Yoga

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Definition

Source: Wikimedia CommonsAuthor:BECMarketing

A Hindu spiritual and ascetic discipline, a part of which, including breath control, simple meditation, and the adoption of specific bodily postures, is widely practised for health and relaxation [1].

Description

Yoga originated thousands of years ago in India as an integrated physical, mental, and spiritual practice based on ancient Vedic philosophy, and is connected to Ayurveda, the system of traditional Indian medicine[1]. During the 20th century, yoga became increasingly recognised outside India, and over the past decades it has continued to grow in popularity worldwide as system for promoting health and well-being. While modern yoga often focuses on physical poses and is sometimes thought of as a type of exercise, the practice usually incorporates one or more of the mental or spiritual elements that are traditionally part of yoga, such as relaxation, concentration, or meditation. For this reason, yoga is considered a mind-body exercise[2].

Physiological effects of yoga include decreased heartrate and blood pressure and physical effects include weight loss and increased muscle strength, A potential underlying mechanisms of these effects are proposed to include the stimulation of pressure receptors leading to enhanced vagal activity and reduced cortisol. The reduction in cortisol, in turn, may contribute to positive effects such as enhanced immune function and a lower prematurity rate.[3]

Yoga Research

The field of yoga research has been growing in a number of areas such as chronic pain, autoimmune disease, cardiovascular disease and mental health [3]. Bibliometric reviews of published research studies reveal a three-fold increase in number of publications using yoga as a therapeutic intervention between 2003 to 2013, with more than 200 new yoga-related titles published each year since 2011 [4][5]

Research has looked into the benefits of yoga on:

Psychological symptoms and disorders

Pain syndromes

Cardiovascular conditions

Autoimmune conditions

Immune conditions

Pregnancy conditions

Physiological effects

Physical effects

As a growing area of research, studies in the yoga literature have commonly been criticised due to various limitations, such as lack of randomization, and standardisation of baseline characteristics, self-selection of samples, significant variability in the samples across studies including sample selection and sample size variables and lack of good physical activity/attention control or comparison groups[3].

Yoga and chronic nonspecific low back pain

Evidence suggests that yoga is a safe, effective holistic and complementary approach for the treatment of chronic low back pain to reduce pain and disability [55] [56][57][58][59]. For this reason, yoga has recently been included as a non-pharmacological adjunct in clinical guidelines for LBP in the USA, UK and Canada. [60][61][62]. Several potential benefits have been proposed in relation to the practice of yoga in persistent pain conditions, including changes in physiological, behavioural and psychological factors [63]. Potential mechanisms for these changes include improved muscular strength, flexibility, and balance resulting from the physical poses (asanas),  increased mental and physical relaxation derived from practicing controlled breathing (pranayama) or meditation exercises (dhyana), and improved body awareness and attention control gained through both the physical and mental aspects of yoga [64][65].

Chronic nonspecific low back pain is a multidimensional condition due to the range of psychological and sociological factors that are linked to poor outcomes[66] such as depression, low self-efficacy, pain catastrophizing and fear avoidance[67][68]. As the benefits from yoga also include mood enhancement and stress reduction [69] [70], it has been proposed that Yoga as a mind-body therapy could address the physical and psychological aspects of chronic nonspecific low back pain. [71]

Upon reviewing the current body of research, a 2017 Cochrane review of 12 trials with 1080 participants concluded with moderate-certainty of evidence that participation in yoga led to better outcomes at six months compared to no exercise however evidence was limited for effectiveness compared to other back specific exercise. However the Cochrane review and a meta-analysis by Beggs et al. [72] commented on low quality of evidence due to methodological concerns. In particular, it is recommended that future RCTs include an active control group to determine whether yoga has specific treatment effects and whether yoga offers any advantages over traditional exercise programs and other alternative therapies for chronic low back pain [72].

Yoga and cardiovascular diseases

Krishna et al in their RCT study has found that yoga therapy in addition to standard medical therapy reduces blood pressure, load on heart and improves parasympathetic activity and decreased the sympathetic activity in heart failure patients [30].Wolf et al in a controlled study has found that a short yoga program for the patients diagnosed with hypertension to practice at home seems to have an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls. This implies that simple yoga exercises may be useful as a supplementary blood pressure therapy in addition to medical treatment when prescribed by primary care physicians[29].

Yoga and cancer patients

Results from a systematic review conducted by Sadja and Mills revealed that yoga interventions may be beneficial for reducing cancer-related fatigue in women with breast cancer [40].Sharma et al in their systematic review has also found positive evidence of yoga as an altenative and complementary treatment. Though there has been liminations in the reviewed studies [73]. In a recently published systematic review by Agarwal and Adi Maroko-Afek has been found that  yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care [74].

Yoga and Physiotherapy

Posadzki and Parekh believe that both yoga and physiotherapy share underlying concepts, such as a holistic approach towards health and well-being of an individual. Yoga can be beneficial to physiotherapeutic goals, such as improving range of motion, increasing flexibility, strengthening weakened muscles, alleviating pain and enhancing patient’s general function. From the physiotherapeutic perspective, somatic dysfunction can be released and flexibility and range of movement improved. With regards to physiotherapeutic processes, yoga as a set of "static dynamic procedures" can be considered as a means to "self-mobilisation" of the nervous system and the joints, spine and limbs.[75]

References

  1. 1.0 1.1 Iyengar BK. Light on yoga: the definitive guide to yoga practice. Thorsons; 2015.
  2. Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non‐specific low back pain. Cochrane Database of Systematic Reviews. 2017(1).
  3. 3.0 3.1 3.2 Field, T. Yoga research review. Complementary Therapies in Clinical Practice 2016 24:145–161. 
  4. Jeter, P.E., Slutsky, J., Singh, N. and Khalsa, S.B.S., Yoga as a therapeutic intervention: a bibliometric analysis of published research studies from 1967 to 2013. The Journal of Alternative and Complementary Medicine, 2015, 21(10):586-592.
  5. McCall, M.C., In search of yoga: Research trends in a western medical database. International journal of yoga, 2014 7(1): 4.
  6. Shelov DV, Suchday S, Friedberg JP. A pilot study measuring the impact of yoga on the trait of mindfulness. Behav Cogn Psychother 2009;37:595
  7. Cowen VS. Functional fitness improvements after a worksite-based yoga initiative. J Bodyw Mov Ther 2010 Jan;14(1):50-4
  8. Brisbon NM, Lowery GA. Mindfulness and levels of stress: a comparison of Beginner and advanced Hatha yoga practitioners. J Relig Health; 2009
  9. Michalsen A, Grossman P, Acil A, Langhorst J, Ludtke R, Esch T, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga programme. Med Sci Mon 2005;11(12): 555-61
  10. Telles S, Gaur V, Balkrishna A. Effect of a yoga practice session and a yoga theory session on state anxiety. Percept Mot Skills 2009 Dec;109(3): 924-30
  11. Khalsa SB, Shorter SM, Cope S, Wyshak G, Sklar E. Yoga ameliorates performance anxiety and mood disturbance in young professional musicians. Appl Psychophysiol Biofeedback 2009 Dec;34(4):279-89.
  12. Khumar SS, Kaur P, Kaur S. Effectiveness of Shavasana on depression among university students. Indian J Clin Psychol 1993;20:82-7.
  13. Uebelacker LA, Tremont G, Epstein-Lubow G, Gaudiano BA, Gillette T, Kalibatseva Z, et al. Open trial of Vinyasa yoga for persistently depressed individuals: evidence of feasibility and acceptability. Behav Modif 2010 May;34 (3):247-64.
  14. Kamei T, Toriumi Y, Kimura H, Ohno S, Kumano H, Kimura K. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Percept Mot Skills 2000;90:1027-32.
  15. Khalsa SB. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Appl Psychophysiol Biofeedback 2004;29(4):269-78.
  16. Beddoe AE, Lee KA, Weiss SJ, Kennedy HP, Yang CP. Effects of mindful yoga on sleep in pregnant women: a pilot study. Biol Res Nurs 2010;11:363-70.
  17. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self rated sleep in a geriatric population. Indian J Med Res 2005;121:683-90.
  18. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med 2005;143:849-56
  19. Saper RB, Sherman KJ, Cullum-Dugan D, Davis RB, Phillips RS, Culpepper L. Yoga for chronic low back pain in a predominantly minority population: a pilot randomized controlled trial. Altern Ther Health Med 2009;15(6): 18-27.
  20. Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain 2005;115:107-17
  21. Wieland, L. S., Skoetz, N., Pilkington, K., Vempati, R., D'Adamo, C. R., and  Berman, B. M. Yoga treatment for chronic non‐specific low back pain. The Cochrane Library. 2017 Jan
  22. Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, Smith D, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine 2009;34(19):2066-76.
  23. John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache 2007;47:654e61
  24. Garfinkel MS, Schumacher HR, Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 1994;21:2341-3
  25. Kolasinski SL, Garfinkel M, Tsai AG, Matz W, Van Dyke A, Schumacher HR. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med 2005;11(4):689-93.
  26. Evans S, Moieni M, Taub R, Subramanian SK, Tsao JC, Sternlieb B, et al. Iyengar yoga for young adults with rheumatoid arthritis: results from a mixedmethods pilot study. J Pain Symptom Manage 2010;39(5):904-13
  27. Yogendra J, Yogendra HJ, Ambardekar S, Lele RD, Shetty S, Dave M, et al. Beneficial effects of yoga lifestyle on reversibility of ischaemic heart disease: caring heart project of International Board of Yoga. J Assoc Physicians India 2004;52:283-9.
  28. Manchanda SC, Narang R, Reddy KS, Sachdeva U, Prabhakaran D, Dharmanand S, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India 2000;48:687-94
  29. 29.0 29.1 Wolff M, Sundquist S et al. Impact of yoga on blood pressure and quality of life in patients with hypertension - a controlled trial in primary care, matched for systolic blood pressure. BMC Cardiovasc Disord, 2013 Dec 7;13:111.
  30. 30.0 30.1 Krishna B, Pal P,Gaur GS, et al. Effect of Yoga Therapy on Heart Rate, Blood Pressure and Cardiac Autonomic Function in Heart Failure. JCDR 2014;Jan;8(1):14-6.
  31. Damodaran A, Malathi A, Patil N, Shah N, Suryavansihi, Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India 2002;50:633-40.
  32. Cade WT, Reeds DN, Mondy KE, Overton ET, Grassino J, Tucker S, et al. Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors. HIV Med 2010;11:379-88
  33. Manocha R, Marks GB, Kenchington P, Peters D, Salome CM. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax 2002;57:110-5
  34. Singh S, Malhotra V, Singh KP, Madhu SV, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India 2004;52:203-6.
  35. Malhotra V, Singh S, Tandon OP, Sharma SB. The beneficial effects of yoga in diabetes. Nepal Med Coll J 2005;7:145-7
  36. Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004;62:2058-64
  37. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004;15: 2253-60.
  38. Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB, et al. Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment. A randomized controlled trial. Complement Ther Med 2009;17:1-8
  39. Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, et al. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 2010;8:43-55
  40. 40.0 40.1 Sadja J, Mills P. Effects of yoga interventions on fatigue in cancer patients and survivors: a systematic review of randomized controlled trials. Explore (NY). 2013 Jul-Aug;9(4):232-43.
  41. Culos-Reed S, Carlson L, Daroux L, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 2006;15:891-7.
  42. Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS. Pilot Eval Iyengar Yoga Program for breast cancer survivors. Cancer Nurs 2010;33: 369-81.
  43. Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med 2005;11: 237-44.
  44. Sathyaprabha TN, Satishchandra P, Pradhan C, Sinha S, Kaveri B, Thennarasu K, et al. Modulation of cardiac autonomic balance with adjuvant yoga in patients with refractory epilepsy. Epilepsy Behav 2008;12: 245-52.
  45. Chuntharapat S, Petpichetchian W, Hatthakit U. Yoga during pregnancy: effects on maternal comfort, labor pains and birth outcomes. Complement Ther Clin Pract 2008;14:105-15.
  46. Field T, Diego M, Hernandez-Reif M. Tai Chi/Yoga effects on anxiety, heartrate, EEG and math computations. Complement Ther Clin Pract, 2010;16: 235-8.
  47. Madanmohan Udupa K, Bhavanani AB, Shatapathy CC, Sahai A. Modulation of cardiovascular response to exercise by yoga training. Indian J Physiol Pharmacol 2004;48:461-5.
  48. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC, et al. Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med 2004; 10:261-8.
  49. Sarang P, Telles S. Effects of two yoga based relaxation techniques on heart rate variability. Int J Stress Manag 2006;13:460-75.
  50. Sinha S, Singh SN, Monga YP, Ray US. Improvement of glutathione and total antioxidant status with yoga. J Altern Complement Med 2007;13: 1085-90.
  51. McIver S, O’Halloran P, McGartland M. Yoga as a treatment for binge eating disorder: a preliminary study. Complement Ther Med 2009;17: 196-202.
  52. Kristal AR, Littman AJ, Benitez D, White E. Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. Altern Ther Health Med 2005;11:28-33
  53. Telles S, Naveen VK, Balkrishna A, Kumar S. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit 2010;16:35-40.
  54. Donohue B, Miller A, Beisecker M, Houser D, Valdez R, Tiller S, et al. Effects of brief yoga exercises and motivational preparatory interventions in distance runners: results of a control trial. Br J Sports Med 2006;40:60-3.
  55. Tilbrook HE, Cox H, Hewitt CE, Kang'ombe AR, Chuang LH, Jayakody S et al. Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):569-78.
  56. Cramer, H., Lauche, R., Haller, H., and Dobos, G.. A systematic review and meta-analysis of yoga for low back pain. The Clinical journal of pain, 2013 29(5): 450-460.
  57. Cramer, H., Ward, L., Saper, R., Fishbein, D., Dobos, G. and Lauche, R.,. The safety of yoga: a systematic review and meta-analysis of randomized controlled trials. American journal of epidemiology, 2015 182(4): 281-293.
  58. Goode, A. P., Coeytaux, R. R., McDuffie, J., Duan-Porter, W., Sharma, P., Mennella, H., and Williams Jr, J. W. An evidence map of yoga for low back pain. Complementary therapies in medicine, 2016 25:170-177.
  59. Holtzman, S., and Beggs, R. T. Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain Research and Management, 2013 18(5):267-272.
  60. Qaseem, A., Wilt, T. J., McLean, R. M., and Forciea, M. A. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 2017. 166(7):514-530.
  61. National Institute for Health and Care Excellence, Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59].2016 [Online] Available at: https://www.nice.org.uk/guidance/ng59
  62. Chou, R., and Huffman, L. H. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of internal medicine,2017 147(7): 492-504.
  63. Wren, A.A., Wright, M.A., Carson, J.W. and Keefe, F.J.. Yoga for persistent pain: new findings and directions for an ancient practice. Pain, 2011 152(3):477-480
  64. Sorosky, S., Stilp, S. and Akuthota, V., Yoga and pilates in the management of low back pain. Current reviews in musculoskeletal medicine, 2008 1(1): 9-47.
  65. Daubenmier, J., Mehling, W., Price, C., Bartmess-Levasseur, E., Acree, M. and Stewart, A., Exploration of body awareness and pain and emotion regulation among yoga and meditation practitioners: does type of mind-body practice matter?. BMC complementary and alternative medicine, 2012 12(1): 54.
  66. Costa, L.D.C.M., Maher, C.G., McAuley, J.H., Hancock, M.J., Herbert, R.D., Refshauge, K.M. and Henschke, N.. Prognosis for patients with chronic low back pain: inception cohort study. Bmj, 2009 339:3829.
  67. Brinzo, J.A., Crenshaw, J.T., Thomas, L. and Sapp, A., The effect of yoga on depression and pain in adult patients with chronic low back pain: a systematic review protocol. JBI database of systematic reviews and implementation reports, 2016: 14:56-66
  68. Pinheiro, M.B., Ferreira, M.L., Refshauge, K., Maher, C.G., Ordoñana, J.R., Andrade, T.B., Tsathas, A. and Ferreira, P.H., Symptoms of depression as a prognostic factor for low back pain: a systematic review. The Spine Journal, 2016: 16(1):105-116.
  69. Tran, M.D., Holly, R.G., Lashbrook, J. and Amsterdam, E.A.,. Effects of Hatha yoga practice on the health‐related aspects of physical fitness. Preventive cardiology, 2001: 4(4):165-170.
  70. Schure, M.B., Christopher, J. and Christopher, S., Mind–body medicine and the art of self‐care: teaching mindfulness to counseling students through yoga, meditation, and qigong. Journal of Counseling & Development,2008: 86(1): 47-56.
  71. Foster, N.E., Anema, J.R., Cherkin, D., Chou, R., Cohen, S.P., Gross, D.P., Ferreira, P.H., Fritz, J.M., Koes, B.W., Peul, W. and Turner, J.A.,. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 2018: 391(10137):2368-2383
  72. 72.0 72.1 Beggs T,Holtzman S. Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain Research and Management.2013 Sep-Oct;18(5):267-72.
  73. Sharma M, Haider T, Knowlde A.Yoga as an alternative and complementary treatment for cancer: a systematic review. J Altern Complement Med. 2013 Nov;19(11):870-5.
  74. Agarwal RP, Maroko A.Yoga into Cancer Care: A Review of the Evidence-based Research.Int J Yoga. 2018 Jan-Apr;11(1):3-29.
  75. Posadzki P, Parekh S. Yoga and physiotherapy: a speculative review and conceptual synthesis. Chinese journal of integrative medicine. 2009 Feb 1;15(1):66-72.