Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement From the American Heart Association.

Complementary and alternative medicines (CAM) are commonly used across the world by diverse populations and ethnicities but remain largely unregulated. Although many CAM agents are purported to be efficacious and safe by the public, clinical evidence supporting the use of CAM in heart failure remains limited and controversial. Furthermore, health care professionals rarely inquire or document use of CAM as part of the medical record, and patients infrequently disclose their use without further prompting. The goal of this scientific statement is to summarize published efficacy and safety data for CAM and adjunctive interventional wellness approaches in heart failure. Furthermore, other important considerations such as adverse effects and drug interactions that could influence the safety of patients with heart failure are reviewed and discussed.

Effect of cognitive behavioural therapy and yoga for generalised anxiety disorder on sleep quality in a randomised controlled trial: the role of worry, mindfulness, and perceived stress as mediators.

Sleep disturbances are present in ~65% of individuals with generalised anxiety disorder (GAD). Although both Kundalini yoga (KY) and cognitive behavioural therapy (CBT) are effective treatment options for GAD, little is known about how these treatments compare in improving sleep for GAD and what drives these changes. Accordingly, we examined the effects of CBT, KY, and stress education (SEdu; an attention control condition) on subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity Index [ISI]) in a randomised controlled trial of 226 adults with GAD (mean age 33.37 years; 70% female; 79% White). We hypothesised that both CBT and KY would outperform SEdu in improving sleep disturbances. Three potential mediators of sleep improvement (worry, mindfulness, perceived stress) were also examined. In line with hypotheses, PSQI and ISI scores significantly improved from pre- to post-treatment for all three treatment groups (all p < 0.001, all d > 0.97). However, contrary to predictions, sleep changes were not significantly greater for CBT or KY compared to SEdu. In mediation analyses, within-person deviations in worry, mindfulness, and stress each significantly mediated the effect of time on sleep outcomes. Degree of change in sleep attributable to worry (CBT > KY > SEdu) and perceived stress (CBT, KY > SEdu) was moderated by treatment group. Personalised medicine as well as combined treatment approaches should be studied to help reduce sleep difficulties for patients with GAD who do not respond.

Cluster Randomized Controlled Trial of a Standard Versus Postures-Only Yoga Session: Potential Self-Regulatory and Neurophysiological Mechanisms of an Ancient Practice.

BACKGROUND: It is well-recognized that maintaining a regular yogic practice is associated with numerous physical and psychological health benefits. However, few studies have explored the possible psychological and neurophysiological mediators through which the component parts of yoga-ethics, breath regulation, postures, and meditation-work to produce salutary effects. PURPOSE: To address this gap, we conducted a cluster randomized trial to test the following set of theory-based mechanisms: emotion regulation for ethics, self-control for breath regulation, discomfort and distress tolerance for postures, and mindfulness for meditation. We also explored yoga's effects on the autonomic nervous system by examining salivary acetylcholinesterase levels. METHODS: Participants (N = 260) were randomly assigned in clusters (n = 37) to a single, hour-long standard or postures-only yoga class. RESULTS: Findings suggest that a single yoga class may confer both psychological and neurophysiological benefits, yet there were few differences between the two types of yoga classes. Pre- to post-session main effects of time, all in the expected direction, emerged for five of eight theoretical mediators, as well as for salivary acetylcholinesterase levels. Time X condition interactions observed for three of the mediators-cognitive reappraisal, discomfort tolerance, and expressive suppression-along with findings from the exploratory mediation analysis suggest potential unique benefits of the two yoga sessions for certain outcomes. CONCLUSIONS: Additional studies are needed to replicate these results and to test other potential mediators and/or primary outcomes through which yoga might work to promote health.

Past studies have suggested that yoga offers many benefits for both mind and body, but researchers do not fully understand how the different elements of yoga­ethics, breath regulation, postures, and meditation­lead to these benefits. To investigate this question, we conducted a study with 260 participants who were randomly assigned to either a standard yoga class incorporating the four different elements or a postures-only class that omitted the elements of ethics, breath regulation, and meditation. We examined if the two yoga classes affected psychological processes including emotion regulation, self-control, tolerance for distress and discomfort, mindfulness, and self-regulation differently. We also measured an enzyme related to nervous system functioning to explore possible physiological changes. Our results showed that both types of yoga classes produced psychological and neurophysiological benefits, but there were few differences between the standard and postures-only classes. This study highlights the potential of yoga to impact various health-related factors, but further research is needed to confirm these results and investigate other pathways through which yoga might work to promote health.

Deep abdominal breathing reduces heart rate and symptoms during orthostatic challenge in patients with postural orthostatic tachycardia syndrome.

BACKGROUND AND PURPOSE: This study investigated the effects of deep abdominal breathing on cardiovascular parameters and symptoms in patients with postural orthostatic tachycardia syndrome (POTS) during head-up tilt-table (HUT) challenge. METHODS: Thirty POTS patients completed two consecutive rounds of 10-min HUT in a crossover design. One round was HUT without intervention, and one round combined the HUT with deep breathing at a rate of 6 breaths/min. Cardiovascular parameters, including mean blood pressure and maximum and mean heart rate (HR), were measured supine and standing. Symptoms were assessed using the Vanderbilt Orthostatic Symptom Score (VOSS). RESULTS: During the breathing technique, the mean HR increase was -7.35 bpm (95% confidence interval [CI] = -11.71 to -2.98), and the maximum HR increase was -6.27 bpm (95% CI = -11.85 to -0.68, p = 0.041), significantly lower compared to normal breathing. Additionally, improvements were observed in all absolute cardiovascular parameters during standing, with VOSS symptoms simultaneously and significantly decreasing by -5.38 (95% CI = -10.43 to -0.36). CONCLUSIONS: Slow deep abdominal breathing can act as a simple technique to reduce the standing HR increase upon HUT in patients with POTS. This suggests that modulation of the cardiopulmonary neurocircuits and the respiratory pump may reduce HR increase and symptoms in patients with POTS. The findings of this study highlight the use of a safe, zero-cost, and simple behavioral tool to suggest to POTS patients for symptom relief apart from standard treatment. The observed improvements in cardiovascular parameters and symptoms offer a promising therapeutic approach for patients in times of inadequate treatment options.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

Yoga as a non-pharmacologic therapy to reduce dinutuximab-induced pain in patients with neuroblastoma.

BACKGROUND: Anti-GD2 antibodies are key components of treatment for high-risk neuroblastoma; however, they cause neuropathic pain. Yoga therapy may help reduce pain and distress associated with anti-GD2 therapy. PROCEDURE: Children 3 years of age or older with neuroblastoma participated in individualized yoga therapy while receiving the anti-GD2 antibody dinutuximab (DIN). Yoga therapy was deemed feasible if patients participated during 60% or more of DIN admissions. Patients and caregivers assessed pain/distress before and after yoga therapy with a distress thermometer (DT) and Wong-Baker FACES pain rating scale and completed questionnaires regarding satisfaction with yoga therapy. Therapy was deemed efficacious if there was a ≥1 point pain score change and reduction in distress after yoga. RESULTS: Eighteen patients were enrolled; 52 encounters (admissions for DIN) were evaluable. Ten of 18 were female, three of 18 were Hispanic, and 10/18 were White. Median age at enrollment was 5.5 years (range: 3-11). Yoga therapy was feasible in 39/52 (75%) encounters. Significant reductions in caregiver-reported pain and distress and reductions in patient-reported pain and distress after yoga therapy were reported. Twelve of 18 caregivers completed questionnaires: seven agreed/strongly agreed that yoga was valuable, and nine agreed/strongly agreed to continued participation in yoga. Thirty-four of 36 clinicians reported that they would recommend yoga therapy for other patients receiving DIN. CONCLUSIONS: Yoga therapy was feasible during DIN therapy and may be effective in reducing DIN-associated pain and distress. Future studies are needed to evaluate changes in opioid usage with the addition of yoga therapy during anti-GD2 antibody therapy.

Integrative Approaches for Cancer Pain Management.

PURPOSE OF REVIEW: The goal of this review is to summarize updates to the broad array of complementary therapies available for cancer pain. This paper will serve as a reference for clinicians managing pain in cancer patients. RECENT FINDINGS: Patients are embracing integrative therapies in growing numbers; clinicians must be prepared to incorporate these therapies into patients' existing treatment regimens. This requires knowledge regarding risks, benefits, and potential interactions with existing cancer therapies. Integrative cancer pain management strategies have shown promise, with several proven effective for the management of cancer pain. Energy therapies, including acupuncture, and biologicals and nutraceuticals including overall diet and vitamin D, have the highest level of evidence for efficacy. The remaining therapies discussed in this chapter may be beneficial for patients on a case-by-case basis; risks and benefits of each individual therapy as described in the text must be further assessed in future rigorous trials to further clarify the role of these complementary therapies in cancer pain management.

Optimizing Care: Integrative Oncology in Myeloproliferative Neoplasm.

PURPOSE OF REVIEW: Myeloproliferative neoplasm (MPN) burdens the lives of those affected. MPN patients endure significant impacts on their physical, psychological, and social well-being. While pharmacological interventions offer some disease and symptom control, they often have unfavorable side effects. This review explores the potential of Integrative Oncology (IO) therapies in managing MPNs and their associated symptoms. RECENT FINDINGS: IO is dedicated to augmenting conventional treatments through integrating interventions targeting the mind, body, nutrition, supplements, and other supportive care therapies. Several small studies suggest the benefit of an IO approach in MPN patients. These benefits are postulated to be modulated through enhanced physical capacity, reduced disease-related inflammation, subconscious mind training, and gut microbiome modulation. By combining IO with evidence-based pharmacological treatments, the potential exists to enhance the quality of life and clinical outcomes for individuals with MPNs. Future research should prioritize well-powered studies, including diverse demographics and symptom profiles, with appropriate study duration, to draw definite conclusions regarding the observed effects.

Yoga as Potential Therapy for Burnout: Health Technology Assessment Report on Efficacy, Safety, Economic, Social, Ethical, Legal and Organizational Aspects.

PURPOSE OF REVIEW: This health technology assessment aimed to systematically assess the efficacy and safety of yoga as therapy for burnout. Economic, ethical, legal, social and organizational aspects were considered as well. RECENT FINDINGS: Yoga as a therapy has been shown to have positive effects on a range of symptoms, including stress, anxiety and depression. Regarding work-related stress and burnout, the effects of yoga have mainly been examined in a preventative context. Meta-analyses revealed no effects on burnout severity comparing yoga with passive controls in general. Compared with passive controls, yoga had a positive effect on subjective stress. Compared to active control, yoga had an effect on the burnout subscale depersonalization on individual study level. Yoga may have positive effects on burnout, but the results are mixed. Common definitions and standardized diagnostic tools are necessary to improve research and further assess yoga as therapy for burnout. TRIAL REGISTRATION: The HTA is registered with PROSPERO, CRD42022299405, on 6th February 2022.

Yoga in Pediatric Gastroenterology.

PURPOSE OF REVIEW: Pediatric use of yoga as an integrative medicine modality has increased in prevalence over the last several decades. In this article, we review the available evidence for yoga in pediatric gastrointestinal disorders. RECENT FINDINGS: Evidence supports that in many pediatric disorders of gut brain interaction (DGBI), including irritable bowel syndrome, functional abdominal pain and functional dyspepsia, yoga decreases pain intensity and frequency and increases school attendance. Yoga has been shown to improve health-related quality of life and improve stress management as an effective adjunct to standard medical therapy in pediatric inflammatory bowel disease (IBD). Further studies are needed regarding optimal frequency, duration of practice and evaluation of the impact on IBD disease activity measures. Yoga may benefit pediatric gastroenterology patients with DGBIs and IBD through improving quality of life and reducing pain. Future yoga studies could investigate biomarkers and continued research will help integrate this modality into routine pediatric gastroenterology care.

Yoga and meditation for menopausal symptoms in breast cancer survivors: a qualitative study exploring participants' experiences.

PURPOSE: Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, they often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore breast cancer survivors' experiences and effects of a yoga and meditation intervention supplementing previously reported RCT outcomes. METHODS: The qualitative data included in this study were part of a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. All participants who underwent the yoga intervention (n = 19) were invited to take part in semi-structured interviews after all quantitative data collection had been completed. Interviews (n = 9) were recorded, transcribed, and then coded into superordinate themes using thematic analysis. RESULTS: Nine female participants were interviewed, and the following themes emerged: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, and spiritual level); (4) differences between the study yoga intervention and other physical activities. CONCLUSIONS: In accordance with the accounts of participants, yoga might offer a promising intervention for breast cancer survivors. All those interviewed either currently attended a yoga class or expressed a desire to continue practicing yoga. Additionally, our findings inform future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e., breast cancer specific), or considering that different intervention components might need different assistance to encourage long-term use.

Preliminary effects of a yoga intervention for lung cancer dyads: benefits for care partners.

PURPOSE: Lung cancer is a disease with high mortality and morbidity, impacting both the patient and their closest contact, referred to in this paper as their care partner. There is limited evidence on how to support mental health and quality of life (QOL) for patient-care partner dyads during cancer treatment. This pilot study examines yoga as an intervention to improve well-being for the dyad. METHODS: A single-group, 12-week pilot trial of yoga for patients and their care partners recruited from two hospitals during cancer treatment (N = 23 patient-partner dyads or 46 individuals). Most care partners were spouses (70%), with the remainder being adult children (22%), a sibling (4%), or a friend (4%). Descriptive statistics, Cohen's d effect sizes, and paired t-tests for validated psychosocial measures were calculated at baseline and 12 weeks. RESULTS: Sixty-five percent of dyads (N = 13) completed the study, with withdrawals mostly due to disease progression. Among care partners, there was a decrease in depression symptomology on the PHQ-8 (p = 0.015, Cohen's d = 0.96) and improvement in QOL on the Caregiver QOL-Cancer scale (p = 0.001, Cohen's d = 0.61). Fifty percent of dyads experienced concordant improvement in depressive symptoms and 77% in QOL. CONCLUSION: Patient-partner yoga is a promising intervention for improving mental health and QOL for patient-partner dyads among lung cancer survivors. This study demonstrates yoga to be acceptable, feasible, and with high concordance within patient-partner dyads for improvements in QOL. Yoga shows promise for patients and care partners to alleviate the negative psychosocial impacts of lung cancer, though more research is needed to confirm effects. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03649737, 12/9/2020.

Effect of yoga as a complementary therapy in prostate cancer survivors: a systematic review.

PURPOSE: Currently, available evidence suggests a positive impact of yoga on physical and psychological well-being in patients across different types of cancer, especially breast cancer survivors. However, there are no available systematic reviews on the effects of yoga on male prostate cancer survivors. The objective of the current systematic review is to specifically examine the quality of life, feasibility, and other effects of yoga on prostate cancer survivors. METHODS: Bibliographic databases such as PubMed/Medline, CINAHL, EMBASE, Cochrane Library, and Google Scholar were searched for studies that were conducted till December 2022 to assess the effect of yoga on prostate cancer survivors. Studies that met predefined eligibility criteria were included. The quality of the included studies was assessed by the Cochrane risk of bias tool, and for single-arm studies, the Newcastle-Ottawa Scale was used. RESULTS: A comprehensive literature search yielded a total of 137 studies. After careful consideration, this review included five studies involving 129 prostate cancer survivors. The included studies were published between 2012 and 2022. This systematic review observed that yoga has the potential to enhance erectile function, reduce fatigue and urinary symptoms, alleviate psychological stress, boost immune function, and improve the overall quality of life in prostate cancer survivors. Furthermore, it demonstrates the feasibility of incorporating yoga into their regular routine. CONCLUSIONS: Yoga could be an effective complementary therapy in the management of physical and psychological symptoms experienced by prostate cancer survivors. However, until more comprehensive evidence becomes available, it would be premature to draw definitive conclusions about the effectiveness of yoga in the context of prostate cancer (PCa).

Co-creating a yoga program for women diagnosed with gynecologic cancer: a consensus study.

PURPOSE: Yoga may be uniquely suited to address bio-psycho-social concerns among adults with gynecologic cancer because it can be tailored to individuals' needs and can help shift focus inward towards self-reflection, body appreciation, and gratitude. This study describes the collaborative process guided by the Knowledge-to-Action framework used to develop a yoga program for adults diagnosed with gynecologic cancer and inform a feasibility trial. METHODS: In 3 collaborative phases, yoga instructors and women diagnosed with gynecologic cancer formulated recommendations for a yoga program and evaluated the co-created program. RESULTS: The program proposed is 12 weeks in length and offers two 60-min group-based Hatha yoga classes/week to five to seven participants/class, online or in person, with optional supplemental features. Overall, participants deemed the co-created program and instructor guidebook to be reflective of their needs and preferences, though they provided feedback to refine the compatibility, performability, accessibility, risk precautions, and value of the program as well as the instructor guidebook. CONCLUSION: The feasibility, acceptability, and benefits of the program are being assessed in an ongoing feasibility trial. If deemed feasible and acceptable, and the potential for enhancing patient-reported outcomes is observed, further investigation will focus on larger-scale trials to determine its value for broader implementation.

Experiences of Irritable Bowel Syndrome Patients in a Virtual Yoga Program: Qualitative Findings from a Clinical Trial.

BACKGROUND AND AIMS: In-person yoga interventions have shown feasibility and effectiveness in improving the outcomes of patients with irritable bowel syndrome (IBS), but experiences in virtual yoga interventions have not been examined. This study aimed to explore patients' experiences of a virtually delivered yoga intervention for IBS. METHODS: An embedded qualitative substudy was included in a randomized controlled trial examining the feasibility and effectiveness of a virtual yoga program among adult patients with IBS. Semi-structured interviews captured participants' past and current experiences, program satisfaction, perceived impact on IBS symptoms and overall physical and mental health, facilitators and barriers to participation, perceptions of social support and supervised learning, and input on improving future programming. Data were coded and analyzed in duplicate using NVivo 12. An analytic template based on the interview guide was developed and thematic analysis identified themes, as well as the relationship between themes and subthemes. RESULTS: Among the 14 participants (all female, mean age 47.7 years), three major themes were identified: (1) positive experience in the yoga program, (2) incorporating yoga into IBS management post-study, and (3) recommendations for program improvement. CONCLUSION: Patients with IBS experience in a virtual yoga program was positive with improvements in physical and mental health outcomes. Considering the barriers and facilitators to participating in an online yoga program along with participant recommendations may improve future intervention design and delivery to increase self-efficacy and confidence among patients with IBS.

Yoga as an Add-on Therapy in Parkinson's Disease: A Single Group Open-label Trial.

OBJECTIVE: We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD). METHODS: We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS: The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004). CONCLUSION: Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability. CLINICALTRIALSGOV IDENTIFIER: CTRI/2019/02/017564.

Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review.

BACKGROUND: Yoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness. OBJECTIVE: To investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders. METHODS: We performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. RESULTS: Out of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners' Continuous Performance Test IIª and Conners' Parent Rating Scale-Revised: Long. CONCLUSIONS: Yoga didn't have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects. PROSPERO REGISTRATION: CRD42023389088.

Effect of Yoga in Pregnancy on Maternal Pelvic Floor Distress Symptoms-A Randomised Control Study.

INTRODUCTION AND HYPOTHESIS: Pregnancy is associated with an increase in pelvic floor dysfunction. Yoga, an ancient Indian practice involving asanas (physical postures), pranayam (breathing patterns) and meditation, can help women to control their pelvic floor muscles. However, the literature to support yoga as a remedy for pelvic floor dysfunction is lacking. We hypothesized that yoga could be an important method in improving pelvic floor dysfunction in pregnancy. METHODS: In a randomised control study, 200 pregnant women matched for age, weight, parity and physical activity were randomised at the 13- to 20-week period of gestation into two groups: group I (n = 100, undergoing yoga therapy) and group II (n = 100, given usual antenatal care). A trained instructor provided two physical sessions, each lasting for 60 min and further online sessions for 5 days a week for 3 months. The Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to assess the primary outcome at recruitment, 32 weeks (antenatal), 1 week and 6 weeks post-partum in both groups. RESULTS: In the 200 women randomised and matched for age and parity, there were no complications seen throughout the pregnancy and none of the patients was lost to follow-up in either group. The proportion of women exhibiting a decline in PFDI-20 scores was greater in group 1 (24%) than in group 2 (8%). The mean difference of scores between recruitment and 6 weeks post-partum was statistically significant (p value = 0.0026). CONCLUSIONS: Yoga in pregnancy significantly improves pelvic floor dysfunction in an easy manner with no proven adverse effects.

Comparative Efficacy of Acute Exercise Intervention on Anxiety in Adolescents and Young Adults: A Network Meta-Analysis.

Acute exercise is a promising non-pharmacological therapy for alleviating anxiety. However, the effects of different types of acute exercise on anxiety in adolescents and young adults remain unclear. Therefore, our study aims to conduct a network meta-analysis to compare the effectiveness of various exercise interventions in improving anxiety in adolescents and young adults. We conducted an online literature search in five databases: PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. The search was conducted from inception to March 1, 2023, and was limited to English-language publications. Pairwise and network meta-analyses were performed using random-effects models. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to rate the certainty of evidence. A total of 33 studies involving 1121 participants were included. The network meta-analysis results revealed that mind-body exercise was the most effective intervention for reducing anxiety in adolescents and young adults (SMD = -0.36, 95% CI: -0.70, -0.03, moderate certainty). Additionally, aerobic exercise (SMD = -0.16, 95% CI: -0.28, -0.03, high certainty) showed significant reduction in anxiety, while resistance exercise (SMD = -0.09, 95% CI: -0.33, 0.14, moderate certainty) and multicomponent exercise (SMD = -0.01, 95% CI: -0.59, 0.57, moderate certainty) did not show significant reduction in anxiety. Moderate certainty evidence suggests that acute mind-body exercise may be the most effective type of exercise for reducing anxiety in adolescents and young adults. Future research should focus on conducting more multi-arm randomized controlled trials to provide more direct evidence on the relative effectiveness of different exercise interventions.

Key characteristics of effective yoga interventions for managing osteoarthritis: a systematic review and meta-analysis.

This systematic review aimed to synthesise the content, structure, and delivery characteristics of effective yoga interventions for managing osteoarthritis symptoms, including joint pain and joint function. JBI guidelines were followed. 17 databases were searched for randomised controlled trials (RCTs) assessing yoga's effectiveness on osteoarthritis symptoms. Meta-analyses and a narrative synthesis were conducted to address the objective. The systematic review and meta-analysis included 18 and 16 articles (representing 16 and 14 RCTs), respectively. Overall, the included studies had low methodological quality scores. 10 of 14 yoga interventions effectively reduced pain (standardised mean difference (SMD) - 0.70; 95% confidence interval (CI) - 1.08, - 0.32) and/or improved function (- 0.40; - 0.75, - 0.04). Notably, 8 effective interventions had centre-based (supervised, group) sessions, and 6 included additional home-based (unsupervised, individual) sessions. Effective interventions included 34 yogic poses (12 sitting, 10 standing, 8 supine, 4 prone), 8 breathing practices, and 3 meditation and relaxation practices. 8 interventions included yogic poses, and 7 also incorporated breathing practices and/or meditation and relaxation practices. 4 interventions included yogic pose modifications for osteoarthritis. The median duration of centre-based sessions was 8 weeks and each session was around 53 min, mostly delivered once a week. The median duration of home-based sessions was 10 weeks and each session was 30 min, usually instructed to practice 4 times a week. Given previous studies' limitations, a high-quality long-term RCT should be conducted using synthesised findings of previous effective yoga interventions.