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 4 611 40 DEVELOPMENT OF A YOGA MODULE TARGETING CARDIOVASCULAR HEALTH FOR PATIENTS WITH POST-MYOCARDIAL LEFT VENTRICULAR DYSFUNCTION IN INDIA. BACKGROUND: YOGA IS KNOWN TO CONTRIBUTE TOWARDS CARDIOVASCULAR HEALTH. THIS PAPER DESCRIBES THE DEVELOPMENT OF A NEED-BASED YOGA PROGRAM WHICH IS SUITABLE TO BE INTEGRATED INTO THE CARDIAC REHABILITATION OF POST-MYOCARDIAL INFARCTION PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION. MATERIALS AND METHODS: BASED ON THE ASSESSMENT OF THE NEED OF THE PATIENTS, LITERATURE REVIEW, AND EXPERT OPINION, A YOGA MODULE WAS DEVELOPED USING THE QUALITATIVE METHOD OF INQUIRY. THE PROGRAM INCLUDED WARM-UP EXERCISES, YOGIC ASANAS, PRANAYAMA, MEDITATION AND COUNSELING SESSIONS. A STRUCTURED QUESTIONNAIRE ELICITING COMMENTS ON THE CONTENTS WAS GIVEN INDEPENDENTLY TO TEN EXPERTS WORKING IN THE FIELD OF HEALTH AND YOGA FOR VALIDATION. THE FINAL MODULE WAS DERIVED AFTER INCORPORATING THE SUGGESTIONS OF THE EXPERTS. RESULTS: USING THE RATERS' EXPERTISE IN CARDIOLOGY AND YOGA PRACTICE, THE PRACTICES WHICH CONSTITUTE THE MODULE WERE OPTIMIZED. MAJORITY OF THE EXPERTS (RATERS) AGREED WITH THE DURATION OF 1 H TRAINING FOR 1MONTH UNDER SUPERVISION AS ADEQUATE FOR SUBSEQUENT PRACTICE AT HOME. THERE WAS A 0.786 INTER-RATER RELIABILITY ESTIMATED USING THE INTERCLASS COEFFICIENT (ICC) AND 0.789 INTERNAL CONSISTENCY OF THE QUESTIONS, MEASURED USING CRONBACH'S ALPHA. BOTH VALUES INDICATE "GOOD" RELIABILITY AND CONSISTENCY OF THE YOGA MODULE. CONCLUSION: THE DEVELOPED YOGA MODULE WAS FOUND TO BE ACCEPTABLE. FUTURE RANDOMIZED CONTROL TRIALS WILL BE NECESSARY TO VALIDATE THE EFFECTIVENESS OF THIS MODULE AND IF THE MODULE DEMONSTRATES TO BE EFFECTIVE BY CLINICAL STUDIES, IT MAY ADD A THERAPEUTIC OPTION IN THE REHABILITATION OF PATIENTS WITH HEART FAILURE FOLLOWING MYOCARDIAL INFARCTION, WHICH CAN BE APPLIED IN THE HOSPITALS AND COMMUNITY LEVEL. 2019 5 1941 60 SAFETY AND EFFICACY OF AYURVEDIC INTERVENTIONS AND YOGA ON LONG TERM EFFECTS OF COVID-19: A STRUCTURED SUMMARY OF A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. OBJECTIVES: PRIMARY OBJECTIVE * TO ASSESS THE EFFICACY OF AYURVEDA INTERVENTIONS AND YOGA IN REHABILITATION OF COVID-19 CASES SUFFERING WITH LONG TERM EFFECTS OF COVID 19 AS COMPARED TO WHO REHABILITATION SELF-MANAGEMENT AFTER COVID-19- RELATED ILLNESS. SECONDARY OBJECTIVE * TO ASSESS THE SAFETY OF AYURVEDIC INTERVENTIONS IN CASES SUFFERING WITH LONG TERM EFFECTS OF COVID 19 TRIAL DESIGN: MULTI-CENTRIC, RANDOMIZED, CONTROLLED, PARALLEL GROUP, OPEN-LABEL, EXPLORATORY STUDY. THE STUDY DURATION IS 9 MONTHS AND THE INTERVENTION PERIOD IS 90 DAYS FROM THE DAY OF ENROLMENT OF THE PARTICIPANT. PARTICIPANTS: PATIENTS OF EITHER SEX BETWEEN 18 TO 60 YEARS, AMBULATORY, WILLING TO PARTICIPATE, WITH HISTORY (NOT MORE THAN 4 WEEKS) OF POSITIVE RT-PCR FOR COVID-19 OR IGM ANTIBODIES POSITIVITY FOR SARS COV-2, BUT HAVING NEGATIVE RT-PCR FOR COVID-19 AT THE TIME OF SCREENING WILL BE CONSIDERED ELIGIBLE FOR ENROLMENT IN THE STUDY. CRITICALLY ILL PATIENTS WITH ARDS (ACUTE RESPIRATORY DISTRESS SYNDROME), REQUIRING INVASIVE RESPIRATORY SUPPORT IN THE INTENSIVE CARE UNIT, KNOWN CASE OF ANY MALIGNANCY, IMMUNE-COMPROMISED STATE (E.G. HIV), DIABETES MELLITUS, ACTIVE PULMONARY TUBERCULOSIS, PAST HISTORY OF ANY CHRONIC RESPIRATORY DISEASE, MOTOR NEURON DISEASE, MULTIPLE SCLEROSIS, STROKE, IMPAIRED COGNITION, ATRIAL FIBRILLATION, ACUTE CORONARY SYNDROME, MYOCARDIAL INFARCTION, SEVERE ARRHYTHMIA, CONCURRENT SERIOUS HEPATIC DISEASE OR RENAL DISEASE, PREGNANT OR LACTATING WOMEN, PATIENTS ON IMMUNOSUPPRESSIVE MEDICATIONS, HISTORY OF HYPERSENSITIVITY TO THE TRIAL DRUGS OR THEIR INGREDIENTS, DEPRESSIVE ILLNESS (BEFORE COVID-19), DIAGNOSED PSYCHOTIC ILLNESSES, SUBSTANCE DEPENDENCE OR ALCOHOLISM WILL BE EXCLUDED. THE TRIAL WILL BE CONDUCTED AT TWO MEDICAL COLLEGES IN MAHARASHTRA, INDIA. INTERVENTION AND COMPARATOR: INTERVENTION ARM (GROUP-I): AYURVEDA INTERVENTIONS INCLUDING AGASTYA HARITAKI SIX GRAM AND ASHWAGANDHA TABLET 500 MG TWICE DAILY ORALLY AFTER MEALS WITH WARM WATER AND TWO SESSIONS OF YOGA (MORNING 30 MINUTES AND EVENING 15 MINUTES) DAILY FOR 90 DAYS, AS PER THE POST-COVID-19 CARE PROTOCOL PROVIDED IN NATIONAL CLINICAL MANAGEMENT PROTOCOL BASED ON AYURVEDA AND YOGA FOR MANAGEMENT OF COVID-19 PUBLISHED BY MINISTRY OF AYUSH, GOVERNMENT OF INDIA. COMPARATOR ARM (GROUP-II): WHO REHABILITATION SELF-MANAGEMENT AFTER COVID-19 RELATED ILLNESS FOR 90 DAYS. THE TRIAL DRUGS ARE BEING PROCURED FROM A GMP CERTIFIED PHARMACEUTICAL COMPANY. MAIN OUTCOMES: PRIMARY OUTCOME: CHANGE IN RESPIRATORY FUNCTION TO BE ASSESSED BY SAN DIEGO SHORTNESS OF BREATH QUESTIONNAIRE, 6-MINUTES WALK TEST AND PULMONARY FUNCTION TEST. SECONDARY OUTCOMES: CHANGE IN HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) CHEST CHANGE IN FATIGUE SCORE ASSESSED BY MODIFIED FATIGUE IMPACT SCALE CHANGE IN ANXIETY SCORE ASSESSED BY HOSPITAL ANXIETY AND DEPRESSION SCALE SCORE CHANGE IN SLEEP QUALITY ASSESSED BY PITTSBURGH SLEEP QUALITY INDEX CHANGE IN THE QUALITY OF LIFE ASSESSED BY COV19-QOL SCALE SAFETY OF THE INTERVENTIONS WILL BE ASSESSED BY COMPARING HEMATOLOGICAL AND BIOCHEMICAL INVESTIGATIONS BEFORE AND AFTER THE INTERVENTION PERIOD AND ADVERSE EVENT/ ADVERSE DRUG REACTION TIMELINES FOR OUTCOME ASSESSMENT: SUBJECTIVE PARAMETERS AND CLINICAL ASSESSMENT WILL BE ASSESSED AT BASELINE, 15(TH) DAY, 30(TH) DAY, 60(TH) DAY AND 90(TH) DAY. LABORATORY PARAMETERS (CBC, LFT, KFT, HBA1C, HS-CRP, D-DIMER), PULMONARY FUNCTION TEST AND HRCT CHEST WILL BE DONE AT BASELINE AND AFTER COMPLETION OF STUDY PERIOD I.E. 90(TH) DAY. RANDOMISATION: STATISTICAL PACKAGE FOR SOCIAL SCIENCES (SPSS) VERSION 15.0 IS USED TO GENERATE THE RANDOM NUMBER SEQUENCES. THE PARTICIPANTS WILL BE RANDOMIZED TO TWO STUDY GROUPS IN THE RATIO OF 1:1. BLINDING (MASKING): THE STUDY IS OPEN-LABEL DESIGN. HOWEVER, THE OUTCOME ASSESSOR WILL BE KEPT BLINDED REGARDING THE STUDY GROUP ALLOCATION OF THE PARTICIPANTS. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) SAMPLE SIZE: THE SAMPLE SIZE FOR THE STUDY IS CALCULATED ASSUMING IMPROVEMENT IN 6-MINUTES WALK TEST BY 40 METER IN GROUP I AND A CHANGE OF 10 METER IN GROUP II WITH A STANDARD DEVIATION OF 50 METER BASED ON THE RESULTS OF THE PREVIOUS STUDIES, WITH 95% CONFIDENCE LEVEL (ALPHA = 0.05) AND 80% POWER AND EXPECTING A DROPOUT RATE OF 20%. THE NUMBER OF PARTICIPANTS TO BE ENROLLED IN THE STUDY SHOULD BE APPROXIMATELY 55 IN EACH GROUP. HENCE, A TOTAL OF 110 PARTICIPANTS WILL BE ENROLLED IN THE TRIAL AT EACH STUDY SITE. TRIAL STATUS: PARTICIPANTS' RECRUITMENT STARTED ON 1(ST) MAY 2021. ANTICIPATED END OF RECRUITMENT IS AUGUST 2021. PROTOCOL NUMBER: CCRAS-01 PROTOCOL VERSION NUMBER: 1.1, 13TH JANUARY 2021. TRIAL REGISTRATION: THE TRIAL IS PROSPECTIVELY REGISTERED WITH THE CLINICAL TRIAL REGISTRY OF INDIA (CTRI) ON 03(RD) MARCH 2021 [ CTRI/2021/03/031686 ]. FULL PROTOCOL: THE FULL PROTOCOL IS ATTACHED AS AN ADDITIONAL FILE, ACCESSIBLE FROM THE JOURNAL WEBSITE (ADDITIONAL FILE 1). THIS COMMUNICATION SERVES AS A SUMMARY OF THE KEY ELEMENTS OF THE FULL PROTOCOL. 2021 6 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 7 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 8 2663 24 YOGA IN CARDIAC HEALTH (A REVIEW). THIS REVIEW STUDIES THE EFFICACY OF YOGA IN THE PRIMARY AND SECONDARY PREVENTION OF ISCHAEMIC HEART DISEASE AND POST-MYOCARDIAL INFARCTION PATIENT REHABILITATION. YOGA IS AN UNCONVENTIONAL FORM OF PHYSICAL EXERCISE THAT HAS BEEN PRACTISED OVER A LONG PERIOD OF TIME IN THE INDIAN SUB-CONTINENT. IT HAS GAINED IMMENSE POPULARITY AS A FORM OF RECREATIONAL ACTIVITY ALL OVER THE WORLD. ITS POSSIBLE CONTRIBUTIONS TO HEALTHY LIVING HAVE BEEN STUDIED AND MANY INTERESTING REVELATIONS HAVE BEEN MADE. BENEFITS OF YOGA IN THE MODIFICATION OF CARDIOVASCULAR RISK FACTORS AND IN THE REHABILITATION OF THE POST-MYOCARDIAL INFARCTION PATIENT ARE AREAS OF SIGNIFICANT IMPORTANCE. IT IS IMPORTANT TO ASSESS THE PRACTICAL SIGNIFICANCE AND THE SUITABILITY OF INCORPORATING YOGA INTO THE COMPREHENSIVE CARDIAC REHABILITATION PROGRAMME. MAJORITY OF THE REHABILITATION WORKERS BELIEVES THAT INCORPORATING NONCONVENTIONAL FORMS OF PHYSICAL EXERCISE SUCH AS YOGA DEFINITELY WOULD ENHANCE EFFICACY AND ADD VALUE. THIS ARTICLE ATTEMPTS TO STUDY THE HISTORY AND THE SCIENCE OF YOGA AND EVALUATE ITS EFFECTS ON CARDIOVASCULAR HEALTH. 2004 9 1973 45 SHOULD ACUPUNCTURE, BIOFEEDBACK, MASSAGE, QI GONG, RELAXATION THERAPY, DEVICE-GUIDED BREATHING, YOGA AND TAI CHI BE USED TO REDUCE BLOOD PRESSURE?: RECOMMENDATIONS BASED ON HIGH-QUALITY SYSTEMATIC REVIEWS. BACKGROUND: THIS REVIEW AIMS TO RATE THE QUALITY OF EVIDENCE AND THE STRENGTH OF RECOMMENDATIONS IN HIGH-QUALITY SYSTEMATIC REVIEWS OF NON-DRUG THERAPIES. HYPERTENSIVE PATIENTS WHO ARE RESISTANT OR NON-ADHERENT TO ANTIHYPERTENSIVE DRUGS MAY BE EASIER TO MANAGE IF THEY CHOOSE ALTERNATIVE NON-DRUG THERAPIES FOR HYPERTENSION, BASED ON THIS REVIEW. METHODS: P: ADULTS (>18 YEARS), EXCEPT PREGNANT WOMEN, WITH ESSENTIAL HYPERTENSION. I: CUPPING, MOXIBUSTION, ACUPUNCTURE, ACUPOINT STIMULATION, YOGA, MEDITATION, TAI CHI, QI GONG, CHINESE MASSAGE, MASSAGE, SPINAL MANIPULATION, BIOFEEDBACK, DEVICE-GUIDED BREATHING THERAPY, AROMATHERAPY, MUSIC THERAPY, AND RELAXATION APPROACHES. C: 1. NO TREATMENT. 2. SHAM THERAPY. 3. CONVENTIONAL TREATMENT, INCLUDING ANTIHYPERTENSIVE DRUGS AND LIFESTYLE MODIFICATION (E.G., EXERCISE). O: 1. CHANGE IN THE INCIDENCE OF CARDIOVASCULAR DEATH. 2. CHANGE IN THE INCIDENCE OF MYOCARDIAL INFARCTION. 3. CHANGE IN THE INCIDENCE OF STROKE. 4. CHANGE IN BLOOD PRESSURE (BP). 5. EFFICACY RATE OF BP LOWERING. 6. ADVERSE EFFECTS (REVIEW SPECIFIC). S: SYSTEMATIC REVIEWS OF RANDOMIZED CONTROLLED TRIALS, INCLUDING META-ANALYSES AND ASSESSMENTS OF THE METHODOLOGICAL QUALITY/RISK OF BIAS. INFORMATION SOURCES: COCHRANE DATABASE OF SYSTEMATIC REVIEWS, DATABASE OF ABSTRACTS OF REVIEWS OF EFFECTS, COCHRANE LIBRARY, PUBMED, WEB OF SCIENCE, CHINA NATIONAL KNOWLEDGE INFRASTRUCTURE, AND CHINESE SCIENTIFIC JOURNAL DATABASE WERE SEARCHED. THE BIBLIOGRAPHIES OF THE INCLUDED ARTICLES WERE ALSO SEARCHED FOR RELEVANT SYSTEMATIC REVIEWS. GRADE CRITERIA WERE USED TO RATE THE QUALITY OF EVIDENCE IN SYSTEMATIC REVIEWS CONSIDERING 6 FACTORS, INCLUDING RISK OF BIAS. RESULTS: THIS REVIEW ULTIMATELY INCLUDED 13 SYSTEMATIC REVIEWS OF 14 NON-DRUG THERAPIES (ACUPUNCTURE, WET CUPPING, BADUANJIN, BLOOD LETTING, AURICULAR ACUPUNCTURE, MUSIC, MASSAGE, QI GONG, MOXIBUSTION, RELAXATION THERAPIES, BIOFEEDBACK, DEVICE-GUIDED BREATHING, YOGA AND TAI CHI) BASED ON THE INCLUSION CRITERIA. THE QUALITY OF EVIDENCE WAS GENERALLY LOW, AND WEAK RECOMMENDATIONS WERE GIVEN FOR MOST THERAPIES EXCEPT MASSAGE AND ACUPUNCTURE PLUS ANTIHYPERTENSIVE DRUG. BASED ON THE ANALYZED EVIDENCE, MASSAGE AND ACUPUNCTURE PLUS ANTIHYPERTENSIVE DRUG COULD BENEFIT PEOPLE WHO WANT TO LOWER THEIR BP AND DO NOT HAVE CONTRAINDICATIONS FOR MASSAGE AND ACUPUNCTURE PLUS ANTIHYPERTENSIVE DRUG. DISCUSSION/STRENGTH: THE GRADE APPROACH MAKES THIS REVIEW A UNIQUE REFERENCE FOR PEOPLE WHO ARE CONSIDERING THE GRADE OF QUALITY OF EVIDENCE IN SYSTEMATIC REVIEWS, THE BALANCE OF DESIRABLE AND UNDESIRABLE CONSEQUENCES AND THE STRENGTH OF RECOMMENDATIONS TO DECIDE WHICH INTERVENTION SHOULD BE USED TO REDUCE BP. LIMITATIONS: MANY NON-DRUG THERAPIES WERE EXCLUDED DUE TO THE LOW METHODOLOGICAL QUALITY OF THEIR SYSTEMATIC REVIEWS, AND ONLY 14 THERAPIES WERE EVALUATED IN THIS REVIEW. AS NO PATIENT-IMPORTANT OUTCOMES WERE REVIEWED, SURROGATE OUTCOMES WERE USED TO RATE THE STRENGTH OF RECOMMENDATIONS. THIS APPROACH MAY CAUSE A DECREASE IN EVIDENCE QUALITY ACCORDING TO GRADE, BUT WE ARGUE THAT THIS IS APPROPRIATE IN THE CONTEXT OF THIS REVIEW. 2019 10 2629 57 YOGA FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE. BACKGROUND: A SEDENTARY LIFESTYLE AND STRESS ARE MAJOR RISK FACTORS FOR CARDIOVASCULAR DISEASE (CVD). SINCE YOGA INVOLVES EXERCISE AND IS THOUGHT TO HELP IN STRESS REDUCTION IT MAY BE AN EFFECTIVE STRATEGY IN THE PRIMARY PREVENTION OF CVD. OBJECTIVES: TO DETERMINE THE EFFECT OF ANY TYPE OF YOGA ON THE PRIMARY PREVENTION OF CVD. SEARCH METHODS: WE SEARCHED THE FOLLOWING ELECTRONIC DATABASES: THE COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (CENTRAL) (2013, ISSUE 11) IN THE COCHRANE LIBRARY; MEDLINE (OVID) (1946 TO NOVEMBER WEEK 3 2013); EMBASE CLASSIC + EMBASE (OVID) (1947 TO 2013 WEEK 48); WEB OF SCIENCE (THOMSON REUTERS) (1970 TO 4 DECEMBER 2013); DATABASE OF ABSTRACTS OF REVIEWS OF EFFECTS (DARE), HEALTH TECHNOLOGY ASSESSMENT DATABASE AND HEALTH ECONOMICS EVALUATIONS DATABASE (ISSUE 4 OF 4, 2013) IN THE COCHRANE LIBRARY. WE ALSO SEARCHED A NUMBER OF ASIAN DATABASES AND THE ALLIED AND COMPLEMENTARY MEDICINE DATABASE (AMED) (INCEPTION TO DECEMBER 2012). WE SEARCHED TRIAL REGISTERS AND REFERENCE LISTS OF REVIEWS AND ARTICLES, AND APPROACHED EXPERTS IN THE FIELD. WE APPLIED NO LANGUAGE RESTRICTIONS. SELECTION CRITERIA: RANDOMISED CONTROLLED TRIALS LASTING AT LEAST THREE MONTHS INVOLVING HEALTHY ADULTS OR THOSE AT HIGH RISK OF CVD. TRIALS EXAMINED ANY TYPE OF YOGA AND THE COMPARISON GROUP WAS NO INTERVENTION OR MINIMAL INTERVENTION. OUTCOMES OF INTEREST WERE CLINICAL CVD EVENTS AND MAJOR CVD RISK FACTORS. WE DID NOT INCLUDE ANY TRIALS THAT INVOLVED MULTIFACTORIAL LIFESTYLE INTERVENTIONS OR WEIGHT LOSS. DATA COLLECTION AND ANALYSIS: TWO AUTHORS INDEPENDENTLY SELECTED TRIALS FOR INCLUSION, EXTRACTED DATA AND ASSESSED THE RISK OF BIAS. MAIN RESULTS: WE IDENTIFIED 11 TRIALS (800 PARTICIPANTS) AND TWO ONGOING STUDIES. STYLE AND DURATION OF YOGA DIFFERED BETWEEN TRIALS. HALF OF THE PARTICIPANTS RECRUITED TO THE STUDIES WERE AT HIGH RISK OF CVD. MOST OF STUDIES WERE AT RISK OF PERFORMANCE BIAS, WITH INADEQUATE DETAILS REPORTED IN MANY OF THEM TO JUDGE THE RISK OF SELECTION BIAS.NO STUDY REPORTED CARDIOVASCULAR MORTALITY, ALL-CAUSE MORTALITY OR NON-FATAL EVENTS, AND MOST STUDIES WERE SMALL AND SHORT-TERM. THERE WAS SUBSTANTIAL HETEROGENEITY BETWEEN STUDIES MAKING IT IMPOSSIBLE TO COMBINE STUDIES STATISTICALLY FOR SYSTOLIC BLOOD PRESSURE AND TOTAL CHOLESTEROL. YOGA WAS FOUND TO PRODUCE REDUCTIONS IN DIASTOLIC BLOOD PRESSURE (MEAN DIFFERENCE (MD) -2.90 MMHG, 95% CONFIDENCE INTERVAL (CI) -4.52 TO -1.28), WHICH WAS STABLE ON SENSITIVITY ANALYSIS, TRIGLYCERIDES (MD -0.27 MMOL/L, 95% CI -0.44 TO -0.11) AND HIGH-DENSITY LIPOPROTEIN (HDL) CHOLESTEROL (MD 0.08 MMOL/L, 95% CI 0.02 TO 0.14). HOWEVER, THE CONTRIBUTING STUDIES WERE SMALL, SHORT-TERM AND AT UNCLEAR OR HIGH RISK OF BIAS. THERE WAS NO CLEAR EVIDENCE OF A DIFFERENCE BETWEEN GROUPS FOR LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL (MD -0.09 MMOL/L, 95% CI -0.48 TO 0.30), ALTHOUGH THERE WAS MODERATE STATISTICAL HETEROGENEITY. ADVERSE EVENTS, OCCURRENCE OF TYPE 2 DIABETES AND COSTS WERE NOT REPORTED IN ANY OF THE INCLUDED STUDIES. QUALITY OF LIFE WAS MEASURED IN THREE TRIALS BUT THE RESULTS WERE INCONCLUSIVE. AUTHORS' CONCLUSIONS: THE LIMITED EVIDENCE COMES FROM SMALL, SHORT-TERM, LOW-QUALITY STUDIES. THERE IS SOME EVIDENCE THAT YOGA HAS FAVOURABLE EFFECTS ON DIASTOLIC BLOOD PRESSURE, HDL CHOLESTEROL AND TRIGLYCERIDES, AND UNCERTAIN EFFECTS ON LDL CHOLESTEROL. THESE RESULTS SHOULD BE CONSIDERED AS EXPLORATORY AND INTERPRETED WITH CAUTION. 2014 11 2831 36 YOGA VS. PHYSICAL THERAPY VS. EDUCATION FOR CHRONIC LOW BACK PAIN IN PREDOMINANTLY MINORITY POPULATIONS: STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: CHRONIC LOW BACK PAIN CAUSES SUBSTANTIAL MORBIDITY AND COST TO SOCIETY WHILE DISPROPORTIONATELY IMPACTING LOW-INCOME AND MINORITY ADULTS. SEVERAL RANDOMIZED CONTROLLED TRIALS SHOW YOGA IS AN EFFECTIVE TREATMENT. HOWEVER, THE COMPARATIVE EFFECTIVENESS OF YOGA AND PHYSICAL THERAPY, A COMMON MAINSTREAM TREATMENT FOR CHRONIC LOW BACK PAIN, IS UNKNOWN. METHODS/DESIGN: THIS IS A RANDOMIZED CONTROLLED TRIAL FOR 320 PREDOMINANTLY LOW-INCOME MINORITY ADULTS WITH CHRONIC LOW BACK PAIN, COMPARING YOGA, PHYSICAL THERAPY, AND EDUCATION. INCLUSION CRITERIA ARE ADULTS 18-64 YEARS OLD WITH NON-SPECIFIC LOW BACK PAIN LASTING >/= 12 WEEKS AND A SELF-REPORTED AVERAGE PAIN INTENSITY OF >/= 4 ON A 0-10 SCALE. RECRUITMENT TAKES PLACE AT BOSTON MEDICAL CENTER, AN URBAN ACADEMIC SAFETY-NET HOSPITAL AND SEVEN FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS LOCATED IN DIVERSE NEIGHBORHOODS. THE 52-WEEK STUDY HAS AN INITIAL 12-WEEK TREATMENT PHASE WHERE PARTICIPANTS ARE RANDOMIZED IN A 2:2:1 RATIO INTO I) A STANDARDIZED WEEKLY HATHA YOGA CLASS SUPPLEMENTED BY HOME PRACTICE; II) A STANDARDIZED EVIDENCE-BASED EXERCISE THERAPY PROTOCOL ADAPTED FROM THE TREATMENT BASED CLASSIFICATION METHOD, INDIVIDUALLY DELIVERED BY A PHYSICAL THERAPIST AND SUPPLEMENTED BY HOME PRACTICE; AND III) EDUCATION DELIVERED THROUGH A SELF-CARE BOOK. CO-PRIMARY OUTCOME MEASURES ARE 12-WEEK PAIN INTENSITY MEASURED ON AN 11-POINT NUMERICAL RATING SCALE AND BACK-SPECIFIC FUNCTION MEASURED USING THE MODIFIED ROLAND MORRIS DISABILITY QUESTIONNAIRE. IN THE SUBSEQUENT 40-WEEK MAINTENANCE PHASE, YOGA PARTICIPANTS ARE RE-RANDOMIZED IN A 1:1 RATIO TO EITHER STRUCTURED MAINTENANCE YOGA CLASSES OR HOME PRACTICE ONLY. PHYSICAL THERAPY PARTICIPANTS ARE SIMILARLY RE-RANDOMIZED TO EITHER FIVE BOOSTER SESSIONS OR HOME PRACTICE ONLY. EDUCATION PARTICIPANTS CONTINUE TO FOLLOW RECOMMENDATIONS OF EDUCATIONAL MATERIALS. WE WILL ALSO ASSESS COST EFFECTIVENESS FROM THE PERSPECTIVES OF THE INDIVIDUAL, INSURERS, AND SOCIETY USING CLAIMS DATABASES, ELECTRONIC MEDICAL RECORDS, SELF-REPORT COST DATA, AND STUDY RECORDS. QUALITATIVE DATA FROM INTERVIEWS WILL ADD SUBJECTIVE DETAIL TO COMPLEMENT QUANTITATIVE DATA. TRIAL REGISTRATION: THIS TRIAL IS REGISTERED IN CLINICALTRIALS.GOV, WITH THE ID NUMBER: NCT01343927. 2014 12 989 38 EFFECTS OF HATHA YOGA ON CARDIAC HEMODYNAMIC PARAMETERS AND PHYSICAL CAPACITY IN CARDIAC REHABILITATION PATIENTS. PURPOSE: THE PURPOSE OF THE PRESENT STUDY WAS TO ASSESS THE EFFECT OF HATHA YOGA TRAINING THAT WAS ADDED TO THE STANDARD CARDIAC REHABILITATION (CR) PROGRAM ON THE CARDIAC HEMODYNAMIC PARAMETERS AND PHYSICAL CAPACITY OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION (STEMI). METHODS: THE STUDY INCLUDED 70 MALE PATIENTS AGED 45-65 YR WITH STEMI WHO WERE TREATED BY ANGIOPLASTY. PATIENTS WERE RANDOMIZED TO STANDARD CR (CONTROL GROUP) VERSUS STANDARD CR PLUS HATHA YOGA (EXPERIMENTAL GROUP). THE TRAINING PROGRAM LASTED FOR A TOTAL OF 24 D FOR EACH PATIENT, WITH DAY 1 AND DAY 24 USED FOR MEDICAL EXAMINATIONS (ELECTROCARDIOGRAM, SPIROERGOMETRIC SUBMAXIMAL TREADMILL TEST, AND ECHOCARDIOGRAPHY). THE REMAINING 22 D CONSISTED OF THE ACTUAL TRAINING. RESULTS: AFTER THE CR PROGRAM THE SPIROERGOMETRIC STRESS TEST PARAMETERS AND LEFT VENTRICULAR EJECTION FRACTION (LVEF) IMPROVED IN BOTH THE EXPERIMENTAL AND CONTROL GROUPS. THE MOST NOTABLE CHANGES IN ECHOCARDIOGRAPHY PARAMETERS AND PHYSICAL CAPACITY WERE IN THE EXPERIMENTAL GROUP. THE RESULTS SHOWED SIGNIFICANT MAIN EFFECT OVER TIME, A TIME-VERSUS-GROUP INTERACTION IN LVEF, THE DURATION OF THE TEST, AND PEAK OXYGEN UPTAKE, AND A TIME-VERSUS-GROUP INTERACTION IN METABOLIC EQUIVALENTS (METS). WE ALSO NOTED THE IMPROVEMENT OF LEFT VENTRICULAR END-DIASTOLIC DIAMETER, LEFT VENTRICULAR END-SYSTOLIC DIAMETER, AND HEART RATE OVER TIME. CONCLUSION: THE RESULTS REVEALED BETTER EFFECTIVENESS IN THE CR PROGRAM WITH A MODIFIED HATHA YOGA TRAINING PROGRAM. HATHA YOGA TRAINING COULD BE RECOMMENDED AS AN ADJUNCT TO STANDARD CR. 2020 13 867 41 EFFECT OF YOGA REGIMEN ON LUNG FUNCTIONS INCLUDING DIFFUSION CAPACITY IN CORONARY ARTERY DISEASE PATIENTS: A RANDOMIZED CONTROLLED STUDY. BACKGROUND: LUNG FUNCTIONS ARE FOUND TO BE IMPAIRED IN CORONARY ARTERY DISEASE (CAD), CONGESTIVE HEART FAILURE, LEFT VENTRICULAR DYSFUNCTION, AND AFTER CARDIAC SURGERY. DIFFUSION CAPACITY PROGRESSIVELY WORSENS AS THE SEVERITY OF CAD INCREASES DUE TO REDUCTION IN LUNG TISSUE PARTICIPATING IN GAS EXCHANGE. AIMS AND OBJECTIVES: PRANAYAMA BREATHING EXERCISES AND YOGIC POSTURES MAY PLAY AN IMPRESSIVE ROLE IN IMPROVING CARDIO-RESPIRATORY EFFICIENCY AND FACILITATING GAS DIFFUSION AT THE ALVEOLO-CAPILLARY MEMBRANE. THIS STUDY WAS DONE TO SEE THE EFFECT OF YOGA REGIMEN ON LUNG FUNCTIONS PARTICULARLY DIFFUSION CAPACITY IN CAD PATIENTS. MATERIALS AND METHODS: A TOTAL OF 80 STABLE CAD PATIENTS BELOW 65 YEARS OF AGE OF BOTH SEXES WERE SELECTED AND RANDOMIZED INTO TWO GROUPS OF 40 EACH. GROUP I CAD PATIENTS WERE GIVEN YOGA REGIMEN FOR 3 MONTHS WHICH CONSISTED OF YOGIC POSTURES, PRANAYAMA BREATHING EXERCISES, DIETARY MODIFICATION, AND HOLISTIC TEACHING ALONG WITH THEIR CONVENTIONAL MEDICINE WHILE GROUP II CAD PATIENTS WERE PUT ONLY ON CONVENTIONAL MEDICINE. LUNG FUNCTIONS INCLUDING DIFFUSION CAPACITY WERE RECORDED THRICE IN BOTH THE GROUPS: 0 DAY AS BASELINE, 22(ND) DAY AND ON 90(TH) DAY BY USING COMPUTERIZED MS MEDISOFT CARDIO-RESPIRATORY INSTRUMENT, HYP'AIR COMPACT MODEL OF CARDIO-RESPIRATORY TESTING MACHINE WAS MANUFACTURED BY P K MORGAN, INDIA. THE RECORDED PARAMETERS WERE STATISTICALLY ANALYZED BY REPEATED MEASURES ANOVA FOLLOWED BY TUKEY'S TEST IN BOTH THE GROUPS. CARDIOVASCULAR PARAMETERS WERE ALSO COMPARED BEFORE AND AFTER INTERVENTION IN BOTH THE GROUPS. RESULTS: STATISTICALLY SIGNIFICANT IMPROVEMENTS WERE SEEN IN SLOW VITAL CAPACITY, FORCED VITAL CAPACITY, PEAK EXPIRATORY FLOW RATE, MAXIMUM VOLUNTARY VENTILATION, AND DIFFUSION FACTOR/ TRANSFER FACTOR OF LUNG FOR CARBON MONOXIDE AFTER 3 MONTHS OF YOGA REGIMEN IN GROUP I. FORCED EXPIRATORY VOLUME IN 1(ST) SEC (FEV1), AND FEV1 % ALSO SHOWED A TREND TOWARD IMPROVEMENT ALTHOUGH NOT STATISTICALLY SIGNIFICANT. HR, SBP AND DBP ALSO SHOWED SIGNIFICANT IMPROVEMENT IN GROUP-I PATIENTS WHO FOLLOWED YOGA REGIMEN. CONCLUSIONS: YOGA REGIMEN WAS FOUND TO IMPROVE LUNG FUNCTIONS AND DIFFUSION CAPACITY IN CAD PATIENTS BESIDES IMPROVING CARDIOVASCULAR FUNCTIONS. THUS, IT CAN BE USED AS A COMPLIMENTARY OR ADJUNCT THERAPY ALONG WITH THE CONVENTIONAL MEDICINE FOR THEIR TREATMENT AND REHABILITATION. 2015 14 61 33 A COMPREHENSIVE REVIEW OF YOGA RESEARCH IN 2020. OBJECTIVES: ACCUMULATED EVIDENCE GARNERED IN THE LAST FEW DECADES HAS HIGHLIGHTED THE ROLE OF YOGA IN HEALTH AND DISEASE. THE OVERWHELMING MORTALITY AND MORBIDITY MEDIATED BY NONCOMMUNICABLE EPIDEMICS SUCH AS HEART DISEASE AND CANCER HAVE FOSTERED A SEARCH FOR MECHANISMS TO ATTENUATE THEM. DESPITE OVERWHELMING SUCCESS IN ACUTE CARE, THE EFFICACY OF MODERN MEDICINES HAS BEEN LIMITED ON THIS FRONT. YOGA IS ONE OF THE INTEGRATIVE THERAPIES THAT HAS COME TO LIGHT AS HAVING A SUBSTANTIAL ROLE IN PREVENTING AND MITIGATING SUCH DISORDERS. IT THUS SEEMS TRITE TO ANALYZE AND DISCUSS THE RESEARCH ADVANCEMENTS IN YOGA FOR 2020. THE PRESENT REVIEW ATTEMPTS TO DISTILL RECENT RESEARCH HIGHLIGHTS FROM VOLUMINOUS LITERATURE GENERATED IN 2020. METHODS: THIS REVIEW WAS CONDUCTED ON THE ARTICLES PUBLISHED OR ASSIGNED TO AN ISSUE IN 2020. THE AUTHORS SEARCHED THE PUBMED DATABASE FOR CLINICAL STUDIES PUBLISHED IN THE ENGLISH LANGUAGE, USING YOGA (INCLUDING MEDITATION) AS THE INTERVENTION, AND HAVING AN ADEQUATE DESCRIPTION OF THE INTERVENTION. THEN, THEY EXTRACTED DATA FROM EACH STUDY INTO A STANDARDIZED GOOGLE SHEET. RESULTS: A TOTAL OF 1149 CITATIONS WERE RETRIEVED IN THE INITIAL SEARCH. OF THESE, 46 STUDIES MET ELIGIBILITY CRITERIA AND WERE FINALLY INCLUDED. THE STUDIES WERE PREDOMINANTLY ON MENTAL HEALTH AND NEUROPSYCHOLOGY, ADDRESSING VARIOUS ISSUES SUCH AS ANXIETY, POSTURAL BALANCE, MIGRAINE, ACADEMIC PERFORMANCE, AND CHILDHOOD NEGLECT. ANXIETY, STRESS, AND DEPRESSION WERE OTHER COMMON DENOMINATORS. EIGHT STUDIES WERE ON CARDIORESPIRATORY SYSTEMS, INCLUDING EXERCISE CAPACITY, CARDIAC REHABILITATION, MYOCARDIAL INFARCTION, AND HYPERTENSION. THREE STUDIES WERE ON DIABETES, EVALUATING THE EFFECT OF YOGA. FIVE STUDIES FOCUSED ON COGNITION, HEALTH STATUS, AND AUTONOMIC REGULATION AND FEW OTHERS INCLUDED CANCERS, INFERTILITY, ULCERATIVE COLITIS, URINARY INCONTINENCE, RESTLESS LEG SYNDROME, RHEUMATOID ARTHRITIS, CHRONIC PAIN, AND METABOLIC SYNDROME. FINALLY, MOST STUDIES WERE ON NONCOMMUNICABLE DISEASES WITH ONE EXCEPTION, HUMAN IMMUNODEFICIENCY VIRUS; TWO RANDOMIZED CONTROLLED TRIALS WERE DEDICATED TO IT. CONCLUSIONS: YOGA HAS BEEN STUDIED UNDER A WIDE VARIETY OF CLINICOPATHOLOGICAL CONDITIONS IN THE YEAR 2020. THIS LANDSCAPE REVIEW INTENDS TO PROVIDE AN IDEA OF THE ROLE OF YOGA IN VARIOUS CLINICAL CONDITIONS AND ITS FUTURE THERAPEUTIC IMPLICATIONS. 2022 15 1927 23 ROLE OF YOGA IN CARDIAC DISEASE AND REHABILITATION. PURPOSE: CARDIOVASCULAR DISEASE CONTINUES TO BE THE LEADING CAUSE OF MORBIDITY AND MORTALITY AROUND THE WORLD. YOGA, A COMBINATION OF PHYSICAL POSTURES (ASANA), BREATHING EXERCISES (PRANAYAMA), AND MEDITATION (DHYANA), HAS GAINED INCREASING RECOGNITION AS A FORM OF MIND-BODY EXERCISE. IN THIS NARRATIVE REVIEW, WE INTENDED TO REVIEW THE EMERGING EVIDENCE ASSESSING THE PHYSIOLOGIC AND CLINICAL EFFECTS OF YOGA ON THE CARDIOVASCULAR SYSTEM AND THE POTENTIAL ROLE OF YOGA AS A COMPONENT OF COMPREHENSIVE CARDIAC REHABILITATION. METHODS: WE SEARCHED PUBMED, GOOGLE SCHOLAR, EMBASE, AND COCHRANE DATABASES FOR LITERATURE RELATED TO CARDIOVASCULAR EFFECTS OF YOGA FROM INCEPTION UP UNTIL 2017. RESULTS: YOGA HAS BEEN SHOWN TO HAVE FAVORABLE EFFECTS ON SYSTEMIC INFLAMMATION, STRESS, THE CARDIAC AUTONOMIC NERVOUS SYSTEM, AND TRADITIONAL AND EMERGING CARDIOVASCULAR RISK FACTORS. CONCLUSIONS: YOGA HAS SHOWN PROMISE AS A USEFUL LIFESTYLE INTERVENTION THAT CAN BE INCORPORATED INTO CARDIOVASCULAR DISEASE MANAGEMENT ALGORITHMS. ALTHOUGH MANY INVESTIGATORS HAVE REPORTED THE CLINICAL BENEFITS OF YOGA IN REDUCING CARDIOVASCULAR EVENTS, MORBIDITY, AND MORTALITY, EVIDENCE SUPPORTING THESE CONCLUSIONS IS SOMEWHAT LIMITED, THEREBY EMPHASIZING THE NEED FOR LARGE, WELL-DESIGNED RANDOMIZED TRIALS THAT MINIMIZE BIAS AND METHODOLOGICAL DRAWBACKS. 2019 16 1675 21 OBESITY-RELATED INFLAMMATION & CARDIOVASCULAR DISEASE: EFFICACY OF A YOGA-BASED LIFESTYLE INTERVENTION. OBESITY IS A GLOBAL HEALTH BURDEN AND ITS PREVALENCE IS INCREASING SUBSTANTIALLY DUE TO CHANGING LIFESTYLE. CHRONIC ADIPOSITY IS ASSOCIATED WITH METABOLIC IMBALANCE LEADING TO DYSLIPIDAEMIA, DIABETES, HYPERTENSION AND CARDIOVASCULAR DISEASES (CVD). ADIPOSE TISSUE ACTS AS AN ENDOCRINE ORGAN RELEASING SEVERAL ADIPOCYTOKINES, AND IS ASSOCIATED WITH INCREASED LEVELS OF TISSUE AND CIRCULATING INFLAMMATORY BIOMOLECULES CAUSING VASCULAR INFLAMMATION AND ATHEROGENESIS. FURTHER, INFLAMMATION IS ALSO ASSOCIATED INDEPENDENTLY WITH OBESITY AS WELL AS CVD. KEEPING THIS IN VIEW, IT IS POSSIBLE THAT A REDUCTION IN WEIGHT MAY LEAD TO A DECREASE IN INFLAMMATION, RESULTING IN CVD RISK REDUCTION, AND BETTER MANAGEMENT OF PATIENTS WITH CVD. LIFESTYLE INTERVENTION HAS BEEN ENDORSED BY SEVERAL HEALTH AUTHORITIES IN PREVENTION AND MANAGEMENT OF CHRONIC DISEASES. A YOGA-BASED LIFESTYLE INTERVENTION APPEARS TO BE A PROMISING OPTION IN REDUCING THE RISK FOR CVD AS WELL AS MANAGEMENT OF PATIENTS WITH CVD AS IT IS SIMPLE TO FOLLOW AND COST-EFFECTIVE WITH HIGH COMPLIANCE. THE EFFICACY OF SUCH LIFESTYLE INTERVENTION PROGRAMMES IS MULTIFACETED, AND IS ACHIEVED VIA REDUCTION IN WEIGHT, OBESITY-RELATED INFLAMMATION AND STRESS, THEREBY CULMINATING INTO RISK REDUCTION TOWARDS SEVERAL CHRONIC DISEASES INCLUDING CVD. IN THIS REVIEW, THE ASSOCIATION BETWEEN OBESITY-RELATED INFLAMMATION AND CVD, AND THE ROLE OF YOGA-BASED LIFESTYLE INTERVENTION IN PREVENTION AND MANAGEMENT OF CVD ARE DISCUSSED. 2014 17 1904 36 RETARDATION OF CORONARY ATHEROSCLEROSIS WITH YOGA LIFESTYLE INTERVENTION. BACKGROUND: YOGA HAS POTENTIAL FOR BENEFIT FOR PATIENTS WITH CORONARY ARTERY DISEASE THOUGH OBJECTIVE, ANGIOGRAPHIC STUDIES ARE LACKING. MATERIAL AND METHODS: WE EVALUATED POSSIBLE ROLE OF LIFESTYLE MODIFICATION INCORPORATING YOGA, ON RETARDATION OF CORONARY ATHEROSCLEROTIC DISEASE. IN THIS PROSPECTIVE, RANDOMIZED, CONTROLLED TRIAL, 42 MEN WITH ANGIOGRAPHICALLY PROVEN CORONARY ARTERY DISEASE (CAD) WERE RANDOMIZED TO CONTROL (N = 21) AND YOGA INTERVENTION GROUP (N = 21) AND WERE FOLLOWED FOR ONE YEAR. THE ACTIVE GROUP WAS TREATED WITH A USER-FRIENDLY PROGRAM CONSISTING OF YOGA, CONTROL OF RISK FACTORS, DIET CONTROL AND MODERATE AEROBIC EXERCISE. THE CONTROL GROUP WAS MANAGED BY CONVENTIONAL METHODS I.E. RISK FACTOR CONTROL AND AMERICAN HEART ASSOCIATION STEP I DIET. RESULTS: AT ONE YEAR, THE YOGA GROUPS SHOWED SIGNIFICANT REDUCTION IN NUMBER OF ANGINAL EPISODES PER WEEK, IMPROVED EXERCISE CAPACITY AND DECREASE IN BODY WEIGHT. SERUM TOTAL CHOLESTEROL, LDL CHOLESTEROL AND TRIGLYCERIDE LEVELS ALSO SHOWED GREATER REDUCTIONS AS COMPARED WITH CONTROL GROUP. REVASCULARISATION PROCEDURES (CORONARY ANGIOPLASTY OR BYPASS SURGERY) WERE LESS FREQUENTLY REQUIRED IN THE YOGA GROUP (ONE VERSUS EIGHT PATIENTS; RELATIVE RISK = 5.45; P = 0.01). CORONARY ANGIOGRAPHY REPEATED AT ONE YEAR SHOWED THAT SIGNIFICANTLY MORE LESIONS REGRESSED (20% VERSUS 2%) AND LESS LESIONS PROGRESSED (5% VERSUS 37%) IN THE YOGA GROUP (CHI-SQUARE = 24.9; P < 0.0001). THE COMPLIANCE TO THE TOTAL PROGRAM WAS EXCELLENT AND NO SIDE EFFECTS WERE OBSERVED. CONCLUSION: YOGA LIFESTYLE INTERVENTION RETARDS PROGRESSION AND INCREASES REGRESSION OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH SEVERE CORONARY ARTERY DISEASE. IT ALSO IMPROVES SYMPTOMATIC STATUS, FUNCTIONAL CLASS AND RISK FACTOR PROFILE. 2000 18 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 19 613 33 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 20 2496 33 YOGA AS PART OF A PACKAGE OF CARE VERSUS NON-STANDARD CARE FOR SCHIZOPHRENIA. BACKGROUND: YOGA IS AN ANCIENT BODY-MIND PRACTICE WHICH ORIGINATED IN INDIA AND IS POPULAR IN THE WESTERN WORLD AS A FORM OF RELAXATION AND EXERCISE. IT HAS BEEN OF INTEREST FOR PEOPLE WITH SCHIZOPHRENIA TO DETERMINE THE EFFICACY OF YOGA DELIVERED AS A PACKAGE OF CARE VERSUS NON-STANDARD CARE. OBJECTIVES: TO EXAMINE THE EFFECTS OF YOGA AS PART OF A PACKAGE OF CARE VERSUS NON-STANDARD CARE FOR SCHIZOPHRENIA. SEARCH METHODS: WE SEARCHED THE COCHRANE SCHIZOPHRENIA GROUP TRIALS REGISTER (LATEST 15 MAY 2018) WHICH IS BASED ON REGULAR SEARCHES OF MEDLINE, PUBMED, EMBASE, CINAHL, BIOSS, AMED, PSYCHINFO, AND REGISTRIES OF CLINICAL TRIALS. WE SEARCHED THE REFERENCES OF ALL INCLUDED STUDIES. THERE ARE NO LANGUAGE, DATE, DOCUMENT TYPE, OR PUBLICATION STATUS LIMITATIONS FOR INCLUSION OF RECORDS IN THE REGISTER. SELECTION CRITERIA: ALL RANDOMISED CONTROLLED TRIALS (RCTS) INCLUDING PEOPLE WITH SCHIZOPHRENIA COMPARING YOGA AS PART OF A PACKAGE OF CARE WITH NON-STANDARD CARE. DATA COLLECTION AND ANALYSIS: THERE WERE NO DATA TO ANALYSE AS NO STUDIES MET THE INCLUSION CRITERIA. MAIN RESULTS: THE SEARCHES IDENTIFIED 30 STUDIES THAT COULD BE RELEVANT TO THIS REVIEW. AFTER CAREFUL INSPECTION, 29 WERE EXCLUDED AND ONE IS AWAITING CLASSIFICATION. NO DATA WERE AVAILABLE FOR ANALYSES. AUTHORS' CONCLUSIONS: IN VIEW OF THE LACK OF EVIDENCE FROM RCTS, IT IS CURRENTLY NOT POSSIBLE FOR US TO COMMENT ON THE USE OF YOGA AS PART OF A PACKAGE OF CARE VERSUS NON-STANDARD CARE. 2019