Mapa de evidências efetividade clínica da prática do Yoga / Evidence Map: clinical efectiveness of yoga

O Mapa sobre a efetividade clínica da prática do Yoga é parte de uma série de Mapas de Evidências sobre aplicação clínica das Práticas Integrativas e Complementares da Saúde (PICS) que estão na Política Nacional de Práticas Integrativas e Complementares (PNPIC), e tem como objetivo fornecer uma visualização fácil de informações valiosas para pacientes, profissionais de saúde e gerentes, a fim de promover PICS baseadas em evidências. Método: a partir de uma ampla busca bibliográfica nas bases de dados da BVS e PubMed de estudos publicados de janeiro de 2005 até novembro de 2019 e, com expressões de busca pré-definidas, foram incluídas no mapa revisões sistemáticas e metanálises de ensaios clínicos e estudos observacionais, que foram devidamente avaliados, caracterizados e categorizados. Principais Achados: ● O mapa é baseado em 149 estudos. Oitenta e dois estudos são revisões sistemáticas e 58 são metanálises. A maioria das revisões foi publicada nos anos 2016 a 2019. ● A maioria dos estudos primários incluídos nas revisões está concentrada nos seguintes países: Índia (82), Estados Unidos (78) e Austrália (33). ● A intervenção mais pesquisada foi Ashtanga Yoga (93) e em seguida a intervenção Hatha Yoga (77), Iyengar Yoga (72) e Yoga não especificado (64) sendo investigadas como intervenções para vários desfechos em saúde. ● Os estudos foram analisados com base no AMSTAR, resultando nos seguintes níveis de confiança: alto (24), moderado (69) e baixo (56). ● Os efeitos foram classificados em: positivos (90); potencial positivo (19) inconclusivos/misturados (23); sem efeitos (17). Não foram encontrados efeitos negativos. ● Os resultados foram divididos em 3 grupos principais: Vitalidade, Bem-Estar e Qualidade de Vida; Indicadores Metabólicos e Fisiológicos; Transtornos Mentais; ● Os desfechos mais comuns foram: qualidade de vida (24); depressão (22), transtornos de ansiedade (16) e pressão arterial (13). Implicações para a prática e pesquisa: ● Efeitos positivos apresentados foram relacionados principalmente a prática de Hatha Yoga, Iyengar Yoga, Yoga não especificado e Pranayama associado a outras Práticas, destacando como desfechos principais qualidade de vida, depressão e pressão arterial; ● Efeitos do tipo inconclusivo/misturado merecem mais pesquisas, principalmente para os seguintes desfechos: hiperglicemia, função social, hipertensão, humor, esquizofrenia.

Mapa de Evidência: efetividade clínica da Prática do Yoga / Mapa de Evidencia: efetividad clínica de la Práctica del Yoga / Evidence Map: Clinical Effectiveness of Yoga Practice

O mapa apresenta uma visão geral das evidências sobre os efeitos clínicos da prática do Yoga em diversas condições de saúde, qualidade de vida e bem-estar. A partir de uma ampla busca bibliográfica foram incluídos no mapa 150 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores em Yoga.

El mapa proporciona una visión general de la evidencia sobre los efectos clínicos de la práctica del yoga en diversas condiciones de salud, calidad de vida y bienestar. A partir de una amplia búsqueda bibliográfica, se incluyeron 150 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores en Yoga.

The map provides an overview of the evidence on clinical effects of Yoga practice on various health conditions, quality of life and well-being. From a wide bibliographic search, 150 studies of systematic review were included in the map. All studies were evaluated, characterized and categorized by a group of researchers in Yoga.

Greater Anteroposterior Default Mode Network Functional Connectivity in Long-Term Elderly Yoga Practitioners.

Large-scale brain networks exhibit changes in functional connectivity during the aging process. Recent literature data suggests that Yoga and other contemplative practices may revert, at least in part, some of the aging effects in brain functional connectivity, including the Default Mode Network (DMN). The aim of this cross-sectional investigation was to compare resting-state functional connectivity of the medial prefrontal cortex (MPFC) and posterior cingulate cortex-precuneus (PCC-Precuneus) in long-term elderly Yoga practitioners and healthy paired Yoga-naïve controls. Two paired groups: yoga (Y-20 women, Hatha Yoga practitioners; practicing a minimum of twice a week with a frequency of at least 8 years) and a control group (C-20 women, Yoga-naïve, matched by age, years of formal education, and physical activity) were evaluated for: Mini Mental State Examination (MMSE), Beck Depression Inventory (BDI), Instrumental Activities of Daily Living (IADL), and open-eyes resting-state functional magnetic resonance imaging (fMRI)-seed to voxel connectivity analysis (CONN toolbox 17.f) with pre-processing-realignment and unwarping, slice-timing correction, segmentation, normalization, outlier detection, and spatial filtering. The analysis included a priori regions of interest (ROI) of DMN main nodes-MPFC and PCC-Precuneus. There was no difference between groups in terms of: age, years of formal education, MMSE, BDI and IADL. The Yoga group had a higher correlation between MPFC and the right angular gyrus (AGr), compared to the controls. Elderly women with at least 8 years of yoga practice presented greater intra-network anteroposterior brain functional connectivity of the DMN. This finding may contribute to the understanding of the influences of practicing Yoga for a healthier cognitive aging process.

Yoga Training Has Positive Effects on Postural Balance and Its Influence on Activities of Daily Living in People with Multiple Sclerosis: A Pilot Study.

CONTEXT: There is a little evidence about the influence of yoga as a complementary therapy for postural balance and its influence on activities of daily living in multiple sclerosis (MS) patients. OBJECTIVE: To evaluate the influence of a six-month yoga program on postural balance and subjective impact of postural balance impairment on activities of daily living in people with MS. DESIGN: Randomized controlled pilot study. SETTING: Protocol developed at the Adaptive Physical Activity Study Department, College of Physical Education, State University of Campinas, Brazil. SUBJECTS: A total of 12 (11 women) yoga naive people with MS randomly divided into two groups as follows: Control (C-waiting list, n = 6) and Yoga (Y-Yoga training, n = 6). INTERVENTIONS: Yoga group practiced postures, breathing exercises, meditation, and relaxation on weekly 60-min classes for a six-month period. MAIN OUTCOME MEASURES: The following evaluations were performed at study entry (baseline), and after six months (six months): Berg Balance Scale (BBS), Expanded Disability Status Scale (EDSS), and self-reported postural balance quality and influence of postural balance on activities of daily living. RESULTS: There was a significant improvement in BBS score from baseline to six months only in the Yoga group, especially in subjects with higher EDSS score, with increased quality of self-reported postural balance, and decreased influence of postural balance impairment on activities of daily living. In conclusion, a six-month yoga training is beneficial for people with MS, since it improves postural balance and decreases the influence of postural balance impairment on activities of daily living. A greater sample size is necessary to increase generalization, but it seems that yoga could be included as a feasible complementary therapy for people with MS.

Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis.

OBJECTIVE: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, and children with DMD die prematurely because of respiratory failure. We sought to determine the efficacy and safety of yoga breathing exercises, as well as the effects of those exercises on respiratory function, in such children. METHODS: This was a prospective open-label study of patients with a confirmed diagnosis of DMD, recruited from among those followed at the neurology outpatient clinic of a university hospital in the city of São Paulo, Brazil. Participants were taught how to perform hatha yoga breathing exercises and were instructed to perform the exercises three times a day for 10 months. RESULTS: Of the 76 patients who entered the study, 35 dropped out and 15 were unable to perform the breathing exercises, 26 having therefore completed the study (mean age, 9.5 ± 2.3 years; body mass index, 18.2 ± 3.8 kg/m(2)). The yoga breathing exercises resulted in a significant increase in FVC (% of predicted: 82.3 ± 18.6% at baseline vs. 90.3 ± 22.5% at 10 months later; p = 0.02) and FEV1 (% of predicted: 83.8 ± 16.6% at baseline vs. 90.1 ± 17.4% at 10 months later; p = 0.04). CONCLUSIONS: Yoga breathing exercises can improve pulmonary function in patients with DMD.

Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis / Efeitos de exercícios respiratórios de ioga na função pulmonar de pacientes com distrofia muscular de Duchenne: uma análise exploratória

OBJECTIVE: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, and children with DMD die prematurely because of respiratory failure. We sought to determine the efficacy and safety of yoga breathing exercises, as well as the effects of those exercises on respiratory function, in such children. METHODS: This was a prospective open-label study of patients with a confirmed diagnosis of DMD, recruited from among those followed at the neurology outpatient clinic of a university hospital in the city of São Paulo, Brazil. Participants were taught how to perform hatha yoga breathing exercises and were instructed to perform the exercises three times a day for 10 months. RESULTS: Of the 76 patients who entered the study, 35 dropped out and 15 were unable to perform the breathing exercises, 26 having therefore completed the study (mean age, 9.5 ± 2.3 years; body mass index, 18.2 ± 3.8 kg/m2). The yoga breathing exercises resulted in a significant increase in FVC (% of predicted: 82.3 ± 18.6% at baseline vs. 90.3 ± 22.5% at 10 months later; p = 0.02) and FEV1 (% of predicted: 83.8 ± 16.6% at baseline vs. 90.1 ± 17.4% at 10 months later; p = 0.04). CONCLUSIONS: Yoga breathing exercises can improve pulmonary function in patients with DMD. .

OBJETIVO: A distrofia muscular de Duchenne (DMD) é a forma mais comum de distrofia muscular em crianças, e crianças com DMD morrem prematuramente por causa de insuficiência respiratória. Analisamos a eficácia e segurança de exercícios respiratórios de ioga nessas crianças, bem como os efeitos desses exercícios em sua função respiratória. MÉTODOS: Estudo prospectivo aberto envolvendo pacientes com diagnóstico confirmado de DMD recrutados no ambulatório de neurologia de um hospital universitário em São Paulo (SP). Os participantes aprenderam exercícios respiratórios de hatha ioga e foram instruídos a praticá-los três vezes ao dia durante 10 meses. RESULTADOS: Dos 76 pacientes incluídos no estudo, 35 o abandonaram e 15 não conseguiram realizar os exercícios respiratórios, de modo que 26 pacientes completaram o estudo (média de idade: 9,5 ± 2,3 anos; índice de massa corporal: 18,2 ± 3,8 kg/m2). Os exercícios respiratórios de ioga resultaram em um aumento significativo da CVF em porcentagem do previsto (82,3 ± 18,6% antes do início do programa de exercícios vs. 90,3 ± 22,5% 10 meses depois; p = 0,02) e do VEF1 em porcentagem do previsto (83,8 ± 16,6% antes do início do programa de exercícios vs. 90,1 ± 17,4% 10 meses depois; p = 0,04). CONCLUSÕES: Os exercícios respiratórios de ioga podem melhorar a função pulmonar de pacientes com DMD. .

Efeitos da intervenção Hatha-Yoga nos níveis de estresse e ansiedade em mulheres mastectomizadas / The effects of hatha yoga exercises on stress and anxiety levels in mastectomized women

O objetivo deste artigo é avaliar os efeitos da Hatha-Yoga nos níveis de estresse e ansiedade de mulheres mastectomizadas, bem como examinar a relação destes níveis com as variáveis: idade, estado civil, religião, escolaridade, profissão, tabagismo, etilismo, estadiamento da doença e fase de tratamento. Trata-se de um ensaio clínico aleatorizado controlado cuja amostra foi constituída por 45 mulheres mastectomizadas atendidas no Ambulatório Ilza Bianco do Hospital Santa Rita de Cássia, Espírito Santo, Brasil, de março a novembro de 2010. O grupo experimental participou de 6 intervenções aplicadas individualmente com incentivo para a prática domiciliar e foi reavaliado após esse período, enquanto o grupo controle foi reavaliado em período proporcional. Para o estudo das variáveis, foi utilizada a técnica de entrevista com registro em formulário, os Inventários de Ansiedade Traço e Estado e o Sinais e Sintomas de Stress. Para o tratamento estatístico foi utilizado o Pacote Estatístico para Ciências Sociais. Os dados encontrados são estatisticamente significantes e demonstraram que a intervenção Hatha-Yoga diminuiu o estresse e a ansiedade no grupo experimental. Não foi encontrada relação das variáveis de confundimento com os níveis de ansiedade e estresse.

This article seeks to evaluate the effects of hatha yoga on stress and anxiety levels in mastectomized women. It also investigates the relationship between these levels with the following variables: age; marital status; religion; instruction; profession; smoke addiction; elitism; staging of the disease; and treatment phase. This involved controlled random clinical trial sampling of 45 mastectomized women treated at the Ilza Bianco outpatient service of Santa Rita de Cássia Hospital in the Brazilian state of Espírito Santo from March to November 2010. The experimental group participated in 6 individually-applied sessions with incentive for ongoing home practice and was re-evaluated after the period, whereas the control group was re-evaluated after a proportional period. For the study of the variables, the interview and recording on a form technique was used, along with the Anxiety Trait and State Test, and the Stress Symptoms and Signs Test. For statistical treatment, the Statistical Pack for Social Sciences was used. The data are statistically significant and have shown that hatha yoga exercises decrease stress and anxiety in the experimental group. No connection between confounding variables and anxiety and stress levels was found.

[The effects of hatha yoga exercises on stress and anxiety levels in mastectomized women]. / Efeitos da intervenção Hatha-Yoga nos níveis de estresse e ansiedade em mulheres mastectomizadas.

This article seeks to evaluate the effects of hatha yoga on stress and anxiety levels in mastectomized women. It also investigates the relationship between these levels with the following variables: age; marital status; religion; instruction; profession; smoke addiction; elitism; staging of the disease; and treatment phase. This involved controlled random clinical trial sampling of 45 mastectomized women treated at the Ilza Bianco outpatient service of Santa Rita de Cássia Hospital in the Brazilian state of Espírito Santo from March to November 2010. The experimental group participated in 6 individually-applied sessions with incentive for ongoing home practice and was re-evaluated after the period, whereas the control group was re-evaluated after a proportional period. For the study of the variables, the interview and recording on a form technique was used, along with the Anxiety Trait and State Test, and the Stress Symptoms and Signs Test. For statistical treatment, the Statistical Pack for Social Sciences was used. The data are statistically significant and have shown that hatha yoga exercises decrease stress and anxiety in the experimental group. No connection between confounding variables and anxiety and stress levels was found.

Análise da amplitude de movimento dos ombros antes e após a intervenção Hatha-Yoga em mulheres mastectomizadas / Survey over shoulders' movement amplitude in mastectomyzed women before and after Hatha-Yoga intervention

Introdução: Diversos benefícios decorrentes da intervenção Hatha-Yoga às mulheres mastectomizadastêm sido estudados, mas não há exploração dos ganhos obtidos na recuperação da amplitude demovimento dos ombros (ADM) dessas mulheres. Objetivos: Observar a ADM dos ombros homolaterais(OHL) e contralaterais (OCL) à cirurgia das mulheres mastectomizadas, antes e após a intervençãoHatha-Yoga. Método: Trata-se de um ensaio piloto randomizado e controlado, em 45 mulheresmastectomizadas, atendidas no Hospital Santa Rita de Cássia (HSRC), em Vitória (ES), Brasil, entremarço e novembro de 2010. Todas as voluntárias foram submetidas à avaliação inicial da ADM deflexão, extensão, abdução e adução horizontal nos OHL e OCL à cirurgia. O grupo experimental participoude 6 intervenções e foi reavaliado após esse período, enquanto o grupo controle foi reavaliadoem período proporcional. Resultados: Houve melhora significativa na ADM dos OHL nos 2 gruposna flexão e abdução, enquanto a adução e abdução não tiveram comprometimentos tão expressivos.Conclusão: Os resultados não demonstraram a relevância da intervenção Hatha-Yoga na melhora daADM das mulheres mastectomizadas. Sugerimos estudos com maior amostra e com maior período detempo a fim de avaliar melhor os efeitos musculoesqueléticos dessa intervenção nessa população.

Introduction: Several benefits of Hatha-Yoga in mastectomized women have been assessed, although withoutinquiring about the gains obtained after the recovery of their shoulders’ movement amplitude (SMA). Objectives:To observe SMA in homolateral (HLS) and contralateral shoulders (CLS) after surgery, both before andafter Hatha-Yoga intervention. Method: Controlled, randomized pilot-survey in 45 mastectomyzed women,assisted in the Hospital Santa Rita de Cássia (HSRC), in the state of Vitória (ES), Brazil, from March toNovember, 2010. All subjects underwent initial evaluation of SMA for flexion, extension, abdution and horizontaladduction in HLS and CLS to the surgery’s spot. The experimental group underwent 6 interventionsand was reevaluated thereafter, whereas control group was reevaluated after a corresponding period. Results:In both groups, HLS for flexion and abduction improved significantly, whilst neither abduction nor horizontaladduction were severely impaired. Conclusion: The results did not demonstrate the relevance of Hatha-Yogaintervention over the recovery of the mastectomized women. Surveys over a wider sample, during a longerperiod, are suggested in order to better evaluate the muscular effects of such intervention in that population..

Efeitos do treinamento em técnica respiratória do ysobre a função pulmonar, a variabilidade da freqüência cardíaca, a qualidade de vida, a qualidade de sono e os sintomas de estresse em idosos saudáveis / Efects of a yoga respiratory technic training on respiratory function, heart rate variability, quality of life, quality of sleep, and stress symptoms in healthy elderly subjects

Introdução: O envelhecimento está associado com a diminuição de uma série de funções, incluindo a função pulmonar, a variabilidade da freqüência cardíaca, o barorreflexo espontâneo, a qualidade de vida e de sono, assim como com o aumento de níveis de estresse. Estudos recentes sugerem que os exercícios respiratórios do Yoga podem melhorar as funções respiratória e cardiovascular, além de aumentar a qualidade de vida e de sono e reduzir os sintomas de estresse em populações de pacientes com doença pulmonar. A hipótese testada no presente trabalho é de que o treinamento respiratório do Yoga pode melhorar a função respiratória, a variabilidade da freqüência cardíaca, a qualidade de vida e de sono e os sintomas de estresse de idosos saudáveis. Objetivo: Investigar os efeitos do treinamento de técnica respiratória do Yoga na função pulmonar, na variabilidade da freqüência cardíaca e no barorreflexo espontâneo, assim como na qualidade de vida, na qualidade de sono e nos sintomas de estresse de idosos saudáveis. Métodos: Vinte e nove voluntários idosos saudáveis (idade: 68±6 anos, homens: 34%, índice de massa corporal=25±3 kg/m2) foram aleatorizados para 4 meses de treinamento constituído por 2 aulas/semana, acrescidas de exercícios em casa 2 vezes por dia de alongamento (Controle, n=14) ou exercícios respiratórios (Yoga, n=15). Os exercícios respiratórios do Yoga (bhastrika) são constituídos de uma seqüência de exercícios que se iniciam por expirações rápidas e forçadas (kapalabhati), seguidas por inspiração pela narina direita, apnéia inspiratória com a geração de pressão negativa intratorácica e expiração pela narina esquerda (surya bedhana). Foram realizadas medidas de função pulmonar, pressões expiratória e inspiratória máximas (PEmax e PImax, respectivamente), variabilidade da freqüência cardíaca e da pressão arterial para a determinação do barorreflexo espontâneo no início do estudo (basal) e ao final, após 4 meses de treinamento (4 meses). Também foram...

Introduction: Aging is associated with a decline of many functions, including pulmonary function, heart rate variability, spontaneous baroreflex, quality of life, quality of sleep, and with the increase of stress symptoms. Recent studies suggest that Yoga respiratory exercises may improve respiratory and cardiovascular function, increase quality of life, quality of sleep and decrease stress symptoms in patients with pulmonary disease. The hypothesis tested in the present study is that Yoga respiratory training may improve respiratory function, heart rate variability, quality of life, quality of sleep and stress symptoms in healthy elderly subjects. Objective: To investigate the effects of a respiratory Yoga training on respiratory function, heart rate variability and spontaneous baroreflex, as well as on quality of life, quality of sleep and stress symptoms in healthy elderly subjects. Methods: Twenty-nine healthy elderly volunteers (age: 68±6 years, males: 34%, body mass index=25±3 kg/m2) were randomized into a 4-month training program composed of 2 classes/week plus home exercises twice a day of either stretching (Control, n=14) or respiratory exercises (Yoga, n=15). Yoga respiratory exercises (bhastrika) are composed by a sequence of exercises which begins with rapid forced expirations (kapalabhati), followed by inspiration through the right nostril, inspiratory apnoea with generation of intrathoracic negative pressure, and expiration through the left nostril (surya bedhana). Pulmonary function test, maximum expiratory and inspiratory pressures (PEmax and PImax, respectively), heart rate and blood pressure variability for spontaneous baroreflex determination were measured at baseline and after 4 months. Quality of life, quality of sleep, and stress symptoms questionnaires were also applied in the beginning and at the end of the study. Results: Subjects from both groups were similar for demographic parameters. Physiological variables did not change...

Aftereffects of exercise and relaxation on blood pressure.

OBJECTIVE: To study the acute aftereffects of exercise and relaxation, performed alone and in combination, on blood pressure (BP) measured at baseline and during stressful conditions. DESIGN: Clinical trial with comparison of groups and repeated measures in each group. SETTING: Exercise Hemodynamic Laboratory, University of São Paulo, Brazil. PARTICIPANTS: Fourteen normotensive (NT) and 16 essential hypertensive (HT) subjects. INTERVENTIONS: Four random experimental sessions: relaxation (RX-20 min); exercise [EX-cycle ergometer, 53 min, 50% peak oxygen uptake (VO2peak)]; exercise plus relaxation (EX+RX); and control (C-73 min rest). Measures were taken before and after interventions at baseline and during Stroop color test. MAIN OUTCOME MEASURES: Auscultatory and plesthysmographic BPs. RESULTS: Systolic and diastolic BPs decreased significantly after all the interventions. The decreases in both BPs were significantly greater after the EX+RX session, and were also greater in the HT (EX+RX session, -10+/-1/-7+/-1 and -15+/-2/-8+/-1 mm Hg for the NT and HT, respectively). During mental stress, systolic BP increased significantly and similarly after all the experimental sessions. Diastolic BP also increased significantly during stress; however, the increase was significantly greater after the RX session. At the end of the mental stress, diastolic BP was significantly lower after the EX (74+/-3 mm Hg) and EX+RX (72+/-3 mm Hg) sessions than after the C (79+/-3 mm Hg) and RX (78+/-3 mm Hg) sessions. CONCLUSIONS: In NT and HT subjects, a single bout of exercise or relaxation has hypotensive effects, further enhanced by their combination, and greater in the HT. Moreover, exercise performed alone or in combination with relaxation decreases systolic and diastolic BPs during mental stress.