Integrated Yoga Practice in Cardiac Rehabilitation Program: A Randomized Control Trial.

Background: Coronary artery disease (CAD) is a detrimental noncommunicable disease, which is increasing due to sedentary lifestyle and urbanization in the young population. It is further elevated with risk factors such as stress, anxiety, depression, an increase in triglycerides, dyslipidemia, hyperglycemia, hypertension, and so on, which manifests as atherosclerotic disease. Yoga-based lifestyle intervention is a noninvasive effective treatment method to control and prevent cardiac risk factors in CAD patients. Yoga has been used in India as a therapeutic method to manage hypertension and other chronic disorders and is fast gaining popularity as an effective means for the alleviation of stress, improvement of fitness, and enhancement of well-being. This study aimed to determine the feasibility of introducing the integrated approach of yoga therapy (IAYT) in a cardiac rehabilitation center in India and understand its usefulness in improving the cardiac function and managing the cardiac risk factors in acute myocardial infarction patients with left ventricular dysfunction. Methods and Design: Cardiac patients were randomized to a yoga-practicing group (n = 33) and a control group (n = 33). The yoga-practicing group was instructed to attend three supervised IAYT classes 3 days per week for 12 weeks at the hospital yoga center. The control group received standard care that included pharmacologic treatment and the instructions of the cardiologist. The outcome measures were assessed at baseline (T1 = 0) and completion (T2 = 3 months). The primary outcome measure was the left ventricular ejection fraction (LVEF). Results: There was no statistically significant difference in LVEF (U = 420.500, p value = 0.218) between the two groups. However, the yoga-practicing group showed significant reduction in depression (Cardiac Depression Scale [CDS], U = 71, p value = 0.0), anxiety (Hamilton Anxiety Rating Scale [HAM-A], U = 128, p value = 0.0), and a significant increase in quality of life (QOL) scores (Duke Activity Status Index [DASI], U = 146, p value = 0.0; and metabolic equivalents (METs), U = 136, p value = 0.0) at 3 months compared to control. Overall, the CAD patients practicing yoga showed a favorable profile compared to control individuals on CDS, HAM-A, DASI, and MET outcomes. Control and yoga practicing groups did not differ significantly in the lipid levels. Conclusion: This study indicated that the integration of yoga practice in a cardiac rehabilitation program is feasible and has no added benefit in improving the cardiac function. However, the addition of yoga to cardiac rehabilitation may be beneficial in reducing depression and anxiety and improving QOL in patients.

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.

Yoga practice to improve sleep quality and body composition parameters of obese male - a randomized controlled trial.

Background Globally obesity increase is a big challenge. Obesity causes many non-communicable diseases. Options to control obesity are in search. Aim: To assess the outcome of 3 months follow-up period, after 14 weeks yoga intervention, for body composition and sleep quality parameters on obese male in urban setting. Materials and methods Design: Parallel group RCT (randomized controlled trial) on obese male. The two groups were yoga and control groups, with yoga (n = 37, age 40.03 ± 8.74), control (n = 35, age 42.20 ± 12.06). The IAYT (integrated approach of yoga therapy) training was given to yoga group for 14 weeks, and the unsupervised yoga practice was continued by the subjects at their home, for further 3 months. Training was 1.5 hour daily for 5 days in a week, which included the IAYT module of Suryanamaskara Asana Pranayama and relaxation. No yoga activity but walking etc. for the same time, was given to control group. Body composition parameters were assessed through BIA (bioelectrical impedance) method using InBody R 20 model. The sleep quality was assessed using PSQI (Pittsburgh sleep quality index). Within group and between group analysis were performed, using SPSS version 21. The correlation analysis was carried out on the difference in pre follow-up values. Results During the follow-up period within the group, the body composition parameters improved and the parameters of quality of sleep showed trends of improvement. Also some of the gain obtained during 14 weeks intervention was lost during follow-up period. Conclusions The changes observed may indicate the long-term benefits of yoga practice for control of obesity in urban setting for males.

Yoga Practice for Reducing the Male Obesity and Weight Related Psychological Difficulties-A Randomized Controlled Trial.

INTRODUCTION: Obesity is a health disorder and increasing all over the world. It is also a cause for many non-communicable diseases. Yoga practice reduces the stress level which may improve the eating habits and help in weight reduction. AIM: To assess the final outcome of the effects after 3 months of the 14 weeks yoga training on obesity of adult male in an urban setting. MATERIALS AND METHODS: This was a randomized controlled trial with parallel groups (Yoga and Control groups) on male obese. Total 80 subjects with Body Mass Index (BMI) between 25 to 35 kg/cm2 were enrolled and randomized into two equal groups in which 72 subjects (yoga n = 37 and control n=35) completed the trial. Yoga group mean age ± SD was 40.03±8.74 and Control group mean age±SD was 42.20±12.06. A 14 weeks special IAYT (Integrated Approach of Yoga Therapy) yoga training was given to the Yoga group and no specific activity was given to Control group. The interim results of this study at 14 weeks were covered in another article which is under process. After the 14 weeks of yoga training the Yoga group was asked to continue the yoga practice for the next 3 months and the Control group was not given any physical activity. The final outcome is covered in this paper. The assessments were anthropometric parameters of body weight (Wt), BMI (Body Mass Index), MAC (Mid-upper Arm Circumferences of left and right arm), WC (Waist Circumference), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF (Skin Fold Thickness) of biceps, triceps, sub scapular, suprailiac and cumulative skin fold thickness value), Percentage body fat based on SKF and Psychological questionnaires of PSS (Perceived Stress Scale) and AAQW (Acceptance and Action Questionnaire for Weight related difficulty). Assessments were taken after 3 months of yoga training, for both Yoga and Control groups. Within group, between group and correlation analyses were carried out using SPSS 21. RESULTS: Improvement in anthropometric and psychological parameters such as Wt, Percentage body fat, PSS were observed in the final outcome. Also, some of the improvements such as AAQW score were lost in the final outcome, compared to interim results. CONCLUSION: The yoga practice is effective for obesity control for adult male in an urban setting.

Effects of a holistic yoga program on endocrine parameters in adolescents with polycystic ovarian syndrome: a randomized controlled trial.

OBJECTIVES: The objectives of this trial were to compare the effects of a holistic yoga program with the conventional exercise program in adolescent polycystic ovarian syndrome (PCOS). DESIGN: This was a prospective, randomized, active controlled trial. SETTING: Ninety (90) adolescent (15-18 years) girls from a residential college in Andhra Pradesh who satisfied the Rotterdam criteria were randomized into two groups. INTERVENTION: The yoga group practiced a holistic yoga module, while the control group practiced a matching set of physical exercises (1 hour/day, for 12 weeks). OUTCOME MEASURES: Anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin, body-mass index (BMI), hirsutism, and menstrual frequency were measured at inclusion and after 12 weeks. RESULTS: Mann-Whitney test on difference score shows that changes in AMH (Y=-2.51, C=-0.49, p=0.006), LH, and LH/FSH ratio (LH: Y=-4.09, C=3.00, p=0.005; LH/FSH: Y=-1.17, C=0.49, p=0.015) were significantly different between the two intervention groups. Also, changes in testosterone (Y=-6.01, C=2.61, p=0.014) and Modified Ferriman and Gallway (mFG) score (Y=-1.14, C=+0.06, p=0.002) were significantly different between the two groups. On the other hand, changes in FSH and prolactin postintervention were nonsignificantly different between the two groups. Also, body weight and BMI showed nonsignificantly different changes between the two groups, while changes in menstrual frequency were significantly different between the two groups (Y=0.89, C=0.49, p=0.049). CONCLUSIONS: A holistic yoga program for 12 weeks is significantly better than physical exercise in reducing AMH, LH, and testosterone, mFG score for hirsutism, and improving menstrual frequency with nonsignificant changes in body weight, FSH, and prolactin in adolescent PCOS.

Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: A randomized control trial.

CONTEXT: Yoga techniques practiced for varying durations have been shown to reduce state anxiety. This was never assessed in adolescents with polycystic ovarian syndrome (PCOS). AIMS: To compare the effect of a holistic yoga program with the conventional exercise program on anxiety level in adolescents with PCOS. SETTINGS AND DESIGN: Ninety adolescent (15-18 years) girls from a residential college in Andhra Pradesh, who satisfied the Rotterdam criteria, were randomized into two groups. MATERIALS AND METHODS: Anxiety levels were assessed at inclusion and after 12 weeks of intervention wherein yoga group practiced a holistic yoga module while the control group practiced a matching set of physical exercises (1 h/day, for 12 weeks). STATISTICAL ANALYSIS USED: Mann-Whitney U test was used to compare difference scores (delta change) between the two groups RESULTS: Changes in state anxiety after the intervention were nonsignificantly different between the two groups (P=0.243), while changes after the intervention were significantly different between the two groups (P=0.002) for trait anxiety. CONCLUSIONS: Twelve weeks of a holistic yoga program in adolescents with PCOS is significantly better than physical exercise program in reducing anxiety symptoms.

Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome.

OBJECTIVE: To assess the efficacy of yoga therapy on glucose metabolism and blood lipid values in adolescent girls with polycystic ovary syndrome (PCOS). METHODS: A prospective, randomized, interventional controlled trial recruited 90 adolescents aged between 15 and 18 years who met the Rotterdam criteria for PCOS. A yoga group practiced suryanamaskara, asanas, pranayama, and meditation 1 hour per day each day for 12 weeks while another group practiced conventional physical exercises. The Mann-Whitney U test was used to compare score changes between the 2 groups. RESULTS: The changes in fasting insulin, fasting blood glucose, and homeostasis model assessment of insulin resistance were significantly different in the 2 groups (P<0.05). Except for high-density lipoprotein cholesterol, the changes in blood lipid values were also significantly different (P<0.05). The changes in body mass index, waist circumference, hip circumference, and waist-to-hip ratio, however, were not significantly different (P>0.05). CONCLUSION: Yoga was found to be more effective than conventional physical exercises in improving glucose, lipid, and insulin values, including insulin resistance values, in adolescent girls with PCOS independent of anthropometric changes. Central Trial Registry of India No.: REFCTRI-2008 000291.

Prevalence of polycystic ovarian syndrome in Indian adolescents.

BACKGROUND: PCOS is a common female endocrine disorder with prevalence ranging from 2.2% to 26%. Most reports have studied adult women with age ranged from 18 to 45 years. The aim of this study was to find the prevalence of PCOS in Indian adolescents. METHOD: We prospectively studied 460 girls aged 15 to 18 years from a residential college in Andhra Pradesh, South India, who underwent clinical examination. Out of which 72 girls with oligomenorrhea and/or hirsutism were invited for biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS by Rotterdam criteria. PCOS was defined as the presence of any two of the three features: (1) Oligo/amenorrhea: absence of menstruation for 45 days or more and/or ≤8 menses per year. (2) Clinical hyperandrogenism: Modified Ferriman and Gallway (mFG) score of 6 or higher. (3) Polycystic ovaries: presence of >10 cysts, 2-8 mm in diameter, usually combined with increased ovarian volume of >10 cm(3), and an echo-dense stroma in pelvic ultrasound scan. RESULTS: Out of 460 girls, one (0.22%) had oligo/amenorrhea with clinical hyperandrogenism, 29 (6.30%) had oligomenorrhea with polycystic ovaries, one (0.22%) had polycystic ovaries with clinical hyperandrogenism and 11 (2.39%) had oligomenorrhea with polycystic ovaries in the presence of clinical hyperandrogenism. Thus 42 (9.13%) girls satisfied Rotterdam's criteria for PCOS, which increased to 50.46 (10.97%) when imputed data were included. CONCLUSION: Prevalence of PCOS in Indian adolescents is 9.13%.This draws attention to the issue of early diagnosis in adolescent girls.