN TO PRE-INFARCT ACTIVITIES, BUT THERE WAS NO DIFFERENCE IN TOBACCO CESSATION OR MEDICATION ADHERENCE BETWEEN THE TREATMENT GROUPS (SECONDARY OUTCOMES). CONCLUSIONS: YOGA-CARE IMPROVED SELF-RATED HEALTH AND RETURN TO PRE-INFARCT ACTIVITIES AFTER ACUTE MYOCARDIAL INFARCTION, BUT THE TRIAL LACKED STATISTICAL POWER TO SHOW A DIFFERENCE IN MACE. YOGA-CARE MAY BE AN OPTION WHEN CONVENTIONAL CR IS UNAVAILABLE OR UNACCEPTABLE TO INDIVIDUALS. (A STUDY ON EFFECTIVENESS OF YOGA BASED CARDIAC REHABILITATION PROGRAMME IN INDIA AND UNITED KINGDOM; CTRI/2012/02/002408). 2020 2 900 70 EFFECTIVENESS AND COST-EFFECTIVENESS OF A YOGA-BASED CARDIAC REHABILITATION (YOGA-CARE) PROGRAM FOLLOWING ACUTE MYOCARDIAL INFARCTION: STUDY RATIONALE AND DESIGN OF A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL. BACKGROUND: CARDIAC REHABILITATION (CR) IS A STANDARD TREATMENT FOR SECONDARY PREVENTION OF ACUTE MYOCARDIAL INFARCTION (AMI) IN HIGH INCOME COUNTRIES (HICS), BUT IT IS INACCESSIBLE TO MOST PATIENTS IN INDIA DUE TO HIGH COSTS AND SKILLS REQUIRED FOR MULTIDISCIPLINARY CR TEAMS. WE DEVELOPED A LOW-COST AND SCALABLE CR PROGRAM BASED ON CULTURALLY-ACCEPTABLE PRACTICE OF YOGA (YOGA-CARE). IN THIS PAPER, WE REPORT THE RATIONALE AND DESIGN FOR EVALUATION OF ITS EFFECTIVENESS AND COST-EFFECTIVENESS. METHODS: THIS IS A MULTI-CENTER, SINGLE-BLIND, TWO-ARM PARALLEL-GROUP RANDOMIZED CONTROLLED TRIAL ACROSS 22 CARDIAC CARE HOSPITALS IN INDIA. FOUR THOUSAND PATIENTS AGED 18-80YEARS WITH AMI WILL BE RECRUITED AND RANDOMIZED 1:1 TO RECEIVE YOGA-CARE PROGRAM (13 SESSIONS SUPERVISED BY AN INSTRUCTOR AND ENCOURAGEMENT TO SELF-PRACTICE DAILY) OR ENHANCED STANDARD CARE (3 SESSIONS OF HEALTH EDUCATION) DELIVERED OVER A PERIOD OF THREE MONTHS. PARTICIPANTS WILL BE FOLLOWED 3-MONTHLY TILL THE END OF THE TRIAL. THE CO-PRIMARY OUTCOMES ARE A) TIME TO OCCURRENCE OF FIRST CARDIOVASCULAR EVENT (COMPOSITE OF ALL-CAUSE MORTALITY, NON-FATAL MYOCARDIAL INFARCTION, NON-FATAL STROKE AND EMERGENCY CARDIOVASCULAR HOSPITALIZATION), AND B) QUALITY OF LIFE (EURO-QOL-5L) AT 12WEEKS. SECONDARY OUTCOMES INCLUDE NEED FOR REVASCULARIZATION PROCEDURES, RETURN TO PRE-INFARCT ACTIVITIES, TOBACCO CESSATION, MEDICATION ADHERENCE, AND COST-EFFECTIVENESS OF THE INTERVENTION. CONCLUSION: THIS TRIAL WILL ALONE CONTRIBUTE >20% PARTICIPANTS TO EXISTING META-ANALYSES OF RANDOMIZED TRIALS OF CR WORLDWIDE. IF YOGA-CARE IS FOUND TO BE EFFECTIVE, IT HAS THE POTENTIAL TO SAVE MILLIONS OF LIVES AND TRANSFORM CARE OF AMI PATIENTS IN INDIA AND OTHER LOW AND MIDDLE INCOME COUNTRY SETTINGS. 2019 3 614 50 DEVELOPMENT OF A YOGA-BASED CARDIAC REHABILITATION (YOGA-CARE) PROGRAMME FOR SECONDARY PREVENTION OF MYOCARDIAL INFARCTION. CARDIAC REHABILITATION (CR) AFTER MYOCARDIAL INFARCTION IS HIGHLY EFFECTIVE. IT IS UNAVAILABLE IN PUBLIC HOSPITALS IN INDIA DUE TO LIMITED RESOURCES. OUR OBJECTIVE WAS TO DEVELOP A SCALABLE MODEL OF CR FOR INDIA BASED ON YOGA, WHICH COULD ALSO APPEAL TO SOME GROUPS WITH LOW UPTAKE OF CR (E.G., ETHNIC MINORITIES, WOMEN, AND OLDER PEOPLE) GLOBALLY. THE INTERVENTION WAS DEVELOPED USING A STRUCTURED PROCESS. A LITERATURE REVIEW AND CONSULTATIONS WITH YOGA EXPERTS, CR EXPERTS, AND POSTMYOCARDIAL INFARCTION PATIENTS WERE CONDUCTED TO SYSTEMATICALLY IDENTIFY AND SHORTLIST APPROPRIATE YOGA EXERCISES AND POSTURES, BREATHING EXERCISES, MEDITATION AND RELAXATION PRACTICES, AND LIFESTYLE CHANGES, WHICH WERE INCORPORATED INTO A CONVENTIONAL CR FRAMEWORK. THE DRAFT INTERVENTION WAS FURTHER REFINED BASED ON THE FEEDBACK FROM AN INTERNAL STAKEHOLDER GROUP AND AN EXTERNAL PANEL OF INTERNATIONAL EXPERTS, BEFORE BEING PILOTED WITH YOGA INSTRUCTORS AND PATIENTS WITH MYOCARDIAL INFARCTION. A FOUR-PHASE YOGA-BASED CR (YOGA-CARE) PROGRAMME WAS DEVELOPED FOR DELIVERY BY A SINGLE YOGA INSTRUCTOR WITH BASIC TRAINING. THE PROGRAMME CONSISTS OF A TOTAL OF 13 INSTRUCTOR-LED SESSIONS (2 INDIVIDUAL AND 11 GROUP) OVER A 3-MONTH PERIOD. GROUP SESSIONS INCLUDE GUIDED PRACTICE OF YOGA EXERCISES AND POSTURES, BREATHING EXERCISES, AND MEDITATION AND RELAXATION PRACTICES, AND SUPPORT FOR THE LIFESTYLE CHANGE AND COPING THROUGH A MODERATED DISCUSSION. PATIENTS ARE ENCOURAGED TO SELF-PRACTICE DAILY AT HOME AND CONTINUE LONG-TERM WITH THE HELP OF A BOOKLET AND DIGITAL VIDEO DISC (DVD). FAMILY MEMBERS/CARERS ARE ENCOURAGED TO JOIN THROUGHOUT. IN CONCLUSION, A NOVEL YOGA-BASED CR PROGRAMME HAS BEEN DEVELOPED, WHICH PROMISES TO PROVIDE A SCALABLE CR SOLUTION FOR INDIA AND AN ALTERNATIVE CHOICE FOR CR GLOBALLY. IT IS CURRENTLY BEING EVALUATED IN A LARGE MULTICENTRE RANDOMISED CONTROLLED TRIAL ACROSS INDIA. 2019 4 2858 44 YOGA-BASED CARDIAC REHABILITATION: CURRENT PERSPECTIVES FROM RANDOMIZED CONTROLLED TRIALS IN CORONARY ARTERY DISEASE. CORONARY ARTERY DISEASE CARRIES A HIGH MORBIDITY AND MORTALITY WORLDWIDE, AND EXERCISE-BASED CARDIAC REHABILITATION PROGRAMMES PLAY A LARGE ROLE IN SECONDARY PREVENTION. EXERCISE-BASED REHABILITATION PROGRAMMES ARE EXPENSIVE, AND IN CERTAIN SUBGROUPS UPTAKE IS POOR. YOGA HAS BEEN SUGGESTED TO SHOW IMPROVEMENTS IN CARDIOVASCULAR HEALTH WHICH WOULD SUPPORT ITS USE IN CARDIAC REHABILITATION PROGRAMMES. WE CARRIED OUT A REVIEW OF CURRENT RANDOMIZED CONTROLLED TRIALS TO DETERMINE IF YOGA-BASED CARDIAC REHABILITATION LEADS TO REDUCED CARDIAC RISK FACTORS, AND IMPROVED PHYSIOLOGICAL AND PSYCHOLOGICAL OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE COMPARED TO STANDARD CARE. SIX RANDOMIZED CONTROLLED STUDIES WERE IDENTIFIED AFTER A MEDICAL DATABASE SEARCH, AND META-ANALYSIS WAS CARRIED OUT FOR THE DIFFERENT OUTCOMES. OVERALL, THE ADDITION OF YOGA TO STANDARD CARE RESULTED IN IMPROVED SUBJECTIVE FEELING OF CARDIAC HEALTH AND QUALITY OF LIFE. THERE WAS ALSO A TREND TOWARDS IMPROVEMENT IN LEFT VENTRICULAR SYSTOLIC FUNCTION. IMPROVEMENT IN CARDIAC RISK FACTORS, MACE AND PSYCHOLOGICAL HEALTH IN THIS COHORT HAS STILL TO BE PROVEN, BUT WAS NOT INFERIOR TO STANDARD OR ENHANCED CARE, AND THE BENEFITS BECAME MORE PRONOUNCED AT LONGER FOLLOW-UP. FUTURE STUDIES WITH LONGER FOLLOW-UP AND LARGER PATIENT NUMBERS WOULD AID IN ACCURATELY ASSESSING THE LONG-TERM BENEFIT OF YOGA-BASED REHABILITATION. 2021 5 953 55 EFFECTS OF A HEALTH WORKER-LED 3-MONTH YOGA INTERVENTION ON BLOOD PRESSURE OF HYPERTENSIVE PATIENTS: A RANDOMISED CONTROLLED MULTICENTRE TRIAL IN THE PRIMARY CARE SETTING. BACKGROUND: HYPERTENSION CONTROL REMAINS A MAJOR CHALLENGE GLOBALLY. A RECENT SYSTEMATIC REVIEW SUGGESTED THAT YOGA HAS BENEFICIAL EFFECTS ON REDUCING BLOOD PRESSURE. HOWEVER, THE ROLE OF YOGA IN HYPERTENSION MANAGEMENT IN PRIMARY HEALTH CARE HAS RECEIVED LITTLE ATTENTION, AND NO STUDIES HAVE EVALUATED THE IMPACT OF A YOGA PROGRAM FULLY DELIVERED BY HEALTH CARE STAFF ON HYPERTENSION. THIS STUDY, THEREFORE, ASSESSED THE EFFECTS OF A HEALTH WORKER-LED YOGA INTERVENTION ON BLOOD PRESSURE REDUCTION AMONG HYPERTENSIVES PATIENTS IN THE PRIMARY CARE SETTING. METHODS: THIS WAS A MULTICENTRIC, TWO-ARM, RANDOMISED TRIAL CONDUCTED AMONG HYPERTENSIVE PATIENTS IN SEVEN AYURVEDA HEALTH CENTRES IN NEPAL BETWEEN MARCH 2017 AND JUNE 2018. ONE HUNDRED AND TWENTY-ONE PARTICIPANTS WHO WERE ON OR WITHOUT MEDICATIONS WERE RANDOMISED TO INTERVENTION (N = 61) AND WAIT-LIST CONTROL (N = 60) GROUPS USING STRATIFIED BLOCK RANDOMISATION. PARTICIPANTS IN THE INTERVENTION ARM RECEIVED AN INTERVENTION CONSISTING OF AN INITIAL FIVE-DAY STRUCTURED YOGA TRAINING AT THE CENTRES AND THEN A FURTHER HOME-BASED PRACTICE OF YOGA FOR FIVE DAYS A WEEK FOR THE FOLLOWING 90 DAYS. BOTH INTERVENTION AND CONTROL GROUPS ALSO PARTICIPATED IN A 2-H HEALTH EDUCATION SESSION. THE PRIMARY OUTCOME OF THIS TRIAL WAS SYSTOLIC BLOOD PRESSURE AT 90-DAY FOLLOW-UP. DATA WERE ANALYSED ON AN INTENTION-TO-TREAT BASIS USING LINEAR MIXED-EFFECTS REGRESSION MODELS. RESULTS: WE INCLUDED ALL 121 STUDY PARTICIPANTS (INTERVENTION/CONTROL = 61/60) IN THE PRIMARY ANALYSIS (52.1% MALES; MEAN +/- SD AGE = 47.8 +/- 10.8 YEARS). THE DIFFERENCE IN SYSTOLIC BLOOD PRESSURE BETWEEN THE INTERVENTION GROUP AND THE CONTROL GROUP WAS - 7.66 MMHG (95% CI: - 10.4, - 4.93). FOR DIASTOLIC BLOOD PRESSURE, THE DIFFERENCE WAS - 3.86 MMHG (95% CI: - 6.65, - 1.06). NO ADVERSE EVENTS WERE REPORTED BY THE PARTICIPANTS. CONCLUSIONS: A YOGA PROGRAM FOR HYPERTENSIVE PATIENTS CONSISTING OF A FIVE-DAY TRAINING IN HEALTH CENTRES AND 90 DAYS OF PRACTICE AT HOME IS EFFECTIVE FOR REDUCING BLOOD PRESSURE. SIGNIFICANT BENEFITS FOR HYPERTENSIVE PATIENTS COULD BE EXPECTED IF SUCH PROGRAMMES WOULD BECOME A PART OF THE STANDARD TREATMENT PRACTICE. TRIAL REGISTRATION: THIS TRIAL WAS PROSPECTIVELY REGISTERED WITH THE CLINICAL TRIAL REGISTRY OF INDIA [ CTRI/2017/02/007822 ] ON 10/02/2017. 2021 6 1153 33 ENHANCING THE APPEAL OF CARDIAC REHABILITATION FOR WOMEN: DEVELOPMENT AND PILOT TESTING OF A WOMEN-ONLY YOGA CARDIAC REHABILITATION PROGRAMME. AIMS: DESPITE ITS DEMONSTRATED BENEFITS, CARDIAC REHABILITATION (CR) ATTENDANCE, AND COMPLETION IS SUBOPTIMAL, PARTICULARLY IN WOMEN. THE AIMS OF THIS STUDY WERE (I) TO DEVELOP AND PILOT TEST A WOMEN-ONLY YOGA-BASED CR PROGRAMME (THE WOMEN'S YOGA CR PROGRAMME; WYCRP); (II) TO INVESTIGATE PROGRAMME ACCEPTABILITY; AND (III) TO INVESTIGATE ATTENDANCE AND COMPLETION OF THE WYCRP AND CONTINUATION TO PHASE III COMMUNITY-BASED CR. METHODS AND RESULTS: WOMEN ELIGIBLE FOR CR AT A TERTIARY HOSPITAL IN MELBOURNE, AUSTRALIA WERE RECRUITED. OVER A 6-MONTH PERIOD IN 2019, THEY WERE OFFERED THE WYCRP OR USUAL CR. THE WYCRP INVOLVED ATTENDANCE AT A 1-H YOGA SESSION FOLLOWING THE USUAL 1-H MIXED-SEX EDUCATION SESSION, OVER A 7-WEEK PERIOD. PARTICIPANTS COMPLETED PRE- AND POST-PROGRAMME QUESTIONNAIRES AND ATTENDED FOCUS GROUPS TO ASSESS PROGRAMME ACCEPTABILITY. RATES OF ATTENDANCE, COMPLETION, AND CONTINUATION FOR THE WYCRP WERE RECORDED AND COMPARED TO THOSE FOR THE STANDARD CR PROGRAMME OFFERED IN 2018. IN TOTAL, 27 WOMEN WERE ELIGIBLE FOR THE STUDY AND ATTENDED THE INITIAL CR ASSESSMENT. OF THOSE, 22 (81%) ATTENDED THE WYCRP, 1 (4%) ATTENDED USUAL CR, AND 4 (15%) DID NOT ATTEND CR. RATINGS OF PROGRAMME ACCEPTABILITY WERE CONSISTENTLY POSITIVE; QUALITATIVE COMMENTS HIGHLIGHTED BOTH PHYSICAL AND EMOTIONAL BENEFITS. WHILE ATTENDANCE AT THE WYCRP WAS NOT SIGNIFICANTLY HIGHER THAN FOR USUAL CR THE PREVIOUS YEAR (81% VS. 76%; P = 0.40), CR COMPLETION, AND CONTINUATION WERE (95% VS. 56%; P = 0.02, AND 72% VS. 12%; P < 0.001, RESPECTIVELY). CONCLUSION: THIS PILOT STUDY HAS DEMONSTRATED THAT WOMEN-ONLY YOGA-BASED CR IS APPEALING TO WOMEN AND CAN IMPROVE WOMEN'S CR COMPLETION AND CONTINUATION. THESE PRELIMINARY FINDINGS SUPPORT FURTHER DEVELOPMENT OF WOMEN-ONLY AND YOGA-BASED CR OPTIONS. 2021 7 279 44 ADHERENCE AND RETENTION OF AFRICAN AMERICANS IN A RANDOMIZED CONTROLLED TRIAL WITH A YOGA-BASED INTERVENTION: THE EFFECTS OF HEALTH PROMOTING PROGRAMS ON CARDIOVASCULAR DISEASE RISK STUDY. OBJECTIVES: SEDENTARY LIFESTYLE IS A RISK FACTOR FOR CARDIOVASCULAR DISEASE (CVD). FEW ALTERNATIVE LIFESTYLE INTERVENTIONS, SUCH AS YOGA PRACTICE, FOCUS ON AFRICAN AMERICANS (AA), THE POPULATION MOST VULNERABLE TO CVD. OUR OBJECTIVE IS TO COMPARE THE RETENTION AND ADHERENCE RATES BETWEEN YOGA, WALKING, AND HEALTH EDUCATION INTERVENTIONS WHILE PROVIDING INFORMATION ABOUT THE ACCEPTANCE OF VARIOUS YOGA REGIMENS. DESIGN: THREE HUNDRED SEVENTY-FIVE AA PARTICIPANTS WERE RECRUITED EXCLUSIVELY FROM AN ACTIVE COHORT STUDY AND RANDOMIZED INTO A 48-WEEK STUDY (24 WEEKS INTERVENTION, 24 WEEKS FOLLOW-UP) WITH 5 HEALTH PROMOTION INTERVENTIONS: HIGH FREQUENCY YOGA, MODERATE FREQUENCY YOGA, LOW FREQUENCY YOGA, GUIDED WALKING, AND HEALTH EDUCATION. IN ADDITION TO EXAMINING THE SEPARATE YOGA INTERVENTIONS, A POOLED YOGA INTERVENTION IS CONSIDERED FOR COMPARISON TO GUIDED WALKING AND HEALTH EDUCATION. PARTICIPANT RETENTION, ADHERENCE, AND VITALS WERE MONITORED AT EACH INTERVENTION SESSION. PARTICIPANTS WERE ALSO SCHEDULED FOR FOUR CLINIC VISITS THROUGHOUT THE STUDY WHERE BLOOD PANELS, HEALTH BEHAVIOR, AND MEDICATION SURVEYS WERE ADMINISTERED. RESULTS: OF THE 375 PARTICIPANTS RECRUITED, 31.7% DID NOT COMPLETE THE STUDY. AT BASELINE, IN BOTH THE GUIDED WALKING GROUP AND THE HIGH FREQUENCY YOGA GROUP, THERE WERE SIGNIFICANT DIFFERENCES BETWEEN THOSE WHO COMPLETED THE STUDY AND THOSE WHO DID NOT. ALTHOUGH INTERVENTION RETENTION IN THE POOLED YOGA PROGRAM (78.3%) WAS HIGHER COMPARED TO THE WALKING (60%) AND EDUCATION PROGRAMS (74.3%) (P = 0.007), DIFFERENCES IN POST-INTERVENTION RETENTION WAS NOT SIGNIFICANT. MEDIAN ADHERENCE RATES FOR THE POOLED YOGA PROGRAM EXCEEDED RATES FOR GUIDED WALKING AND EDUCATION WITH MODERATE FREQUENCY YOGA OUT PERFORMING HIGH AND LOW FREQUENCY YOGA. CONCLUSION: STUDY-DEFINED RETENTION SUCCESS RATES WERE NOT REACHED BY ALL HEALTH PROMOTION PROGRAMS. HOWEVER, RETENTION AND ADHERENCE RATES FOR THE POOLED YOGA PROGRAM SHOW THAT OLDER AFRICAN AMERICANS ARE RECEPTIVE TO PARTICIPATING IN YOGA-BASED HEALTH PROMOTION PRACTICES. 2020 8 2560 54 YOGA FOR CHRONIC LOW BACK PAIN: A RANDOMIZED TRIAL. BACKGROUND: PREVIOUS STUDIES INDICATE THAT YOGA MAY BE AN EFFECTIVE TREATMENT FOR CHRONIC OR RECURRENT LOW BACK PAIN. OBJECTIVE: TO COMPARE THE EFFECTIVENESS OF YOGA AND USUAL CARE FOR CHRONIC OR RECURRENT LOW BACK PAIN. DESIGN: PARALLEL-GROUP, RANDOMIZED, CONTROLLED TRIAL USING COMPUTER-GENERATED RANDOMIZATION CONDUCTED FROM APRIL 2007 TO MARCH 2010. OUTCOMES WERE ASSESSED BY POSTAL QUESTIONNAIRE. (INTERNATIONAL STANDARD RANDOMISED CONTROLLED TRIAL NUMBER REGISTER: ISRCTN 81079604) SETTING: 13 NON-NATIONAL HEALTH SERVICE PREMISES IN THE UNITED KINGDOM. PATIENTS: 313 ADULTS WITH CHRONIC OR RECURRENT LOW BACK PAIN. INTERVENTION: YOGA (N = 156) OR USUAL CARE (N = 157). ALL PARTICIPANTS RECEIVED A BACK PAIN EDUCATION BOOKLET. THE INTERVENTION GROUP WAS OFFERED A 12-CLASS, GRADUALLY PROGRESSING YOGA PROGRAM DELIVERED BY 12 TEACHERS OVER 3 MONTHS. MEASUREMENTS: SCORES ON THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE (RMDQ) AT 3 (PRIMARY OUTCOME), 6, AND 12 (SECONDARY OUTCOMES) MONTHS; PAIN, PAIN SELF-EFFICACY, AND GENERAL HEALTH MEASURES AT 3, 6, AND 12 MONTHS (SECONDARY OUTCOMES). RESULTS: 93 (60%) PATIENTS OFFERED YOGA ATTENDED AT LEAST 3 OF THE FIRST 6 SESSIONS AND AT LEAST 3 OTHER SESSIONS. THE YOGA GROUP HAD BETTER BACK FUNCTION AT 3, 6, AND 12 MONTHS THAN THE USUAL CARE GROUP. THE ADJUSTED MEAN RMDQ SCORE WAS 2.17 POINTS (95% CI, 1.03 TO 3.31 POINTS) LOWER IN THE YOGA GROUP AT 3 MONTHS, 1.48 POINTS (CI, 0.33 TO 2.62 POINTS) LOWER AT 6 MONTHS, AND 1.57 POINTS (CI, 0.42 TO 2.71 POINTS) LOWER AT 12 MONTHS. THE YOGA AND USUAL CARE GROUPS HAD SIMILAR BACK PAIN AND GENERAL HEALTH SCORES AT 3, 6, AND 12 MONTHS, AND THE YOGA GROUP HAD HIGHER PAIN SELF-EFFICACY SCORES AT 3 AND 6 MONTHS BUT NOT AT 12 MONTHS. TWO OF THE 157 USUAL CARE PARTICIPANTS AND 12 OF THE 156 YOGA PARTICIPANTS REPORTED ADVERSE EVENTS, MOSTLY INCREASED PAIN. LIMITATION: THERE WERE MISSING DATA FOR THE PRIMARY OUTCOME (YOGA GROUP, N = 21; USUAL CARE GROUP, N = 18) AND DIFFERENTIAL MISSING DATA (MORE IN THE YOGA GROUP) FOR SECONDARY OUTCOMES. CONCLUSION: OFFERING A 12-WEEK YOGA PROGRAM TO ADULTS WITH CHRONIC OR RECURRENT LOW BACK PAIN LED TO GREATER IMPROVEMENTS IN BACK FUNCTION THAN DID USUAL CARE. PRIMARY FUNDING SOURCE: ARTHRITIS RESEARCH UK. 2011 9 2811 42 YOGA TO PREVENT MOBILITY LIMITATIONS IN OLDER ADULTS: FEASIBILITY OF A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: THE LOSS OF MOBILITY DURING AGING IMPACTS INDEPENDENCE AND LEADS TO FURTHER DISABILITY, MORBIDITY, AND REDUCED LIFE EXPECTANCY. OUR OBJECTIVE WAS TO EXAMINE THE FEASIBILITY AND SAFETY OF CONDUCTING A RANDOMIZED CONTROLLED TRIAL OF YOGA FOR OLDER ADULTS AT RISK FOR MOBILITY LIMITATIONS. METHODS: SEDENTARY OLDER ADULTS (N = 46; AGE 60-89) WERE RECRUITED AND RANDOMIZED TO EITHER YOGA OR A HEALTH EDUCATION COMPARISON GROUP. YOGA SESSIONS (60-MIN) OCCURRED 2X WEEKLY, AND 90-MIN HEALTH EDUCATION SESSIONS OCCURRED WEEKLY, FOR 10 WEEKS. THE PRIMARY OUTCOMES WERE RECRUITMENT RATE, INTERVENTION ATTENDANCE, AND RETENTION AT ASSESSMENTS. ADVERSE EVENT RATES AND PARTICIPANT SATISFACTION WERE ALSO MEASURED. PHYSICAL PERFORMANCE MEASURES OF GAIT, BALANCE, AND STRENGTH AND SELF-REPORT OUTCOME MEASURES WERE ADMINISTERED AT BASELINE AND 10-WEEKS. RESULTS: RECRUITMENT LASTED 6 MONTHS. RETENTION OF PARTICIPANTS AT THE 10-WEEK FOLLOW-UP WAS HIGH (89% - PERFORMANCE MEASURES; 98% - SELF-REPORT QUESTIONNAIRES). ATTENDANCE WAS GOOD WITH 82% OF YOGA AND 74% OF HEALTH EDUCATION PARTICIPANTS ATTENDING AT LEAST 50% OF THE SESSIONS. NO SERIOUS ADVERSE EVENTS WERE REPORTED. PATIENT SATISFACTION WITH THE INTERVENTIONS WAS HIGH. THE MEAN EFFECT SIZE FOR THE PHYSICAL PERFORMANCE MEASURES WAS 0.35 WITH SOME OVER 0.50. THE MEAN EFFECT SIZE FOR SELF-REPORT OUTCOME MEASURES WAS 0.36. CONCLUSIONS: RESULTS INDICATE THAT IT IS FEASIBLE TO CONDUCT A LARGER RCT OF YOGA FOR SEDENTARY OLDER ADULTS AT RISK FOR MOBILITY PROBLEMS. THE YOGA AND COMPARISON INTERVENTIONS WERE SAFE, WELL ACCEPTED, AND WELL ATTENDED. EFFECT SIZES SUGGEST YOGA MAY HAVE IMPORTANT BENEFITS FOR THIS POPULATION AND SHOULD BE STUDIED FURTHER. TRIAL REGISTRATION: CLINICALTRIALS # NCT03544879 ; RETROSPECTIVELY REGISTERED 4 JUNE, 2018. 2018 10 2395 43 YOGA AND CARDIOVASCULAR HEALTH TRIAL (YACHT): A UK-BASED RANDOMISED MECHANISTIC STUDY OF A YOGA INTERVENTION PLUS USUAL CARE VERSUS USUAL CARE ALONE FOLLOWING AN ACUTE CORONARY EVENT. OBJECTIVE: TO DETERMINE THE EFFECTS OF YOGA PRACTICE ON SUBCLINICAL CARDIOVASCULAR MEASURES, RISK FACTORS AND NEURO-ENDOCRINE PATHWAYS IN PATIENTS UNDERGOING CARDIAC REHABILITATION (CR) FOLLOWING ACUTE CORONARY EVENTS. DESIGN: 3-MONTH, TWO-ARM (YOGA +USUAL CARE VS USUAL CARE ALONE) PARALLEL RANDOMISED MECHANISTIC STUDY. SETTING: ONE GENERAL HOSPITAL AND TWO PRIMARY CARE CR CENTRES IN LONDON. ASSESSMENTS WERE CONDUCTED AT IMPERIAL COLLEGE LONDON. PARTICIPANTS: 80 PARTICIPANTS, AGED 35-80 YEARS (68% MEN, 60% SOUTH ASIAN) REFERRED TO CR PROGRAMMES 2012-2014. INTERVENTION: A CERTIFIED YOGA TEACHER CONDUCTED YOGA CLASSES WHICH INCLUDED EXERCISES IN STRETCHING, BREATHING, HEALING IMAGERY AND DEEP RELAXATION. IT WAS PRE-SPECIFIED THAT AT LEAST 18 YOGA CLASSES WERE ATTENDED FOR INCLUSION IN ANALYSIS. PARTICIPANTS AND PARTNERS IN BOTH GROUPS WERE INVITED TO ATTEND WEEKLY A 6- TO 12-WEEK LOCAL STANDARD UK NATIONAL HEALTH SERVICE CR PROGRAMME. MAIN OUTCOME MEASURES: (I) ESTIMATED LEFT VENTRICULAR FILLING PRESSURE (E/E'), (II) DISTANCE WALKED, FATIGUE AND BREATHLESSNESS IN A 6 MIN WALK TEST, (III) BLOOD PRESSURE, HEART RATE AND ESTIMATED PEAK VO2 FOLLOWING A 3 MIN STEP-TEST. EFFECTS ON THE HYPOTHALAMUS-PITUITARY-ADRENAL AXIS, AUTONOMIC FUNCTION, BODY FAT, BLOOD LIPIDS AND GLUCOSE, STRESS AND GENERAL HEALTH WERE ALSO EXPLORED. RESULTS: 25 PARTICIPANTS IN THE YOGA + USUAL CARE GROUP AND 35 PARTICIPANTS IN THE USUAL CARE GROUP COMPLETED THE STUDY. FOLLOWING THE 3-MONTH INTERVENTION PERIOD, E/E' WAS NOT IMPROVED BY YOGA (E/E': BETWEEN-GROUP DIFFERENCE: YOGA MINUS USUAL CARE:-0.40 (-1.38, 0.58). EXERCISE TESTING AND SECONDARY OUTCOMES ALSO SHOWED NO BENEFITS OF YOGA. CONCLUSIONS: IN THIS SMALL UK-BASED RANDOMISED MECHANISTIC STUDY, WITH 60 COMPLETING PARTICIPANTS (OF WHOM 25 WERE IN THE YOGA + USUAL CARE GROUP), WE FOUND NO DISCERNIBLE IMPROVEMENT ASSOCIATED WITH THE ADDITION OF A STRUCTURED 3-MONTH YOGA INTERVENTION TO USUAL CR CARE IN KEY CARDIOVASCULAR AND NEUROENDOCRINE MEASURES SHOWN TO BE RESPONSIVE TO YOGA IN PREVIOUS MECHANISTIC STUDIES. TRIAL REGISTRATION NUMBER: NCT01597960; PRE-RESULTS. 2019 11 1477 58 INTEGRATED YOGA PRACTICE IN CARDIAC REHABILITATION PROGRAM: A RANDOMIZED CONTROL TRIAL. BACKGROUND: CORONARY ARTERY DISEASE (CAD) IS A DETRIMENTAL NONCOMMUNICABLE DISEASE, WHICH IS INCREASING DUE TO SEDENTARY LIFESTYLE AND URBANIZATION IN THE YOUNG POPULATION. IT IS FURTHER ELEVATED WITH RISK FACTORS SUCH AS STRESS, ANXIETY, DEPRESSION, AN INCREASE IN TRIGLYCERIDES, DYSLIPIDEMIA, HYPERGLYCEMIA, HYPERTENSION, AND SO ON, WHICH MANIFESTS AS ATHEROSCLEROTIC DISEASE. YOGA-BASED LIFESTYLE INTERVENTION IS A NONINVASIVE EFFECTIVE TREATMENT METHOD TO CONTROL AND PREVENT CARDIAC RISK FACTORS IN CAD PATIENTS. YOGA HAS BEEN USED IN INDIA AS A THERAPEUTIC METHOD TO MANAGE HYPERTENSION AND OTHER CHRONIC DISORDERS AND IS FAST GAINING POPULARITY AS AN EFFECTIVE MEANS FOR THE ALLEVIATION OF STRESS, IMPROVEMENT OF FITNESS, AND ENHANCEMENT OF WELL-BEING. THIS STUDY AIMED TO DETERMINE THE FEASIBILITY OF INTRODUCING THE INTEGRATED APPROACH OF YOGA THERAPY (IAYT) IN A CARDIAC REHABILITATION CENTER IN INDIA AND UNDERSTAND ITS USEFULNESS IN IMPROVING THE CARDIAC FUNCTION AND MANAGING THE CARDIAC RISK FACTORS IN ACUTE MYOCARDIAL INFARCTION PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION. METHODS AND DESIGN: CARDIAC PATIENTS WERE RANDOMIZED TO A YOGA-PRACTICING GROUP (N = 33) AND A CONTROL GROUP (N = 33). THE YOGA-PRACTICING GROUP WAS INSTRUCTED TO ATTEND THREE SUPERVISED IAYT CLASSES 3 DAYS PER WEEK FOR 12 WEEKS AT THE HOSPITAL YOGA CENTER. THE CONTROL GROUP RECEIVED STANDARD CARE THAT INCLUDED PHARMACOLOGIC TREATMENT AND THE INSTRUCTIONS OF THE CARDIOLOGIST. THE OUTCOME MEASURES WERE ASSESSED AT BASELINE (T1 = 0) AND COMPLETION (T2 = 3 MONTHS). THE PRIMARY OUTCOME MEASURE WAS THE LEFT VENTRICULAR EJECTION FRACTION (LVEF). RESULTS: THERE WAS NO STATISTICALLY SIGNIFICANT DIFFERENCE IN LVEF (U = 420.500, P VALUE = 0.218) BETWEEN THE TWO GROUPS. HOWEVER, THE YOGA-PRACTICING GROUP SHOWED SIGNIFICANT REDUCTION IN DEPRESSION (CARDIAC DEPRESSION SCALE [CDS], U = 71, P VALUE = 0.0), ANXIETY (HAMILTON ANXIETY RATING SCALE [HAM-A], U = 128, P VALUE = 0.0), AND A SIGNIFICANT INCREASE IN QUALITY OF LIFE (QOL) SCORES (DUKE ACTIVITY STATUS INDEX [DASI], U = 146, P VALUE = 0.0; AND METABOLIC EQUIVALENTS (METS), U = 136, P VALUE = 0.0) AT 3 MONTHS COMPARED TO CONTROL. OVERALL, THE CAD PATIENTS PRACTICING YOGA SHOWED A FAVORABLE PROFILE COMPARED TO CONTROL INDIVIDUALS ON CDS, HAM-A, DASI, AND MET OUTCOMES. CONTROL AND YOGA PRACTICING GROUPS DID NOT DIFFER SIGNIFICANTLY IN THE LIPID LEVELS. CONCLUSION: THIS STUDY INDICATED THAT THE INTEGRATION OF YOGA PRACTICE IN A CARDIAC REHABILITATION PROGRAM IS FEASIBLE AND HAS NO ADDED BENEFIT IN IMPROVING THE CARDIAC FUNCTION. HOWEVER, THE ADDITION OF YOGA TO CARDIAC REHABILITATION MAY BE BENEFICIAL IN REDUCING DEPRESSION AND ANXIETY AND IMPROVING QOL IN PATIENTS. 2020 12 162 46 A RANDOMISED CONTROLLED TRIAL OF YOGA FOR THE TREATMENT OF CHRONIC LOW BACK PAIN: RESULTS OF A PILOT STUDY. OBJECTIVE: TO CONDUCT A PILOT TRIAL OF YOGA FOR THE TREATMENT OF CHRONIC LOW BACK PAIN (LBP) TO INFORM THE FEASIBILITY AND PRACTICALITY OF CONDUCTING A FULL-SCALE TRIAL IN THE UK; AND TO ASSESS THE EFFICACY OF YOGA FOR THE TREATMENT OF CHRONIC LOW BACK PAIN. DESIGN: A PRAGMATIC RANDOMISED CONTROLLED TRIAL WAS UNDERTAKEN COMPARING YOGA TO USUAL CARE. PARTICIPANTS: TWENTY PARTICIPANTS WHO HAD PRESENTED TO THEIR GP WITH CHRONIC LOW BACK PAIN IN THE PREVIOUS 18 MONTHS WERE RECRUITED VIA GP RECORDS FROM ONE PRACTICE IN YORK, UK. INTERVENTIONS: TWENTY PATIENTS WERE RANDOMISED TO EITHER 12 WEEKLY 75-MIN SESSIONS OF SPECIALISED YOGA PLUS WRITTEN ADVICE, OR USUAL CARE PLUS WRITTEN ADVICE. ALLOCATION WAS 50/50. MAIN OUTCOME MEASURES: RECRUITMENT RATE, LEVELS OF INTERVENTION ATTENDANCE, AND LOSS TO FOLLOW-UP WERE THE MAIN NON-CLINICAL OUTCOMES. CHANGE AS MEASURED BY THE ROLAND AND MORRIS DISABILITY QUESTIONNAIRE WAS THE PRIMARY CLINICAL OUTCOME. CHANGES IN THE ABERDEEN BACK PAIN SCALE, SF-12, EQ-5D, AND PAIN SELF-EFFICACY WERE SECONDARY CLINICAL OUTCOMES. DATA WERE COLLECTED VIA POSTAL QUESTIONNAIRE AT BASELINE, 4 WEEKS, AND 12 WEEKS FOLLOW-UP. RESULTS: OF THE 286 PATIENTS IDENTIFIED FROM THE GP DATABASE, 52 (18%) CONSENTED AND RETURNED THE ELIGIBILITY QUESTIONNAIRE, OUT OF THESE 20 (6.9%) WERE ELIGIBLE AND RANDOMISED. THE TOTAL PERCENTAGE OF PATIENTS RANDOMISED FROM THE GP PRACTICE POPULATION WAS 0.28%. TEN PATIENTS WERE RANDOMISED TO YOGA, RECEIVING AN AVERAGE OF 1.7 SESSIONS (RANGE 0-5), AND 10 WERE RANDOMISED TO USUAL CARE. AT 12 WEEKS FOLLOW-UP DATA WAS RECEIVED FROM 60% OF PATIENTS IN THE YOGA GROUP AND 90% OF PATIENTS IN THE USUAL CARE GROUP (75% OVERALL). NO SIGNIFICANT DIFFERENCES WERE SEEN BETWEEN GROUPS IN CLINICAL OUTCOMES APART FROM ON THE ABERDEEN BACK PAIN SCALE AT FOUR WEEKS FOLLOW-UP WHERE THE YOGA GROUP REPORTED SIGNIFICANTLY LESS PAIN. CONCLUSION: THIS PILOT STUDY PROVIDED USEFUL DATA AND INFORMATION TO INFORM THE DESIGN AND DEVELOPMENT OF A FULL-SCALE TRIAL OF YOGA FOR CLBP IN THE UK. A KEY FINDING IS THE CALCULATION OF GP PRACTICE TOTAL LIST SIZE REQUIRED FOR PATIENT RECRUITMENT IN A FULL-SCALE TRIAL, AND THE NEED TO IMPLEMENT METHODS TO INCREASE CLASS ATTENDANCE. 2010 13 2834 43 YOGA'S EFFECT ON INFLAMMATORY BIOMARKERS AND METABOLIC RISK FACTORS IN A HIGH RISK POPULATION - A CONTROLLED TRIAL IN PRIMARY CARE. BACKGROUND: YOGA CAN REDUCE BLOOD PRESSURE AND HAS ALSO BEEN SUGGESTED TO REDUCE INFLAMMATORY BIOMARKERS AND METABOLIC RISK FACTORS FOR CARDIOVASCULAR DISEASES (CVDS). WE AIMED TO ASSESS THE BENEFIT OF TWO YOGA INTERVENTIONS ON INFLAMMATORY BIOMARKERS AND METABOLIC RISK FACTORS IN A HIGH RISK POPULATION IN PRIMARY CARE. METHODS: ADULT PATIENTS FROM A HEALTH CARE CENTER IN SWEDEN, WITH DIAGNOSED HYPERTENSION, WERE INVITED TO UNDERGO A BASELINE CHECK AT THE HEALTH CARE CENTER. BASELINE CHECK INCLUDED STANDARDIZED BLOOD PRESSURE MEASUREMENT, BMI AND WEIGHT CIRCUMFERENCE MEASUREMENTS, BLOOD SAMPLING (HS-CRP, IL-6, FP-GLUCOSE, HBA1C, CHOLESTEROL, TG, LDL AND HDL) AND A QUESTIONNAIRE ON SELF-RATED QUALITY OF LIFE (WHOQOL-BREF). THERE WERE THREE GROUPS: 1) YOGA CLASS WITH YOGA INSTRUCTOR; 2) YOGA AT HOME; AND 3) A CONTROL GROUP. IN TOTAL, 83 PATIENTS WERE INCLUDED AND MATCHED AT THE GROUP LEVEL FOR SYSTOLIC BLOOD PRESSURE. A MAJORITY OF THE PATIENTS (92 %) WERE ON ANTIHYPERTENSIVE MEDICATION, WHICH THEY WERE REQUESTED NOT TO CHANGE DURING THE STUDY. AFTER 12 WEEKS OF INTERVENTION, THE ASSESSMENTS WERE PERFORMED AGAIN. RESULTS: WE RECORDED NO EVIDENCE THAT YOGA ALTERED INFLAMMATORY BIOMARKERS OR METABOLIC RISK FACTORS IN OUR STUDY POPULATION. A TOTAL OF 49 PARTICIPANTS (59 %) MET THE CRITERIA FOR METABOLIC SYNDROME. CONCLUSION: THE YOGA INTERVENTIONS PERFORMED IN OUR STUDY DID NOT AFFECT INFLAMMATORY BIOMARKERS OR METABOLIC RISK FACTORS ASSOCIATED WITH CVD IN THE STUDY POPULATION OF PRIMARY CARE PATIENTS WITH HYPERTENSION. FURTHER RANDOMIZED TRIALS ARE NEEDED TO ELUCIDATE THE EFFECTS OF YOGA ON CVD RISK FACTORS IN THIS PARTICULAR GROUP. TRAIL REGISTRATION: NCT01302535 , FEBRUARY 22, 2011. 2015 14 1902 36 RESTORATIVE YOGA IN ADULTS WITH METABOLIC SYNDROME: A RANDOMIZED, CONTROLLED PILOT TRIAL. BACKGROUND: METABOLIC SYNDROME INCREASES THE RISK OF DIABETES AND CARDIOVASCULAR DISEASE. YOGA IMPROVES SOME METABOLIC PARAMETERS, BUT IT HAS NOT BEEN STUDIED IN PERSONS WITH METABOLIC SYNDROME. WE CONDUCTED A RANDOMIZED CONTROLLED PILOT TRIAL TO DETERMINE WHETHER A RESTORATIVE YOGA INTERVENTION WAS FEASIBLE AND ACCEPTABLE IN UNDERACTIVE, OVERWEIGHT ADULTS WITH METABOLIC SYNDROME. METHODS: TWENTY SIX UNDERACTIVE, OVERWEIGHT ADULT MEN AND WOMEN WITH METABOLIC SYNDROME WERE RANDOMIZED TO ATTEND 15 YOGA SESSIONS OF 90 MINUTES EACH OVER 10 WEEKS OR TO A WAIT-LIST CONTROL GROUP. FEASIBILITY WAS MEASURED BY RECRUITMENT RATES, SUBJECT RETENTION, AND ADHERENCE. ACCEPTABILITY WAS ASSESSED BY INTERVIEW AND QUESTIONNAIRES. CHANGES IN METABOLIC OUTCOMES AND QUESTIONNAIRE MEASURES FROM BASELINE TO WEEK 10 WERE CALCULATED. RESULTS: A TOTAL OF 280 PEOPLE WERE SCREENED BY PHONE, AND 93 WITH HIGH LIKELIHOOD OF METABOLIC SYNDROME WERE INVITED TO A SCREENING VISIT. OF THE 68 WHO ATTENDED SCREENING VISITS, 26 (38%) WERE RANDOMIZED, AND 24 (92%) COMPLETED THE TRIAL. ATTENDANCE AT YOGA CLASSES AND ADHERENCE TO HOME PRACTICE EXCEEDED OUR GOALS. IN THE YOGA GROUP, ALL PARTICIPANTS GAVE THE STUDY THE HIGHEST POSSIBLE SATISFACTION RATING, AND THE MAJORITY (87%) FELT THAT THE YOGA POSES WERE EASY TO PERFORM. THERE WAS TREND TO REDUCED BLOOD PRESSURE (P = 0.07), A SIGNIFICANT INCREASE IN ENERGY LEVEL (P < 0.009), AND TRENDS TO IMPROVEMENT IN WELL-BEING (P < 0.12) AND STRESS (P < 0.22) IN THE YOGA VERSUS CONTROL GROUP. CONCLUSIONS: RESTORATIVE YOGA WAS A FEASIBLE AND ACCEPTABLE INTERVENTION IN OVERWEIGHT ADULTS WITH METABOLIC SYNDROME. THE EFFICACY OF YOGA FOR IMPROVING METABOLIC PARAMETERS IN THIS POPULATION SHOULD BE EXPLORED IN A LARGER RANDOMIZED CONTROLLED TRIAL. 2008 15 1854 43 RANDOMISED CONTROLLED TRIAL OF A 12 WEEK YOGA INTERVENTION ON NEGATIVE AFFECTIVE STATES, CARDIOVASCULAR AND COGNITIVE FUNCTION IN POST-CARDIAC REHABILITATION PATIENTS. BACKGROUND: NEGATIVE AFFECTIVE STATES SUCH AS ANXIETY, DEPRESSION AND STRESS ARE SIGNIFICANT RISK FACTORS FOR CARDIOVASCULAR DISEASE, PARTICULARLY IN CARDIAC AND POST-CARDIAC REHABILITATION POPULATIONS.YOGA IS A BALANCED PRACTICE OF PHYSICAL EXERCISE, BREATHING CONTROL AND MEDITATION THAT CAN REDUCE PSYCHOSOCIAL SYMPTOMS AS WELL AS IMPROVE CARDIOVASCULAR AND COGNITIVE FUNCTION. IT HAS THE POTENTIAL TO POSITIVELY AFFECT MULTIPLE DISEASE PATHWAYS AND MAY PROVE TO BE A PRACTICAL ADJUNCT TO CARDIAC REHABILITATION IN FURTHER REDUCING CARDIAC RISK FACTORS AS WELL AS IMPROVING SELF-EFFICACY AND POST-CARDIAC REHABILITATION ADHERENCE TO HEALTHY LIFESTYLE BEHAVIOURS. METHOD AND DESIGN: THIS IS A PARALLEL ARM, MULTI-CENTRE, RANDOMISED CONTROLLED TRIAL THAT WILL ASSESS THE OUTCOMES OF POST- PHASE 2 CARDIAC REHABILITATION PATIENTS ASSIGNED TO A YOGA INTERVENTION IN COMPARISON TO A NO-TREATMENT WAIT-LIST CONTROL GROUP. PARTICIPANTS RANDOMISED TO THE YOGA GROUP WILL ENGAGE IN A 12 WEEK YOGA PROGRAM COMPRISING OF TWO GROUP BASED SESSIONS AND ONE SELF-ADMINISTERED HOME SESSION EACH WEEK. GROUP BASED SESSIONS WILL BE LED BY AN EXPERIENCED YOGA INSTRUCTOR. THIS WILL INVOLVE TEACHING BEGINNER STUDENTS A HATHA YOGA SEQUENCE THAT INCORPORATES ASANA (POSES AND POSTURES), PRANAYAMA (BREATHING CONTROL) AND MEDITATION. THE PRIMARY OUTCOMES OF THIS STUDY ARE NEGATIVE AFFECTIVE STATES OF ANXIETY, DEPRESSION AND STRESS ASSESSED USING THE DEPRESSION ANXIETY STRESS SCALE. SECONDARY OUTCOMES INCLUDE MEASURES OF QUALITY OF LIFE, AND CARDIOVASCULAR AND COGNITIVE FUNCTION. THE CARDIOVASCULAR OUTCOMES WILL INCLUDE BLOOD PRESSURE, HEART RATE, HEART RATE VARIABILITY, PULSE WAVE VELOCITY, CAROTID INTIMA MEDIA THICKNESS MEASUREMENTS, LIPID/GLUCOSE PROFILES AND C-REACTIVE PROTEIN ASSAYS. ASSESSMENTS WILL BE CONDUCTED PRIOR TO (WEEK 0), MID-WAY THROUGH (WEEK 6) AND FOLLOWING THE INTERVENTION PERIOD (WEEK 12) AS WELL AS AT A FOUR WEEK FOLLOW-UP (WEEK 16). DISCUSSION: THIS STUDY WILL DETERMINE THE EFFECT OF YOGA PRACTICE ON NEGATIVE AFFECTIVE STATES, CARDIOVASCULAR AND COGNITIVE FUNCTION IN POST-PHASE 2 CARDIAC REHABILITATION PATIENTS. THE FINDINGS MAY PROVIDE EVIDENCE TO INCORPORATE YOGA INTO STANDARDISED CARDIAC REHABILITATION PROGRAMS AS A PRACTICAL ADJUNCT TO IMPROVE THE MANAGEMENT OF PSYCHOSOCIAL SYMPTOMS ASSOCIATED WITH CARDIOVASCULAR EVENTS IN ADDITION TO IMPROVING PATIENTS' COGNITIVE AND CARDIOVASCULAR FUNCTIONS. TRIAL REGISTRATION: ACTRN12612000358842. 2014 16 1370 42 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 17 1180 50 EVALUATION OF THE EFFECTIVENESS AND EFFICACY OF IYENGAR YOGA THERAPY ON CHRONIC LOW BACK PAIN. STUDY DESIGN: THE EFFECTIVENESS AND EFFICACY OF IYENGAR YOGA FOR CHRONIC LOW BACK PAIN (CLBP) WERE ASSESSED WITH INTENTION-TO-TREAT AND PER-PROTOCOL ANALYSIS. NINETY SUBJECTS WERE RANDOMIZED TO A YOGA (N = 43) OR CONTROL GROUP (N = 47) RECEIVING STANDARD MEDICAL CARE. PARTICIPANTS WERE FOLLOWED 6 MONTHS AFTER COMPLETION OF THE INTERVENTION. OBJECTIVE: THIS STUDY AIMED TO EVALUATE IYENGAR YOGA THERAPY ON CHRONIC LOW BACK PAIN. YOGA SUBJECTS WERE HYPOTHESIZED TO REPORT GREATER REDUCTIONS IN FUNCTIONAL DISABILITY, PAIN INTENSITY, DEPRESSION, AND PAIN MEDICATION USAGE THAN CONTROLS. SUMMARY OF BACKGROUND DATA: CLBP IS A MUSCULOSKELETAL DISORDER WITH PUBLIC HEALTH AND ECONOMIC IMPACT. PILOT STUDIES OF YOGA AND BACK PAIN HAVE REPORTED SIGNIFICANT CHANGES IN CLINICALLY IMPORTANT OUTCOMES. METHODS: SUBJECTS WERE RECRUITED THROUGH SELF-REFERRAL AND HEALTH PROFESSIONAL REFERRALS ACCORDING TO EXPLICIT INCLUSION/EXCLUSION CRITERIA. YOGA SUBJECTS PARTICIPATED IN 24 WEEKS OF BIWEEKLY YOGA CLASSES DESIGNED FOR CLBP. OUTCOMES WERE ASSESSED AT 12 (MIDWAY), 24 (IMMEDIATELY AFTER), AND 48 WEEKS (6-MONTH FOLLOW-UP) AFTER THE START OF THE INTERVENTION USING THE OSWESTRY DISABILITY QUESTIONNAIRE, A VISUAL ANALOG SCALE, THE BECK DEPRESSION INVENTORY, AND A PAIN MEDICATION-USAGE QUESTIONNAIRE. RESULTS: USING INTENTION-TO-TREAT ANALYSIS WITH REPEATED MEASURES ANOVA (GROUP X TIME), SIGNIFICANTLY GREATER REDUCTIONS IN FUNCTIONAL DISABILITY AND PAIN INTENSITY WERE OBSERVED IN THE YOGA GROUP WHEN COMPARED TO THE CONTROL GROUP AT 24 WEEKS. A SIGNIFICANTLY GREATER PROPORTION OF YOGA SUBJECTS ALSO REPORTED CLINICAL IMPROVEMENTS AT BOTH 12 AND 24 WEEKS. IN ADDITION, DEPRESSION WAS SIGNIFICANTLY LOWER IN YOGA SUBJECTS. FURTHERMORE, WHILE A REDUCTION IN PAIN MEDICATION OCCURRED, THIS WAS COMPARABLE IN BOTH GROUPS. WHEN RESULTS WERE ANALYZED USING PER-PROTOCOL ANALYSIS, IMPROVEMENTS WERE OBSERVED FOR ALL OUTCOMES IN THE YOGA GROUP, INCLUDING AGREATER TREND FOR REDUCED PAIN MEDICATION USAGE. ALTHOUGH SLIGHTLY LESS THAN AT 24 WEEKS, THE YOGA GROUP HAD STATISTICALLY SIGNIFICANT REDUCTIONS IN FUNCTIONAL DISABILITY, PAIN INTENSITY, AND DEPRESSION COMPARED TO STANDARD MEDICAL CARE 6-MONTHS POSTINTERVENTION. CONCLUSION: YOGA IMPROVES FUNCTIONAL DISABILITY, PAIN INTENSITY, AND DEPRESSION IN ADULTS WITH CLBP. THERE WAS ALSO A CLINICALLY IMPORTANT TREND FOR THE YOGA GROUP TO REDUCE THEIR PAIN MEDICATION USAGE COMPARED TO THE CONTROL GROUP. 2009 18 2660 46 YOGA IN ARTERIAL HYPERTENSION. BACKGROUND: YOGA SEEMS TO EXERT ITS EFFECT AGAINST ARTERIAL HYPERTENSION MAINLY THROUGH THE ASSOCIATED BREATHING AND MEDITATION TECHNIQUES, AND LESS SO THROUGH YOGA POSTURES. THE GOAL OF THIS TRIAL WAS TO COMPARE THE BLOOD PRESSURE-LOWERING EFFECT OF YOGA INTERVENTIONS WITH AND WITHOUT YOGA POSTURES IN PATIENTS WITH ARTERIAL HYPERTENSION. METHODS: 75 PATIENTS TAKING MEDICATIONS FOR ARTERIAL HYPERTENSION (72% WOMEN, MEAN AGE 58.7 +/- 9.5 YEARS) WERE RANDOMIZED INTO THREE GROUPS: A YOGA INTERVENTION GROUP WITH YOGA POSTURES (25 PATIENTS, OF WHOM 5 DROPPED OUT OF THE TRIAL BEFORE ITS END), A YOGA INTERVENTION GROUP WITHOUT YOGA POSTURES (25 PATIENTS, 3 DROPOUTS), AND A WAIT LIST CONTROL GROUP (25 PATIENTS, ONE DROPOUT). THE INTERVENTIONS CONSISTED OF 90 MINUTES OF YOGA PRACTICE PER WEEK FOR TWELVE WEEKS. THE DATA COLLECTORS, WHO WERE BLINDED TO THE INTERVENTION RECEIVED, ASSESSED THE PRIMARY OUTCOME MEASURES "SYSTOLIC 24-HOUR BLOOD PRESSURE" AND "DIASTOLIC 24-HOUR BLOOD PRESSURE" BEFORE AND AFTER THE INTERVENTION. IN THIS REPORT, WE ALSO PRESENT THE FINDINGS ON SECONDARY OUTCOME MEASURES, INCLUDING FOLLOW-UP DATA. RESULTS: AFTER THE INTERVENTION, THE SYSTOLIC 24-HOUR BLOOD PRESSURE IN THE YOGA INTERVENTION GROUP WITHOUT YOGA POSTURES WAS SIGNIFICANTLY LOWER THAN IN THE CONTROL GROUP (GROUP DIFFERENCE [DELTA]= -3.8 MMHG; [95% CONFIDENCE INTERVAL (CI): (-0.3; -7.4) P = 0.035]); IT WAS ALSO SIGNIFICANTLY LOWER THAN IN THE YOGA INTERVENTION GROUP WITH YOGA POSTURES (DELTA = -3.2 MMHG; 95% CI: [-6.3; -0.8]; P = 0.045). DIASTOLIC BLOOD PRESSURES DID NOT DIFFER SIGNIFICANTLY ACROSS GROUPS. NO SERIOUS ADVERSE EVENTS WERE ENCOUNTERED IN THE COURSE OF THE TRIAL. CONCLUSION: IN ACCORDANCE WITH THE FINDINGS OF EARLIER STUDIES, WE FOUND THAT ONLY YOGA WITHOUT YOGA POSTURES INDUCED A SHORT-TERM LOWERING OF AMBULATORY SYSTOLIC BLOOD PRESSURE. YOGA IS SAFE AND EFFECTIVE IN PATIENTS TAKING MEDICATIONS FOR ARTERIAL HYPERTENSION AND THUS CAN BE RECOMMENDED AS AN ADDITIONAL TREATMENT OPTION FOR PERSONS IN THIS CATEGORY. 2018 19 2628 40 YOGA FOR THE MANAGEMENT OF PAIN AND SLEEP IN RHEUMATOID ARTHRITIS: A PILOT RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: THE AIM OF THE PRESENT STUDY WAS TO DETERMINE THE FEASIBILITY OF A RELAXATION-BASED YOGA INTERVENTION FOR RHEUMATOID ARTHRITIS, DESIGNED AND REPORTED IN ACCORDANCE WITH DELPHI RECOMMENDATIONS FOR YOGA INTERVENTIONS FOR MUSCULOSKELETAL CONDITIONS. METHODS: PARTICIPANTS WERE RECRUITED FROM A HOSPITAL DATABASE, AND RANDOMIZED TO EITHER EIGHT WEEKLY 75-MIN YOGA CLASSES OR A USUAL CARE CONTROL. FEASIBILITY WAS DETERMINED BY RECRUITMENT RATES, RETENTION, PROTOCOL ADHERENCE, PARTICIPANT SATISFACTION AND ADVERSE EVENTS. SECONDARY PHYSICAL AND PSYCHOSOCIAL OUTCOMES WERE ASSESSED USING SELF-REPORTED QUESTIONNAIRES AT BASELINE (WEEK 0), WEEK 9 (PRIMARY TIME POINT) AND WEEK 12 (FOLLOW-UP). RESULTS: OVER A 3-MONTH PERIOD, 26 PARTICIPANTS WITH MILD PAIN, MILD TO MODERATE FUNCTIONAL DISABILITY AND MODERATE DISEASE ACTIVITY WERE RECRUITED INTO THE STUDY (25% RECRUITMENT RATE). RETENTION RATES WERE 100% FOR YOGA PARTICIPANTS AND 92% FOR USUAL CARE PARTICIPANTS AT BOTH WEEKS 9 AND 12. PROTOCOL ADHERENCE AND PARTICIPANT SATISFACTION WERE HIGH. YOGA PARTICIPANTS ATTENDED A MEDIAN OF SEVEN CLASSES; ADDITIONALLY, SEVEN OF THE YOGA PARTICIPANTS (54%) REPORTED CONTINUING YOGA AT HOME DURING THE FOLLOW-UP PERIOD. NO SERIOUS ADVERSE EVENTS WERE RELATED TO THE STUDY. SECONDARY OUTCOMES SHOWED NO GROUP EFFECTS OF YOGA COMPARED WITH USUAL CARE. CONCLUSIONS: A RELAXATION-BASED YOGA PROGRAMME WAS FOUND TO BE FEASIBLE AND SAFE FOR PARTICIPANTS WITH RHEUMATOID ARTHRITIS-RELATED PAIN AND FUNCTIONAL DISABILITY. ADVERSE EVENTS WERE MINOR, AND NOT UNEXPECTED FROM AN INTERVENTION INCLUDING PHYSICAL COMPONENTS. THIS PILOT PROVIDES A FRAMEWORK FOR LARGER INTERVENTION STUDIES, AND SUPPORTS FURTHER EXPLORATION OF YOGA AS A COMPLEX INTERVENTION TO ASSIST WITH THE MANAGEMENT OF RHEUMATOID ARTHRITIS. 2018 20 1402 52 IMPACT OF YOGA ON BLOOD PRESSURE AND QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION - A CONTROLLED TRIAL IN PRIMARY CARE, MATCHED FOR SYSTOLIC BLOOD PRESSURE. BACKGROUND: MEDICAL TREATMENT OF HYPERTENSION IS NOT ALWAYS SUFFICIENT TO ACHIEVE BLOOD PRESSURE CONTROL. DESPITE THIS, PREVIOUS STUDIES ON SUPPLEMENTARY THERAPIES, SUCH AS YOGA, ARE RELATIVELY FEW. WE INVESTIGATED THE EFFECTS OF TWO YOGA INTERVENTIONS ON BLOOD PRESSURE AND QUALITY OF LIFE IN PATIENTS IN PRIMARY HEALTH CARE DIAGNOSED WITH HYPERTENSION. METHODS: ADULT PATIENTS (AGE 20-80 YEARS) WITH DIAGNOSED HYPERTENSION WERE IDENTIFIED BY AN ELECTRONIC CHART SEARCH AT A PRIMARY HEALTH CARE CENTER IN SOUTHERN SWEDEN. IN TOTAL, 83 SUBJECTS WITH BLOOD PRESSURE VALUES OF 120-179/