Yoga Therapy in Functional Dyspepsia. A Narrative Review.

Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.

Adjuvant yoga therapy for symptom management of functional dyspepsia: A case series.

Functional Dyspepsia (FD), commonly called chronic indigestion, comes under the umbrella of 'Disorders of Gut-Brain Axis'. It manifests as a cluster of upper gastrointestinal symptoms including epigastric pain or burning, postprandial fullness and early satiety. Since the pathophysiology is complex, it is often difficult to effectively manage and significantly impacts the patient's quality of life. This case series aims to elucidate the role of Yoga as an adjuvant therapy to modern medicine in providing relief of dyspeptic symptoms in such patients. Yoga is an ancient Indian mind-body practise that has the potential to be used for various brain-gut disorders. Apart from treating the gut disorders from top down (mind-gut) pathway, it may have more direct physiological effects as well. Researches on IBS and one research on abdominal pain related FGID have shown Yoga therapy to be effective in ameliorating the symptoms. In this study, we present three such cases (1 male and 2 female) having a clinical diagnosis of FD in detail. These patients were initially non-responsive to medications but later showed remarkable improvement in symptoms within one month of added Yoga therapy intervention. This study was conducted as a part of a larger study conducted at a tertiary hospital in Pondicherry in collaboration between its Yoga department and Medical Gastroenterology Department. Yoga therapy protocol was given along with their regular medical management for a month. Gastrointestinal Symptom Rating Scale (GSRS) and Dyspepsia Symptom Score questionnaires were used to assess symptoms before and after the intervention period. All three patients showed marked reductions in symptom scores both in the GSRS and Dyspepsia Questionnaire. The present case series suggests effect of adjuvant Yoga therapy in reducing symptoms of functional dyspepsia. Future studies may clarify the psycho-physiological basis of the same.

Methodological issues in yoga therapy research among psychiatric patients.

Yoga therapy has been widely accepted as part of the evidence-based modern healthcare system. Although research publications are growing in leaps and bounds, many methodological issues pose stumbling blocks. In this narrative review, various issues like standalone or add-on treatment, blinding, randomization, nature of dependent and intervening variables, duration of intervention, sustainability of effects, attrition bias, adherence and accuracy, all or none performance, diverse schools, heterogeneity and multidimensionality, assortment, permutations, and combinations of different components, neglect of essential ingredients, mindfulness, catch-22 situation, credentials of the instructors, cultural factors, naivety, multicentric studies, duration of collection of data, primary or standard treatment, interdisciplinary research, statistical lapses, qualitative research, biomedical research are discussed. There is a need to frame guidelines for conducting yoga therapy research and publication.

Effect of Pranayama Techniques with Marmanasthanam Kriya as Yogic Relaxation on Biopsychosocial Parameters Prior to Endodontic Therapy: A Cross Sectional Study Design.

BACKGROUND: The root canal treatment is one of the common dental or endodontic therapies associated with high levels of patient anxiety. Yoga therapy (YT) is reported in medical literature as an effective modality in bringing down anxiety in clinical scenarios; however, the reports of the same for dental settings are fewer. The current study aimed to evaluate the effect of YT on biopsychosocial parameters in patients undergoing root canal therapy. MATERIALS AND METHODS: A cross sectional study was conducted on 50 participants who underwent dental root canal therapy. The sample was divided into two groups: Yoga group (Group A; n = 25) who received YT and control group (Group B; n = 25) who were subjected to self-relaxation during dental procedure. The state of anxiety was measured by a 5-point single-item Likert scale and the cardiovascular (CV) parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) and CV indices (pulse pressure [PP], mean arterial pressure [MAP], rate-pressure product [RPP], and double product [DoP]) were derived and compared between both the groups. RESULTS: The intergroup comparison showed statistically significant differences in anxiety score (P < 0.001), SBP (P < 0.001), MAP (P < 0.001), RPP (P < 0.001), DoP (P < 0.001), HR (P < 0.029), DBP (P < 0.003), and PP (P < 0.116). CONCLUSION: A significant reduction was recorded in terms of anxiety and primary and derived CV parameters in the yoga group. The YT can be adopted as an interventional tool for anxiety management in patients indicated for dental root canal therapy.

Effectiveness of Adjuvant Yoga Therapy in Diabetic Lung: A Randomized Control Trial.

CONTEXT: Recent studies provide ample evidence of the benefits of yoga in various chronic disorders. Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia and Sandler coined the term "Diabetic Lung" for the abnormal pulmonary function detected in diabetic patients due underlying pulmonary dysfunction. Yoga therapy may help in achieving better pulmonary function along with enhanced glycaemic control and overall health benefits. AIM: To study the effect of adjuvant yoga therapy in diabetic lung through spirometry. SETTINGS AND DESIGN: Randomized control trial was made as interdisciplinary collaborative work between departments of Yoga Therapy, Pulmonary Medicine and Endocrinology, of MGMC & RI, Sri Balaji Vidyapeeth Puducherry. MATERIALS AND METHODS: 72 patients of diabetic lung as confirmed by spirometry (<70% of expected) were randomized into control group (n=36) who received only standard medical treatment and yoga group (n=36) who received yoga training thrice weekly for 4 months along with standard medical management. Yoga therapy protocol included yogic counseling, preparatory practices, Asanas or static postures, Pranayama or breathing techniques and relaxation techniques. Hathenas of the Gitananda Yoga tradition were the main practices used. Spirometry was done at the end of the study period. Data was analyzed by Student's paired and unpaired 't' test as it passed normality. RESULTS: There was a statistically significant (P < 0.05) reduction in weight, and BMI along with a significant (P < 0.01) improvement in pulmonary function (FEV1, FVC) in yoga group as compared to control group where parameters worsened over study period. CONCLUSION: It is concluded from the present RCT that yoga has a definite role as an adjuvant therapy as it enhances standard medical care and hence is even more significant in routine clinical management of diabetes, improving physical condition and pulmonary function.

Effect of a 12-week yoga therapy program on mental health status in elderly women inmates of a hospice.

AIM AND OBJECTIVES: This study was undertaken to evaluate the effectiveness of yoga on the mental health status of elderly women inmates residing in a hospice in Puducherry. MATERIALS AND METHODS: Forty elderly women were randomly divided into yoga and wait-listed control group. A yoga therapy program of 60 min was given twice a week for 12 weeks. This protocol was specially designed for senior citizens, keeping in mind their health status and physical limitations that included simple warm-up and breath-body movement coordination practices (jathis and kriyas), static stretching postures (asanas), breathing techniques (pranayamas), and relaxation. Hamilton anxiety scale for measuring anxiety, Hamilton rating scale for depression, and Rosenberg self-esteem scale to measure self-esteem were administered to both groups before and after the 12-week study period. Data were assessed for normality, and appropriate parametric and nonparametric statistical methods were applied for intra- and inter-group comparisons. RESULTS: Overall, intra- and inter-group comparison of prepost data showed statistically significant (P < 0.001) differences for all three parameters. There was an overall improvement in the scores indicating decreased levels of depression and anxiety coupled with an increase in the level of self-esteem after the yoga therapy program. DISCUSSION: The influence of yoga in the reduction of depression and anxiety scores and improvement in self-esteem scores in elderly women subjects is evident from this study. As reported in earlier studies, this may be attributed to changes in central neurotransmitters such as gamma-aminobutyric-acid coupled with increased parasympathetic tone and decreased sympatho-adrenal activity. CONCLUSION: It is recommended that yoga should be a part of health-care facilities for elderly as it can enhance the quality of life by improving their overall mental health status. It could provide a healthy and positive alternative from depressing negative thoughts, and give them a sense of purpose and hope.

Single session of integrated "silver yoga" program improves cardiovascular parameters in senior citizens.

AIM AND OBJECTIVE: This pilot study was carried out to determine cardiovascular effects of a single session of an integrated "silver yoga" program in senior citizens of Serene Pelican Township, Pondicherry. MATERIALS AND METHODS: Heart rate (HR) and blood pressure (BP) measurements were recorded in 124 senior citizens (75 female, 49 male) with mean age of 67.19 ± 10.61 year who attended an integrated "Silver Yoga" program at Centre for Yoga Therapy, Education and Research from August to October 2014. Participants practiced the protocol that was specially designed for senior citizens, keeping in mind their health status and physical limitations. This included simple warm-ups (jathis), breath body movement coordination practices (kriyas), static stretching postures (asanas), breathing techniques (pranayamas), relaxation and simple chanting. Non-invasive BP apparatus was used to record the HR, systolic (SP) and diastolic pressure (DP) before and after the 60 min sessions. Pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (DoP) indices were derived from the recorded parameters. Student's paired t-test was used to compare data that passed normality testing by Kolmogorov-Smirnov Test and Wilcoxon matched-pairs signed-ranks test for those that did not. P < 0.05 were accepted as indicating significant differences for pre-post comparisons. RESULTS: All parameters witnessed a reduction following the single session. This was statistically more significant (P < 0. 0001) in HR, RPP and DoP while it was also significant (P < 0.01 and P < 0.05) in SP and PP, respectively. The decrease in MP just missed significance (P = 0.054) while it was not significant in DP. CONCLUSION: There is a healthy reduction in HR, BP and derived cardiovascular indices following a single yoga session in geriatric subjects. These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to an integrated "Silver Yoga" program.

Immediate effects of Suryanamaskar on reaction time and heart rate in female volunteers.

Suryanamaskar (SN), a yogic technique is composed of dynamic muscular movements synchronised with deep rhythmic breathing. As it may have influence on CNS, this study planned to investigate immediate effects of SN on reaction time (RT) and heart rate (HR). 21 female volunteers attending yoga classes were recruited for study group and 19 female volunteers not participating in yoga were recruited as external-controls. HR, auditory reaction time (ART) and visual reaction time (VRT) were recorded before and after three rounds of SN in study group as well as 5 minutes of quiet sitting in both groups. Performance of SN produced immediate decrease in both VRT and ART (P < 0.001). This was significant when compared to self-control period (P < 0.001) and compared to external-control group, it decreased significantly in ART (p = 0.02). This was pronounced when delta% was compared between groups (P < 0.001). HR increased significantly following SN compared with both self-control (p = 0.025) and external-control group (p = 0.032). Faster reactivity may be due to intermediate level of arousal by conscious synchronisation of dynamic movements with breathing. Rise in HR is attributed to sympathetic arousal and muscular exertion. We suggest that SN may be used as an effective training means to improve neuro-muscular abilities.

Immediate effect of mukha bhastrika (a bellows type pranayama) on reaction time in mentally challenged adolescents.

Mentally challenged individuals are known to have slower speed of reaction. As a previous study has shown immediate improvement in reaction time (RT) following mukha bhastrika, a bellows type of pranayama, we planned to study the effect of this pranayama in mentally challenged adolescents. 34 mentally challenged adolescents (15.1 +/- 0.806 y) studying in a school for Special Needs were recruited as they have been receiving yoga training once a week for more than 3 years. Exclusion criteria were inability to either perform mukha bhastrika or to understand procedure for testing RT. Visual (VRT) and auditory reaction time (ART) was measured using RT apparatus before and after nine rounds of mukha bhastrika and a control period of ten minutes of normal activities to rule out any test-retest practice effect. Analysis of non-intervention period values showed that the reliability in terms of reproducibility of the observation for both VRT (r = 0.87) and ART (r = 0.95) was excellent. Mukha bhastrika produced an immediate and significant decrease in both VRT and ART. There was a statistically significant decrease in VRT (P < 0.0001) from 296.15ms +/- 13.49 to 263.59ms +/- 12.53 and ART (P < 0.0001) from 247.88 ms +/- 14.33 to 217.35 ms +/- 11.36 following mukha bhastrika. Decrease in RT signifies improved central neuronal processing ability. This may be due to greater arousal and faster rate of information processing, improved concentration and/or ability to ignore or inhibit extraneous stimuli. Mukha bhastrika may be altering afferent inputs from abdominal and thoracic regions, in turn modulating activity at ascending reticular activating system and thalamo-cortical levels. It is suggested that yogic breathing techniques like mukha bhastrika be used as an effective means of improving neuromuscular abilities in special children.