A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial.

BACKGROUND: Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. OBJECTIVE: To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. MATERIALS AND METHODS: Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. RESULTS: Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. CONCLUSION: Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.

Geriatric rehabilitation and resilience from a cultural perspective.

Resiliency is a key aspect to aging successfully. Promoting healthy lifestyles, strong social bonds, enhancements to one's environment, accessibility to quality care and rehabilitation are critical in a positive aging experience. Issues of personal, social, medical, and rehabilitative care are addressed in the context of resiliency from a cultural perspective. Various research studies explore resiliency through the progression of aging within changing environments, medical needs, and social conditions. Findings suggest that a strong connection to culture, accessibility to medical attention, and comprehensive assessment of a patient's background can effectively improve the rehabilitation for an aging individual. This article addresses aspects of caregiving that are essential in raising cultural sensitivity and resiliency, discussing three case studies (i.e. fall risk; stroke; congestive heart failure) in the geriatric patient. Resiliency in culture and rehabilitation has a connection needed to advance the quality of care and quality of life for an aging patient population.

Peripheral response to cervical or thoracic spinal manual therapy: an evidence-based review with meta analysis.

OBJECTIVES: Spinal manual therapy (SMT) is commonly used for treatment of musculoskeletal pain in the neck, upper back, or upper extremity. Some authors report a multi-system effect of SMT, including peripheral alterations in skin conductance and skin temperature, suggesting that SMT may initiate a sympathetic nervous system (SNS) response. The focus of this evidence-based review and meta-analysis is to evaluate the evidence of SNS responses and clinically relevant outcomes following SMT to the cervical or thoracic spine. METHODS: A SYSTEMATIC SEARCH USED THE TERMS: 'manual therapy', 'SMT', 'spinal manipulation', 'mobilization', 'SNS', 'autonomic nervous system', 'neurophysiology', 'hypoalgesia', 'pain pathophysiology', 'cervical vertebrae', 'thoracic vertebrae', 'upper extremity', and 'neurodynamic test'. Data were extracted and within-group and between-group effect sizes were calculated for outcomes of skin conductance, skin temperature, pain, and upper extremity range of motion (ROM) during upper limb neurodynamic tests (ULNTs). RESULTS: Eleven studies were identified. Statistically significant changes were seen with increased skin conductance, decreased skin temperature, decreased pain, and increased upper extremity ROM during ULNT. DISCUSSION: A mechanical stimulus at the cervical or thoracic spine can produce a SNS excitatory response (increased skin conductance and decreased skin temperature). Findings of reduced pain and increased ROM during ULNT provide support to the clinical relevance of SMT. This evidence points toward additional mechanisms underlying the therapeutic effect of SMT. The effect sizes are small to moderate and no long-term effects post-SMT were collected. Future research is needed to associate peripheral effects with a possible centrally-mediated response to SMT.

Rapid Conversion of a Group-Based Yoga Trial for Diverse Older Women to Home-Based Telehealth: Lessons Learned Using Zoom to Deliver Movement-Based Interventions.

This brief report describes the rapid conversion of a randomized trial of a Hatha-based yoga program for older women with urinary incontinence to a telehealth videoconference platform during the coronavirus disease 2019 (COVID-19) pandemic. Interim results demonstrate the feasibility of recruiting and retaining participants across a wide range of ages and ethnic backgrounds, but also point to potential obstacles and safety concerns arising from telehealth-based instruction. The investigators present lessons learned about the benefits and challenges of using telehealth platforms to deliver movement-based interventions and consider strategies to promote accessible and well-tolerated telehealth-based yoga programs for older and diverse populations. Clinical Trial Registration number: NCT03672461.

Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women.

OBJECTIVE: To determine if subjects maintained improvements in kyphosis, spinal extensor strength, and physical performance 1 year after a 12-week multidimensional group exercise program. DESIGN: Follow-up data compared with posttest outcome measures. SETTING: Outpatient academic medical center. PARTICIPANTS: Nineteen of the initial 21 women, ages 65 to 80, with thoracic kyphosis of 50 degrees or greater at the onset of the study completed follow-up testing. INTERVENTIONS: Initial intervention included multidimensional group exercise performed 2 times a week for 12 weeks, consisting of spinal extensor strengthening, flexibility exercises, and integrated spinal proprioception training. Subjects exercised independently during the following year. MAIN OUTCOME MEASURES: Primary measures at the 1-year follow-up were usual and best kyphosis. Secondary measures included spinal extensor strength, modified Physical Performance Test (PPT), and the Jug Test. RESULTS: Subjects maintained gains at the 1-year follow-up (P>.05). Best kyphosis improved by 3 degrees during the follow-up year (P=.022). There were no significant declines in usual kyphosis (P=.302), spinal extensor strength (P=.999), PPT (P=.087), and the Jug Test (P=.999) at follow-up. CONCLUSIONS: Hyperkyphotic women maintained gains in usual kyphosis, spinal extensor strength, and physical performance 1 year after a group exercise program. Improvement in best kyphosis in the year after the intervention was also observed. Detraining effects may be minimized by multidimensional exercises.

Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: the PRYSMS randomized controlled trial.

PURPOSE: Chronic stimulation and dysregulation of the neuroendocrine system by stress may cause metabolic abnormalities. We estimated how much cortisol and psychosocial outcomes improved with a restorative yoga (relaxation) versus a low impact stretching intervention for individuals with the metabolic syndrome. METHODS: We conducted a 1-year multi-center randomized controlled trial (6-month intervention and 6-month maintenance phase) of restorative yoga vs. stretching. Participants completed surveys to assess depression, social support, positive affect, and stress at baseline, 6 months and 12 months. For each assessment, we collected saliva at four points daily for three days and collected response to dexamethasone on the fourth day for analysis of diurnal cortisol dynamics. We analyzed our data using multivariate regression models, controlling for study site, medications (antidepressants, hormone therapy), body mass index, and baseline cortisol values. RESULTS: Psychosocial outcome measures were available for 171 study participants at baseline, 140 at 6 months, and 132 at 1 year. Complete cortisol data were available for 136 of 171 study participants (72 in restorative yoga and 64 in stretching) and were only available at baseline and 6 months. At 6 months, the stretching group had decreased cortisol at waking and bedtime compared to the restorative yoga group. The pattern of changes in stress mirrored this improvement, with the stretching group showing reductions in chronic stress severity and perseverative thoughts about their stress. Perceived stress decreased by 1.5 points (-0.4; 3.3, p=0.11) at 6 months, and by 2.0 points (0.1; 3.9, p=0.04) at 1 year in the stretching compared to restorative yoga groups. Post hoc analyses suggest that in the stretching group only, perceived increases in social support (particularly feelings of belonging), but not changes in stress were related to improved cortisol dynamics. CONCLUSIONS: We found significant decreases in salivary cortisol, chronic stress severity, and stress perception in the stretching group compared to the restorative yoga group. Group support during the interactive stretch classes may have contributed to these changes.

Restorative yoga and metabolic risk factors: the Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial.

AIMS: Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. METHODS: In 2009-2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-min group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-h glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. RESULTS: 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (-0.35 mmol/L vs. -0.03 mmol/L; p=0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. CONCLUSIONS: Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors.