1 2071 135 THE EFFECT OF A SINGLE YOGA CLASS ON INTEROCEPTIVE ACCURACY IN PATIENTS AFFECTED BY ANOREXIA NERVOSA AND IN HEALTHY CONTROLS: A PILOT STUDY. PURPOSE: TO EVALUATE INTEROCEPTIVE ACCURACY (IAC) BEFORE AND AFTER A SINGLE YOGA CLASS IN A POPULATION OF PATIENTS WITH ANOREXIA NERVOSA (AN) AND IN A POPULATION OF HEALTHY CONTROLS (HC). METHODS: FIFTEEN PATIENTS WITH AN AND TWENTY HC WERE INCLUDED IN THE STUDY. ALL INDIVIDUALS PARTICIPATED IN A SINGLE YOGA CLASS. BEFORE (T0) AND AFTER (T1) THE YOGA CLASS, THEY UNDERWENT THE HEARTBEAT DETECTION TASK FOR THE EVALUATION OF IAC. AT T0, ALL PARTICIPANTS ALSO UNDERWENT A PSYCHOLOGICAL ASSESSMENT, INCLUDING EVALUATION OF DEPRESSION, ANXIETY, BODY AWARENESS, ALEXITHYMIA, SELF-OBJECTIFICATION AND EATING DISORDERS PSYCHOPATHOLOGY. RESULTS: PATIENTS WITH AN HAD LOWER IAC THAN HC AT T0. A SIGNIFICANT IMPROVEMENT OF IAC AT T1 WAS FOUND IN THE HC GROUP BUT NOT IN THE GROUP OF PATIENTS WITH AN. CONCLUSION: WE INFER THAT OUR FINDINGS MIGHT BE LINKED TO THE FACT THAT PATIENTS WITH AN, DIFFERENTLY FROM HC, DID NOT PROPERLY ATTEND TO THEIR BODIES, DESPITE THE YOGA CLASS. THIS HYPOTHESIS IS CONSISTENT WITH PREVIOUS STUDIES SHOWING THAT PATIENTS WITH AN HAVE DECREASED IAC DURING SELF-FOCUSED BEHAVIOR BECAUSE OF BODY-RELATED AVOIDANCE. MOREOVER, WE SURMISE THAT HC MIGHT BE KEENER TO IMPROVE THEIR PERCEPTION OF INTERNAL BODY SIGNALS EVEN AFTER A SINGLE YOGA CLASS BECAUSE THEIR EMOTIONAL AWARENESS SYSTEM IS NOT IMPAIRED. PATIENTS WITH AN, ON THE CONTRARY, MAY HAVE AN INTRINSIC IMPAIRMENT OF THEIR EMOTIONAL AWARENESS, MAKING IT HARDER FOR THEM TO MODULATE THEIR IAC. LEVEL OF EVIDENCE: LEVEL III, EVIDENCE OBTAINED FROM WELL-DESIGNED COHORT OR CASE-CONTROL ANALYTICAL STUDIES. 2021
2 1894 31 RESEARCH TRENDS IN THE APPLICATION OF YOGA TO HUMAN HEALTH: A DATA SCIENCE APPROACH. YOGA IS AN INTEGRATIVE MIND-BODY SYSTEM OF WELLBEING DEVELOPED IN INDIA SINCE AT LEAST THREE MILLENNIA. YOGA HAS GAINED CONSIDERABLE ATTENTION IN RECENT DECADES, PARTLY DRIVEN BY RECENT RESEARCH AND EVIDENCE ABOUT ITS EFFECTIVENESS. IN THIS WORK, WE EXTRACTED RESEARCH TRENDS ON THE EFFECTS OF YOGA ON HUMAN HEALTH FROM THE US NATIONAL LIBRARY OF MEDICINE'S PUBMED DATABASE (PEER-REVIEWED JOURNAL PAPERS). WE FOUND THAT YOGA RESEARCH SPANS ALL ORGAN SYSTEMS AND SYSTEM-WIDE ISSUES SUCH AS PAIN AND CANCER. RESEARCH ON THE NERVOUS SYSTEM FAR OUTPACES OTHER SYSTEMS, WHICH IS EXPECTED BECAUSE OF THE EFFECTS OF BREATHING AND EXERCISE ON STRESS REDUCTION, WHICH HAS BEEN A MAJOR APPLICATION OF YOGA. THE NEXT CLUSTER OF IMPACT CONCERNS THE MUSCULOSKELETAL SYSTEM AND PAIN (BOTH RELATED TO THE EXERCISE [ASANA] ASPECTS OF YOGA), AS WELL AS CARDIOVASCULAR/ENDOCRINE (ALSO RELATED TO STRESS) AND CANCER. STRESS AND MENTAL HEALTH, PAIN, DIABETES, AND CANCER ARE HEALTH ISSUES FOR WHICH A PERMANENT CURE IS NOT AVAILABLE IN A MAJORITY OF CASES IN MODERN MEDICINE, ALTHOUGH ALLEVIATING TREATMENTS ARE AVAILABLE. THIS HAS PROBABLY FUELED INTEREST IN COMPLEMENTARY APPROACHES SUCH AS YOGA FOR THESE HEALTH ISSUES. RESEARCH TIMELINE SHOWS THAT YOGA-RELATED RESEARCH LARGELY EXPANDED ONLY AFTER THE 2000S. THERE WAS A SPECIFIC UPTICK AFTER 2004. SIMILAR TRENDS ARE SEEN IF WE LOOK AT JUST CLINICAL TRIALS OR RANDOMIZED CONTROL TRIALS (RCTS) OR SYSTEMATIC REVIEWS. THE PERCENTAGE OF TRIALS (CLINICAL AND RCT) AMONG PUBLISHED LITERATURE IS AROUND 10-15 % THIS IS COMPARABLE TO OTHER FIELDS THAT GAINED TRACTION AROUND 2000S (E.G. NON-INVASIVE BRAIN STIMULATION). GEOGRAPHICAL DISTRIBUTION SHOWS THAT 37% OF ALL YOGA RELATED RESEARCH OUTPUT ORIGINATES IN THE USA, 19% FROM INDIA, 13% FROM EUROPE AND 31% FROM THE REST OF THE WORLD. THEREFORE, THE INTEREST IS WIDESPREAD AND GLOBAL. AT LEAST THE UPTICK IN YOGA-RELATED RESEARCH IN THE US POST-2000S CAN BE ATTRIBUTED TO A SUBSTANTIAL JUMP IN FUNDING BETWEEN 1998 AND 2005 FROM US NATIONAL INSTITUTES OF HEALTH'S NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH). WE CAN ONLY SURMISE THAT RESEARCH IN THIS FIELD REACHED A CRITICAL MASS IN LATE-1990S, WHICH INFUSED MORE MONEY INTO THIS FIELD, GENERATING MORE RESEARCH AND CREATING A POSITIVE FEEDBACK LOOP THAT HAS SUSTAINED THE GROWTH SO FAR. WE PROPOSE THAT IN ORDER TO SUSTAIN OR EVEN ACCELERATE FUTURE RESEARCH IN THE AREA, RIGOR AND REPRODUCIBILITY MUST BE ENHANCED IN ADDITION TO PERFORMING MORE RCT AND CLINICAL TRIALS (INCREASING % OF TRIALS TO 20-25% FROM 10-15%). THE FRUITS OF RESEARCH IN THE FIELD HAS TO REACH THE COMMON MAN IN TERMS OF EVIDENCE-BASED SOLUTIONS TO HEALTH ISSUES. WITHOUT THIS, ACCELERATED FUNDING IN DEMOCRACIES SUCH AS INDIA AND THE USA WILL NOT BE REALIZABLE. 2020
3 2121 32 THE EFFECTIVENESS AND CHARACTERISTICS OF PREGNANCY YOGA INTERVENTIONS: A SYSTEMATIC REVIEW PROTOCOL. BACKGROUND: THE PURPOSE OF THIS REVIEW IS TO SYSTEMATICALLY EXAMINE THE REPORTED CLINICAL EFFECTIVENESS OF PREGNANCY YOGA. THE REVIEW WILL USE THE FITT (FREQUENCY, INTENSITY, TIME/DURATION AND TYPE) PRINCIPLE OF PHYSICAL ACTIVITY TO CHARACTERISE THE DIFFERENT TYPES OF YOGA INTERVENTIONS THAT HAVE BEEN EVALUATED IN THE INCLUDED STUDIES. STUDIES WILL BE CATEGORISED AS EFFECTIVENESS OR EFFICACY STUDIES AND THIS CONTINUUM OF EFFICACY VERSUS EFFECTIVENESS WILL BE INCORPORATED INTO THE FULL REVIEW. METHODS/DESIGN: THE FOLLOWING ELECTRONIC DATABASES WILL BE SEARCHED USING A DETAILED SEARCH STRATEGY: MEDLINE, PSYCINFO, EMBASE, CINAHL, WHOLIS, AMED, SCIELO, ASSIA AND WEB OF SCIENCE. RANDOMISED CONTROL TRIALS AND QUASI-EXPERIMENTAL STUDIES EXAMINING PREGNANCY YOGA AND REPORTING ON EFFECT WILL BE INCLUDED. TITLES, ABSTRACTS AND FULL ARTICLES WILL BE SCREENED BY TWO INVESTIGATORS INDEPENDENTLY TO IDENTIFY ELIGIBLE STUDIES. THE COCHRANE COLLABORATION'S RISK OF BIAS ASSESSMENT TOOL WILL BE USED TO ASSESS STUDY QUALITY. QUALITY OF THE EVIDENCE WILL BE EVALUATED USING THE GRADE CRITERIA. A STANDARDISED DATA EXTRACTION FORM WILL BE USED TO EXTRACT DATA. EFFECT SIZES WILL BE ESTIMATED USING MEAN DIFFERENCES FOR CONTINUOUS OUTCOMES, AND RELATIVE RISKS FOR DICHOTOMOUS OUTCOME. WHERE POSSIBLE, POOLING OF EFFECT ESTIMATES WILL BE DONE USING A RANDOM EFFECT MODEL. THE OUTCOMES OF INTEREST ARE QUALITY OF LIFE, STRESS, ANXIETY, DEPRESSION, MODE OF BIRTH, LABOUR DURATION AND PAIN MANAGEMENT IN LABOUR. DISCUSSION: THIS REVIEW WILL SYNTHESISE THE BEST AVAILABLE EVIDENCE ON THE EFFECTIVENESS OF YOGA DURING PREGNANCY AND PROVIDE VALUABLE HIGH-QUALITY INFORMATION FOR CLINICIANS AND HEALTH POLICYMAKERS. FINDINGS WILL BE DISSEMINATED THROUGH PUBLICATION IN A PEER-REVIEWED JOURNAL AND PRESENTATION AT RELEVANT CONFERENCE PROCEEDINGS. THE REVIEW WILL MAKE RECOMMENDATIONS FOR THE APPROPRIATE VOLUME, INTENSITY AND TYPE OF PREGNANCY YOGA FOR MAXIMUM EFFECT AND MAY HAVE IMPLICATIONS FOR POLICY AND PRACTICE RELATING TO PREGNANCY YOGA AS AN INTERVENTION. REGISTRATION: PROSPERO, CRD42019119916. REGISTERED ON 11TH JANUARY 2019. 2019
4 2821 51 YOGA TREATMENT FOR CHRONIC NON-SPECIFIC LOW BACK PAIN. BACKGROUND: NON-SPECIFIC LOW BACK PAIN IS A COMMON, POTENTIALLY DISABLING CONDITION USUALLY TREATED WITH SELF-CARE AND NON-PRESCRIPTION MEDICATION. FOR CHRONIC LOW BACK PAIN, CURRENT GUIDELINES STATE THAT EXERCISE THERAPY MAY BE BENEFICIAL. YOGA IS A MIND-BODY EXERCISE SOMETIMES USED FOR NON-SPECIFIC LOW BACK PAIN. OBJECTIVES: TO ASSESS THE EFFECTS OF YOGA FOR TREATING CHRONIC NON-SPECIFIC LOW BACK PAIN, COMPARED TO NO SPECIFIC TREATMENT, A MINIMAL INTERVENTION (E.G. EDUCATION), OR ANOTHER ACTIVE TREATMENT, WITH A FOCUS ON PAIN, FUNCTION, AND ADVERSE EVENTS. SEARCH METHODS: WE SEARCHED CENTRAL, MEDLINE, EMBASE, FIVE OTHER DATABASES AND FOUR TRIALS REGISTERS TO 11 MARCH 2016 WITHOUT RESTRICTION OF LANGUAGE OR PUBLICATION STATUS. WE SCREENED REFERENCE LISTS AND CONTACTED EXPERTS IN THE FIELD TO IDENTIFY ADDITIONAL STUDIES. SELECTION CRITERIA: WE INCLUDED RANDOMIZED CONTROLLED TRIALS OF YOGA TREATMENT IN PEOPLE WITH CHRONIC NON-SPECIFIC LOW BACK PAIN. WE INCLUDED STUDIES COMPARING YOGA TO ANY OTHER INTERVENTION OR TO NO INTERVENTION. WE ALSO INCLUDED STUDIES COMPARING YOGA AS AN ADJUNCT TO OTHER THERAPIES, VERSUS THOSE OTHER THERAPIES ALONE. DATA COLLECTION AND ANALYSIS: TWO AUTHORS INDEPENDENTLY SCREENED AND SELECTED STUDIES, EXTRACTED OUTCOME DATA, AND ASSESSED RISK OF BIAS. WE CONTACTED STUDY AUTHORS TO OBTAIN MISSING OR UNCLEAR INFORMATION. WE EVALUATED THE OVERALL CERTAINTY OF EVIDENCE USING THE GRADE APPROACH. MAIN RESULTS: WE INCLUDED 12 TRIALS (1080 PARTICIPANTS) CARRIED OUT IN THE USA (SEVEN TRIALS), INDIA (THREE TRIALS), AND THE UK (TWO TRIALS). STUDIES WERE UNFUNDED (ONE TRIAL), FUNDED BY A YOGA INSTITUTION (ONE TRIAL), FUNDED BY NON-PROFIT OR GOVERNMENT SOURCES (SEVEN TRIALS), OR DID NOT REPORT ON FUNDING (THREE TRIALS). MOST TRIALS USED IYENGAR, HATHA, OR VINIYOGA FORMS OF YOGA. THE TRIALS COMPARED YOGA TO NO INTERVENTION OR A NON-EXERCISE INTERVENTION SUCH AS EDUCATION (SEVEN TRIALS), AN EXERCISE INTERVENTION (THREE TRIALS), OR BOTH EXERCISE AND NON-EXERCISE INTERVENTIONS (TWO TRIALS). ALL TRIALS WERE AT HIGH RISK OF PERFORMANCE AND DETECTION BIAS BECAUSE PARTICIPANTS AND PROVIDERS WERE NOT BLINDED TO TREATMENT ASSIGNMENT, AND OUTCOMES WERE SELF-ASSESSED. THEREFORE, WE DOWNGRADED ALL OUTCOMES TO 'MODERATE' CERTAINTY EVIDENCE BECAUSE OF RISK OF BIAS, AND WHEN THERE WAS ADDITIONAL SERIOUS RISK OF BIAS, UNEXPLAINED HETEROGENEITY BETWEEN STUDIES, OR THE ANALYSES WERE IMPRECISE, WE DOWNGRADED THE CERTAINTY OF THE EVIDENCE FURTHER.FOR YOGA COMPARED TO NON-EXERCISE CONTROLS (9 TRIALS; 810 PARTICIPANTS), THERE WAS LOW-CERTAINTY EVIDENCE THAT YOGA PRODUCED SMALL TO MODERATE IMPROVEMENTS IN BACK-RELATED FUNCTION AT THREE TO FOUR MONTHS (STANDARDIZED MEAN DIFFERENCE (SMD) -0.40, 95% CONFIDENCE INTERVAL (CI) -0.66 TO -0.14; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MEAN DIFFERENCE (MD) -2.18, 95% -3.60 TO -0.76), MODERATE-CERTAINTY EVIDENCE FOR SMALL TO MODERATE IMPROVEMENTS AT SIX MONTHS (SMD -0.44, 95% CI -0.66 TO -0.22; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD -2.15, 95% -3.23 TO -1.08), AND LOW-CERTAINTY EVIDENCE FOR SMALL IMPROVEMENTS AT 12 MONTHS (SMD -0.26, 95% CI -0.46 TO -0.05; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD -1.36, 95% -2.41 TO -0.26). ON A 0-100 SCALE THERE WAS VERY LOW- TO MODERATE-CERTAINTY EVIDENCE THAT YOGA WAS SLIGHTLY BETTER FOR PAIN AT THREE TO FOUR MONTHS (MD -4.55, 95% CI -7.04 TO -2.06), SIX MONTHS (MD -7.81, 95% CI -13.37 TO -2.25), AND 12 MONTHS (MD -5.40, 95% CI -14.50 TO -3.70), HOWEVER WE PRE-DEFINED CLINICALLY SIGNIFICANT CHANGES IN PAIN AS 15 POINTS OR GREATER AND THIS THRESHOLD WAS NOT MET. BASED ON INFORMATION FROM SIX TRIALS, THERE WAS MODERATE-CERTAINTY EVIDENCE THAT THE RISK OF ADVERSE EVENTS, PRIMARILY INCREASED BACK PAIN, WAS HIGHER IN YOGA THAN IN NON-EXERCISE CONTROLS (RISK DIFFERENCE (RD) 5%, 95% CI 2% TO 8%).FOR YOGA COMPARED TO NON-YOGA EXERCISE CONTROLS (4 TRIALS; 394 PARTICIPANTS), THERE WAS VERY-LOW-CERTAINTY EVIDENCE FOR LITTLE OR NO DIFFERENCE IN BACK-RELATED FUNCTION AT THREE MONTHS (SMD -0.22, 95% CI -0.65 TO 0.20; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD -0.99, 95% -2.87 TO 0.90) AND SIX MONTHS (SMD -0.20, 95% CI -0.59 TO 0.19; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD -0.90, 95% -2.61 TO 0.81), AND NO INFORMATION ON BACK-RELATED FUNCTION AFTER SIX MONTHS. THERE WAS VERY LOW-CERTAINTY EVIDENCE FOR LOWER PAIN ON A 0-100 SCALE AT SEVEN MONTHS (MD -20.40, 95% CI -25.48 TO -15.32), AND NO INFORMATION ON PAIN AT THREE MONTHS OR AFTER SEVEN MONTHS. BASED ON INFORMATION FROM THREE TRIALS, THERE WAS LOW-CERTAINTY EVIDENCE FOR NO DIFFERENCE IN THE RISK OF ADVERSE EVENTS BETWEEN YOGA AND NON-YOGA EXERCISE CONTROLS (RD 1%, 95% CI -4% TO 6%).FOR YOGA ADDED TO EXERCISE COMPARED TO EXERCISE ALONE (1 TRIAL; 24 PARTICIPANTS), THERE WAS VERY-LOW-CERTAINTY EVIDENCE FOR LITTLE OR NO DIFFERENCE AT 10 WEEKS IN BACK-RELATED FUNCTION (SMD -0.60, 95% CI -1.42 TO 0.22; CORRESPONDING TO A CHANGE IN THE OSWESTRY DISABILITY INDEX OF MD -17.05, 95% -22.96 TO 11.14) OR PAIN ON A 0-100 SCALE (MD -3.20, 95% CI -13.76 TO 7.36). THERE WAS NO INFORMATION ON OUTCOMES AT OTHER TIME POINTS. THERE WAS NO INFORMATION ON ADVERSE EVENTS.STUDIES PROVIDED LIMITED EVIDENCE ON RISK OF CLINICAL IMPROVEMENT, MEASURES OF QUALITY OF LIFE, AND DEPRESSION. THERE WAS NO EVIDENCE ON WORK-RELATED DISABILITY. AUTHORS' CONCLUSIONS: THERE IS LOW- TO MODERATE-CERTAINTY EVIDENCE THAT YOGA COMPARED TO NON-EXERCISE CONTROLS RESULTS IN SMALL TO MODERATE IMPROVEMENTS IN BACK-RELATED FUNCTION AT THREE AND SIX MONTHS. YOGA MAY ALSO BE SLIGHTLY MORE EFFECTIVE FOR PAIN AT THREE AND SIX MONTHS, HOWEVER THE EFFECT SIZE DID NOT MEET PREDEFINED LEVELS OF MINIMUM CLINICAL IMPORTANCE. IT IS UNCERTAIN WHETHER THERE IS ANY DIFFERENCE BETWEEN YOGA AND OTHER EXERCISE FOR BACK-RELATED FUNCTION OR PAIN, OR WHETHER YOGA ADDED TO EXERCISE IS MORE EFFECTIVE THAN EXERCISE ALONE. YOGA IS ASSOCIATED WITH MORE ADVERSE EVENTS THAN NON-EXERCISE CONTROLS, BUT MAY HAVE THE SAME RISK OF ADVERSE EVENTS AS OTHER BACK-FOCUSED EXERCISE. YOGA IS NOT ASSOCIATED WITH SERIOUS ADVERSE EVENTS. THERE IS A NEED FOR ADDITIONAL HIGH-QUALITY RESEARCH TO IMPROVE CONFIDENCE IN ESTIMATES OF EFFECT, TO EVALUATE LONG-TERM OUTCOMES, AND TO PROVIDE ADDITIONAL INFORMATION ON COMPARISONS BETWEEN YOGA AND OTHER EXERCISE FOR CHRONIC NON-SPECIFIC LOW BACK PAIN. 2017
5 2130 33 THE EFFECTIVENESS OF YOGA TO PREVENT DIABETES MELLITUS TYPE 2: A PROTOCOL FOR SYSTEMATIC REVIEW AND META-ANALYSIS. BACKGROUND: TYPE 2 DIABETES MELLITUS (T2DM) IS BECOMING A LEADING PROBLEM WORLDWIDE. EMERGING REPORTS REVEAL ALARMING EVIDENCE OF INCREASING PREVALENCE OF T2DM THAT HAS REACHED PANDEMIC LEVELS. DESPITE THE SIGNIFICANT INCIDENCE, THERE ARE LIMITED RELIABLE DATA RESOURCES AND COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS ON THE EFFECTS OF YOGA ON PEOPLE WHO ARE A PREDIABETIC OR HIGH RISK FOR DEVELOPING T2DM. OBJECTIVE: THE OBJECTIVE OF THIS PROTOCOL IS TO CONDUCT A FULL-SCALE SYSTEMATIC REVIEW AND META-ANALYSES ON THE EFFECTS OF YOGA ON PEOPLE WHO ARE PREDIABETES OR HIGH RISK OF DEVELOPING T2DM. METHODS: THE ARTICLES ENROLLED IN THE STUDY WILL BE RETRIEVED FROM THE ONLINE DATABASES BETWEEN 2002 AND THE DATE THE SEARCHES ARE EXECUTED. THE SEARCHES WILL BE REPEATED JUST BEFORE THE FINAL ANALYSES AND FURTHER RELEVANT STUDIES FOR INCLUSION. WE WILL CONDUCT A BIBLIOGRAPHIC SEARCH IN DATABASES: MEDLINE/PUBMED, SCOPUS, COCHRANE LIBRARY, EBSCO, AND INDMED USING KEYWORDS INCLUDING PREDIABETES STATE, HIGH RISK FOR DIABETES, METABOLIC SYNDROME, AND YOGA. A DEFINED SEARCH STRATEGY WILL BE IMPLEMENTED ALONG WITH SELECTION CRITERIA TO OBTAIN FULL-TEXT ARTICLES OF RELEVANT STUDIES. THIS STUDY PROTOCOL WAS PREPARED ACCORDING TO THE PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META-ANALYSIS FOR PROTOCOLS 2015 GUIDELINES. THERE WILL BE NO LANGUAGE RESTRICTIONS. ETHICS AND DISSEMINATION: THE PROPOSED STUDY WILL BE BASED ON PUBLISHED STUDIES AND PUBLICLY AVAILABLE ANONYMIZED DATA WITHOUT DIRECTLY INVOLVING HUMAN PARTICIPANTS AND THEREFORE REQUIRES NEITHER FORMAL HUMAN ETHICAL REVIEW NOR APPROVAL BY A HUMAN RESEARCH ETHICS COMMITTEE. WE PUBLISHED AN OUTLINE OF THE PROTOCOL IN THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) IN 2018. WE PLAN TO DISSEMINATE THE FINDINGS OF THIS SYSTEMATIC REVIEW AND META-ANALYSIS THROUGH PUBLICATION IN A PEER-REVIEWED JOURNAL AND PRESENTATION AT RELEVANT CONFERENCE PROCEEDINGS. IN ADDITION, WE BELIEVE THE RESULTS OF THE SYSTEMATIC REVIEW WILL HAVE IMPLICATIONS FOR POLICY AND PRACTICE. WE WILL PREPARE POLICYMAKER SUMMARY USING A VALIDATED FORMAT, DISSEMINATE THROUGH SOCIAL MEDIA AND EMAIL DISCUSSION GROUPS. REVIEW REGISTRATION NUMBER: PROSPERO REGISTRATION NUMBER CRD 42018106657. 2019
6 957 41 EFFECTS OF A SINGLE YOGA SESSION ON CARDIAC INTEROCEPTIVE ACCURACY AND EMOTIONAL EXPERIENCE. BACKGROUND: THERE IS AN INCREASING BODY OF RESEARCH SUPPORTING THE IDEA THAT CARDIAC INTEROCEPTIVE ACCURACY (IAC) CAN BE IMPROVED BY TRAINING. FINDINGS CONCERNING THE EFFECTS OF A SINGLE YOGA SESSION ON IAC AND THE RELATED CONSTRUCT EMOTIONAL EXPERIENCE ARE SPARSE. THE AIM OF THIS STUDY WAS TO EXAMINE IF A SINGLE YOGA SESSION INCREASES IAC AND IMPROVES EMOTIONAL EXPERIENCE. METHODS: 137 STUDENTS WERE RANDOMLY ASSIGNED TO A 20-MIN YOGA SESSION (N = 47), AN ENDURANCE SESSION (N = 46), OR AN INACTIVE CONTROL CONDITION (N = 44). IAC AND EMOTIONAL EXPERIENCE WERE ASSESSED BEFORE AND AFTER THE SESSIONS. RESULTS: THERE WERE NO SIGNIFICANT CHANGES IN IAC, OR POSITIVE AND NEGATIVE AFFECT. IAC AT BASELINE AND THE CHANGE IN POSITIVE EFFECT WERE FOUND AS PREDICTORS FOR IAC AFTER THE YOGA SESSION. CONCLUSION: A 20-MIN YOGA SESSION SEEMS TO BE NOT APPLICABLE TO IMPROVE IAC AND EMOTIONAL EXPERIENCE. FUTURE STUDIES SHOULD INVESTIGATE LONG-TERM INTERVENTIONS AND DIVERSE HEALTHY AND CLINICAL POPULATIONS. 2021
7 2636 45 YOGA FOR TREATING URINARY INCONTINENCE IN WOMEN. BACKGROUND: URINARY INCONTINENCE IN WOMEN IS ASSOCIATED WITH POOR QUALITY OF LIFE AND DIFFICULTIES IN SOCIAL, PSYCHOLOGICAL AND SEXUAL FUNCTIONING. THE CONDITION MAY AFFECT UP TO 15% OF MIDDLE-AGED OR OLDER WOMEN IN THE GENERAL POPULATION. CONSERVATIVE TREATMENTS SUCH AS LIFESTYLE INTERVENTIONS, BLADDER TRAINING AND PELVIC FLOOR MUSCLE TRAINING (USED EITHER ALONE OR IN COMBINATION WITH OTHER INTERVENTIONS) ARE THE INITIAL APPROACHES TO THE MANAGEMENT OF URINARY INCONTINENCE. MANY WOMEN ARE INTERESTED IN ADDITIONAL TREATMENTS SUCH AS YOGA, A SYSTEM OF PHILOSOPHY, LIFESTYLE AND PHYSICAL PRACTICE THAT ORIGINATED IN ANCIENT INDIA. OBJECTIVES: TO ASSESS THE EFFECTS OF YOGA FOR TREATING URINARY INCONTINENCE IN WOMEN. SEARCH METHODS: WE SEARCHED THE COCHRANE INCONTINENCE AND COCHRANE COMPLEMENTARY MEDICINE SPECIALISED REGISTERS. WE SEARCHED THE WORLD HEALTH ORGANIZATION INTERNATIONAL CLINICAL TRIALS REGISTRY PLATFORM (WHO ICTRP) AND CLINICALTRIALS.GOV TO IDENTIFY ANY ONGOING OR UNPUBLISHED STUDIES. WE HANDSEARCHED PROCEEDINGS OF THE INTERNATIONAL CONGRESS ON COMPLEMENTARY MEDICINE RESEARCH AND THE EUROPEAN CONGRESS FOR INTEGRATIVE MEDICINE. WE SEARCHED THE NHS ECONOMIC EVALUATION DATABASE FOR ECONOMIC STUDIES, AND SUPPLEMENTED THIS SEARCH WITH SEARCHES FOR ECONOMICS STUDIES IN MEDLINE AND EMBASE FROM 2015 ONWARDS. DATABASE SEARCHES ARE UP-TO-DATE AS OF 21 JUNE 2018. SELECTION CRITERIA: RANDOMISED CONTROLLED TRIALS IN WOMEN DIAGNOSED WITH URINARY INCONTINENCE IN WHICH ONE GROUP WAS ALLOCATED TO TREATMENT WITH YOGA. DATA COLLECTION AND ANALYSIS: TWO REVIEW AUTHORS INDEPENDENTLY SCREENED TITLES AND ABSTRACTS OF ALL RETRIEVED ARTICLES, SELECTED STUDIES FOR INCLUSION, EXTRACTED DATA, ASSESSED RISK OF BIAS AND EVALUATED THE CERTAINTY OF THE EVIDENCE FOR EACH REPORTED OUTCOME. ANY DISAGREEMENTS WERE RESOLVED BY CONSENSUS. WE PLANNED TO COMBINE CLINICALLY COMPARABLE STUDIES IN REVIEW MANAGER 5 USING RANDOM-EFFECTS META-ANALYSIS AND TO CARRY OUT SENSITIVITY AND SUBGROUP ANALYSES. WE PLANNED TO CREATE A TABLE LISTING ECONOMIC STUDIES ON YOGA FOR INCONTINENCE BUT NOT CARRY OUT ANY ANALYSES ON THESE STUDIES. MAIN RESULTS: WE INCLUDED TWO STUDIES (INVOLVING A TOTAL OF 49 WOMEN). EACH STUDY COMPARED YOGA TO A DIFFERENT COMPARATOR, THEREFORE WE WERE UNABLE TO COMBINE THE DATA IN A META-ANALYSIS. A THIRD STUDY THAT HAS BEEN COMPLETED BUT NOT YET FULLY REPORTED IS AWAITING ASSESSMENT.ONE INCLUDED STUDY WAS A SIX-WEEK STUDY COMPARING YOGA TO A WAITING LIST IN 19 WOMEN WITH EITHER URGENCY URINARY INCONTINENCE OR STRESS URINARY INCONTINENCE. WE JUDGED THE CERTAINTY OF THE EVIDENCE FOR ALL REPORTED OUTCOMES AS VERY LOW DUE TO PERFORMANCE BIAS, DETECTION BIAS, AND IMPRECISION. THE NUMBER OF WOMEN REPORTING CURE WAS NOT REPORTED. WE ARE UNCERTAIN WHETHER YOGA RESULTS IN SATISFACTION WITH CURE OR IMPROVEMENT OF INCONTINENCE (RISK RATIO (RR) 6.33, 95% CONFIDENCE INTERVAL (CI) 1.44 TO 27.88; AN INCREASE OF 592 FROM 111 PER 1000, 95% CI 160 TO 1000). WE ARE UNCERTAIN WHETHER THERE IS A DIFFERENCE BETWEEN YOGA AND WAITING LIST IN CONDITION-SPECIFIC QUALITY OF LIFE AS MEASURED ON THE INCONTINENCE IMPACT QUESTIONNAIRE SHORT FORM (MEAN DIFFERENCE (MD) 1.74, 95% CI -33.02 TO 36.50); THE NUMBER OF MICTURITIONS (MD -0.77, 95% CI -2.13 TO 0.59); THE NUMBER OF INCONTINENCE EPISODES (MD -1.57, 95% CI -2.83 TO -0.31); OR THE BOTHERSOMENESS OF INCONTINENCE AS MEASURED ON THE UROGENITAL DISTRESS INVENTORY 6 (MD -0.90, 95% CI -1.46 TO -0.34). THERE WAS NO EVIDENCE OF A DIFFERENCE IN THE NUMBER OF WOMEN WHO EXPERIENCED AT LEAST ONE ADVERSE EVENT (RISK DIFFERENCE 0%, 95% CI -38% TO 38%; NO DIFFERENCE FROM 222 PER 1000, 95% CI 380 FEWER TO 380 MORE).THE SECOND INCLUDED STUDY WAS AN EIGHT-WEEK STUDY IN 30 WOMEN WITH URGENCY URINARY INCONTINENCE THAT COMPARED MINDFULNESS-BASED STRESS REDUCTION (MBSR) TO AN ACTIVE CONTROL INTERVENTION OF YOGA CLASSES. THE STUDY WAS UNBLINDED, AND THERE WAS HIGH ATTRITION FROM BOTH STUDY ARMS FOR ALL OUTCOME ASSESSMENTS. WE JUDGED THE CERTAINTY OF THE EVIDENCE FOR ALL REPORTED OUTCOMES AS VERY LOW DUE TO PERFORMANCE BIAS, ATTRITION BIAS, IMPRECISION AND INDIRECTNESS. THE NUMBER OF WOMEN REPORTING CURE WAS NOT REPORTED. WE ARE UNCERTAIN WHETHER WOMEN IN THE YOGA GROUP WERE LESS LIKELY TO REPORT IMPROVEMENT IN INCONTINENCE AT EIGHT WEEKS COMPARED TO WOMEN IN THE MBSR GROUP (RR 0.09, 95% CI 0.01 TO 1.43; A DECREASE OF 419 FROM 461 PER 1000, 95% CI 5 TO 660). WE ARE UNCERTAIN ABOUT THE EFFECT OF MBSR COMPARED TO YOGA ON REPORTS OF CURE OR IMPROVEMENT IN INCONTINENCE, IMPROVEMENT IN CONDITION-SPECIFIC QUALITY OF LIFE MEASURED ON THE OVERACTIVE BLADDER HEALTH-RELATED QUALITY OF LIFE SCALE, REDUCTION IN INCONTINENCE EPISODES OR REDUCTION IN BOTHERSOMENESS OF INCONTINENCE AS MEASURED ON THE OVERACTIVE BLADDER SYMPTOM AND QUALITY OF LIFE-SHORT FORM AT EIGHT WEEKS. THE STUDY DID NOT REPORT ON ADVERSE EFFECTS. AUTHORS' CONCLUSIONS: WE IDENTIFIED FEW TRIALS ON YOGA FOR INCONTINENCE, AND THE EXISTING TRIALS WERE SMALL AND AT HIGH RISK OF BIAS. IN ADDITION, WE DID NOT FIND ANY STUDIES OF ECONOMIC OUTCOMES RELATED TO YOGA FOR URINARY INCONTINENCE. DUE TO THE LACK OF EVIDENCE TO ANSWER THE REVIEW QUESTION, WE ARE UNCERTAIN WHETHER YOGA IS USEFUL FOR WOMEN WITH URINARY INCONTINENCE. ADDITIONAL, WELL-CONDUCTED TRIALS WITH LARGER SAMPLE SIZES ARE NEEDED. 2019
8 2543 50 YOGA FOR ASTHMA. BACKGROUND: ASTHMA IS A COMMON CHRONIC INFLAMMATORY DISORDER AFFECTING ABOUT 300 MILLION PEOPLE WORLDWIDE. AS A HOLISTIC THERAPY, YOGA HAS THE POTENTIAL TO RELIEVE BOTH THE PHYSICAL AND PSYCHOLOGICAL SUFFERING OF PEOPLE WITH ASTHMA, AND ITS POPULARITY HAS EXPANDED GLOBALLY. A NUMBER OF CLINICAL TRIALS HAVE BEEN CARRIED OUT TO EVALUATE THE EFFECTS OF YOGA PRACTICE, WITH INCONSISTENT RESULTS. OBJECTIVES: TO ASSESS THE EFFECTS OF YOGA IN PEOPLE WITH ASTHMA. SEARCH METHODS: WE SYSTEMATICALLY SEARCHED THE COCHRANE AIRWAYS GROUP REGISTER OF TRIALS, WHICH IS DERIVED FROM SYSTEMATIC SEARCHES OF BIBLIOGRAPHIC DATABASES INCLUDING THE COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, AND PSYCINFO, AND HANDSEARCHING OF RESPIRATORY JOURNALS AND MEETING ABSTRACTS. WE ALSO SEARCHED PEDRO. WE SEARCHED CLINICALTRIALS.GOV AND THE WHO ICTRP SEARCH PORTAL. WE SEARCHED ALL DATABASES FROM THEIR INCEPTION TO 22 JULY 2015, AND USED NO RESTRICTION ON LANGUAGE OF PUBLICATION. WE CHECKED THE REFERENCE LISTS OF ELIGIBLE STUDIES AND RELEVANT REVIEW ARTICLES FOR ADDITIONAL STUDIES. WE ATTEMPTED TO CONTACT INVESTIGATORS OF ELIGIBLE STUDIES AND EXPERTS IN THE FIELD TO LEARN OF OTHER PUBLISHED AND UNPUBLISHED STUDIES. SELECTION CRITERIA: WE INCLUDED RANDOMISED CONTROLLED TRIALS (RCTS) THAT COMPARED YOGA WITH USUAL CARE (OR NO INTERVENTION) OR SHAM INTERVENTION IN PEOPLE WITH ASTHMA AND REPORTED AT LEAST ONE OF THE FOLLOWING OUTCOMES: QUALITY OF LIFE, ASTHMA SYMPTOM SCORE, ASTHMA CONTROL, LUNG FUNCTION MEASURES, ASTHMA MEDICATION USAGE, AND ADVERSE EVENTS. DATA COLLECTION AND ANALYSIS: WE EXTRACTED BIBLIOGRAPHIC INFORMATION, CHARACTERISTICS OF PARTICIPANTS, CHARACTERISTICS OF INTERVENTIONS AND CONTROLS, CHARACTERISTICS OF METHODOLOGY, AND RESULTS FOR THE OUTCOMES OF OUR INTEREST FROM ELIGIBLE STUDIES. FOR CONTINUOUS OUTCOMES, WE USED MEAN DIFFERENCE (MD) WITH 95% CONFIDENCE INTERVAL (CI) TO DENOTE THE TREATMENT EFFECTS, IF THE OUTCOMES WERE MEASURED BY THE SAME SCALE ACROSS STUDIES. ALTERNATIVELY, IF THE OUTCOMES WERE MEASURED BY DIFFERENT SCALES ACROSS STUDIES, WE USED STANDARDISED MEAN DIFFERENCE (SMD) WITH 95% CI. FOR DICHOTOMOUS OUTCOMES, WE USED RISK RATIO (RR) WITH 95% CI TO MEASURE THE TREATMENT EFFECTS. WE PERFORMED META-ANALYSIS WITH REVIEW MANAGER 5.3. WE USED THE FIXED-EFFECT MODEL TO POOL THE DATA, UNLESS THERE WAS SUBSTANTIAL HETEROGENEITY AMONG STUDIES, IN WHICH CASE WE USED THE RANDOM-EFFECTS MODEL INSTEAD. FOR OUTCOMES INAPPROPRIATE OR IMPOSSIBLE TO POOL QUANTITATIVELY, WE CONDUCTED A DESCRIPTIVE ANALYSIS AND SUMMARISED THE FINDINGS NARRATIVELY. MAIN RESULTS: WE INCLUDED 15 RCTS WITH A TOTAL OF 1048 PARTICIPANTS. MOST OF THE TRIALS WERE CONDUCTED IN INDIA, FOLLOWED BY EUROPE AND THE UNITED STATES. THE MAJORITY OF PARTICIPANTS WERE ADULTS OF BOTH SEXES WITH MILD TO MODERATE ASTHMA FOR SIX MONTHS TO MORE THAN 23 YEARS. FIVE STUDIES INCLUDED YOGA BREATHING ALONE, WHILE THE OTHER STUDIES ASSESSED YOGA INTERVENTIONS THAT INCLUDED BREATHING, POSTURE, AND MEDITATION. INTERVENTIONS LASTED FROM TWO WEEKS TO 54 MONTHS, FOR NO MORE THAN SIX MONTHS IN THE MAJORITY OF STUDIES. THE RISK OF BIAS WAS LOW ACROSS ALL DOMAINS IN ONE STUDY AND UNCLEAR OR HIGH IN AT LEAST ONE DOMAIN FOR THE REMAINDER.THERE WAS SOME EVIDENCE THAT YOGA MAY IMPROVE QUALITY OF LIFE (MD IN ASTHMA QUALITY OF LIFE QUESTIONNAIRE (AQLQ) SCORE PER ITEM 0.57 UNITS ON A 7-POINT SCALE, 95% CI 0.37 TO 0.77; 5 STUDIES; 375 PARTICIPANTS), IMPROVE SYMPTOMS (SMD 0.37, 95% CI 0.09 TO 0.65; 3 STUDIES; 243 PARTICIPANTS), AND REDUCE MEDICATION USAGE (RR 5.35, 95% CI 1.29 TO 22.11; 2 STUDIES) IN PEOPLE WITH ASTHMA. THE MD FOR AQLQ SCORE EXCEEDED THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) OF 0.5, BUT WHETHER THE MEAN CHANGES EXCEEDED THE MCID FOR ASTHMA SYMPTOMS IS UNCERTAIN DUE TO THE LACK OF AN ESTABLISHED MCID IN THE SEVERITY SCORES USED IN THE INCLUDED STUDIES. THE EFFECTS OF YOGA ON CHANGE FROM BASELINE FORCED EXPIRATORY VOLUME IN ONE SECOND (MD 0.04 LITRES, 95% CI -0.10 TO 0.19; 7 STUDIES; 340 PARTICIPANTS; I(2) = 68%) WERE NOT STATISTICALLY SIGNIFICANT. TWO STUDIES INDICATED IMPROVED ASTHMA CONTROL, BUT DUE TO VERY SIGNIFICANT HETEROGENEITY (I(2) = 98%) WE DID NOT POOL DATA. NO SERIOUS ADVERSE EVENTS ASSOCIATED WITH YOGA WERE REPORTED, BUT THE DATA ON THIS OUTCOME WAS LIMITED. AUTHORS' CONCLUSIONS: WE FOUND MODERATE-QUALITY EVIDENCE THAT YOGA PROBABLY LEADS TO SMALL IMPROVEMENTS IN QUALITY OF LIFE AND SYMPTOMS IN PEOPLE WITH ASTHMA. THERE IS MORE UNCERTAINTY ABOUT POTENTIAL ADVERSE EFFECTS OF YOGA AND ITS IMPACT ON LUNG FUNCTION AND MEDICATION USAGE. RCTS WITH A LARGE SAMPLE SIZE AND HIGH METHODOLOGICAL AND REPORTING QUALITY ARE NEEDED TO CONFIRM THE EFFECTS OF YOGA FOR ASTHMA. 2016
9 2035 18 TELE-YOGA FOR CHRONIC PAIN: CURRENT STATUS AND FUTURE DIRECTIONS. PAIN IS A PERVASIVE, DEBILITATING DISORDER THAT IS RESISTANT TO LONG-TERM PHARMACOLOGICAL INTERVENTIONS. ALTHOUGH PSYCHOLOGICAL THERAPIES SUCH AS COGNITIVE BEHAVIOR THERAPY DEMONSTRATE MODERATE EFFICACY, MANY INDIVIDUALS CONTINUE TO HAVE ONGOING DIFFICULTIES FOLLOWING TREATMENT. THERE IS A CURRENT TREND TO ESTABLISH COMPLEMENTARY AND INTEGRATIVE HEALTH INTERVENTIONS FOR CHRONIC PAIN, FOR WHICH YOGA HAS BEEN FOUND TO HAVE EXCITING POTENTIAL. NEVERTHELESS, AN IMPORTANT CONSIDERATION WITHIN THE FIELD IS ACCESSIBILITY TO ADEQUATE CARE. TELEHEALTH CAN BE USED TO PROVIDE REAL-TIME INTERACTIVE VIDEO CONFERENCING LEADING TO INCREASED ACCESS TO HEALTH CARE FOR INDIVIDUALS LOCATED REMOTELY OR WHO OTHERWISE HAVE DIFFICULTY ACCESSING SERVICES, PERHAPS THROUGH ISSUES OF MOBILITY OR PROXIMITY OF ADEQUATE SERVICES. THIS ARTICLE ASSESSES THE CURRENT STATUS AND FEASIBILITY OF IMPLEMENTING TELE-YOGA FOR CHRONIC PAIN. METHODOLOGICAL LIMITATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH ARE DISCUSSED. 2018
10 2587 50 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
11 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
12 2629 43 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
13 2013 31 SUDARSHAN KRIYA YOGA: A BREATH OF HOPE DURING COVID-19 PANDEMIC. IMPORTANT COUNTER MEASURES TO COMBAT AN INFECTIOUS DISEASE PANDEMIC INCLUDE VACCINATION, ANTIVIRAL THERAPY, AND IMMUNOMODULATION THERAPY. VACCINATIONS ARE DISEASE SPECIFIC AND MOREOVER STRAIN SPECIFIC, SO THE PROTECTION PROVIDED IS ALSO SPECIFIC AND LIMITED. ANTIVIRAL THERAPIES ARE COSTLY AND REQUIRE BULK PRODUCTION OF DRUGS, HENCE GLOBALLY THERE IS AN INCREASED INTEREST TOWARD LOW-RISK, COST-EFFECTIVE COMPLEMENTARY ALTERNATIVE THERAPIES, SUCH AS YOGA AND AYURVEDA TO TACKLE THE INFECTIOUS PANDEMIC, CORONAVIRUS DISEASE 2019 (COVID-19). THERE IS CLINICAL EVIDENCE AVAILABLE ON THE POTENTIAL COMPLEMENTARY ROLE OF YOGIC PRACTICES IN THE MANAGEMENT OF NONCOMMUNICABLE AND COMMUNICABLE DISEASES. VARIOUS ONLINE DATABASES WERE SEARCHED FOR ARTICLES PUBLISHED BETWEEN 2000 AND 2020. DATABASES EXPLORED WERE MEDLINE, EMBASE, INDIAN CITATION INDEX, PSYCINFO, INDEX MEDICUS FOR SOUTH-EAST ASIA REGION, AND GOOGLE SCHOLAR. ALL SEARCH RESULTS WERE SCREENED, AND ARTICLES RELATED TO KEYWORDS SUCH AS COVID-19, YOGA THERAPY, AND SUDARSHAN KRIYA YOGA (SKY) WERE SELECTED FOR DATA EXTRACTION. QUALITY OF THE STUDIES INCLUDED WAS EVALUATED ON THE BASIS OF THE CONSTRUCT VALIDITY, CONTENT VALIDITY, RELEVANCE, BIAS, CREDIBILITY RELATING TO INFORMATION, AND DATA SOURCES. SKY IS A UNIQUE YOGIC PRACTICE THAT INCLUDES SPECIFIC SEQUENTIAL BREATHING TECHNIQUES. IT BALANCES THE AUTONOMIC NERVOUS SYSTEM AND THUS CAN ALLEVIATE ANXIETY, ROUTINE STRESS, DEPRESSION, STRESS-RELATED MEDICAL DISORDERS, AND POSTTRAUMATIC STRESS. IT POTENTIATES NATURAL HOST IMMUNE DEFENSES THAT ARE ESSENTIAL TO TACKLE A PLETHORA OF MICROBIAL INFECTIONS. THIS NARRATIVE REVIEW ARTICLE PROVIDES AN OVERVIEW OF POTENTIAL THERAPEUTIC BENEFITS THAT SKY CAN OFFER TO THE POPULATION AT LARGE DURING THIS COVID-19 PANDEMIC. 2021
14 2496 32 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
15 2820 44 YOGA TREATMENT FOR CHRONIC NON-SPECIFIC LOW BACK PAIN (2017). WIELAND LS, SKOETZ N, PILKINGTON K, VEMPATI R, DADAMO CR, BERMAN BM. YOGA TREATMENT FOR CHRONIC NON-SPECIFIC LOW BACK PAIN.COCHRANE DATABASE SYST REV2017, ISSUE 1. ART. NO.: CD010671. DOI: 10.1002/14651858.CD010671.PUB2. BACKGROUND: NON-SPECIFIC LOW BACK PAIN IS A COMMON, POTENTIALLY DISABLING CONDITION USUALLY TREATED WITH SELF-CARE AND NON-PRESCRIPTION MEDICATION. FOR CHRONIC LOW BACK PAIN, CURRENT GUIDELINES STATE THAT EXERCISE THERAPY MAY BE BENEFICIAL. YOGA IS A MIND-BODY EXERCISE SOMETIMES USED FOR NON-SPECIFIC LOW BACK PAIN. OBJECTIVES: TO ASSESS THE EFFECTS OF YOGA FOR TREATING CHRONIC NON-SPECIFIC LOW BACK PAIN, COMPARED TO NO SPECIFIC TREATMENT, A MINIMAL INTERVENTION (E.G., EDUCATION), OR ANOTHER ACTIVE TREATMENT, WITH A FOCUS ON PAIN, FUNCTION, AND ADVERSE EVENTS. SEARCH METHODS: WE SEARCHED CENTRAL, MEDLINE, EMBASE, FIVE OTHER DATABASES, AND FOUR TRIALS REGISTERS TO 11 MARCH 2016 WITHOUT RESTRICTION OF LANGUAGE OR PUBLICATION STATUS. WE SCREENED REFERENCE LISTS AND CONTACTED EXPERTS IN THE FIELD TO IDENTIFY ADDITIONAL STUDIES. SELECTION CRITERIA: WE INCLUDED RANDOMIZED CONTROLLED TRIALS OF YOGA TREATMENT IN PEOPLE WITH CHRONIC NON-SPECIFIC LOW BACK PAIN. WE INCLUDED STUDIES COMPARING YOGA TO ANY OTHER INTERVENTION OR TO NO INTERVENTION. WE ALSO INCLUDED STUDIES COMPARING YOGA AS AN ADJUNCT TO OTHER THERAPIES, VERSUS THOSE OTHER THERAPIES ALONE. DATA COLLECTION AND ANALYSIS: TWO AUTHORS INDEPENDENTLY SCREENED AND SELECTED STUDIES, EXTRACTED OUTCOME DATA, AND ASSESSED RISK OF BIAS. WE CONTACTED STUDY AUTHORS TO OBTAIN MISSING OR UNCLEAR INFORMATION. WE EVALUATED THE OVERALL CERTAINTY OF EVIDENCE USING THE GRADE APPROACH. MAIN RESULTS: WE INCLUDED 12 TRIALS (1080 PARTICIPANTS) CARRIED OUT IN THE USA (SEVEN TRIALS), INDIA (THREE TRIALS), AND THE UK (TWO TRIALS). STUDIES WERE UNFUNDED (ONE TRIAL), FUNDED BY A YOGA INSTITUTION (ONE TRIAL), FUNDED BY NON-PROFIT OR GOVERNMENT SOURCES (SEVEN TRIALS), OR DID NOT REPORT ON FUNDING (THREE TRIALS). MOST TRIALS USED IYENGAR, HATHA, OR VINIYOGA FORMS OF YOGA. THE TRIALS COMPARED YOGA TO NO INTERVENTION OR A NON-EXERCISE INTERVENTION SUCH AS EDUCATION (SEVEN TRIALS), AN EXERCISE INTERVENTION (THREE TRIALS), OR BOTH EXERCISE AND NON-EXERCISE INTERVENTIONS (TWO TRIALS). ALL TRIALS WERE AT HIGH RISK OF PERFORMANCE AND DETECTION BIAS BECAUSE PARTICIPANTS AND PROVIDERS WERE NOT BLINDED TO TREATMENT ASSIGNMENT, AND OUTCOMES WERE SELF-ASSESSED. THEREFORE, WE DOWNGRADED ALL OUTCOMES TO "MODERATE" CERTAINTY EVIDENCE BECAUSE OF RISK OF BIAS, AND WHEN THERE WAS ADDITIONAL SERIOUS RISK OF BIAS, UNEXPLAINED HETEROGENEITY BETWEEN STUDIES, OR THE ANALYSES WERE IMPRECISE, WE DOWNGRADED THE CERTAINTY OF THE EVIDENCE FURTHER. FOR YOGA COMPARED TO NON-EXERCISE CONTROLS (9 TRIALS; 810 PARTICIPANTS), THERE WAS LOW-CERTAINTY EVIDENCE THAT YOGA PRODUCED SMALL TO MODERATE IMPROVEMENTS IN BACK-RELATED FUNCTION AT THREE TO FOUR MONTHS [STANDARDIZED MEAN DIFFERENCE (SMD) = -0.40, 95% CI: -0.66 TO -0.14; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MEAN DIFFERENCE (MD) = -2.18, 95% CI: -3.60 TO -0.76], MODERATE-CERTAINTY EVIDENCE FOR SMALL TO MODERATE IMPROVEMENTS AT SIX MONTHS (SMD = -0.44, 95% CI: -0.66 TO -0.22; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD = -2.15, 95% CI: -3.23 TO -1.08), AND LOW-CERTAINTY EVIDENCE FOR SMALL IMPROVEMENTS AT 12 MONTHS (SMD = -0.26, 95% CI: -0.46 TO -0.05; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD = -1.36, 95% CI: -2.41 TO -0.26). ON A 0-100 SCALE THERE WAS VERY LOW- TO MODERATE-CERTAINTY EVIDENCE THAT YOGA WAS SLIGHTLY BETTER FOR PAIN AT THREE TO FOUR MONTHS (MD = -4.55, 95% CI: -7.04 TO -2.06), SIX MONTHS (MD = -7.81, 95% CI: -13.37 TO -2.25), AND 12 MONTHS (MD = -5.40, 95% CI: -14.50 TO -3.70); HOWEVER, WE PRE-DEFINED CLINICALLY SIGNIFICANT CHANGES IN PAIN AS 15 POINTS OR GREATER AND THIS THRESHOLD WAS NOT MET. BASED ON INFORMATION FROM SIX TRIALS, THERE WAS MODERATE-CERTAINTY EVIDENCE THAT THE RISK OF ADVERSE EVENTS, PRIMARILY INCREASED BACK PAIN, WAS HIGHER IN YOGA THAN IN NON-EXERCISE CONTROLS [RISK DIFFERENCE (RD) = 5%, 95% CI: 2-8%]. FOR YOGA COMPARED TO NON-YOGA EXERCISE CONTROLS (4 TRIALS; 394 PARTICIPANTS), THERE WAS VERY-LOW-CERTAINTY EVIDENCE FOR LITTLE OR NO DIFFERENCE IN BACK-RELATED FUNCTION AT THREE MONTHS (SMD = -0.22, 95% CI: -0.65 TO 0.20; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD = -0.99, 95% CI: -2.87 TO 0.90) AND SIX MONTHS (SMD = -0.20, 95% CI: -0.59 TO 0.19; CORRESPONDING TO A CHANGE IN THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE OF MD = -0.90, 95% CI: -2.61 TO 0.81), AND NO INFORMATION ON BACK-RELATED FUNCTION AFTER SIX MONTHS. THERE WAS VERY LOW-CERTAINTY EVIDENCE FOR LOWER PAIN ON A 0-100 SCALE AT SEVEN MONTHS (MD = -20.40, 95% CI: -25.48 TO -15.32), AND NO INFORMATION ON PAIN AT THREE MONTHS OR AFTER SEVEN MONTHS. BASED ON INFORMATION FROM THREE TRIALS, THERE WAS LOW-CERTAINTY EVIDENCE FOR NO DIFFERENCE IN THE RISK OF ADVERSE EVENTS BETWEEN YOGA AND NON-YOGA EXERCISE CONTROLS (RD = 1%, 95% CI: -4% TO 6%). FOR YOGA ADDED TO EXERCISE COMPARED TO EXERCISE ALONE (1 TRIAL; 24 PARTICIPANTS), THERE WAS VERY-LOW-CERTAINTY EVIDENCE FOR LITTLE OR NO DIFFERENCE AT 10 WEEKS IN BACK-RELATED FUNCTION (SMD = -0.60, 95% CI: -1.42 TO 0.22; CORRESPONDING TO A CHANGE IN THE OSWESTRY DISABILITY INDEX OF MD = -17.05, 95% CI: -22.96 TO 11.14) OR PAIN ON A 0-100 SCALE (MD = -3.20, 95% CI: -13.76 TO 7.36). THERE WAS NO INFORMATION ON OUTCOMES AT OTHER TIME POINTS. THERE WAS NO INFORMATION ON ADVERSE EVENTS. STUDIES PROVIDED LIMITED EVIDENCE ON RISK OF CLINICAL IMPROVEMENT, MEASURES OF QUALITY OF LIFE, AND DEPRESSION. THERE WAS NO EVIDENCE ON WORK-RELATED DISABILITY. 2017
16 2657 52 YOGA IN ADDITION TO STANDARD CARE FOR PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES. BACKGROUND: HAEMATOLOGICAL MALIGNANCIES ARE MALIGNANT NEOPLASMS OF THE MYELOID OR LYMPHATIC CELL LINES INCLUDING LEUKAEMIA, LYMPHOMA AND MYELOMA. IN ORDER TO MANAGE PHYSICAL AND PSYCHOLOGICAL ASPECTS OF THE DISEASE AND ITS TREATMENT, COMPLEMENTARY THERAPIES LIKE YOGA ARE COMING INCREASINGLY INTO FOCUS. HOWEVER, THE EFFECTIVENESS OF YOGA PRACTICE FOR PEOPLE SUFFERING FROM HAEMATOLOGICAL MALIGNANCIES REMAINS UNCLEAR. OBJECTIVES: TO ASSESS THE EFFECTS OF YOGA PRACTICE IN ADDITION TO STANDARD CANCER TREATMENT FOR PEOPLE WITH HAEMATOLOGICAL MALIGNANCIES. SEARCH METHODS: OUR SEARCH STRATEGY INCLUDED THE COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS (CENTRAL), MEDLINE (1950 TO 4TH FEBRUARY 2014), DATABASES OF ONGOING TRIALS (CONTROLLED-TRIALS.COM; CLINICALTRIALS.GOV), CONFERENCE PROCEEDINGS OF THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY, THE AMERICAN SOCIETY OF HEMATOLOGY, THE EUROPEAN HAEMATOLOGY ASSOCIATION, THE EUROPEAN CONGRESS FOR INTEGRATIVE MEDICINE, AND GLOBAL ADVANCES IN HEALTH AND MEDICINE. WE HANDSEARCHED REFERENCES OF THESE STUDIES FROM IDENTIFIED TRIALS AND RELEVANT REVIEW ARTICLES. TWO REVIEW AUTHORS INDEPENDENTLY SCREENED THE SEARCH RESULTS. SELECTION CRITERIA: WE INCLUDED RANDOMISED CONTROLLED TRIALS (RCTS) OF YOGA IN ADDITION TO STANDARD CARE FOR HAEMATOLOGICAL MALIGNANCIES COMPARED WITH STANDARD CARE ONLY. WE DID NOT RESTRICT THIS TO ANY SPECIFIC STYLE OF YOGA. DATA COLLECTION AND ANALYSIS: TWO REVIEW AUTHORS INDEPENDENTLY EXTRACTED DATA FOR ELIGIBLE STUDIES AND ASSESSED THE RISK OF BIAS ACCORDING TO PREDEFINED CRITERIA. WE EVALUATED DISTRESS, FATIGUE, ANXIETY, DEPRESSION AND QUALITY OF SLEEP. FURTHER OUTCOMES WE PLANNED TO ASSESS WERE HEALTH-RELATED QUALITY OF LIFE (HRQOL), OVERALL SURVIVAL (OS) AND ADVERSE EVENTS (AE), BUT DATA ON THESE WERE NOT AVAILABLE. MAIN RESULTS: OUR SEARCH STRATEGIES LED TO 149 POTENTIALLY RELEVANT REFERENCES, BUT ONLY A SINGLE SMALL STUDY MET OUR INCLUSION CRITERIA. THE INCLUDED STUDY WAS PUBLISHED AS A FULL TEXT ARTICLE AND INVESTIGATED THE FEASIBILITY AND EFFECT OF TIBETAN YOGA ADDITIONAL TO STANDARD CARE (N = 20; 1 PERSON DROPPED OUT BEFORE ATTENDING ANY CLASSES AND NO DATA WERE COLLECTED) COMPARED TO STANDARD CARE ONLY (N = 19). THE STUDY INCLUDED PEOPLE WITH ALL STAGES OF HODGKIN AND NON-HODGKIN'S LYMPHOMA, WITH AND WITHOUT CURRENT CANCER TREATMENT. THE MEAN AGE WAS 51 YEARS.WE JUDGED THE OVERALL RISK OF BIAS AS HIGH AS WE FOUND A HIGH RISK FOR PERFORMANCE, DETECTION AND ATTRITION BIAS. ADDITIONALLY, POTENTIAL OUTCOME REPORTING BIAS COULD NOT BE COMPLETELY RULED OUT. FOLLOWING THE RECOMMENDATIONS OF GRADE, WE JUDGED THE OVERALL QUALITY OF THE BODY OF EVIDENCE FOR ALL PREDEFINED OUTCOMES AS 'VERY LOW', DUE TO THE METHODICAL LIMITATIONS AND THE VERY SMALL SAMPLE SIZE.THE INFLUENCE OF YOGA ON HRQOL AND OS WAS NOT REPORTED. THERE IS NO EVIDENCE THAT YOGA IN ADDITION TO STANDARD CARE COMPARED WITH STANDARD CARE ONLY CAN IMPROVE DISTRESS IN PEOPLE WITH HAEMATOLOGICAL MALIGNANCIES (MEAN DIFFERENCE (MD) -0.30, 95% CONFIDENCE INTERVAL (CI) -5.55 TO 4.95; P = 0.91). SIMILARLY, THERE IS NO EVIDENCE OF A DIFFERENCE BETWEEN EITHER GROUP FOR FATIGUE (MD 0.00, 95% CI -0.94 TO 0.94; P = 1.00), ANXIETY (MD 0.30, 95% CI -5.01 TO 5.61; P = 0.91) OR DEPRESSION (MD -0.70, 95% CI -3.21 TO 1.81; P = 0.58).THERE IS VERY LOW QUALITY EVIDENCE THAT YOGA IMPROVES THE OVERALL QUALITY OF SLEEP (MD -2.30, 95% CI -3.78 TO -0.82; P = 0.002). THE YOGA GROUPS' TOTAL SCORE FOR THE PITTSBURGH SLEEP QUALITY INDEX (PSQI) WAS 5.8 (+/- 2.3 SD) AND BETTER THAN THE TOTAL SCORE (8.1 (+/- 2.4 SD)) OF THE CONTROL GROUP. A PSQI TOTAL SCORE OF 0 TO 5 INDICATES GOOD SLEEP WHEREAS PSQI TOTAL SCORE 6 TO 21 POINTS TOWARDS SIGNIFICANT SLEEP DISTURBANCES. THE OCCURRENCE OF AES WAS NOT REPORTED. AUTHORS' CONCLUSIONS: THE CURRENTLY AVAILABLE DATA PROVIDE LITTLE INFORMATION ABOUT THE EFFECTIVENESS OF YOGA INTERVENTIONS FOR PEOPLE SUFFERING FROM HAEMATOLOGICAL MALIGNANCIES. THE FINDING THAT YOGA MAY BE BENEFICIAL FOR THE PATIENTS' QUALITY OF SLEEP IS BASED ON A VERY SMALL BODY OF EVIDENCE. THEREFORE, THE ROLE OF YOGA AS AN ADDITIONAL THERAPY FOR HAEMATOLOGICAL MALIGNANCIES REMAINS UNCLEAR. FURTHER HIGH-QUALITY RANDOMISED CONTROLLED TRIALS WITH LARGER NUMBERS OF PARTICIPANTS ARE NEEDED TO MAKE A DEFINITIVE STATEMENT. 2014
17 906 35 EFFECTIVENESS OF APP-BASED YOGA OF IMMORTALS (YOI) INTERVENTION FOR INSOMNIA IN ASIAN POPULATION DURING PANDEMIC RESTRICTIONS. THE CORONAVIRUS DISEASE 2019 (COVID-19) PANDEMIC CREATED SIGNIFICANT PSYCHOLOGICAL CHALLENGES WORLDWIDE, INCLUDING STRESS, EMOTIONAL DISTRESS, AND INSOMNIA. IN ADDITION, SOCIAL DISTANCING, TRAVEL RESTRICTIONS, AND SPREAD OF DISEASE HAVE RESULTED IN UNIQUE CHALLENGES, CREATING BARRIERS TO HEALTHCARE ACCESS. COMPARED TO THE RATE PRIOR TO THE COVID-19 PANDEMIC, A SIGNIFICANT INCREASE IN CLINICAL INSOMNIA RATES HAVE BEEN REPORTED. WITH WELL-KNOWN LIMITATIONS OF CURRENTLY ESTABLISHED TREATMENTS (E.G., COGNITIVE BEHAVIORAL THERAPY-INSOMNIA (CBT-I), PHARMACOTHERAPY), THERE IS A NEED TO EXPLORE OTHER EFFECTIVE AND SAFE TREATMENT MODALITIES TO TREAT INSOMNIA, ESPECIALLY THOSE THAT CAN BE USED REMOTELY. THE PURPOSE OF THIS STUDY IS TO ASSESS THE EFFECTIVENESS OF APP-BASED INTERVENTION TO TREAT INSOMNIA IN THE CURRENT ERA OF THE COVID-19 PANDEMIC (USING THE YOGA OF IMMORTALS (YOI) APP). THIS PROSPECTIVE COHORT STUDY WAS APPROVED BY THE INSTITUTIONAL REVIEW BOARD. ALL PARTICIPANTS IN THIS STUDY WERE ASKED TO COMPLETE AN ONLINE SURVEY INCLUDING DEMOGRAPHIC DATA AND VALIDATED INSOMNIA SEVERITY INDEX (ISI) AT BASELINE (15 MAY 2020), 4 WEEKS, AND 8 WEEKS AFTER STARTING THE YOI INTERVENTION. SURVEY DATA WAS EXPORTED USING MICROSOFT EXCEL. STATISTICAL ANALYSIS WAS DONE USING THE GRAPHPAD PRISM 8. YOI INTERVENTION SIGNIFICANTLY IMPROVED THE MEAN ISI SCORES IN ALL CATEGORIES OF INSOMNIA (SEVERE, MODERATE, AND SUBTHRESHOLD) AT EACH FOLLOW-UP (P </= 0.0001). THE IMPROVEMENT WAS SIGNIFICANT AMONG ALL AGE GROUPS AND IN BOTH GENDERS. IN OUR STUDY, YOI WAS A NOVEL AND EFFECTIVE INTERVENTION FOR IMPROVING INSOMNIA SYMPTOMS AND MAY BE A NEW ADDITION TO THE ARMAMENTARIUM OF INSOMNIA MANAGEMENT. BEING APP-BASED, THIS HAS POTENTIAL WIDER APPLICABILITY, ESPECIALLY DURING THE CURRENT COVID-19 PANDEMIC. 2021
18 2408 23 YOGA AND HEALTHCARE IN THE UNITED KINGDOM. THE EMERGENCE OF YOGA THERAPY IN THE UNITED KINGDOM BEGAN ABOUT 45 YEARS AGO WITH THE EMERGENCE OF YOGA THERAPY ORGANIZATIONS THAT OFFERED BOTH TREATMENT AND TRAINING. THE INTEGRATION OF YOGA INTO THE NATIONAL HEALTH SERVICE (NHS) IS GRADUALLY HAPPENING BECAUSE: (A) YOGA RESEARCH SUPPORTS ITS EFFICACY AS A COST-EFFECTIVE, PREVENTIVE AND COMPLEMENTARY TREATMENT FOR A HOST OF NON-COMMUNICABLE DISEASES; AND (B) THE ESCALATING ECONOMIC BURDEN OF LONG-TERM CONDITIONS IS OVERWHELMING THE NHS. THE NHS IS ACTIVELY DEVELOPING 'SUSTAINABILITY AND TRANSFORMATION PLANS' THAT INCLUDE YOGA. CHIEF AMONG THESE IS 'SOCIAL PRESCRIBING,' WHICH EMPOWERS PATIENTS WITH COMPLEX HEALTH NEEDS THROUGH ACTIVITIES GROUPS. THESE ACTIVITIES REDUCE SEDENTARY HABITS AND SOCIAL ISOLATION, WHILE HELPING PATIENTS TO BE MORE SELF-RELIANT. THE NHS HAS ALLOCATED POUND450 MILLION IN FUNDING TO IMPLEMENT A VARIETY OF PROGRAMS FOR ITS OWN STAFF, IN WHICH STAFF YOGA CLASSES WERE EXPRESSLY MENTIONED. THE YOGA COMMUNITY IS MOBILIZING FORCES AND APPLYING FOR FUNDING TO PILOT RELEVANT NHS STAFF YOGA COURSES THAT CAN SUPPORT THE SERVICE IN ACHIEVING ITS VISION. RESEARCH SHOWS THAT INTEGRATING YOGA THERAPY FOR THE TREATMENT OF LOW BACK PAIN (LBP) INTO THE NHS WOULD RESULT IN SIGNIFICANT COST SAVINGS AS COMPARED WITH USUAL CARE. THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) GUIDELINES ON LBP AND SCIATICA INCLUDE YOGA AS ONE OF THE RECOMMENDED TREATMENTS FOR THESE CONDITIONS. THREE GROUPS OF YOGA TEACHERS, USING DIFFERENT YOGA PRACTICES, HAVE GAINED TRACTION WITH THE NHS FOR THE APPLICATION OF YOGA THERAPY TO LBP. MANY REGIONAL HOSPITALS IN ENGLAND HAVE YOGA CLASSES. THE NHS CHOICES WEBSITE, WHICH CONVEYS INFORMATION TO THE PUBLIC REGARDING TREATMENT OPTIONS, HAS A PAGE DEDICATED TO THE HEALTH BENEFITS OF YOGA. SEVERAL INSTITUTIONS OFFER COMPREHENSIVE TRAINING PROGRAMS IN YOGA THERAPY AND YOGA THERAPY IS RECOGNIZED AS AN OFFICIAL PROFESSION. THE YOGA IN HEALTHCARE ALLIANCE HAS BEEN ESTABLISHED TO HELP INTEGRATE YOGA THERAPY INTO THE NHS. THIS CONSISTS OF PARLIAMENTARIANS, LEADERS IN THE NHS, YOGA RESEARCHERS, HEALTH PROFESSIONALS, AND REPRESENTATIVES FROM LEADING YOGA ORGANIZATIONS. 2017
19 1294 16 GUIDELINES FOR DEVELOPING YOGA INTERVENTIONS FOR RANDOMIZED TRIALS. LITTLE GUIDANCE IS AVAILABLE TO ASSIST RESEARCHERS IN DEVELOPING TREATMENT PROTOCOLS FOR RESEARCH ON YOGA FOR HEALTH CONCERNS. BECAUSE YOGA IS A COMPLEX MULTIFACTORIAL MIND-BODY DISCIPLINE HISTORICALLY DEVELOPED FOR NONMEDICAL PURPOSES, NUMEROUS DECISIONS MUST BE MADE IN ORDER TO THOUGHTFULLY DEVELOP SUCH PROTOCOLS. IN THIS PAPER, A SYSTEMATIC APPROACH IS PROPOSED TO ASSIST RESEARCHERS IN SELECTING AN INTERVENTION THAT IS APPROPRIATE FOR THE CONDITION UNDER CONSIDERATION AND EXPLICITLY DEVELOPED. RESEARCHERS NEED TO CONSIDER THE TYPE OR "STYLE" OF YOGA, THE COMPONENTS TO INCLUDE (E.G., BREATHING EXERCISES, POSTURES) AS WELL AS THE SPECIFIC PROTOCOL FOR EACH COMPONENT, THE DOSE TO BE DELIVERED (FREQUENCY, DURATION OF PRACTICE, AND THE TOTAL DURATION OF PRACTICE), AND ISSUES RELATED TO SELECTION OF INSTRUCTORS AND MONITORING THE FIDELITY TO THE INTERVENTION. EACH OF THESE DOMAINS AND THE KEY ISSUES FOR THE DEVELOPMENT OF PROTOCOLS IS DISCUSSED. FINALLY, SOME AREAS FOR FURTHER RESEARCH RELATED TO PROTOCOL DEVELOPMENT ARE RECOMMENDED. 2012
20 1185 30 EVIDENCE BASE OF YOGA STUDIES ON CARDIOVASCULAR HEALTH: A BIBLIOMETRIC ANALYSIS. NONCOMMUNICABLE DISEASES INCLUDING CORONARY ARTERY DISEASE CONTRIBUTE TO APPROXIMATELY 50% OF GLOBAL MORTALITY. PHARMACOLOGICAL TREATMENT ALONE MAY NOT BE A PANACEA FOR SUCH DISEASES SINCE IT MAY BE ASSOCIATED WITH VARIOUS OTHER ADVERSE EFFECTS. HENCE, STRATEGIES SUCH AS YOGA INVOLVING HEALTHY LIFESTYLE AND STRESS MANAGEMENT ARE WIDELY SOUGHT BY THE PATIENT POPULATION. MATERIALS AND METHODS: AN ELECTRONIC SEARCH OF PUBMED AS A STANDARD BIBLIOGRAPHIC DATABASE WAS PERFORMED THROUGH FEBRUARY 2015 USING THE KEYWORDS "YOGA" AND "CARDIOVASCULAR." STUDIES WITH YOGA AS THE INDEPENDENT VARIABLE AND PARAMETERS RELATED TO CARDIAC HEALTH AS THE DEPENDENT VARIABLE WERE INCLUDED AND EXCLUSION CRITERIA WERE APPLIED. RESULTS: A TOTAL OF 149 PUBLICATIONS WERE IDENTIFIED WHICH MET THE INCLUSION CRITERIA FOR ANALYSIS. OF THE TOTAL PUBLICATIONS, 44% WERE CLINICAL TRIALS OF WHICH 19% WERE RANDOMIZED CONTROLLED TRIALS WHICH MAY BE CATEGORIZED AS HIGH-QUALITY ONES. AN UPWARD TREND IN THE OVERALL RESEARCH IN THIS AREA IS EVIDENT. MAJOR WORK HAS BEEN ACCOMPLISHED BY RESEARCHERS OF THE UNITED STATES (38%) AND INDIA (29%). CONCLUSION: THE SURVEY INDICATES THAT THE NUMBER OF PUBLICATIONS IN THE FIELD OF "YOGA" AND "CARDIOVASCULAR" HEALTH HAS INCREASED RAPIDLY IN THE LATE YEARS. ANALYSIS COMPRISING THE NATION/STATE HELPS DEFINE ITS STATUS WITH REGARD TO ITS COUNTERPARTS AND HELPS UNDERSTAND SCIENCE PRIORITIES AND DISEASE CONTROL STRATEGIES IN AN EFFORT TO PROVIDE COST-EFFECTIVENESS AND QUALITY CONTROL. THERE IS A NEED FOR FURTHER HIGH-QUALITY STUDIES IN THE FIELD OF "YOGA" AND "CARDIOVASCULAR" DISEASES TO VALIDATE THE EFFECTS OF YOGA ON HEALTH PARAMETERS. 2019