#MindinBody - feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial.

BACKGROUND: The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain. METHODS: This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing. RESULTS: A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (ηp2) = .175 and mental health: F(1, 29) = 9.09, p = .005, ηp2 = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, ηp2 = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT . CONCLUSIONS: Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12617001507370 , 26/10/2017).

Randomized controlled trial of bikram yoga and aerobic exercise for depression in women: Efficacy and stress-based mechanisms.

BACKGROUND: The current study presents a randomized controlled 8-week trial of Bikram yoga, aerobic exercise, and waitlist for depression. Bikram yoga was chosen specifically for its standardized nature. Further, we examined changes in three stress-related constructs-perceived stress, rumination, and mindfulness-as mediators of antidepressant effects. METHOD: Fifty-three women (age 18-65; 74% White) with a unipolar depressive disorder were randomly assigned to one of the three conditions. Response was defined as >50% reduction on the Hamilton Rating Scale for Depression (HAM-D). Remission was defined as no longer meeting criteria for depression and a HAM-D ≤ 7. Self-reported perceived stress, rumination, and mindfulness were assessed weekly. RESULTS: In the intention-to-treat sample (n = 53), response rates were significantly higher in the Bikram yoga (61.1%; χ2 = 10.48, p = .001) and aerobic exercise (60.0%; χ2 = 10.44, p = .001) conditions relative to waitlist (6.7%). In the completer sample (n = 42), 73.3% (χ2 = 11.41, p = .001) of women in yoga and 80.0% (χ2 = 13.72, p < .001) in exercise achieved response compared to 8.3% in waitlist. Reductions in rumination significantly mediated HAM-D change for both active treatments, and mindful acceptance was a partial mediator in the exercise condition. LIMITATIONS: The sample was small in size, consisted of women only, and was ethnically homogenous. Inter-rater reliability was not assessed, aerobic exercise was not standardized, and mediators were assessed by self-report. CONCLUSIONS: Bikram yoga showed descriptively similar efficacy to aerobic exercise and both may work, in part, by helping individuals interrupt negative thinking.

Salt and water balance after sweat loss: A study of Bikram yoga.

Bikram yoga is practiced in a room heated to 105°F with 40% humidity for 90 min. During the class a large volume of water and electrolytes are lost in the sweat, specifically, sodium is lost, the main cation of the extracellular fluid. There is little known about the volume of sweat and the amount of sodium lost in sweat during Bikram yoga or the optimum quantity of fluid required to replace these losses. The participants who took part in this small feasibility study were five females with a mean age of 47.4 ± 4.7 years and 2.6 ± 1.6 years of experience at Bikram yoga. The total body weight, water consumed, serum sodium concentration, serum osmolality, and serum aldosterone levels were all measured before and after a Bikram yoga practice. Sweat sodium chloride concentration and osmolality were measured at the end of the practice. The mean estimated sweat loss was 1.54 ± 0.65 L, while the amount of water consumed during Bikram yoga was 0.38 ± 0.22 L. Even though only 25% of the sweat loss was replenished with water intake during the Bikram yoga class, we did not observe a change in serum sodium levels or serum osmolality. The sweat contained 82 ± 16 mmol/L of sodium chloride for an estimated total of 6.8 ± 2.1 g of sodium chloride lost in the sweat. The serum aldosterone increased 3.5-fold from before to after Bikram yoga. There was a decrease in the extracellular body fluid compartment of 9.7%. Sweat loss in Bikram yoga predominately produced a volume depletion rather than the dehydration of body fluids. The sweating-stimulated rise in serum aldosterone levels will lead to increased sodium reabsorption from the kidney tubules and restore the extracellular fluid volume over the next 24 hr.

Acute Physiologic Effects of Performing Yoga in The Heat on Energy Expenditure, Range of Motion, and Inflammatory Biomarkers.

Performing yoga in a heated environment (HY) is a popular exercise mode purported to improve range of motion (ROM), body composition, and aerobic fitness. The purpose of this investigation was to compare a session of HY to room temperature yoga (RTY) with regards to ROM, oxygen consumption, caloric expenditure, and biomarkers of acute stress and inflammation. Sixteen experienced yoga practitioners (F14, M2; 40 ± 11yr; 22.6 ± 1.8 kg/m2) completed a 1-hour standardized Bikram sequence in HY (105°F, 40°C) and RTY (74°F, 23.3°C) conditions (order of conditions randomized, humidity standardized at 40%). Intra-exercise metabolic gas exchange and heart rate (HR) was monitored using a metabolic cart. ROM measures were taken pre and post-exercise at the elbow, shoulder, hip, and knee. Cytokines interleukin 6,10 (IL-6, IL-10) and tumor-necrosis-factor alpha (TNF-α) were analyzed from blood samples collected pre- and 30-minutes post-exercise. Intra-exercise metabolic gas exchange and heart rate (HR) was monitored using a metabolic cart. Both bouts elicited similar acute changes in ROM although HY elicited a greater increase in hip abduction (RTYΔ° = 2.3 ± 1.3|HYΔ° = 6.6 ± 1.5; p < 0.05). Mean VO2, peak VO2, %VO2max, HR, and kcal expenditure did not differ between conditions. RER was lower during the HY (RTY = 0.95 ± 0.02| HY = 0.89 ± 0.02; p < 0.05) with a concomitant elevation in fat oxidation (RTY = 0.05 ± 0.01|HY = 0.09 ± 0.01, g·min-1; p < 0.05) and decrease in carbohydrate oxidation (RTY = 0.51 ± 0.04|HY = 0.44 ± 0.03, g·min-1; p < 0.05). Serum IL-6 was increased (15.5 ± 8.0-fold) following HY only (p < 0.05). HY does not significantly elevate aerobic energy cost compared to RTY but may acutely increase fat substrate utilization and hip ROM. Future studies remain needed to establish dose-response relationships for including HY or RTY into well-rounded fitness programs.

Effect of 90-Min Bikram Yoga on Basic Psychological Needs Among Practitioners in the Southwestern United States.

BACKGROUND: In our modern society, physical activity is a lifestyle choice. Bikram Yoga is a low impact; moderate exercise and the understanding of motivation and adherence to the practice is unknown. This study aimed to evaluate the effect of 90 min Bikram Yoga practice on basic psychological needs of competence (the sense of skill mastery), autonomy (volitionally performing a task), and relatedness (a connection with others) as postulated in self-determination theory for motivation. METHODS: The sample included Bikram Yoga practitioners in the Southwestern United States (n = 126) averaged between the age group of 35 and 64, predominately female, and highly educated. Responses to the Psychological Need Satisfaction in Exercise Scale were analyzed using multivariate analysis of variance. RESULTS: Results showed a statistically significant effect of frequency of Yoga attendance on the satisfaction of basic psychological needs (i.e., competence, autonomy, and relatedness); (P = 0.025); specifically, Yoga practitioners who attended four or more classes per week had higher satisfaction levels of Basic Psychological Need for competence (P = 0.013) and relatedness (P = 0.034). A statistically significant effect of the level of experience on the satisfaction of basic psychological needs (i.e., competence, autonomy, and relatedness) (P = 0.014) found in experienced Bikram Yoga practitioners, specifically for competence (P = 0.013) and relatedness (P = 0.023) compared to novice counterparts. CONCLUSION: The study provides some evidence of an individual's motivation for a 90 min Bikram Yoga practice and possible adherence. Future investigation of Bikram Yoga practice adopting self-determination theory appears worthwhile.

Acute Cardiovascular Responses to a Session of Bikram Yoga: A Pilot Uncontrolled Trial.

INTRODUCTION: Main cardiovascular parameters such as heart rate (HR), blood pressure, and myocardial oxygen consumption (MOC) are tightly regulated by a multifactorial, nonlinear control system. Increased HR because of physical activity is often accompanied by an increase in blood pressure. Postural changes have an effect on the baroreceptors, and stretching exercises and isometric contractions modulate muscle mechanoreceptors eliciting increases in blood pressure. However, a hot environment increases the core temperature inducing vasodilation and plasma volume changes that might contribute to a drop in blood pressure. During the practice of Bikram yoga, all these factors converge and little is known about the resulting changes in blood pressure and MOC. METHODS: Sixteen apparently healthy female volunteers, regular practitioners of Bikram yoga, were evaluated during a 90 min session. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured immediately after each posture and HR was measured continuously during the practice. RESULTS: HR and estimated MOC increased significantly over baseline during the exercise (+62.3% and +63.6%, respectively). HR mean value across the entire Bikram yoga session was 126.6 ± 14.3 bpm reaching a maximum of 168.1 ± 20.2 bpm. SBP was not significantly increased over baseline at any time during the practice with a mean value of 117.0 ± 10.1 mmHg and DBP was significantly decreased over baseline most of the time (-10.1%, mean 71.2 ± 7.3 mmHg) with particular decline toward the end of the practice during the floor postures. CONCLUSIONS: DBP during the practice of Bikram yoga was significantly different from that previously reported for nonheated Hatha yoga for normotensive subjects. Further studies evaluating the same group at both conditions are needed to better characterize the magnitude of the changes in HR, SBP, DBP, and MOC.