Tele-yoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial.

PURPOSE: Ankylosing spondylitis (AS) signficantly affect day to day activities contributing to signficant disability. Patients with AS often report to have psychological problems and poor quality of life (QoL). This study investigates the effect of a three-month tele-yogic intervention on disease activity, functional index, inflammatory markers, quality of life and mental health measures in patients with AS. METHODS: One hundred and twenty AS patients were assigned to either the yoga intervention group (YG) or the control group (CG). The YG (n = 57) received a 60-min structured yoga module online for 3 months in addition to standard medical care. The CG participants (n = 52) received only standard care during the same period. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis-Quality of Life (ASQOL) and psychological and inflammatory biomarkers were assessed at baseline and after three months. RESULTS: YG showed significant improvement in BASDAI (p = 0.001), anxiety (p = 0.0004), and depression (p = 0.001) at three months compared to baseline. The CG showed no significant change in similar outcome measures. At three months, the intervention resulted in a significant improvement in BASDI (-0.79; 95% CI (-1.3, to -0.29); p = 0.0021), BASFI (-0.86, 95% CI (-1.59, to -0.14); p = 0.0193), anxiety (-0.42, 95% CI (-0.84 to -0.01), p = 0.0468), and AS-QoL (-3.37; 95% CI (-5.21 to 1.53); p = 0.0004) compared to the CG. CONCLUSIONS: The present study suggests that yoga helps improve pain, functional index, and mental health in patients with AS. Tele-yoga intervention is feasible and effective in treating AS.

Effect of Yoga on Stress, Anxiety, Depression, and Spinal Mobility in Computer Users with Chronic Low Back Pain.

Background: Office workers who need to use a computer while maintaining a static position for prolonged periods have more chance of having low back pain (LBP). Objective: The objective of the study is to investigate the effect of yoga on stress, anxiety, depression, and spinal mobility in computer users with chronic LBP (CLBP). Materials and Methods: In this randomized control trial, eighty computer users (42.6 ± 8.45 years of age; suffering from CLBP since 5.20 ± 3.01 years; 51 males and 29 females) who use a computer for their professional work, recruited from Bengaluru, India, were randomized into two groups: yoga group (n = 40) and physical exercise group (n = 40). The yoga group practiced an integrated module comprising yoga postures and mindfulness meditation, and the physical exercise group practiced physical exercise designed for LBP (1 h/day, 3 days/week for 16 weeks). Assessments of dial-type goniometer and Depression Anxiety Stress Scale-42 were performed at baseline, after 8 weeks, and after 16 weeks. Results: Stress, anxiety, and depression scores were significantly lower in the yoga group as compared to the physical exercise group at 16 weeks (P < 0.001), whereas spinal flexion (P < 0.001), spinal extension (P < 0.001), right lateral flexion (P = 0.001), and left lateral flexion (P = 0.007) scores were significantly higher in the yoga group as compared to the physical exercise group at 16 weeks. Conclusion: Yoga is more effective in reducing stress, anxiety, and depression and improving spinal mobility in computer users with CLBP than physical exercise designed for LBP.

A study protocol for a randomised controlled trial on the efficacy of yoga as an adjuvant therapy for patients with Ankylosing spondylitis amidst COVID-19 pandemic.

Background: Amidst the adversities of the COVID-19 pandemic, the health care system has seen a new paradigm shift towards e-health or telehealth services. In the advent of catering to the geometrically increasing health care needs of the patients suffering from various chronic health conditions when in social isolation, the need for such shifts is paramount. Patients with Ankylosing spondylitis using immunosuppressants with variable degrees of disabilities are at higher risk from this isolated status. This study aims to assess the efficacy of e-Yoga as a treatment option for these patients. Methods: The proposed study is a single-center, parallel-group prospective randomized, open-blinded end-point trial. Patients aged between 30 and 50 years will be recruited from the members of Antardhwani: A society of ankylosing spondylitis based in Ahmedabad, Gujarat. Yoga experts will administer a scientifically developed and validated Yoga module via e-Yoga modalities. A total of 135 patients will be recruited and randomly allocated to Yoga and control groups. Data will be recorded at baseline and three months on disease activity, degree of functional limitations in patients, quality of life, inflammatory biomarkers, depression, and anxiety using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), AS Quality of Life index (ASQOL), C reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Physical health questionnaire-4 (PHQ-4), respectively. Discussion: The study will report the efficacy of e-Yoga in catering to the physical and mental insufficiencies of inpatients with Ankylosing spondylitis amidst COVID-19 pandemic. The study is prospectively registered in the Clinical Trial Registry of India (CTRI/2020/08/027215).

Designing, validation, and feasibility of a yoga module for patients with ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes significant disability and reduced quality of life. Scientific studies on yoga have revealed its various health benefits in chronic conditions, including autoimmune diseases. However, whether yoga is feasible for AS patients or not is not studied. Further, no validated yoga module is available for AS patients. OBJECTIVE(S): This study intended to develop a yoga module for AS patients and investigated its feasibility of use. MATERIALS AND METHODS: The study was completed in three stages. In Stage I, six yoga experts prepared a list of 64 yoga practices based on the classical and contemporary yogic literature review. Of these practices, 41 were included in the designed yoga module. In Stage II, 41 experts with a minimum of five years of experience in yoga therapy were invited for yoga module validation. The usefulness of the practices was rated by experts on a 3-point scale (1: not at all useful, 2: moderately useful, and 3: very much useful). The Lawshe content validity ratio (CVR) method was used for the content validity of the yoga module. Practices with a CVR score of > 0.3 were retained in the final yoga module. In Stage III, a certified yoga instructor administered the validated yoga module to 19 AS patients (average age: 35.5 ± 10.7 years) thrice weekly for a month. Feasibility was assessed on the basis of the attrition rate, retention rate, attendance of the participants, and the subjective response on practical sessions using a structured checklist. RESULTS: Of the 41 practices in the module, 31 had a CVR score of > 0.3 and were included in the final yoga module. Of the 25 participants, 19 (76%) completed the study while six dropped out (24%). Nineteen patients reported greater improvement in pain and flexibility. They found yoga relaxing and easy to practice. Most participants (65%) were able to practice a minimum of 30 min/day. CONCLUSION: The present study offers a validated yoga module consisting of 31 practices for AS patients. The results of the pilot suggested that the module is feasible, acceptable, and easy to practice for AS patients. We recommend that AS patients should practice this yoga module for a minimum of 30 min every day under the supervision of a yoga expert.

Potential Role of Yoga in the Management of Ankylosing Spondylitis: A Retrospective Study.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory spondyloarthropathy with unclear pathogenesis. The inflammatory pain in AS leads to restricted spinal mobility and significant disability. Yoga is a nonpharmacological intervention that has positive effects on various musculoskeletal-related problems. However, its role in AS is unknown. OBJECTIVE: The present retrospective study assessed the efficacy of a two-week residential yoga intervention on spinal flexibility among AS patients. METHODS: The records for 24 male AS patients within the age range 30 to 50 years (average age 38.3 ± 10.5 years) who underwent a two-week residential yoga retreat between 2015 and 2020 were obtained from a yoga center located in South India. Yoga intervention consisted of yoga postures, breathing practices, meditation, a healthy diet, and devotional sessions. Pre and Post data of the sit-and-reach test, blood pressure, heart rate, and symptom score were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: Compared to the baseline, the post scores of the sit-and-reach test, systolic blood pressure and heart rate were found to be significantly (P < .05) lower. The symptom score and analgesic medication score also showed significant improvement after two-weeks compared to the baseline. CONCLUSION: This retrospective study indicates the positive impact of on and analgesic use among AS patients. However, additional studies using robust research designs are warranted.

A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of Life in among nursing population with Chronic Low Back Pain.

BACKGROUND: Chronic low back pain (CLBP) adversely affects quality of life (QOL) in nursing professionals. Integrated yoga has a positive impact on CLBP. Studies assessing the effects of yoga on CLBP in nursing population are lacking. Aim: This study was conducted to evaluate the effects of integrated yoga and physical exercises on QOL in nurses with CLBP. METHODS: A total of 88 women nurses from a tertiary care hospital of South India were randomized into yoga group (n = 44; age - 31.45 ± 3.47 years) and physical exercise group (n = 44; age - 32.75 ± 3.71 years). Yoga group was intervened with integrated yoga therapy module practices, 1 h/day and 5 days a week for 6 weeks. Physical exercise group practiced a set of physical exercises for the same duration. All participants were assessed at baseline and after 6 weeks with the World Health Organization Quality of Life-brief (WHOQOL-BREF) questionnaire. RESULTS: Data were analyzed by Paired-samples t-test and Independent-samples t-test for within- and between-group comparisons, respectively, using the Statistical Package for the Social Sciences (SPSS). Within-group analysis for QOL revealed a significant improvement in physical, psychological, and social domains (except environmental domain) in both groups. Between-group analysis showed a higher percentage of improvement in yoga as compared to exercise group except environmental domain. CONCLUSIONS: Integrated yoga was showed improvements in physical, psychological, and social health domains of QOL better than physical exercises among nursing professionals with CLBP. There is a need to incorporate yoga as lifestyle intervention for nursing professionals.

Development and Validation of Integrated Yoga Module for Obesity in Adolescents.

BACKGROUND: Obesity is a growing global epidemic and cause of noncommunicable diseases. Yoga is one of the effective ways to reduce stress which is one of the causes of obesity. Nowadays, children in adolescent age are more prone to get obese due to lack of physical activity making them more sedentary. AIM: To identify the design and validation of Integrated Approach of Yoga Therapy Module (IAYTM) for obesity in adolescents. Materials and Methods: First phase - IAYTM for obesity was designed based on the literature review of classical texts and recently published research articles. Second phase - Designed IAYTM was validated by 16 subject matter (yoga) experts. Content-validity ratio (CVR) was analyzed using Lawshe's formula. RESULTS: Yoga practices were designed for Integrated Yoga Module for Obesity in Adolescents. Yoga practices with CVR ≥0.5 and which were validated by 16 yoga experts and approved in faculty group discussion were included in final Integrated Yoga Therapy Module. CONCLUSION: The yoga practices were designed and validated for IAYTM for obesity in adolescents.

Designing, validation, and feasibility of integrated yoga therapy module for chronic low back pain.

CONTEXT: Chronic low back pain (CLBP) is a significant public health problem that has reached epidemic proportions. Yoga therapy has emerged as one of the complementary and alternative therapies for CLBP. AIM: The present study reports the development, validation, and feasibility of an integrated yoga therapy module (IYTM) for CLBP. SETTINGS AND DESIGN: This study was carried out at the SVYASA Yoga University, Bengaluru, South India. The IYTM for CLBP was designed, validated, and later tested for feasibility in patients with CLBP. MATERIALS AND METHODS: In the first phase, IYTM for CLBP was designed based on the literature review of classical texts and recently published research studies. In the second phase, designed IYTM (26 yoga practices) was validated by thirty subject matter (yoga) experts. Content validity ratio (CVR) was analyzed using Lawshe's formula. In the third phase, the validated IYTM (20 yoga practices) was tested on 12 patients for pain, disability and perceived stress at baseline and after 1-month of this intervention. RESULTS: A total of 20 yoga practices with CVR ≥0.33 were included, 6 yoga practices with CVR ≥0.33 were excluded from the designed IYTM. The feasibility study with validated IYTM showed significant reduction in numerical pain rating scale (P = 0.02), Oswestry disability scale (P = 0.02), and Perceived Stress Scale (P = 0.03). CONCLUSION: The designed IYTM was validated by thirty yoga experts and later evaluated on a small sample. This study has shown that the validated IYTM is feasible, had no adverse effects and was useful in alleviating pain, disability, and perceived stress in patients with CLBP. However, randomized control trials with larger sample are needed to strengthen the study.

Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain.

BACKGROUND: Studies have shown that Integrated Yoga reduces pain, disability, anxiety and depression and increases spinal flexibility and quality-of-life in chronic low back pain (CLBP) patients. OBJECTIVE: The objective of this study was to compare the effect of two yoga practices namely laghu shankha prakshalana (LSP) kriya, a yogic colon cleansing technique and back pain specific asanas (Back pain special technique [BST]) on pain, disability, spinal flexibility and state anxiety in patients with CLBP. MATERIALS AND METHODS: In this randomized control (self as control) study, 40 in-patients (25 were males, 15 were females) between 25 and 70 years (44.05 ± 13.27) with CLBP were randomly assigned to receive LSP or BST sessions. The measurements were taken immediately before and after each session of either of the practices (30 min) in the same participant. Randomization was used to decide the day of the session (3(rd) or 5(th) day after admission) to ensure random distribution of the hang over effect of the two practices. Statistical analysis was performed using the repeated measures analysis of variance. RESULTS: Significant group * time interaction (P < 0.001) was observed in 11 point numerical rating scale, spinal flexibility (on Leighton type Goniometer) and (straight leg raise test in both legs), Oswestry Disability Index, State Anxiety (XI component of Spieldberger's state and trait anxiety inventory. There was significantly (P < 0.001, between groups) better reduction in LSP than BST group on all variables. No adverse effects were reported by any participant. CONCLUSION: Clearing the bowel by yoga based colon cleansing technique (LSP) is safe and offers immediate analgesic effect with reduced disability, anxiety and improved spinal flexibility in patients with CLBP.

Effect of yoga on quality of life of CLBP patients: A randomized control study.

CONTEXT: In two of the earlier Randomized Control Trials on yoga for chronic lower back pain (CLBP), 12 to 16 weeks of intervention were found effective in reducing pain and disability. AIM: To study the efficacy of a residential short term intensive yoga program on quality of life in CLBP. MATERIALS AND METHODS: About 80 patients with CLBP (females 37) registered for a week long treatment at SVYASA Holistic Health Centre in Bengaluru, India. They were randomized into two groups (40 each). The yoga group practiced a specific module for CLBP comprising of asanas (physical postures), pranayama (breathing practices), meditation and lectures on yoga philosophy. The control group practiced physical therapy exercises for back pain. Perceived stress scale (PSS) was used to measure baseline stress levels. Outcome measures were WHOQOL Bref for quality of life and straight leg raising test (SLR) using a Goniometer. RESULTS: There were significant negative correlations (Pearson's, P<0.005, r>0.30) between baseline PSS with all four domains and the total score of WHOQOLBref. All the four domains' WHOQOLBref improved in the yoga group (repeated measures ANOVA P=0.001) with significant group*time interaction (P<0.05) and differences between groups (P<0.01). SLR increased in both groups (P=0.001) with higher increase in yoga (31.1 % right, 28.4 % left) than control (18.7% right, 21.5 % left) group with significant group*time interaction (SLR right leg P=0.044). CONCLUSION: In CLBP, a negative correlation exists between stress and quality of life. Yoga increases quality of life and spinal flexibility better than physical therapy exercises.

Potential yoga modules for treatment of hematopoietic inhibition in HIV-1 infection.

This article is expected to contribute towards understanding the therapeutic benefits of specific yoga modules on the inhibition of replication and enhancement to normal levels of hematopoiesis in HIV-1 infected subjects. More unique could be the effects of yoga on the indirect effects of HIV-1 induced hematopoietic inhibition of the CD34+ progenitor stem cells, via the CD4+ T lymphocytes. Such indirect effects may be caused by host cellular factors. Yoga practices may also improve the self renewal capacity (a step that precedes commitment of CD34+ progenitor cells to terminal differentiation), via STAT5 gene regulation. This may eliminate the need for constitutive STAT5 gene expression through gene therapy. In this article recent research and ancient Indian literature are reviewed to devise yoga modules for the potential treatment of hematopoietic inhibition in HIV-1 infection. The possible mechanisms through which hematopoietic inhibition may occur in HIV-1 infected patients are first described followed by the role of stress in the progression of HIV where probable involvement of psycho-neuro-immunological axis (PNI) is highlighted. Yoga therapy is introduced and its effectiveness in terms of evidence in relevant area is reviewed. Further, the basic principles of Integrated Approach of Yoga Therapy [IAYT] are described and depending on the potential mechanisms through which yoga therapy may act, both modern scientific research and ancient "scriptural" evidence are provided at all the five levels of existence (body, life force, emotional, intellectual and bliss). This will enable to design comprehensive yoga modules that may intervene in this indirect inhibition of haematopoiesis in HIV-1 infected individuals and potentially restore normal levels of haematopoiesis.

Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study.

OBJECTIVE: The aim of this study was to compare the effect of a short-term intensive residential yoga program with physical exercise (control) on pain and spinal flexibility in subjects with chronic low-back pain (CLBP). DESIGN: This was a wait-list, randomized controlled study. SETTING: The study was conducted at a residential integrative health center in Bangalore, South India. SUBJECTS: Eighty (80) subjects (females, n = 37) with CLBP, who consented were randomly assigned to receive yoga or physical exercise if they satisfied the selection criteria. INTERVENTION: The intervention consisted of a 1-week intensive residential yoga program comprised of asanas (physical postures) designed for back pain, pranayamas (breathing practices), meditation, and didactic and interactive sessions on philosophical concepts of yoga. The control group practiced physical exercises under a trained physiatrist and also had didactic and interactive sessions on lifestyle change. Both of the groups were matched for time on intervention and attention. OUTCOME MEASURES: Pain-related outcomes were assessed by the Oswestry Disability Index (ODI) and by spinal flexibility, which was assessed using goniometer at pre and post intervention. Data were analyzed using repeated measures analysis of variance (RMANOVA). RESULTS: Data conformed to a Gaussian distribution. There was a significant reduction in ODI scores in the yoga group compared to the control group (p = 0.01; effect size 1.264). Spinal flexibility measures improved significantly in both groups but the yoga group had greater improvement as compared to controls on spinal flexion (p = 0.008; effect size 0.146), spinal extension (p = 0.002; effect size 0.251), right lateral flexion (p = 0.059; effect size 0.006); and left lateral flexion (p = 0.006; effect size 0.171). CONCLUSIONS: Seven (7) days of a residential intensive yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in patients with CLBP better than a physical exercise regimen.