1 1035 114 EFFECTS OF YOGA IN INFLAMMATORY BOWEL DISEASES AND ON FREQUENT IBD-ASSOCIATED EXTRAINTESTINAL SYMPTOMS LIKE FATIGUE AND DEPRESSION. QUALITY OF LIFE (QOL) OF PERSONS WITH INFLAMMATORY BOWEL DISEASES (IBD) IS OFTEN IMPAIRED BY SYMPTOMS THAT DO NOT PRIMARILY RELATE TO INTESTINAL INFLAMMATION. AMONG THE MOST CHALLENGING EXTRAINTESTINAL SYMPTOMS ARE DEPRESSION AND FATIGUE, WHICH ARE ALSO FREQUENT IN OTHER CHRONIC DISEASES LIKE MULTIPLE SCLEROSIS, RHEUMATOID ARTHRITIS AND CANCER. YOGA AS AN ANCIENT INDIAN TRADITION CONTAINING POSTURES, BREATHING EXERCISES AND MEDITATION MAY POSITIVELY INFLUENCE THOSE SYMPTOMS. THIS REVIEW EVALUATES THE CURRENT LITERATURE WITH REGARD TO THE EFFECT OF YOGA-BASED INTERVENTIONS IN PERSONS WITH IBD AND WITH REGARD TO QOL, DEPRESSION AND FATIGUE IN OTHER SOMATIC DISORDERS. A SYSTEMATIC LITERATURE SEARCH YIELDED THREE TRIALS EXAMINING THE EFFECTS OF YOGA IN PATIENTS WITH IBD AND 37 TRIALS ADDRESSING DEPRESSIVE SYNDROMES OR FATIGUE IN SOMATIC DISORDERS. IN SUMMARY, BOTH IN-PERSON AND VIDEO-BASED YOGA CLASSES ARE FEASIBLE, ACCEPTABLE AND SAFE AS COMPLEMENTARY TREATMENT IN PATIENTS WITH IBD AND SIGNIFICANTLY IMPROVE ANXIETY AND IMPAIRED QUALITY OF LIFE. CURRENT LITERATURE DOES NOT PROVIDE INFORMATION ON THE EFFECT OF YOGA ON DEPRESSION AND FATIGUE IN PATIENTS WITH IBD, BUT RESEARCH FROM OTHER SOMATIC DISORDERS OR PATIENTS WITH DEPRESSIVE DISORDERS IMPLIES THE POTENTIAL OF YOGA IN THIS REGARD FOR PERSONS WITH IBD. THIS SHOULD BE SPECIFICALLY ADDRESSED IN INTERVENTIONAL TRIALS WITH STANDARDIZED YOGA MODULES INCLUDING PATIENTS WITH IBD SUFFERING FROM FATIGUE, DEPRESSION AND/OR IMPAIRED QOL. 2021
2 891 38 EFFECT OF YOGA-BASED INTERVENTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. BACKGROUND: INFLAMMATORY BOWEL DISEASE (IBD) IS A CHRONIC ILLNESS CHARACTERIZED BY GROSS INFLAMMATION IN THE GASTROINTESTINAL TRACT THAT CAN RESULT IN SYMPTOMS SUCH AS ABDOMINAL PAIN, CRAMPING, DIARRHEA, AND BLOODY STOOLS. IBD IS BELIEVED TO BE INFLUENCED BY PSYCHOLOGICAL FACTORS SUCH AS STRESS AND ANXIETY. THEREFORE, A YOGA INTERVENTION THAT REDUCES STRESS AND ANXIETY MAY BE AN EFFECTIVE COMPLEMENTARY TREATMENT FOR THESE DISORDERS. MATERIAL AND METHODS: A TOTAL OF 100 IBD PATIENTS [ULCERATIVE COLITIS (UC) N = 60 AND CROHN'S DISEASE (CD) N = 40] DURING THE CLINICAL REMISSION PHASE OF DISEASE WERE INCLUDED IN THE STUDY. THESE PATIENTS WERE ALLOCATED RANDOMLY TO EITHER THE YOGA GROUP THAT UNDERWENT AN 8-WEEK YOGA INTERVENTION (PHYSICAL POSTURES, PRANAYAMA, AND MEDITATION) 1- HOUR/DAY IN ADDITION TO STANDARD MEDICAL THERAPY (UC, N = 30; CD, N = 20) OR THE CONTROL GROUP (UC, N = 30; CD N = 20), WHICH CONTINUED WITH STANDARD MEDICAL THERAPY ALONE. THE MAIN OUTCOME MEASURES WERE CARDIOVASCULAR AUTONOMIC FUNCTIONS, SERUM EOSINOPHILIC CATIONIC PROTEIN, INTERLEUKIN- 2 SOLUBLE RECEPTORS, SPEILBERGER'S STATE TRAIT ANXIETY INVENTORY (STAI) SCORES, AND CLINICAL SYMPTOMS. RESULTS: BEFORE THE INTERVENTION, ALL THE OUTCOME MEASURES WERE COMPARABLE IN THE TWO GROUPS. AFTER THE 8-WEEK YOGA INTERVENTION, FEWER UC PATIENTS REPORTED ARTHRALGIA. THE NUMBER OF PATIENTS REPORTING INTESTINAL COLIC PAIN IN THE CONTROL GROUP WAS HIGHER. STATE AND TRAIT ANXIETY LEVELS WERE SIGNIFICANTLY REDUCED IN PATIENTS WITH UC. HOWEVER, NO SIGNIFICANT CHANGES WERE OBSERVED IN CARDIOVASCULAR AUTONOMIC FUNCTIONS, EOSINOPHILIC CATIONIC PROTEINS, OR INTERLEUKIN-2 SOLUBLE RECEPTORS. CONCLUSIONS: A SIMPLIFIED YOGA-BASED REGIMEN IS A SAFE AND EFFECTIVE COMPLEMENTARY CLINICAL TREATMENT MODALITY FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE DURING THE CLINICAL REMISSION PHASE. 2015
3 2472 31 YOGA AS ADJUNCT THERAPY FOR ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE: A PILOT CLINICAL TRIAL. OBJECTIVES: TO DETERMINE WHETHER UTILIZING YOGA AS AN ADJUNCTIVE THERAPY TO THE MEDICAL STANDARD OF CARE FOR ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) IS: (1) FEASIBLE AND ACCEPTABLE, (2) EFFECTIVE IN REDUCING DISEASE SEVERITY, INTESTINAL INFLAMMATION AND IMPROVING WELLNESS. DESIGN: PROSPECTIVE, NON-RANDOMIZED, 8-WEEK PILOT STUDY FOR ADOLESCENTS WITH A DIAGNOSIS OF IBD. FEASIBILITY AND ACCEPTABILITY OF THE INTERVENTION WERE ASSESSED WEEKLY AND POST-INTERVENTION VIA SURVEYS AND A FOCUS GROUP (WEEK 8). DISEASE SEVERITY, INTESTINAL INFLAMMATION, AND WELLNESS MEASURES WERE ASSESSED AT BASELINE AND POST-INTERVENTION (WEEK 8). INTERVENTION: OVER THE 8-WEEK STUDY PERIOD, PATIENTS WERE ASSIGNED THREE 60-MINUTE, IN-PERSON YOGA CLASSES AT WEEKS 1, 3 AND 8, AND THREE 30-MINUTE, ONLINE YOGA VIDEOS PER WEEK. MAIN OUTCOME MEASURES: PRIMARY OUTCOME MEASURES WERE FEASIBILITY AND ACCEPTABILITY. SECONDARY OUTCOME MEASURES ASSESSED PRELIMINARY CLINICAL EFFICACY BY EXAMINING PRE- AND POST-INTERVENTION CHANGE IN DISEASE SEVERITY (PUCAI), INTESTINAL INFLAMMATION (FECAL CALPROTECTIN), AND SIX WELLNESS MEASURES (PROMIS-37). RESULTS: NINE ADOLESCENTS WITH IBD PARTICIPATED. EIGHT PARTICIPATED IN ONE OR MORE YOGA VIDEOS PER WEEK AND ALL NINE ATTENDED AT LEAST TWO IN-PERSON YOGA CLASSES. FOCUS GROUP THEMES REVEALED THAT THE INTERVENTION WAS WELL LIKED, WITH ALL PARTICIPANTS REPORTING REDUCED STRESS, IMPROVED EMOTIONAL SELF-AWARENESS, AND INCREASED ABILITY TO IDENTIFY AND MANAGE THE PHYSICAL SYMPTOMS OF IBD. PARTICIPANTS HAD DIFFICULTY, HOWEVER, COMPLETING THE YOGA VIDEOS DUE TO TIME LIMITATIONS AND COMPETING PRIORITIES. WE LACKED POWER TO DETECT ANY STATISTICALLY SIGNIFICANT CHANGES IN PUCAI, CALPROTECTIN, OR ANY OF THE SIX PROMIS-37 DOMAINS. CONCLUSIONS: A COMBINATION OF IN-PERSON INSTRUCTOR LED YOGA WITH VIDEO-BASED YOGA IS A FEASIBLE AND ACCEPTABLE ADJUNCT THERAPY FOR ADOLESCENTS WITH IBD. PARTICIPANTS REPORTED REDUCED STRESS AND IMPROVED ABILITY TO IDENTIFY AND MANAGE PHYSICAL SYMPTOMS. A LARGER, RANDOMIZED CONTROLLED TRIAL IS NECESSARY TO DETERMINE IF THE YOGA PROTOCOL RESULTS IN CLINICALLY AND STATISTICALLY SIGNIFICANT IMPROVEMENTS IN INFLAMMATORY BIOMARKERS AND PATIENT REPORTED OUTCOMES. 2018
4 1175 38 EVALUATION OF AN INTEGRATED YOGA PROGRAM IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PILOT STUDY. BACKGROUND: THE EFFECTS OF INTEGRATED YOGA PROGRAMS ON MENTAL HEALTH OUTCOMES IN INFLAMMATORY BOWEL DISEASE (IBD) HAVE NOT BEEN WELL EXPLORED. TO EXPLORE THE ACCEPTABILITY, IMPLEMENTATION AND EFFECTIVENESS OF AN INTEGRATED EIGHT-WEEK YOGA PROGRAM PLUS AROMATHERAPY MASSAGE IN PATIENTS WITH IBD. METHODS: NINE PARTICIPANTS WITH DOCUMENTED IBD WERE RECRUITED FROM A GASTROENTEROLOGY CLINIC IN CALGARY, ALBERTA, CANADA TO PARTICIPATE IN AN INTEGRATED YOGA PROGRAM WEEKLY FOR EIGHT WEEKS WITH OUTCOMES ASSESSED AT BASELINE AND WEEK 8. PRIMARY OUTCOMES WERE ASSESSED USING THEORY OF PLANNED BEHAVIOUR AS A GUIDING THEORY TO IDENTIFY SALIENT BELIEFS FROM QUALITATIVE ANALYSIS OF A SEMI-STRUCTURED INTERVIEW, SURVEY ITEMS MEASURING THE STRENGTH OF BELIEFS AND A DAILY LOG WAS USED TO CAPTURE ADHERENCE AND ADVERSE EVENTS. SECONDARY OUTCOMES WERE COLLECTED USING VALIDATED SURVEY TOOLS EXAMINING ANXIETY, DEPRESSION, STRESS, SLEEP QUALITY, AND PHYSICAL AND MENTAL QUALITY OF LIFE. RESULTS: ATTITUDE, SUBJECTIVE NORM AND PERCEIVED BEHAVIORAL CONTROL BELIEFS PERTINENT TO THE YOGA INTERVENTION AND DAILY PRACTICE WERE IDENTIFIED. PARTICIPANTS REPORTED FEELING THE INTERVENTION WAS VERY HELPFUL; HOWEVER, FELT GUILT ABOUT NOT COMPLETING DAILY PRACTICES WHICH DECREASED CONFIDENCE AND INTENTION TO CONTINUE WITH THE PRACTICE. AN AVERAGE OF 55.6% OF IN-PERSON SESSIONS WERE ATTENDED AND DECREASED OVER TIME. PARTICIPANTS PRACTICED ON AVERAGE OF 5.4 DAYS PER WEEK. DEPRESSION AND MENTAL HEALTH SCORES IMPROVED AT WEEK 8 FROM BASELINE. CONCLUSIONS: WE WERE ABLE TO IDENTIFY KEY SALIENT BELIEFS OF IBD PATIENTS IN REGARD TO AN INTEGRATED YOGA PLUS AROMATHERAPY MASSAGE INTERVENTION. THIS INTERVENTION APPEARS TO BE ACCEPTABLE AND FURTHER RESEARCH SHOULD EXPLORE ITS POTENTIAL TO IMPROVE MENTAL AND PHYSICAL HEALTH OUTCOMES INCLUDING IBD SYMPTOMS. 2022
5 219 37 A SYSTEMATIC REVIEW AND META-ANALYSIS OF MINDFULNESS BASED INTERVENTIONS AND YOGA IN INFLAMMATORY BOWEL DISEASE. BACKGROUND: MINDFULNESS INTERVENTIONS ARE INCREASINGLY USED AS A PART OF INTEGRATED TREATMENT IN INFLAMMATORY BOWEL DISEASE (IBD) BUT THERE ARE LIMITED DATA AND A LACK OF CONSENSUS REGARDING EFFECTIVENESS. OBJECTIVES: WE EXPLORED THE EFFICACY OF MINDFULNESS INTERVENTIONS COMPARED TO TREATMENT AS USUAL (TAU), OR OTHER PSYCHOTHERAPEUTIC INTERVENTIONS, IN TREATING PHYSICAL AND PSYCHOSOCIAL SYMPTOMS ASSOCIATED WITH IBD. METHODS: WE CONDUCTED A SYSTEMATIC REVIEW AND META-ANALYSIS OF RELEVANT RANDOMIZED CONTROLLED TRIALS (RCTS). WE INCLUDED A BROAD RANGE OF MINDFULNESS INTERVENTIONS INCLUDING MINDFULNESS-BASED INTERVENTIONS AND YOGA, WITH NO RESTRICTIONS ON DATE OF PUBLICATION, PARTICIPANTS' AGE, LANGUAGE OR PUBLICATION TYPE. WE SEARCHED THE FOLLOWING ELECTRONIC DATABASES: MEDLINE, EMBASE, PSYCINFO, CINAHL AND WHO ICTRP DATABASE. WE ADHERED TO THE PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META-ANALYSIS (PRISMA) GUIDELINES IN CONDUCTING THE REVIEW. RESULTS: WE INCLUDED EIGHT STUDIES IN THE META-ANALYSIS. MINDFULNESS INTERVENTIONS SHOWED A STATISTICALLY SIGNIFICANT EFFECT ON STRESS IN BOTH THE SHORT(SMD=-0.48; 95%CI:-0.97, 0.00; P=.05), AND LONG TERM(SMD=-0.55; 95%CI:-0.78, -0.32; P<.00001), SIGNIFICANT LONG TERM EFFECTS ON DEPRESSION (SMD=-0.36; 95%CI:-0.66, -0.07; P=.02) AND QUALITY OF LIFE (SMD=0.38; 95%CI:0.08, 0.68; P=.01),AND SMALL BUT NOT STATISTICALLY SIGNIFICANT IMPROVEMENTS IN ANXIETY (SMD=-0.27; 95%CI:-0.65, 0.11; P=.16).EFFECTS ON PHYSICAL OUTCOMES WERE EQUIVOCAL AND NOT STATISTICALLY SIGNIFICANT. CONCLUSIONS: MINDFULNESS INTERVENTIONS ARE EFFECTIVE IN REDUCING STRESS AND DEPRESSION AND IMPROVING QUALITY OF LIFE AND ANXIETY, BUT DO NOT LEAD TO SIGNIFICANT IMPROVEMENTS IN THE PHYSICAL SYMPTOMS OF IBD. FURTHER RESEARCH INVOLVING IBD-TAILORED INTERVENTIONS AND MORE RIGOROUSLY DESIGNED TRIALS IS WARRANTED. 2019
6 793 34 EFFECT OF YOGA IN THE THERAPY OF IRRITABLE BOWEL SYNDROME: A SYSTEMATIC REVIEW. BACKGROUND & AIMS: THIS REVIEW AIMS TO SYSTEMATICALLY SURVEY THE EFFECTS OF YOGA ON SYMPTOMS OF IRRITABLE BOWEL SYNDROME (IBS), PAIN, QUALITY OF LIFE, MOOD, STRESS, AND SAFETY IN PATIENTS WITH IBS. METHODS: MEDLINE/PUBMED, SCOPUS, THE COCHRANE LIBRARY, CAM-QUEST, CAMBASE, AND INDMED WERE SCREENED THROUGH NOVEMBER 2015. RANDOMIZED CONTROLLED TRIALS COMPARING YOGA WITH USUAL CARE, NONPHARMACOLOGIC, OR PHARMACOLOGIC INTERVENTIONS WERE ANALYZED FOR PATIENTS WITH IBS. PRIMARY OUTCOMES INCLUDED GASTROINTESTINAL SYMPTOMS, QUALITY OF LIFE, AND PAIN. ANXIETY, MOOD, AND SAFETY WERE DEFINED AS SECONDARY OUTCOMES. RISK OF BIAS WAS ASSESSED ACCORDING TO THE COCHRANE COLLABORATION RECOMMENDATIONS. RESULTS: SIX RANDOMIZED CONTROLLED TRIALS WITH A TOTAL OF 273 PATIENTS WERE INCLUDED IN THE QUALITATIVE ANALYSIS. THERE WAS EVIDENCE FOR A BENEFICIAL EFFECT OF A YOGIC INTERVENTION OVER CONVENTIONAL TREATMENT IN IBS, WITH SIGNIFICANTLY DECREASED BOWEL SYMPTOMS, IBS SEVERITY, AND ANXIETY. FURTHERMORE, THERE WERE SIGNIFICANT IMPROVEMENTS IN QUALITY OF LIFE, GLOBAL IMPROVEMENT, AND PHYSICAL FUNCTIONING AFTER YOGA COMPARED WITH NO TREATMENT. TWO RANDOMIZED CONTROLLED TRIALS REPORTED SAFETY DATA STATING THAT NO ADVERSE EVENTS OCCURRED. OVERALL, RISK OF BIAS OF THE INCLUDED STUDIES WAS UNCLEAR. CONCLUSIONS: THE FINDINGS OF THIS SYSTEMATIC REVIEW SUGGEST THAT YOGA MIGHT BE A FEASIBLE AND SAFE ADJUNCTIVE TREATMENT FOR PEOPLE WITH IBS. NEVERTHELESS, NO RECOMMENDATION CAN BE MADE REGARDING YOGA AS A ROUTINE INTERVENTION FOR PATIENTS WITH IBS BECAUSE OF MAJOR FLAWS IN STUDY METHODS. MORE RESEARCH IS NEEDED WITH RESPECT TO A HIGH-QUALITY STUDY DESIGN AND CONSENSUS IN CLINICAL OUTCOME MEASUREMENTS IN IBS. CLINICALTRIALS.GOV NUMBER, NCT02721836. 2016
7 1061 36 EFFECTS OF YOGA ON HEALTH-RELATED QUALITY, PHYSICAL HEALTH AND PSYCHOLOGICAL HEALTH IN WOMEN WITH BREAST CANCER RECEIVING CHEMOTHERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS. BACKGROUND: YOGA RECEIVE MORE ATTENTION FROM BREAST CANCER PATIENTS, HOWEVER ITS FEASIBILITY AND EFFICACY DURING CHEMOTHERAPY REMAINS CONFLICTING. WE PERFORMED THIS SYSTEMATIC REVIEW TO ASSESS THE EFFECTS OF YOGA ON HEALTH-RELATED QUALITY, PHYSICAL HEALTH AND PSYCHOLOGICAL HEALTH IN BREAST CANCER PATIENTS UNDERGOING CHEMOTHERAPY. METHODS: A SYSTEMATIC SEARCH WAS CONDUCTED TO RETRIEVE RANDOMIZED CONTROLLED TRIALS (RCTS) WHICH INVESTIGATED THE COMPARATIVE EFFICACY OF YOGA VERSUS COMPARATORS SUCH AS USUAL CARE AMONG BREAST CANCER PATIENTS FOR HEALTH-RELATED QUALITY, PHYSICAL HEALTH AND PSYCHOLOGICAL HEALTH IN PUBMED, EMBASE, COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (CNETRAL), NURSING AND ALLIED HEALTH LITERATURE (CINAHL), CHINESE BIOMEDICAL LITERATURE (CBM) DATABASE, CHINA SCIENCE AND TECHNOLOGY JOURNAL (CSTJ) DATABASE, CHINA NATIONAL KNOWLEDGE INFRASTRUCTURE (CNKI), AND WANGFANG DATABASE FROM INCEPTION TO DECEMBER 2018. THE LATEST SEARCH WAS UPDATED ON SEPTEMBER 2020. ALL ANALYSES WERE COMPLETED USING REVMAN VERSION 5.3. RESULTS: SEVEN TRIALS INVOLVING 693 BREAST CANCER PATIENTS MET INCLUSION CRITERIA. META-ANALYSIS INDICATED A SHORT-TERM IMPROVEMENT IN FATIGUE [STANDARD MEAN DIFFERENCE (SMD), -0.62; 95% CONFIDENCE INTERVAL (CI), -1.17 TO -0.07], SLEEP DISTURBANCE (SMD, -0.34; 95% CI, -0.55 TO -0.12), DEPRESSION (SMD, -0.50; 95% CI, -0.70 TO -0.31) ANXIETY (SMD, -0.50; 95% CI, -0.70 TO -0.31), AND HEALTH-RELATED QUALITY OF LIFE (QOL) (SMD, 0.72; 95% CI, -0.12 TO 1.56) IN THE YOGA GROUP; HOWEVER BENEFICIAL MEDIUM- AND LONG-TERM EFFECTS IN FATIGUE, SLEEP DISTURBANCE WERE NOT IDENTIFIED. MOREOVER, QUALITATIVE ANALYSES SUGGESTED THAT YOGA WAS NOT ASSOCIATED WITH DECREASED ADVERSE EVENTS (AES) COMPARED WITH CONTROL GROUPS. CONCLUSIONS: YOGA MAY BENEFIT TO REDUCE FATIGUE, DEPRESSION AND ANXIETY, IMPROVE SLEEP DISTURBANCE, AND IMPROVE QOL IN BREAST CANCER PATIENTS RECEIVING CHEMOTHERAPY IN THE SHORT-TERM; HOWEVER, MEDIUM- AND LONG-TERM EFFECTS SHOULD BE FURTHER ESTABLISHED OWING TO LIMITATIONS. 2021
8 2587 54 YOGA FOR IMPROVING HEALTH-RELATED QUALITY OF LIFE, MENTAL HEALTH AND CANCER-RELATED SYMPTOMS IN WOMEN DIAGNOSED WITH BREAST CANCER. BACKGROUND: BREAST CANCER IS THE CANCER MOST FREQUENTLY DIAGNOSED IN WOMEN WORLDWIDE. EVEN THOUGH SURVIVAL RATES ARE CONTINUALLY INCREASING, BREAST CANCER IS OFTEN ASSOCIATED WITH LONG-TERM PSYCHOLOGICAL DISTRESS, CHRONIC PAIN, FATIGUE AND IMPAIRED QUALITY OF LIFE. YOGA COMPRISES ADVICE FOR AN ETHICAL LIFESTYLE, SPIRITUAL PRACTICE, PHYSICAL ACTIVITY, BREATHING EXERCISES AND MEDITATION. IT IS A COMPLEMENTARY THERAPY THAT IS COMMONLY RECOMMENDED FOR BREAST CANCER-RELATED IMPAIRMENTS AND HAS BEEN SHOWN TO IMPROVE PHYSICAL AND MENTAL HEALTH IN PEOPLE WITH DIFFERENT CANCER TYPES. OBJECTIVES: TO ASSESS EFFECTS OF YOGA ON HEALTH-RELATED QUALITY OF LIFE, MENTAL HEALTH AND CANCER-RELATED SYMPTOMS AMONG WOMEN WITH A DIAGNOSIS OF BREAST CANCER WHO ARE RECEIVING ACTIVE TREATMENT OR HAVE COMPLETED TREATMENT. SEARCH METHODS: WE SEARCHED THE COCHRANE BREAST CANCER SPECIALISED REGISTER, MEDLINE (VIA PUBMED), EMBASE, THE COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (CENTRAL; 2016, ISSUE 1), INDEXING OF INDIAN MEDICAL JOURNALS (INDMED), THE WORLD HEALTH ORGANIZATION (WHO) INTERNATIONAL CLINICAL TRIALS REGISTRY PLATFORM (ICTRP) SEARCH PORTAL AND CLINICALTRIALS.GOV ON 29 JANUARY 2016. WE ALSO SEARCHED REFERENCE LISTS OF IDENTIFIED RELEVANT TRIALS OR REVIEWS, AS WELL AS CONFERENCE PROCEEDINGS OF THE INTERNATIONAL CONGRESS ON COMPLEMENTARY MEDICINE RESEARCH (ICCMR), THE EUROPEAN CONGRESS FOR INTEGRATIVE MEDICINE (ECIM) AND THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO). WE APPLIED NO LANGUAGE RESTRICTIONS. SELECTION CRITERIA: RANDOMISED CONTROLLED TRIALS WERE ELIGIBLE WHEN THEY (1) COMPARED YOGA INTERVENTIONS VERSUS NO THERAPY OR VERSUS ANY OTHER ACTIVE THERAPY IN WOMEN WITH A DIAGNOSIS OF NON-METASTATIC OR METASTATIC BREAST CANCER, AND (2) ASSESSED AT LEAST ONE OF THE PRIMARY OUTCOMES ON PATIENT-REPORTED INSTRUMENTS, INCLUDING HEALTH-RELATED QUALITY OF LIFE, DEPRESSION, ANXIETY, FATIGUE OR SLEEP DISTURBANCES. DATA COLLECTION AND ANALYSIS: TWO REVIEW AUTHORS INDEPENDENTLY COLLECTED DATA ON METHODS AND RESULTS. WE EXPRESSED OUTCOMES AS STANDARDISED MEAN DIFFERENCES (SMDS) WITH 95% CONFIDENCE INTERVALS (CIS) AND CONDUCTED RANDOM-EFFECTS MODEL META-ANALYSES. WE ASSESSED POTENTIAL RISK OF PUBLICATION BIAS THROUGH VISUAL ANALYSIS OF FUNNEL PLOT SYMMETRY AND HETEROGENEITY BETWEEN STUDIES BY USING THE CHI(2) TEST AND THE I(2) STATISTIC. WE CONDUCTED SUBGROUP ANALYSES FOR CURRENT TREATMENT STATUS, TIME SINCE DIAGNOSIS, STAGE OF CANCER AND TYPE OF YOGA INTERVENTION. MAIN RESULTS: WE INCLUDED 24 STUDIES WITH A TOTAL OF 2166 PARTICIPANTS, 23 OF WHICH PROVIDED DATA FOR META-ANALYSIS. THIRTEEN STUDIES HAD LOW RISK OF SELECTION BIAS, FIVE STUDIES REPORTED ADEQUATE BLINDING OF OUTCOME ASSESSMENT AND 15 STUDIES HAD LOW RISK OF ATTRITION BIAS.SEVENTEEN STUDIES THAT COMPARED YOGA VERSUS NO THERAPY PROVIDED MODERATE-QUALITY EVIDENCE SHOWING THAT YOGA IMPROVED HEALTH-RELATED QUALITY OF LIFE (POOLED SMD 0.22, 95% CI 0.04 TO 0.40; 10 STUDIES, 675 PARTICIPANTS), REDUCED FATIGUE (POOLED SMD -0.48, 95% CI -0.75 TO -0.20; 11 STUDIES, 883 PARTICIPANTS) AND REDUCED SLEEP DISTURBANCES IN THE SHORT TERM (POOLED SMD -0.25, 95% CI -0.40 TO -0.09; SIX STUDIES, 657 PARTICIPANTS). THE FUNNEL PLOT FOR HEALTH-RELATED QUALITY OF LIFE WAS ASYMMETRICAL, FAVOURING NO THERAPY, AND THE FUNNEL PLOT FOR FATIGUE WAS ROUGHLY SYMMETRICAL. THIS HINTS AT OVERALL LOW RISK OF PUBLICATION BIAS. YOGA DID NOT APPEAR TO REDUCE DEPRESSION (POOLED SMD -0.13, 95% CI -0.31 TO 0.05; SEVEN STUDIES, 496 PARTICIPANTS; LOW-QUALITY EVIDENCE) OR ANXIETY (POOLED SMD -0.53, 95% CI -1.10 TO 0.04; SIX STUDIES, 346 PARTICIPANTS; VERY LOW-QUALITY EVIDENCE) IN THE SHORT TERM AND HAD NO MEDIUM-TERM EFFECTS ON HEALTH-RELATED QUALITY OF LIFE (POOLED SMD 0.10, 95% CI -0.23 TO 0.42; TWO STUDIES, 146 PARTICIPANTS; LOW-QUALITY EVIDENCE) OR FATIGUE (POOLED SMD -0.04, 95% CI -0.36 TO 0.29; TWO STUDIES, 146 PARTICIPANTS; LOW-QUALITY EVIDENCE). INVESTIGATORS REPORTED NO SERIOUS ADVERSE EVENTS.FOUR STUDIES THAT COMPARED YOGA VERSUS PSYCHOSOCIAL/EDUCATIONAL INTERVENTIONS PROVIDED MODERATE-QUALITY EVIDENCE INDICATING THAT YOGA CAN REDUCE DEPRESSION (POOLED SMD -2.29, 95% CI -3.97 TO -0.61; FOUR STUDIES, 226 PARTICIPANTS), ANXIETY (POOLED SMD -2.21, 95% CI -3.90 TO -0.52; THREE STUDIES, 195 PARTICIPANTS) AND FATIGUE (POOLED SMD -0.90, 95% CI -1.31 TO -0.50; TWO STUDIES, 106 PARTICIPANTS) IN THE SHORT TERM. VERY LOW-QUALITY EVIDENCE SHOWED NO SHORT-TERM EFFECTS ON HEALTH-RELATED QUALITY OF LIFE (POOLED SMD 0.81, 95% CI -0.50 TO 2.12; TWO STUDIES, 153 PARTICIPANTS) OR SLEEP DISTURBANCES (POOLED SMD -0.21, 95% CI -0.76 TO 0.34; TWO STUDIES, 119 PARTICIPANTS). NO TRIAL ADEQUATELY REPORTED SAFETY-RELATED DATA.THREE STUDIES THAT COMPARED YOGA VERSUS EXERCISE PRESENTED VERY LOW-QUALITY EVIDENCE SHOWING NO SHORT-TERM EFFECTS ON HEALTH-RELATED QUALITY OF LIFE (POOLED SMD -0.04, 95% CI -0.30 TO 0.23; THREE STUDIES, 233 PARTICIPANTS) OR FATIGUE (POOLED SMD -0.21, 95% CI -0.66 TO 0.25; THREE STUDIES, 233 PARTICIPANTS); NO TRIAL PROVIDED SAFETY-RELATED DATA. AUTHORS' CONCLUSIONS: MODERATE-QUALITY EVIDENCE SUPPORTS THE RECOMMENDATION OF YOGA AS A SUPPORTIVE INTERVENTION FOR IMPROVING HEALTH-RELATED QUALITY OF LIFE AND REDUCING FATIGUE AND SLEEP DISTURBANCES WHEN COMPARED WITH NO THERAPY, AS WELL AS FOR REDUCING DEPRESSION, ANXIETY AND FATIGUE, WHEN COMPARED WITH PSYCHOSOCIAL/EDUCATIONAL INTERVENTIONS. VERY LOW-QUALITY EVIDENCE SUGGESTS THAT YOGA MIGHT BE AS EFFECTIVE AS OTHER EXERCISE INTERVENTIONS AND MIGHT BE USED AS AN ALTERNATIVE TO OTHER EXERCISE PROGRAMMES. 2017
9 2568 30 YOGA FOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS. BACKGROUND: MIND-BODY MEDICAL INTERVENTIONS ARE COMMONLY USED TO COPE WITH DEPRESSION AND YOGA IS ONE OF THE MOST COMMONLY USED MIND-BODY INTERVENTIONS. THE AIM OF THIS REVIEW WAS TO SYSTEMATICALLY ASSESS AND META-ANALYZE THE EFFECTIVENESS OF YOGA FOR DEPRESSION. METHODS: MEDLINE/PUBMED, SCOPUS, THE COCHRANE LIBRARY, PSYCINFO, AND INDMED WERE SEARCHED THROUGH JANUARY 2013. RANDOMIZED CONTROLLED TRIALS (RCTS) OF YOGA FOR PATIENTS WITH DEPRESSIVE DISORDERS AND INDIVIDUALS WITH ELEVATED LEVELS OF DEPRESSION WERE INCLUDED. MAIN OUTCOMES WERE SEVERITY OF DEPRESSION AND REMISSION RATES, SECONDARY OUTCOMES WERE ANXIETY, QUALITY OF LIFE, AND SAFETY. RESULTS: TWELVE RCTS WITH 619 PARTICIPANTS WERE INCLUDED. THREE RCTS HAD LOW RISK OF BIAS. REGARDING SEVERITY OF DEPRESSION, THERE WAS MODERATE EVIDENCE FOR SHORT-TERM EFFECTS OF YOGA COMPARED TO USUAL CARE (STANDARDIZED MEAN DIFFERENCE (SMD) = -0.69; 95% CONFIDENCE INTERVAL (CI) -0.99, -0.39; P < .001), AND LIMITED EVIDENCE COMPARED TO RELAXATION (SMD = -0.62; 95%CI -1.03, -0.22; P = .003), AND AEROBIC EXERCISE (SMD = -0.59; 95% CI -0.99, -0.18; P = .004). LIMITED EVIDENCE WAS FOUND FOR SHORT-TERM EFFECTS OF YOGA ON ANXIETY COMPARED TO RELAXATION (SMD = -0.79; 95% CI -1.3, -0.26; P = .004). SUBGROUP ANALYSES REVEALED EVIDENCE FOR EFFECTS IN PATIENTS WITH DEPRESSIVE DISORDERS AND IN INDIVIDUALS WITH ELEVATED LEVELS OF DEPRESSION. DUE TO THE PAUCITY AND HETEROGENEITY OF THE RCTS, NO META-ANALYSES ON LONG-TERM EFFECTS WERE POSSIBLE. NO RCT REPORTED SAFETY DATA. CONCLUSIONS: DESPITE METHODOLOGICAL DRAWBACKS OF THE INCLUDED STUDIES, YOGA COULD BE CONSIDERED AN ANCILLARY TREATMENT OPTION FOR PATIENTS WITH DEPRESSIVE DISORDERS AND INDIVIDUALS WITH ELEVATED LEVELS OF DEPRESSION. 2013
10 923 30 EFFECTIVENESS OF YOGA FOR MENOPAUSAL SYMPTOMS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. OBJECTIVES. TO SYSTEMATICALLY REVIEW AND META-ANALYZE THE EFFECTIVENESS OF YOGA FOR MENOPAUSAL SYMPTOMS. METHODS. MEDLINE, SCOPUS, THE COCHRANE LIBRARY, AND PSYCINFO WERE SCREENED THROUGH APRIL 2012. RANDOMIZED CONTROLLED TRIALS (RCTS) WERE INCLUDED IF THEY ASSESSED THE EFFECT OF YOGA ON MAJOR MENOPAUSAL SYMPTOMS, NAMELY, (1) PSYCHOLOGICAL SYMPTOMS, (2) SOMATIC SYMPTOMS, (3) VASOMOTOR SYMPTOMS, AND/OR (4) UROGENITAL SYMPTOMS. FOR EACH OUTCOME, STANDARDIZED MEAN DIFFERENCES (SMDS) AND 95% CONFIDENCE INTERVALS (CIS) WERE CALCULATED. TWO AUTHORS INDEPENDENTLY ASSESSED RISK OF BIAS USING THE RISK OF BIAS TOOL RECOMMENDED BY THE COCHRANE BACK REVIEW GROUP. RESULTS. FIVE RCTS WITH 582 PARTICIPANTS WERE INCLUDED IN THE QUALITATIVE REVIEW, AND 4 RCTS WITH 545 PARTICIPANTS WERE INCLUDED IN THE META-ANALYSIS. THERE WAS MODERATE EVIDENCE FOR SHORT-TERM EFFECTS ON PSYCHOLOGICAL SYMPTOMS (SMD = -0.37; 95% CI -0.67 TO -0.07; P = 0.02). NO EVIDENCE WAS FOUND FOR TOTAL MENOPAUSAL SYMPTOMS, SOMATIC SYMPTOMS, VASOMOTOR SYMPTOMS, OR UROGENITAL SYMPTOMS. YOGA WAS NOT ASSOCIATED WITH SERIOUS ADVERSE EVENTS. CONCLUSION. THIS SYSTEMATIC REVIEW FOUND MODERATE EVIDENCE FOR SHORT-TERM EFFECTIVENESS OF YOGA FOR PSYCHOLOGICAL SYMPTOMS IN MENOPAUSAL WOMEN. WHILE MORE RIGOROUS RESEARCH IS NEEDED TO UNDERPIN THESE RESULTS, YOGA CAN BE PRELIMINARILY RECOMMENDED AS AN ADDITIONAL INTERVENTION FOR WOMEN WHO SUFFER FROM PSYCHOLOGICAL COMPLAINTS ASSOCIATED WITH MENOPAUSE. 2012
11 2518 39 YOGA COMPARED TO NON-EXERCISE OR PHYSICAL THERAPY EXERCISE ON PAIN, DISABILITY, AND QUALITY OF LIFE FOR PATIENTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. BACKGROUND: CHRONIC LOW BACK PAIN (CLBP) IS A COMMON AND OFTEN DISABLING MUSCULOSKELETAL CONDITION. YOGA HAS BEEN PROVEN TO BE AN EFFECTIVE THERAPY FOR CHRONIC LOW BACK PAIN. HOWEVER, THERE ARE STILL CONTROVERSIES ABOUT THE EFFECTS OF YOGA AT DIFFERENT FOLLOW-UP PERIODS AND COMPARED WITH OTHER PHYSICAL THERAPY EXERCISES. OBJECTIVE: TO CRITICALLY COMPARE THE EFFECTS OF YOGA FOR PATIENTS WITH CHRONIC LOW BACK PAIN ON PAIN, DISABILITY, QUALITY OF LIFE WITH NON-EXERCISE (E.G. USUAL CARE, EDUCATION), PHYSICAL THERAPY EXERCISE. METHODS: THIS STUDY WAS REGISTERED IN PROSPERO, AND THE REGISTRATION NUMBER WAS CRD42020159865. RANDOMIZED CONTROLLED TRIALS (RCTS) OF ONLINE DATABASES INCLUDED PUBMED, WEB OF SCIENCE, COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS, EMBASE WHICH EVALUATED EFFECTS OF YOGA FOR PATIENTS WITH CHRONIC LOW BACK PAIN ON PAIN, DISABILITY, AND QUALITY OF LIFE WERE SEARCHED FROM INCEPTION TIME TO NOVEMBER 1, 2019. STUDIES WERE ELIGIBLE IF THEY ASSESSED AT LEAST ONE IMPORTANT OUTCOME, NAMELY PAIN, BACK-SPECIFIC DISABILITY, QUALITY OF LIFE. THE COCHRANE RISK OF BIAS TOOL WAS USED TO ASSESS THE METHODOLOGICAL QUALITY OF INCLUDED RANDOMIZED CONTROLLED TRIALS. THE CONTINUOUS OUTCOMES WERE ANALYZED BY CALCULATING THE MEAN DIFFERENCE (MD) OR STANDARDIZED MEAN DIFFERENCE (SMD) WITH 95% CONFIDENCE INTERVALS (CI) ACCORDING TO WHETHER COMBINING OUTCOMES MEASURED ON DIFFERENT SCALES OR NOT. RESULTS: A TOTAL OF 18 RANDOMIZED CONTROLLED TRIALS WERE INCLUDED IN THIS META-ANALYSIS. YOGA COULD SIGNIFICANTLY REDUCE PAIN AT 4 TO 8 WEEKS (MD = -0.83, 95% CI = -1.19 TO -0.48, P<0.00001, I2 = 0%), 3 MONTHS (MD = -0.43, 95% CI = -0.64 TO -0.23, P<0.0001, I2 = 0%), 6 TO 7 MONTHS (MD = -0.56, 95% CI = -1.02 TO -0.11, P = 0.02, I2 = 50%), AND WAS NOT SIGNIFICANT IN 12 MONTHS (MD = -0.52, 95% CI = -1.64 TO 0.59, P = 0.36, I2 = 87%) COMPARED WITH NON-EXERCISE. YOGA WAS BETTER THAN NON-EXERCISE ON DISABILITY AT 4 TO 8 WEEKS (SMD = -0.30, 95% CI = -0.51 TO -0.10, P = 0.003, I2 = 0%), 3 MONTHS (SMD = -0.31, 95% CI = -0.45 TO -0.18, P<0.00001, I2 = 30%), 6 MONTHS (SMD = -0.38, 95% CI = -0.53 TO -0.23, P<0.00001, I2 = 0%), 12 MONTHS (SMD = -0.33, 95% CI = -0.54 TO -0.12, P = 0.002, I2 = 9%). THERE WAS NO SIGNIFICANT DIFFERENCE ON PAIN, DISABILITY COMPARED WITH PHYSICAL THERAPY EXERCISE GROUP. FURTHERMORE, IT SUGGESTED THAT THERE WAS A NON-SIGNIFICANT DIFFERENCE ON PHYSICAL AND MENTAL QUALITY OF LIFE BETWEEN YOGA AND ANY OTHER INTERVENTIONS. CONCLUSION: THIS META-ANALYSIS PROVIDED EVIDENCE FROM VERY LOW TO MODERATE INVESTIGATING THE EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN PATIENTS AT DIFFERENT TIME POINTS. YOGA MIGHT DECREASE PAIN FROM SHORT TERM TO INTERMEDIATE TERM AND IMPROVE FUNCTIONAL DISABILITY STATUS FROM SHORT TERM TO LONG TERM COMPARED WITH NON-EXERCISE (E.G. USUAL CARE, EDUCATION). YOGA HAD THE SAME EFFECT ON PAIN AND DISABILITY AS ANY OTHER EXERCISE OR PHYSICAL THERAPY. YOGA MIGHT NOT IMPROVE THE PHYSICAL AND MENTAL QUALITY OF LIFE BASED ON THE RESULT OF A MERGING. 2020
12 232 26 A SYSTEMATIC REVIEW OF YOGA FOR MAJOR DEPRESSIVE DISORDER. BACKGROUND: THE PURPOSE OF THIS REVIEW WAS TO INVESTIGATE THE EFFICACY AND SAFETY OF YOGA INTERVENTIONS IN TREATING PATIENTS WITH MAJOR DEPRESSIVE DISORDER. METHODS: MEDLINE, SCOPUS, AND THE COCHRANE LIBRARY WERE SCREENED THROUGH DECEMBER 2016. RANDOMIZED CONTROLLED TRIALS (RCTS) COMPARING YOGA TO INACTIVE OR ACTIVE COMPARATORS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER WERE ELIGIBLE. PRIMARY OUTCOMES INCLUDED REMISSION RATES AND SEVERITY OF DEPRESSION. ANXIETY AND ADVERSE EVENTS WERE SECONDARY OUTCOMES. RISK OF BIAS WAS ASSESSED USING THE COCHRANE TOOL. RESULTS: SEVEN RCTS WITH 240 PARTICIPANTS WERE INCLUDED. RISK OF BIAS WAS UNCLEAR FOR MOST RCTS. COMPARED TO AEROBIC EXERCISE, NO SHORT- OR MEDIUM-TERM GROUP DIFFERENCES IN DEPRESSION SEVERITY WAS FOUND. HIGHER SHORT-TERM DEPRESSION SEVERITY WAS FOUND FOR YOGA COMPARED TO ELECTRO-CONVULSIVE THERAPY; REMISSION RATES DID NOT DIFFER BETWEEN GROUPS. NO SHORT-TERM GROUP DIFFERENCES OCCURRED WHEN YOGA WAS COMPARED TO ANTIDEPRESSANT MEDICATION. CONFLICTING EVIDENCE WAS FOUND WHEN YOGA WAS COMPARED TO ATTENTION-CONTROL INTERVENTIONS, OR WHEN YOGA AS AN ADD-ON TO ANTIDEPRESSANT MEDICATION WAS COMPARED TO MEDICATION ALONE. ONLY TWO RCTS ASSESSED ADVERSE EVENTS AND REPORTED THAT NO TREATMENT-RELATED ADVERSE EVENTS WERE REPORTED. LIMITATIONS: FEW RCTS WITH LOW SAMPLE SIZE. CONCLUSIONS: THIS REVIEW FOUND SOME EVIDENCE FOR POSITIVE EFFECTS BEYOND PLACEBO AND COMPARABLE EFFECTS COMPARED TO EVIDENCE-BASED INTERVENTIONS. HOWEVER, METHODOLOGICAL PROBLEMS AND THE UNCLEAR RISK-BENEFIT RATIO PRECLUDE DEFINITIVE RECOMMENDATIONS FOR OR AGAINST YOGA AS AN ADJUNCT TREATMENT FOR MAJOR DEPRESSIVE DISORDER. LARGER AND ADEQUATELY POWERED RCTS USING NON-INFERIORITY DESIGNS ARE NEEDED. 2017
13 2540 38 YOGA FOR ANXIETY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. YOGA HAS BECOME A POPULAR APPROACH TO IMPROVE EMOTIONAL HEALTH. THE AIM OF THIS REVIEW WAS TO SYSTEMATICALLY ASSESS AND META-ANALYZE THE EFFECTIVENESS AND SAFETY OF YOGA FOR ANXIETY. MEDLINE/PUBMED, SCOPUS, THE COCHRANE LIBRARY, PSYCINFO, AND INDMED WERE SEARCHED THROUGH OCTOBER 2016 FOR RANDOMIZED CONTROLLED TRIALS (RCTS) OF YOGA FOR INDIVIDUALS WITH ANXIETY DISORDERS OR ELEVATED LEVELS OF ANXIETY. THE PRIMARY OUTCOMES WERE ANXIETY AND REMISSION RATES, AND SECONDARY OUTCOMES WERE DEPRESSION, QUALITY OF LIFE, AND SAFETY. RISK OF BIAS WAS ASSESSED USING THE COCHRANE TOOL. EIGHT RCTS WITH 319 PARTICIPANTS (MEAN AGE: 30.0-38.5 YEARS) WERE INCLUDED. RISK OF SELECTION BIAS WAS UNCLEAR FOR MOST RCTS. META-ANALYSES REVEALED EVIDENCE FOR SMALL SHORT-TERM EFFECTS OF YOGA ON ANXIETY COMPARED TO NO TREATMENT (STANDARDIZED MEAN DIFFERENCE [SMD] = -0.43; 95% CONFIDENCE INTERVAL [CI] = -0.74, -0.11; P = .008), AND LARGE EFFECTS COMPARED TO ACTIVE COMPARATORS (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02). SMALL EFFECTS ON DEPRESSION WERE FOUND COMPARED TO NO TREATMENT (SMD = -0.35; 95% CI = -0.66, -0.04; P = .03). EFFECTS WERE ROBUST AGAINST POTENTIAL METHODOLOGICAL BIAS. NO EFFECTS WERE FOUND FOR PATIENTS WITH ANXIETY DISORDERS DIAGNOSED BY DIAGNOSTIC AND STATISTICAL MANUAL CRITERIA, ONLY FOR PATIENTS DIAGNOSED BY OTHER METHODS, AND FOR INDIVIDUALS WITH ELEVATED LEVELS OF ANXIETY WITHOUT A FORMAL DIAGNOSIS. ONLY THREE RCTS REPORTED SAFETY-RELATED DATA BUT THESE INDICATED THAT YOGA WAS NOT ASSOCIATED WITH INCREASED INJURIES. IN CONCLUSION, YOGA MIGHT BE AN EFFECTIVE AND SAFE INTERVENTION FOR INDIVIDUALS WITH ELEVATED LEVELS OF ANXIETY. THERE WAS INCONCLUSIVE EVIDENCE FOR EFFECTS OF YOGA IN ANXIETY DISORDERS. MORE HIGH-QUALITY STUDIES ARE NEEDED AND ARE WARRANTED GIVEN THESE PRELIMINARY FINDINGS AND PLAUSIBLE MECHANISMS OF ACTION. 2018
14 222 28 A SYSTEMATIC REVIEW AND META-ANALYSIS OF YOGA FOR LOW BACK PAIN. OBJECTIVES: TO SYSTEMATICALLY REVIEW AND META-ANALYZE THE EFFECTIVENESS OF YOGA FOR LOW BACK PAIN. METHODS: MEDLINE, THE COCHRANE LIBRARY, EMBASE, CAMBASE, AND PSYCINFO, WERE SCREENED THROUGH JANUARY 2012. RANDOMIZED CONTROLLED TRIALS COMPARING YOGA TO CONTROL CONDITIONS IN PATIENTS WITH LOW BACK PAIN WERE INCLUDED. TWO AUTHORS INDEPENDENTLY ASSESSED RISK OF BIAS USING THE RISK OF BIAS TOOL RECOMMENDED BY THE COCHRANE BACK REVIEW GROUP. MAIN OUTCOME MEASURES WERE PAIN, BACK-SPECIFIC DISABILITY, GENERIC DISABILITY, HEALTH-RELATED QUALITY OF LIFE, AND GLOBAL IMPROVEMENT. FOR EACH OUTCOME, STANDARDIZED MEAN DIFFERENCES (SMD) AND 95% CONFIDENCE INTERVALS (CI) WERE CALCULATED. RESULTS: TEN RANDOMIZED CONTROLLED TRIALS WITH A TOTAL OF 967 CHRONIC LOW BACK PAIN PATIENTS WERE INCLUDED. EIGHT STUDIES HAD LOW RISK OF BIAS. THERE WAS STRONG EVIDENCE FOR SHORT-TERM EFFECTS ON PAIN (SMD=-0.48; 95% CI, -0.65 TO -0.31; P<0.01), BACK-SPECIFIC DISABILITY (SMD=-0.59; 95% CI, -0.87 TO -0.30; P<0.01), AND GLOBAL IMPROVEMENT (RISK RATIO=3.27; 95% CI, 1.89-5.66; P<0.01). THERE WAS STRONG EVIDENCE FOR A LONG-TERM EFFECT ON PAIN (SMD=-0.33; 95% CI, -0.59 TO -0.07; P=0.01) AND MODERATE EVIDENCE FOR A LONG-TERM EFFECT ON BACK-SPECIFIC DISABILITY (SMD=-0.35; 95% CI, -0.55 TO -0.15; P<0.01). THERE WAS NO EVIDENCE FOR EITHER SHORT-TERM OR LONG-TERM EFFECTS ON HEALTH-RELATED QUALITY OF LIFE. YOGA WAS NOT ASSOCIATED WITH SERIOUS ADVERSE EVENTS. DISCUSSION: THIS SYSTEMATIC REVIEW FOUND STRONG EVIDENCE FOR SHORT-TERM EFFECTIVENESS AND MODERATE EVIDENCE FOR LONG-TERM EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN IN THE MOST IMPORTANT PATIENT-CENTERED OUTCOMES. YOGA CAN BE RECOMMENDED AS AN ADDITIONAL THERAPY TO CHRONIC LOW BACK PAIN PATIENTS. 2013
15 1379 34 IMPACT OF IYENGAR YOGA ON QUALITY OF LIFE IN YOUNG WOMEN WITH RHEUMATOID ARTHRITIS. OBJECTIVE: RHEUMATOID ARTHRITIS (RA) IS A CHRONIC, DISABLING DISEASE THAT CAN GREATLY COMPROMISE HEALTH-RELATED QUALITY OF LIFE (HRQOL). THE AIM OF THIS STUDY WAS TO ASSESS THE IMPACT OF A 6-WEEK TWICE/WEEK IYENGAR YOGA PROGRAM ON HRQOL OF YOUNG ADULTS WITH RA COMPARED WITH A USUAL-CARE WAITLIST CONTROL GROUP. METHODS: THE PROGRAM WAS DESIGNED TO IMPROVE THE PRIMARY OUTCOME OF HRQOL INCLUDING PAIN AND DISABILITY AND PSYCHOLOGICAL FUNCTIONING IN PATIENTS. ASSESSMENTS WERE COLLECTED PRETREATMENT, POSTTREATMENT, AND AT 2 MONTHS AFTER TREATMENT. WEEKLY RATINGS OF ANXIETY, DEPRESSION, PAIN, AND SLEEP WERE ALSO RECORDED. A TOTAL OF 26 PARTICIPANTS COMPLETED THE INTERVENTION (YOGA=11; USUAL-CARE WAITLIST=15). ALL PARTICIPANTS WERE FEMALE (MEAN AGE=28 Y). RESULTS: OVERALL ATTRITION WAS LOW AT 15%. ON AVERAGE, WOMEN IN THE YOGA GROUP ATTENDED 96% OF THE YOGA CLASSES. NO ADVERSE EVENTS WERE REPORTED. RELATIVE TO THE USUAL-CARE WAITLIST, WOMEN ASSIGNED TO THE YOGA PROGRAM SHOWED SIGNIFICANTLY GREATER IMPROVEMENT ON STANDARDIZED MEASURES OF HRQOL, PAIN DISABILITY, GENERAL HEALTH, MOOD, FATIGUE, ACCEPTANCE OF CHRONIC PAIN, AND SELF-EFFICACY REGARDING PAIN AT POSTTREATMENT. ALMOST HALF OF THE YOGA GROUP REPORTED CLINICALLY MEANINGFUL SYMPTOM IMPROVEMENT. ANALYSIS OF THE UNCONTROLLED EFFECTS AND MAINTENANCE OF TREATMENT EFFECTS SHOWED IMPROVEMENTS IN HRQOL GENERAL HEALTH, PAIN DISABILITY, AND WEEKLY RATINGS OF PAIN, ANXIETY, AND DEPRESSION WERE MAINTAINED AT FOLLOW-UP. CONCLUSIONS: THE FINDINGS SUGGEST THAT A BRIEF IYENGAR YOGA INTERVENTION IS A FEASIBLE AND SAFE ADJUNCTIVE TREATMENT FOR YOUNG PEOPLE WITH RA, LEADING TO HRQOL, PAIN DISABILITY, FATIGUE, AND MOOD BENEFITS. MOREOVER, IMPROVEMENTS IN QUALITY OF LIFE, PAIN DISABILITY, AND MOOD PERSISTED AT THE 2-MONTH FOLLOW-UP. 2013
16 258 37 ACCEPTABILITY AND FEASIBILITY OF A 12-WEEK YOGA VS. EDUCATIONAL FILM PROGRAM FOR THE MANAGEMENT OF RESTLESS LEGS SYNDROME (RLS): STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: RESTLESS LEGS SYNDROME (RLS) IS A COMMON AND BURDENSOME SLEEP DISORDER ASSOCIATED WITH PROFOUND IMPAIRMENT OF HEALTH, WELL-BEING, AND QUALITY OF LIFE. UNFORTUNATELY, THE MEDICATIONS USED FOR RLS MANAGEMENT CARRY RISK OF SERIOUS SIDE EFFECTS, INCLUDING AUGMENTATION OF SYMPTOMS. YOGA, AN ANCIENT MIND-BODY DISCIPLINE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, AND MENTAL WELL-BEING, MAY OFFER A VIABLE, LOW-RISK NEW TREATMENT. THE PRIMARY OBJECTIVES OF THIS PILOT, PARALLEL-ARM, RANDOMIZED CONTROLLED TRIAL (RCT) ARE TO ASSESS THE ACCEPTABILITY AND FEASIBILITY OF A 12-WEEK YOGA VS. EDUCATIONAL FILM PROGRAM FOR THE MANAGEMENT OF RLS. METHODS: FORTY-FOUR ADULTS WITH CONFIRMED MODERATE TO SEVERE RLS WILL BE RECRUITED AND RANDOMIZED TO A 12-WEEK YOGA (N = 22) OR STANDARDIZED EDUCATIONAL FILM PROGRAM (N = 22). YOGA GROUP PARTICIPANTS WILL ATTEND TWO 75-MIN IYENGAR YOGA CLASSES PER WEEK FOR THE FIRST 4 WEEKS, THEN ONE 75-MIN CLASS PER WEEK FOR THE REMAINING 8 WEEKS, AND WILL COMPLETE A 30-MIN HOMEWORK ROUTINE ON NON-CLASS DAYS. EDUCATIONAL FILM GROUP PARTICIPANTS WILL ATTEND ONE 75-MIN CLASS PER WEEK FOR 12 WEEKS AND COMPLETE A DAILY RLS TREATMENT LOG; CLASSES WILL INCLUDE INFORMATION ON: RLS MANAGEMENT, INCLUDING SLEEP HYGIENE PRACTICES; OTHER SLEEP DISORDERS; AND COMPLEMENTARY THERAPIES LIKELY TO BE OF INTEREST TO THOSE PARTICIPATING IN A YOGA AND SLEEP EDUCATION STUDY. YOGA AND TREATMENT LOGS WILL BE COLLECTED WEEKLY. FEASIBILITY OUTCOMES WILL INCLUDE RECRUITMENT, ENROLLMENT, AND RANDOMIZATION RATES, RETENTION, ADHERENCE, AND PROGRAM SATISFACTION. PROGRAM EVALUATION AND YOGA-DOSING QUESTIONNAIRES WILL BE COLLECTED AT WEEK 12; DATA ON EXPLORATORY OUTCOMES (E.G., RLS SYMPTOM SEVERITY (IRLS), SLEEP QUALITY (PSQI), MOOD (POMS, PSS), AND HEALTH-RELATED QUALITY OF LIFE (SF-36)) WILL BE GATHERED AT BASELINE AND WEEK 12. DISCUSSION: THIS STUDY WILL LAY THE ESSENTIAL GROUNDWORK FOR A PLANNED LARGER RCT TO DETERMINE THE EFFICACY OF A YOGA PROGRAM FOR REDUCING SYMPTOMS AND ASSOCIATED BURDEN OF RLS. IF THE FINDINGS OF THE CURRENT TRIAL AND THE SUBSEQUENT LARGER RCTS ARE POSITIVE, THIS STUDY WILL ALSO HELP SUPPORT A NEW APPROACH TO CLINICAL TREATMENT OF THIS CHALLENGING DISORDER, HELP FOSTER IMPROVED UNDERSTANDING OF RLS ETIOLOGY, AND ULTIMATELY CONTRIBUTE TO REDUCING THE INDIVIDUAL, SOCIETAL, AND ECONOMIC BURDEN ASSOCIATED WITH THIS CONDITION. TRIAL REGISTRATION: CLINICALTRIALS.GOV, ID: NCT03570515 . RETROSPECTIVELY REGISTERED ON 1 FEBRUARY 2017. 2019
17 1054 29 EFFECTS OF YOGA ON CHRONIC NECK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS. OBJECTIVE: THE AIM OF THIS REVIEW WAS TO SYSTEMATICALLY ASSESS AND META-ANALYZE THE EFFECTIVENESS OF YOGA IN RELIEVING CHRONIC NECK PAIN. METHODS: PUBMED/MEDLINE, THE COCHRANE LIBRARY, SCOPUS, AND INDMED WERE SCREENED THROUGH JANUARY 2017 FOR RANDOMIZED CONTROLLED TRIALS ASSESSING NECK PAIN INTENSITY AND/OR NECK PAIN-RELATED DISABILITY IN CHRONIC NECK PAIN PATIENTS. SECONDARY OUTCOME MEASURES INCLUDED QUALITY OF LIFE, MOOD, AND SAFETY. RISK OF BIAS WAS ASSESSED USING THE COCHRANE TOOL. RESULTS: THREE STUDIES ON 188 PATIENTS WITH CHRONIC NON-SPECIFIC NECK PAIN COMPARING YOGA TO USUAL CARE WERE INCLUDED. TWO STUDIES HAD OVERALL LOW RISK OF BIAS; AND ONE HAD HIGH OR UNCLEAR RISK OF BIAS FOR SEVERAL DOMAINS. EVIDENCE FOR SHORT-TERM EFFECTS WAS FOUND FOR NECK PAIN INTENSITY (STANDARDIZED MEAN DIFFERENCE (SMD) = -1.28; 95% CONFIDENCE INTERVAL (CI) = -1.18, -0.75; P < 0.001), NECK PAIN-RELATED DISABILITY (SMD = -0.97; 95% CI = -1.44, -0.50; P < 0.001), QUALITY OF LIFE (SMD = 0.57; 95% CI = 0.17, 0.197; P = 0.005), AND MOOD (SMD = -1.02; 95% CI = -1.38, -0.65; P < 0.001). EFFECTS WERE ROBUST AGAINST POTENTIAL METHODOLOGICAL BIAS AND DID NOT DIFFER BETWEEN DIFFERENT INTERVENTION SUBGROUPS. IN THE TWO STUDIES THAT INCLUDED SAFETY DATA, NO SERIOUS ADVERSE EVENTS OCCURRED. CONCLUSION: YOGA HAS SHORT-TERM EFFECTS ON CHRONIC NECK PAIN, ITS RELATED DISABILITY, QUALITY OF LIFE, AND MOOD SUGGESTING THAT YOGA MIGHT BE A GOOD TREATMENT OPTION. 2017
18 2597 32 YOGA FOR MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. WHILE YOGA SEEMS TO BE EFFECTIVE IN A NUMBER OF NEUROPSYCHIATRIC DISORDERS, THE EVIDENCE OF EFFICACY IN MULTIPLE SCLEROSIS REMAINS UNCLEAR. THE AIM OF THIS REVIEW WAS TO SYSTEMATICALLY ASSESS AND META-ANALYZE THE AVAILABLE DATA ON EFFICACY AND SAFETY OF YOGA IN PATIENTS WITH MULTIPLE SCLEROSIS. MEDLINE/PUBMED, SCOPUS, THE COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS, PSYCINFO, CAM-QUEST, CAMBASE, AND INDMED WERE SEARCHED THROUGH MARCH 2014. RANDOMIZED CONTROLLED TRIALS (RCTS) OF YOGA FOR PATIENTS WITH MULTIPLE SCLEROSIS WERE INCLUDED IF THEY ASSESSED HEALTH-RELATED QUALITY OF LIFE, FATIGUE, AND/OR MOBILITY. MOOD, COGNITIVE FUNCTION, AND SAFETY WERE DEFINED AS SECONDARY OUTCOME MEASURES. RISK OF BIAS WAS ASSESSED USING THE COCHRANE TOOL. SEVEN RCTS WITH A TOTAL OF 670 PATIENTS WERE INCLUDED. EVIDENCE FOR SHORT-TERM EFFECTS OF YOGA COMPARED TO USUAL CARE WERE FOUND FOR FATIGUE (STANDARDIZED MEAN DIFFERENCE [SMD] = -0.52; 95% CONFIDENCE INTERVALS (CI) = -1.02 TO -0.02; P = 0.04; HETEROGENEITY: I2 = 60%; CHI2 = 7.43; P = 0.06) AND MOOD (SMD = -0.55; 95%CI = -0.96 TO -0.13; P = 0.01; HETEROGENEITY: I2 = 0%; CHI2 = 1.25; P = 0.53), BUT NOT FOR HEALTH-RELATED QUALITY OF LIFE, MUSCLE FUNCTION, OR COGNITIVE FUNCTION. THE EFFECTS ON FATIGUE AND MOOD WERE NOT ROBUST AGAINST BIAS. NO SHORT-TERM OR LONGER TERM EFFECTS OF YOGA COMPARED TO EXERCISE WERE FOUND. YOGA WAS NOT ASSOCIATED WITH SERIOUS ADVERSE EVENTS. IN CONCLUSION, SINCE NO METHODOLOGICAL SOUND EVIDENCE WAS FOUND, NO RECOMMENDATION CAN BE MADE REGARDING YOGA AS A ROUTINE INTERVENTION FOR PATIENTS WITH MULTIPLE SCLEROSIS. YOGA MIGHT BE CONSIDERED A TREATMENT OPTION FOR PATIENTS WHO ARE NOT ADHERENT TO RECOMMENDED EXERCISE REGIMENS. 2014
19 2575 37 YOGA FOR FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES IN MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. OBJECTIVES: MUSCULOSKELETAL CONDITIONS (MSCS) ARE THE LEADING CAUSE OF DISABILITY AND CHRONIC PAIN IN THE DEVELOPED WORLD, IMPACTING BOTH FUNCTIONAL ABILITY AND PSYCHOSOCIAL HEALTH. THE CURRENT REVIEW INVESTIGATES THE EFFECTIVENESS OF YOGA ON PRIMARY OUTCOMES OF FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES ACROSS A RANGE OF MSCS. METHODS: A COMPREHENSIVE SEARCH OF 20 DATABASES WAS CONDUCTED FOR FULL-TEXT, RANDOMIZED CONTROLLED TRIALS OF YOGA IN CLINICALLY DIAGNOSED MSCS. RESULT: SEVENTEEN STUDIES MET THE INCLUSION CRITERIA, INVOLVING 1,626 PARTICIPANTS WITH LOW BACK PAIN (LBP), OSTEOARTHRITIS (OA), RHEUMATOID ARTHRITIS (RA), KYPHOSIS OR FIBROMYALGIA. STUDIES WERE QUALITY RATED, AND ANALYSED FOR THE EFFECT OF YOGA ON PRIMARY OUTCOMES, IMMEDIATELY POST-INTERVENTION. TWELVE STUDIES WERE RATED AS GOOD QUALITY. YOGA INTERVENTIONS RESULTED IN A CLINICALLY SIGNIFICANT IMPROVEMENT IN FUNCTIONAL OUTCOMES IN MILD-TO-MODERATE LBP AND FIBROMYALGIA, AND SHOWED A TREND TO IMPROVEMENT IN KYPHOSIS. YOGA SIGNIFICANTLY IMPROVED PAIN IN OA, RA AND MILD-TO-SEVERE LBP. PSYCHOSOCIAL OUTCOMES WERE SIGNIFICANTLY IMPROVED IN MILD-TO-MODERATE LBP AND OA. META-ANALYSIS OF GOOD-QUALITY STUDIES SHOWED A MODERATE TREATMENT EFFECT FOR YOGA OF -0.64 (95%CI -0.89 TO -0.39) FOR FUNCTIONAL OUTCOMES AND -0.61 (95%CI -0.97 TO -0.26) FOR PAIN OUTCOMES. CONCLUSIONS: EVIDENCE SUGGESTS THAT YOGA IS AN ACCEPTABLE AND SAFE INTERVENTION, WHICH MAY RESULT IN CLINICALLY RELEVANT IMPROVEMENTS IN PAIN AND FUNCTIONAL OUTCOMES ASSOCIATED WITH A RANGE OF MSCS. FUTURE ANALYSIS OF OUTCOMES WHICH TAKE INTO ACCOUNT THE AMOUNT OF YOGA RECEIVED BY PARTICIPANTS MAY PROVIDE INSIGHT INTO ANY PUTATIVE DURATION OR DOSAGE EFFECTS OF YOGA INTERVENTIONS FOR MSCS. 2013
20 1748 28 PILOT RANDOMIZED, CONTROLLED TRIAL OF A DYADIC YOGA PROGRAM FOR GLIOMA PATIENTS UNDERGOING RADIOTHERAPY AND THEIR FAMILY CAREGIVERS. BACKGROUND: WHILE THE USE OF BEHAVIORAL MEDICINE IN MANAGING GLIOMA PATIENTS' SYMPTOMS IS NOT WELL STUDIED, THE HIGH SYMPTOM BURDEN IN PATIENTS AND THEIR FAMILY CAREGIVERS IS WELL ESTABLISHED. WE CONDUCTED A PILOT RANDOMIZED, CONTROLLED TRIAL TO EXAMINE THE FEASIBILITY AND PRELIMINARY EFFICACY OF A DYADIC YOGA (DY) INTERVENTION AS A SUPPORTIVE CARE STRATEGY. METHODS: GLIOMA PATIENTS UNDERGOING RADIOTHERAPY AND THEIR CAREGIVERS WERE RANDOMIZED TO A 12-SESSION DY OR WAITLIST CONTROL (WLC) GROUP. PRIOR TO RADIOTHERAPY AND RANDOMIZATION, BOTH GROUPS COMPLETED MEASURES OF CANCER-RELATED SYMPTOMS (MD ANDERSON SYMPTOM INVENTORY-BRAIN TUMOR MODULE), DEPRESSIVE SYMPTOMS (CENTER FOR EPIDEMIOLOGICAL STUDIES-DEPRESSION MEASURE), FATIGUE (BRIEF FATIGUE INVENTORY), AND OVERALL QUALITY OF LIFE (QOL; MEDICAL OUTCOMES STUDY 36-ITEM SHORT-FORM SURVEY). DYADS WERE REASSESSED AT THE LAST DAY OF RADIOTHERAPY. RESULTS: TWENTY PATIENTS (MEAN AGE: 46 YEARS, 50% FEMALE, 80% WHO GRADE IV AND CAREGIVERS (MEAN AGE: 50 YEARS, 70% FEMALE, 50% SPOUSES) PARTICIPATED IN THE TRIAL. A PRIORI FEASIBILITY CRITERIA WERE MET REGARDING CONSENT (70%), ADHERENCE (88%), AND RETENTION (95%) RATES. CONTROLLING FOR RELEVANT COVARIATES, CHANGE SCORE ANALYSES REVEALED CLINICALLY SIGNIFICANT IMPROVEMENTS FOR PATIENTS IN THE DY COMPARED WITH THE WLC GROUP FOR OVERALL CANCER SYMPTOM SEVERITY (D = 0.96) AND SYMPTOM INTERFERENCE (D = 0.74), DEPRESSIVE SYMPTOMS (D = 0.71), AND MENTAL QOL (D = 0.69). CAREGIVERS IN THE DY GROUP REPORTED CLINICALLY SIGNIFICANT IMPROVEMENTS IN DEPRESSIVE SYMPTOMS (D = 1.12), FATIGUE (D = 0.89), AND MENTAL QOL (D = 0.49) RELATIVE TO THOSE IN THE WLC GROUP. CONCLUSION: A DY INTERVENTION APPEARS TO BE A FEASIBLE AND BENEFICIAL SYMPTOM AND QOL MANAGEMENT STRATEGY FOR GLIOMA PATIENTS UNDERGOING RADIOTHERAPY AND THEIR CAREGIVERS. AN EFFICACY TRIAL WITH A MORE STRINGENT CONTROL GROUP IS WARRANTED. CLINICAL TRIAL NUMBER: NCT02481349. 2019