Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP): A Qualitative Study Exploring the Trial Team's Facilitators and Challenges in Conducting a Feasibility Trial in India.

BACKGROUND: In India, around 77 million people are at high risk of developing type 2 diabetes mellitus (T2DM). Yoga interventions can be effective in preventing T2DM. We conducted a feasibility randomized controlled trial (RCT) in India, and the intervention was the Yoga Programme for T2DM Prevention (YOGA-DP). This study aimed to identify and explore the facilitators and challenges in conducting the feasibility trial in India, and more specifically, to explore the perceptions and experiences of trial staff in relation to running the feasibility trial and Yoga instructors in relation to delivering the intervention. METHODS: An exploratory qualitative study was conducted at two trial sites in India (Yoga centers in New Delhi and Bengaluru). Semi-structured interviews were conducted with ten participants (six trial staff and four Yoga instructors) to explore their perceptions and experiences related to the study's aim. Data were analyzed using deductive as well as inductive logic and an interpretative phenomenological approach. RESULTS: Feasibility-trial-related facilitators were useful participant recruitment strategies and help and support received from the trial coordination center. Intervention-related facilitators were strengths of the intervention content, structure, and delivery (including materials) and competencies of Yoga instructors. Feasibility-trial-related challenges were lack of awareness about T2DM among potential participants, stigma and fear associated with T2DM among potential participants, difficulties in explaining the research and obtaining written informed consent from potential participants, expectations and demands of potential participants and control-group participants, gender and language issues in participant recruitment, other participant recruitment-related challenges, issues in participant follow-up, and issues in data collection and trial documentation. Intervention-related challenges were the limited interest of participants in Yoga, participants' time constraints on practicing Yoga, participants' health issues hindered Yoga practice, beginners' difficulties with practicing Yoga, participants' demotivation to practice Yoga at home, issues with the Yoga practice venue, confusion regarding the intervention structure, issues with intervention materials, and the incompetence of Yoga instructors. CONCLUSIONS: The perceptions and experiences of trial staff and Yoga instructors helped us to understand the facilitators and challenges in running a feasibility trial and delivering the intervention for T2DM prevention, respectively. These findings and their suggestions will be used when designing the definitive RCT for evaluating YOGA-DP's effectiveness, and may be helpful to researchers planning similar trials. TRIAL REGISTRATION NUMBER: India (CTRI) CTRI/2019/05/018893.

Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India: A Multicenter Feasibility Randomized Controlled Trial.

INTRODUCTION: Many Indians are at high risk of type 2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YOGA-DP), a 24-week structured lifestyle education and exercise (Yoga) program that included 27 group Yoga sessions and self-practice of Yoga at home. In this study, the feasibility of undertaking a definitive randomized controlled trial (RCT) was explored that will evaluate the intervention's effectiveness among high-risk individuals in India. METHODS: A multicenter, two-arm, parallel-group, feasibility RCT was conducted in India. The outcome assessors and data analysts were blinded. Adults with a fasting blood glucose level of 100-125 mg/dL (i.e., at high risk of T2DM) were eligible. Participants were randomized centrally using a computer-generated randomization schedule. In the intervention group, participants received YOGA-DP. In the control group, participants received enhanced standard care. RESULTS: In this feasibility trial, the recruitment of participants took 4 months (from May to September 2019). We screened 711 people and assessed 160 for eligibility. Sixty-five participants (33 in the intervention group and 32 in the control group) were randomized, and 57 (88%) participants were followed up for 6 months (32 in the intervention group and 25 in the control group). In the intervention group, the group Yoga sessions were continuously attended by 32 (97%) participants (median (interquartile range, IQR) number of sessions attended = 27 (3)). In the intervention group, Yoga was self-practiced at home by 30 (91%) participants (median (IQR) number of days per week and minutes per day self-practiced = 2 (2) and 35 (15), respectively). In the control group, one (3%) participant attended external Yoga sessions (on Pranayama) for 1 week during the feasibility trial period. There was no serious adverse event. CONCLUSIONS: The participant recruitment and follow-up and adherence to the intervention were promising in this feasibility study. In the control group, the potential contamination was low. Therefore, it should be feasible to undertake a definitive RCT in the future that will evaluate YOGA-DP's effectiveness among high-risk people in India. FEASIBILITY TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI) CTRI/2019/05/018893; registered on May 1, 2019.

Estimation of Yoga Postures Using Machine Learning Techniques.

Yoga is a traditional Indian way of keeping the mind and body fit, through physical postures (asanas), voluntarily regulated breathing (pranayama), meditation, and relaxation techniques. The recent pandemic has seen a huge surge in numbers of yoga practitioners, many practicing without proper guidance. This study was proposed to ease the work of such practitioners by implementing deep learning-based methods, which can estimate the correct pose performed by a practitioner. The study implemented this approach using four different deep learning architectures: EpipolarPose, OpenPose, PoseNet, and MediaPipe. These architectures were separately trained using the images obtained from S-VYASA Deemed to be University. This database had images for five commonly practiced yoga postures: tree pose, triangle pose, half-moon pose, mountain pose, and warrior pose. The use of this authentic database for training paved the way for the deployment of this model in real-time applications. The study also compared the estimation accuracy of all architectures and concluded that the MediaPipe architecture provides the best estimation accuracy.

Feasibility Trial of Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) among High-Risk People in India: A Qualitative Study to Explore Participants' Trial- and Intervention-Related Barriers and Facilitators.

Yoga-based interventions can be effective in preventing type 2 diabetes mellitus (T2DM). We developed a Yoga programme for T2DM prevention (YOGA-DP) and conducted a feasibility randomised controlled trial (RCT) among high-risk people in India. This qualitative study's objective was to identify and explore participants' trial- and intervention-related barriers and facilitators. The feasibility trial was conducted at two Yoga centres in New Delhi and Bengaluru, India. In this qualitative study, 25 trial participants (13 intervention group, 12 control group) were recruited for semi-structured interviews. Data were analysed using deductive logic and an interpretative phenomenological approach. Amongst intervention and control participants, key barriers to trial participation were inadequate information about recruitment and randomisation processes and the negative influence of non-participants. Free blood tests to aid T2DM prevention, site staff's friendly behaviour and friends' positive influence facilitated trial participation. Amongst intervention participants, readability and understanding of the programme booklets, dislike of the Yoga diary, poor quality Yoga mats, difficulty in using the programme video, household commitment during home sessions, unplanned travel, difficulty in practising Yoga poses, hesitation in attending programme sessions with the YOGA-DP instructor of the opposite sex and mixed-sex group programme sessions were key barriers to intervention participation. Adequate information was provided on T2DM prevention and self-care, good venue and other support provided for programme sessions, YOGA-DP instructors' positive behaviour and improvements in physical and mental well-being facilitated intervention participation. In conclusion, we identified and explored participants' trial- and intervention-related barriers and facilitators. We identified an almost equal number of barriers (n = 12) and facilitators (n = 13); however, intervention-related barriers and facilitators were greater than for participating in the trial. These findings will inform the design of the planned definitive RCT design and intervention and can also be used to design other Yoga interventions and RCTs.

Transcranial Doppler studies in Type 2 diabetes mellitus: A systematic review.

BACKGROUND: Type II Diabetes mellitus (T2DM) patients are at the risk of developing cerebrovascular diseases, often contributed by altered cerebral haemodynamics. We present a systematic review of studies on cerebral haemodynamics assessment using transcranial Doppler (TCD) in T2DM. REVIEW METHOD: A systematic review of the published articles in the English language between 1991 to 2021. DATA SOURCES: Articles were retrieved via Pubmed and Cochrane library. We included Cross-sectional, prospective, retrospective, randomized controlled, and cross-over studies for this review. RESULTS: A total of 25 articles met the inclusion criteria, which provided data for 3212 patients. CONCLUSION: Cerebral autoregulation is often impaired among patients with T2DM. The risk increased with the duration of T2DM, related complications and presence of comorbidities.

Smart Yoga Instructor for Guiding and Correcting Yoga Postures in Real Time.

In recent days, Yoga is gaining more prominence and people all over the world have started to practice it. Performing Yoga with proper postures is beneficial. Hence, an instructor is required to monitor the correctness of Yoga postures. However, at times, it is difficult to have an instructor. This study aims to provide a system that will act as a personal Yoga instructor and practitioners can practice Yoga in their comfort zone. The device is interactive and provides audio guidance to perform different Yoga asanas. It makes the use of a camera to capture the picture of the person performing Yoga in a particular position. This captured pose is compared with the benchmark postures. A pretrained deep learning model is used for the classification of different Yoga postures using a standard dataset. Based on the comparison, the practitioner's posture will be corrected using a voice message to move the body parts in a certain direction. As the device performs all the operations in real-time, it has a quick response time of a few seconds. Currently, this work aids the practitioners in performing five Asanas, namely, Ardha Chandrasana/Half-moon pose, Tadasana/Mountain pose, Trikonasana/Triangular pose, Veerabhadrasana/Warrior pose, and Vrikshasana/Tree pose.

Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey.

BACKGROUND: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people's health perceptions and lifestyle behaviors. OBJECTIVE: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic. METHODS: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. RESULTS: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (ß=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (ß=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy. CONCLUSIONS: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up.

Development of a Yoga Program for Type-2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India.

Introduction: Many Indians are at high-risk of type-2 diabetes mellitus (T2DM). Yoga is an ancient Indian mind-body discipline, that has been associated with improved glucose levels and can help to prevent T2DM. The study aimed to systematically develop a Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India using a complex intervention development approach. Materials and Methods: As part of the intervention, we developed a booklet and a high-definition video for participants and a manual for YOGA-DP instructors. A systematic iterative process was followed to develop the intervention and included five steps: (i) a systematic review of the literature to generate a list of Yogic practices that improves blood glucose levels among adults at high-risk of or with T2DM, (ii) validation of identified Yogic practices by Yoga experts, (iii) development of the intervention, (iv) consultation with Yoga, exercise, physical activity, diet, behavior change, and/or diabetes experts about the intervention, and (v) pretest the intervention among Yoga practitioners and lay people (those at risk of T2DM and had not practiced Yoga before) in India. Results: YOGA-DP is a structured lifestyle education and exercise program, provided over a period of 24 weeks. The exercise part is based on Yoga and includes Shithilikarana Vyayama (loosening exercises), Surya Namaskar (sun salutation exercises), Asana (Yogic poses), Pranayama (breathing practices), and Dhyana (meditation) and relaxation practices. Once participants complete the program, they are strongly encouraged to maintain a healthy lifestyle in the long-term. Conclusions: We systematically developed a novel Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India. A multi-center feasibility randomized controlled trial is in progress in India.

Yoga programme for type-2 diabetes prevention (YOGA-DP) among high risk people in India: a multicentre feasibility randomised controlled trial protocol.

INTRODUCTION: A huge population in India is at high risk of type-2 diabetes (T2DM). Physical activity and a healthy diet (healthy lifestyle) improve blood glucose levels in people at high risk of T2DM. However, an unhealthy lifestyle is common among Indians. Yoga covers physical activity and a healthy diet and can help to prevent T2DM. The research question to be addressed by the main randomised controlled trial (RCT) is whether a Yoga programme for T2DM prevention (YOGA-DP) is effective in preventing T2DM among high risk people in India as compared with enhanced standard care. In this current study, we are determining the feasibility of undertaking the main RCT. INTERVENTION: YOGA-DP is a structured lifestyle education and exercise programme. The exercise part is based on Yoga and includes Shithilikarana Vyayama (loosening exercises), Surya Namaskar (sun salutation exercises), Asana (Yogic poses), Pranayama (breathing practices) and Dhyana (meditation) and relaxation practices. METHODS AND ANALYSIS: This is a multicentre, two-arm, parallel-group, feasibility RCT with blinded outcome assessment and integrated mixed-methods process evaluation. Eligible participants should be aged 18-74 years, at high risk of T2DM (fasting plasma glucose level 5.6-6.9 mmol/L) and safe to participate in physical activities. At least 64 participants will be randomised to intervention or control group with final follow-up at 6 months. Important parameters, needed to design the main RCT, will be estimated, such as SD of the outcome measure (fasting plasma glucose level at 6-month follow-up), recruitment, intervention adherence, follow-up, potential contamination and time needed to conduct the study. Semistructured qualitative interviews will be conducted with up to 20-30 participants, a sample of those declining to participate, four YOGA-DP instructors and around eight study staff to explore their perceptions and experiences of taking part in the study and of the intervention, reasons behind non-participation, experiences of delivering the intervention and running the study, respectively. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the following Research Ethics Committees: Faculty of Medicine and Health Sciences, University of Nottingham (UK); Centre for Chronic Disease Control (CCDC, India); Bapu Nature Cure Hospital and Yogashram (BNCHY, India) and Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA, India). The results will be widely disseminated among key stakeholders through various avenues. TRIAL REGISTRATION NUMBER: CTRI/2019/05/018893.

Yoga versus physical exercise for cardio-respiratory fitness in adolescent school children: a randomized controlled trial.

Background Yoga is very effective in improving health especially cardio-respiratory fitness and also overall performance in adolescents. There are no large numbers of randomized controlled studies conducted on comparing yoga with physical activity for cardio-respiratory fitness in adolescent school children with large sample size. Objective Aerobic training is known to improve physical and cardio-respiratory fitness in children. Cardio-respiratory fitness is an important indicator of health in children. In this study we evaluate the effects of yoga versus physical exercise training on cardio-respiratory fitness in adolescent school children. Subjects Eight hundred two school students from 10 schools across four districts were recruited for this study. Methods In this prospective two arm RCT around 802 students were randomized to receive daily one hour yoga training (n = 411) or physical exercise (n = 391) over a period of two months. VO2 max was estimated using 20 m shuttle run test. However, yoga (n = 377) and physical exercise (n = 371) students contributed data to the analyses. Data was analysed using students t test. Results There was a significant improvement in VO2 max using 20 m Shuttle run test in both yoga (p < 0.001) and exercise (p < 0.001) group following intervention. There was no significant change in VO2 max between yoga and physical exercise group following intervention. However, in the subgroup with an above median cut-off of VO2 max; there was a significant improvement in yoga group compared to control group following intervention (p = 0.03). Conclusion The results suggest yoga can improve cardio-respiratory fitness and aerobic capacity as physical exercise intervention in adolescent school children.

Voluntarily induced vomiting - A yoga technique to enhance pulmonary functions in healthy humans.

Vomiting is a complex autonomic reflex orchestrated by several neurological centres in the brain. Vagus, the cranial nerve plays a key role in regulation of vomiting. Kunjal Kriya (Voluntarily Induced Vomiting), is a yogic cleansing technique which involves voluntarily inducing vomiting after drinking saline water (5%) on empty stomach. This study was designed with an objective to understand the effect of voluntary induced vomiting (ViV) on pulmonary functions in experienced practitioners and novices and derive its possible therapeutic applications. Eighteen healthy individuals volunteered for the study of which nine had prior experience of ViV while nine did not. Pulmonary function tests were performed before and after 10 min of rest following ViV. Analysis of Covariance was performed adjusted for gender and baseline values. No significant changes were observed across genders. The results of the present study suggest a significant increase in Slow Vital Capacity [F(1,13) = 5.699; p = 0.03] and Forced Inspiratory Volume in 1st Second [p = 0.02] and reduction in Expiratory Reserve Volume [F(1,13) = 5.029; p = 0.04] and Respiratory Rate [F(1,13) = 3.244, p = 0.09]. These changes suggest the possible role of ViV in enhancing the endurance of the respiratory muscles, decreased airway resistance, better emptying of lungs and vagal predominance respectively. We conclude that ViV when practiced regularly enhances the endurance of the respiratory muscles and decreases airway resistance. These findings also indicate need for scientific understanding of ViV in the management of motion sickness and restrictive pulmonary disorders like bronchitis and bronchial asthma.

Immediate Effect of Needling at CV-12 (Zhongwan) Acupuncture Point on Blood Glucose Level in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Placebo-Controlled Trial.

INTRODUCTION: Diabetes mellitus is a major global health problem. Needling at CV-12 has reduced blood glucose level in diabetic rats. The aim of this study was to evaluate the effect of needling at CV-12 (Zhongwan) on blood glucose level in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: Forty T2DM patients were recruited and randomized into either the acupuncture group or placebo control group. The participants in the acupuncture group were needled at CV-12 (4 cun above the center of the umbilicus), and those in the placebo control group were needled at a placebo point on the right side of the abdomen (1 cun beside the CV-12). For both groups, the needle was retained for 30 minutes. Assessments were performed prior to and after the intervention. Statistical analysis was performed using SPSS version 16. RESULTS: There was a significant reduction in random blood glucose level in the acupuncture group compared to baseline. No such significant change was observed in the placebo control group. CONCLUSION: The result of this study suggests that 30 minutes of needling at CV-12 might be useful in reducing blood glucose level in patients with T2DM.

Effect of Needling at CV-12 (Zhongwan) on Blood Glucose Levels in Healthy Volunteers: A Pilot Randomized Placebo Controlled Trial.

INTRODUCTION: Acupuncture, a key part of traditional Chinese medicine, is used to relieve symptoms of diabetes mellitus. The aim of this study was to evaluate the effect of needling CV-12 (Zhongwan) on blood glucose levels in healthy volunteers. MATERIALS AND METHODS: Thirty-six individuals were recruited and randomized into either the acupuncture group or the placebo control group. The participants in the acupuncture group were needled at CV-12 (4 cun above the center of the umbilicus), and those in the placebo control group were needled at a nonexisting "sham" point on the right side of the abdomen (1 cun beside the CV-12)-a nonacupuncture point. For both groups, the needle was retained for 20 minutes without stimulation. Assessments were performed prior to and after the intervention. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 16. RESULTS: The result of this study showed a mild reduction in random blood glucose (RBG) levels in the acupuncture group and a mild increase in RBG levels in the placebo control group. However, these changes were not statistically significant both within and between groups. CONCLUSION: The result of this study suggests that although 20 minutes of needling at CV-12 without stimulation produced a mild reduction in RBG levels in healthy volunteers, it did not produce a statistically significant result.

Influence of Yoga-Based Personality Development Program on Psychomotor Performance and Self-efficacy in School Children.

Selective attention and efficacy are important components of scholastic performance in school children. While attempts are being made to introduce new methods to improve academic performance either as part of curricular or extracurricular activities in schools, the success rates are minimal. Hence, this study assessed the effect of yoga-based intervention on psychomotor performance and self-efficacy in school children. Two hundred ten school children with ages ranging from 11 to 16 years (mean age ± SD; 13.7 ± 0.8 years) satisfying the inclusion and exclusion criteria were recruited for the 10-day yogä program. An equal number of age-matched participants (n = 210; mean ± SD; 13.1 ± 0.8 years) were selected for the control group. Participants were assessed for attention and performance at the beginning and end of 10 days using trail making task (TMT) A and B, and self-efficacy questionnaire. The yoga group showed higher self-efficacy and improved performance after 10 days of yoga intervention. The performance in TMT-A and -B of the yoga group showed a significantly higher number of attempts with a reduction in time taken to complete the task and a number of wrong attempts compared with control group. Results suggest that yoga practice enhances self-efficacy and processing speed with fine motor coordination, visual-motor integration, visual perception, planning ability, and cognitive performance.