The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial

Effects of exergaming and yoga on exercise capacity and physical and mental health in heart failure patients: a randomized sub-study

AIMS

This study aimed to explore effects of exergaming and medical yoga on exercise capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure.

METHODS AND RESULTS

A randomized sub-study with a 3-month intervention and outcomes measures at baseline, 3, 6, and 12 months. Participants were recruited from heart failure clinics in Sweden. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time.In total, 104 patients (37% women, mean age 71 ± 12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n = 35), medical yoga (n = 33), or an active control group (n = 36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming significantly improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at 3 months.

CONCLUSION

Both exergaming and medical yoga demonstrated positive impacts on outcomes when compared with a control group. Exergaming, characterized by its elevated physical intensity, exerted effects primarily on physical health, while medical yoga, as a mind-body intervention, exhibited influences on emotional well-being.

REGISTRATION

ClinicalTrial.gov: NCT01785121.

Functional Measures in Non-COPD Chronic Respiratory Diseases: A Systematic Review

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their measurement properties, their minimum clinically important differences, and their associations with CRD course-related events or prognosis in non-COPD CRD. Methods: Studies employing patient-reported or performance-based instruments to assess FP in non-COPD CRD were systematically identified in the PubMed, PEDro, Embase, and Cochrane Library databases. COPD-exclusive studies or those solely reporting exercise capacity tests were excluded. Examination focused on measurement properties and associations with CRD course-related events or prognosis. The risk of bias was evaluated using the COSMIN, Downs and Black, and PEDro checklists based on the study design. Results: A total of 216 studies across seven CRD categories [asthma, bronchiectasis, cystic fibrosis, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), pre-/post-lung-transplantation] from various study types were included. Thirty-three instruments were identified, with the SF-36 questionnaire's physical function domain being the most commonly used patient-reported tool. The 1 min sit-to-stand test was the most extensively studied performance-based measure, with its measurement properties frequently reported in non-COPD CRD studies. Associations with events were infrequently documented, primarily in ILD and PAH studies related to mortality. Conclusions: Despite the prevalent use of FP instruments, limited information exists concerning their measurement properties and clinical implications. This review furnishes a concise summary of available evidence, aiding informed clinical decisions when selecting FP tools for non-COPD CRD.

The effect of yoga on dyspnea, sleep, and quality of life in patients with bronchiectasis: A randomized controlled trial

BACKGROUND AND PURPOSE

Bronchiectasis is characterized by chronic cough, acute exacerbations, and excessive sputum production, along with symptoms such as shortness of breath and fatigue, which impair respiratory functions and quality of life. This study aims to investigate the effects of yoga on dyspnea, sleep quality, and overall quality of life in patients with bronchiectasis.

MATERIALS AND METHODS

Forty-eight participants with bronchiectasis were included in the study. The patients were randomly divided into two groups, the yoga group (n = 24) or control group (no placebo or sham intervention) (n = 24). The yoga group participated in a total of 24 sessions over 8 weeks, with three sessions per week. No intervention was performed on the patients in the control group. The Modified Medical Research Council (mMRC) questionnaire was used to assess patients' dyspnea level, and the Pittsburgh Sleep Quality Index (PSQI) and St. George's Respiratory Questionnaire (SGRQ) were used to assess sleep quality and health-related quality of life, respectively.

RESULTS

It was observed that the yoga intervention affected the intergroup change in dyspnea severity score over time (p < 0.05) (x̄yoga = 2.64-1.50 = 1.14; x̄control2.24-1.95 = 0.29). The decrease in the mean PSQI score of the yoga practice group (16.41-13.18 = 3.23) was significantly higher compared with the control group (14.90-14.57 = 0.33). Post-practice SGRQ activity scores were significantly different from pre-practice SGRQ activity scores. Similar to the change in SGRQ activity and symptom scores, the impact score also changed significantly over time (x̄yoga12.55-9.09 = 3.46; x̄control12-11.52 = 0.48).

CONCLUSION

The results indicate that yoga may have a positive effect on dyspnea, sleep, and quality of life in patients with bronchiectasis.

Breathing techniques to reduce symptoms in people with serious respiratory illness: a systematic review

BACKGROUND

In adults with serious respiratory illness, breathlessness is prevalent and associated with reduced health-related quality of life. The aim of this review was to assess the impact of breathing techniques on breathlessness in adults with serious respiratory illness.

METHODS

Electronic databases were searched to identify randomised controlled trials testing breathing techniques (techniques that aim to alter the respiratory pattern, excluding respiratory muscle training) in people with serious respiratory illness. The primary outcome was breathlessness and secondary outcomes were health-related quality of life and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.

RESULTS

73 randomised controlled trials were included with 5479 participants, most with COPD or asthma. Breathing exercises (pursed lip and/or diaphragmatic breathing) reduced breathlessness measured by the modified Medical Research Council scale compared to usual care (mean difference (MD) -0.40 points, 95% CI -0.70- -0.11, eight studies, n=323), although the effect did not exceed the minimal important difference. Yoga breathing also improved modified Medical Research Council score compared to usual care (MD -1.05 points, 95% CI -2.45-0.35, three studies, n=175). Breathing techniques consistently improved health-related quality of life in people with COPD and asthma on multiple health-related quality of life measures in comparison to usual care, with effects that generally exceeded the minimal important difference. No adverse events related to breathing techniques were reported.

CONCLUSION

Breathing techniques may improve breathlessness, and consistently improve health-related quality of life, in people with serious respiratory illness. These findings support the use of breathing exercises in the care of people with serious respiratory illness.

Who uses yoga and why? Who teaches yoga? Insights from a national survey in New Zealand

Introduction Globally, yoga has gained popularity as a health-promoting and disease-prevention discipline. The common health conditions prompting yoga use include musculoskeletal disorders, mental health conditions, asthma, fibromyalgia, arthritis, diabetes, and cancers. Although the therapeutic benefits of using yoga are well documented, little is known about the characteristics of yoga instructors (YIs) and yoga users (YUs) in New Zealand (NZ). Aim This paper seeks to profile the characteristics of NZ YIs and YUs and explore reasons for yoga use. Methods Online surveys for YIs and YUs were conducted to collect the sociodemographic characteristics of 84 YIs and 267 YUs. Descriptive statistics were used to determine trends. Results The surveys were conducted between September 2020 and February 2021. The YIs were predominantly female (87.1%) with mean ± s.d. years of practice of 9.8 ± 0.8 (95% CI: 8.2, 11.4). YUs were most commonly female (86%), of NZ European descent (63%), aged 45-64 years (56%), not married (52.5%), and with a university or higher education qualification (61.5%). They use yoga to alleviate chronic health conditions like back pain (18%), menopausal symptoms (14.5%), anxiety (13.5%) and depression (11.5%). Discussion Most YIs in NZ are females facilitating moderate-sized yoga classes. YUs in NZ are disproportionately NZ European, female, middle-aged and tertiary educated. They use yoga to help manage long-term conditions, including mental ill-health and musculoskeletal disorders. The study findings could inform health professionals regarding the utilisation of yoga in NZ. Further research is required to gain insights into yoga use.

Lifestyle interventions improving health-related quality of life: A systematic review and meta-analysis of randomized control trials

Lifestyle interventions have garnered significant research interest for their potential to enhance health-related quality of life (HRQoL). Understanding the impact of these interventions on various dimensions of HRQoL is crucial for effective healthcare strategies. This study aims to systematically review and meta-analyze the effects of lifestyle interventions on HRQoL in randomized control trials. A systematic search was conducted across five scientific databases, including PubMed, Web of Science, Scopus, the Cochrane Library, and gray literature, with a filter applied to include only English language publications. Study selection was carried out by two independent reviewers in several steps, including duplicate removal and eligibility evaluation for meta-analysis. Information extracted from the studies included authors, countries, study designs, target populations, ages, genders, number of participants, interventions, outcomes, and results. A total of 61 randomized control trials were included in this meta-analysis. The meta-analysis revealed that lifestyle interventions significantly improved healthrelated quality of life compared to control groups, with Hedges' g of 0.38 (95% CI 0.25-0.50, Z = 5.94; P < 0.001; I2 = 84.59%). This positive effect was consistently observed in patients with heart-related diseases and metabolic disorders. Meta-regression analysis indicated that lifestyle interventions had the most substantial impact on health-related quality of life in the 1-month follow-up period. Considering the cost-effectiveness of lifestyle interventions compared to other intervention types, they can benefit various patient groups. This systematic review contributes to health policy goals by advocating focused preventive strategies in alignment with the observed benefits of lifestyle interventions.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

Efficacy of Bhramari pranayama and Om chanting on asthma control, quality of life, and airway inflammation in asthmatic children: an open-label randomized controlled trial

OBJECTIVES

To explore the efficacy of combination of Bhramari pranayama and om chanting as an adjunct to standard pharmacological treatment on asthma control, quality of life, pulmonary function, and airway inflammation in asthmatic children.

METHODS

Children (n = 110; 8-15 years) with uncontrolled or partly controlled asthma were recruited from the Pediatric Chest Clinic of All India Institute of Medical Sciences, New Delhi. Eligible participants were randomized to either home-based online Bhramari pranayama and om chanting plus standard treatment (YI + ST) group, or standard treatment (ST) alone group. Primary outcome measures were 12-week change in level of asthma symptom control; asthma control questionnaire (ACQ) score, spirometry indices, impulse oscillometry parameters, and pediatric asthma quality of life questionnaire (PAQLQ) score. Secondary outcome was a change in fractional exhaled nitric oxide (FeNO) levels at 12 weeks. Beginning from the enrollment, every participant was evaluated at 0, 2, 6, and 12 weeks.

RESULTS

After 12 weeks of intervention, higher proportion (68.2%) of children were found to have controlled asthma symptoms in the YI + ST group as compared to ST group (38.5%) according to per protocol analysis (p = 0.03). When compared to ST group, children in YI + ST group showed significantly lower ACQ score, higher PAQLQ score and reduced FeNO levels. No significant changes were observed for the lung function parameters.

CONCLUSION

Children practicing Bhramari pranayama and om chanting for 12 weeks have better asthma symptom control, quality of life, and reduced airway inflammation than those taking standard pharmacotherapy alone.

Improvement in muscular strength, body flexibility and balance by yoɡasana and with reduced detraining effects by yoɡa breathing maneuvers: A non-randomized controlled study

BACKGROUND

Yoɡa was reported to have the potential to improve physical fitness. Its applications are being used by common persons for wellness, but literature on the training and detraining effects of components of yoga is scarce.

OBJECTIVES

To explore the potential of different proportions of yoga postures (Yogasana) and yoga breathing maneuvers (YBM), consisting of Pranayama and kriya, on muscular strength, flexibility, and balance in training and detraining management.

METHODS

ː 32 physically active male students, aged 20.5 ± 1.3 yrs, were divided into control (CG) and yoga group (YG). YG practiced yogasana, YBM, and dhyana for 45 min in each session for 6 days per week for 12 weeks. From 1st week to 6th week, they practiced yogasana in greater proportion. 7th week onwards YBM was inducted by increasing its duration and varieties. CG did not practice yoga. Back-leg strength (BLS), Hand Grip Strength (HGS), flexibility, and balance were recorded before, the 6th week and 12th weekend of training.

RESULTS

ː.In YG, the pre-training value of BLS was 110.8 ± 12.6 kg. It increased (2.3 %) to 113.3 ± 11.4 kg (p < 0.001) on the 6th weekend. On the 12th weekend, it further increased in lesser magnitude (0.4 %) to 113.7 ± 11 kg (p < 0.05) and the pattern of improvement was the same in other parameters, but in flexibility and balance its magnitude was greater (p < 0.001). CG did not show such changes.

CONCLUSIONS

ː Yogasana helps in the improvement of muscular strength, flexibility, and balance and YBM counteracts detraining effects in the absence of yogasana. Judiciously selected components of yoga/YBM may have applications in sports, occpational health and recuperative patients.

The effect of yoga on pulmonary function in patients with asthma: A meta-analysis

BACKGROUND

Asthma is one of the most common non-communicable diseases. Yoga with physical postures, breathing exercises, meditation, and relaxation may play an essential role in the complementary management of lower respiratory diseases. The study aimed to evaluate the impact of yoga (posture, breathing exercises, and meditation) on pulmonary function tests, asthma control tests, and health-related quality of adult asthmatic patients.

METHODS

MEDLINE, PubMed, Embase, Cochrane, Scopus, Google Scholar, ResearchGate, Clinical Key, and Academia electronic search engines were explored to search the relevant literature. The present study included adult asthmatic patients (age -18 and 60 years) with mild to moderate asthma, per GINA (Global Initiative for Asthma) guidelines. The effect of yoga was assessed on the following outcomes; pulmonary function tests, including FeV1 (Forced expiratory volume 1 s), FVC (Forced vital capacity), FeV1/FVC, peak expiratory flow rate (PEFR), health-related quality of life, and asthma control test. A fixed-effect model was applied to compute significance for statistical heterogeneity. P-value <0.05 was considered for statistical significance.

RESULTS

Finally, fifteen articles were included for meta-analysis. The forest plot for overall effect of yoga intervention and usual care favors the yoga intervention for improvement in pulmonary function as FeV1 (SMD = 0.96, CI = 0.77-1.14, I2 = 54%), FVC (SMD = 0.35, CI = 0.14-0.55, p = 0.11, I2 = 50%), Fev1/FVC (SMD = 0.18, CI = -0.38-0.02, p = 0.02, I2 = 50%), PEFR (SMD = 0.38, CI = 0.18-0.58, p = 0.0003, I2 = 0%), asthma control test (SMD = 0.16, CI = 0.15-0.48, p = 0.31, I2 = 86%) and health-related quality of life (SMD = 0.26, CI = 0.18-0.34, p = 0.02, I2 = 51%) of asthmatic patients.

CONCLUSION

This meta-analysis provides a moderate level of evidence regarding yoga as a complementary therapy in managing mild to moderate asthmatic patients. It also adds to the current knowledge of the same.

Effect of exercise intervention on lung function in asthmatic adults: a network meta-analysis

OBJECTIVE

Exercise has traditionally been viewed as a contraindication for individuals with asthma, as it was believed to trigger or worsen acute asthma attacks. However, with scientific and appropriate exercise training, it has been proven that respiratory function and exercise capacity can be effectively improved and enhanced in asthma patients. This study aimed to compare the effects of different types of exercise on pulmonary function in adult patients with asthma using Network Meta-analysis.

METHODS

We conducted a comprehensive search of electronic databases such as PubMed, Cochrane Library, Web of Science, CNKI for randomized controlled trials (RCTs) that investigated the effects of exercise on lung function in adult patients with asthma from inception to February 2023. Information including on first author, publication time, total sample size, intervention period, interventions, and outcome indicators were collected, and relevant statistical analyses were performed using Stata 17.0 software and Revman 5.4.

RESULTS

A total of 28 randomized controlled trials with 2,155 patients with asthma were finally included. The results of Network Meta-analysis showed that compared with control group, breathing training (BT)、aerobic training (AT)、relaxation training (RT)、yoga training (YG) and breathing combined with aerobic training (BT + AT) improved Forced Expiratory Volume in the first second (FEV1) levels; AT、BT、YG and BT + AT improved the level of Forced Vital Capacity (FVC); BT、AT、RT、YG and BT + AT improved Peak Expiratory Flow (PEF); BT、AT、and YG improved Forced Expiratory Volume in the first second/Forced Vital Capacity (FEV1/FVC).The results of SUCRA probability ranking showed that RT had the most significant effect on improving the FEV1[SMD = 1.13,95%CI(0.83,1.43), p<0.001] levels, BT + AT had the most significant effect on improving the FVC[SMD = 0.71,95%CI(0.47,0.95), p<0.001] level; YG had the most significant effect on improving the PEF[SMD = 0.79,95%CI(0.55,1.02), p<0.001] level.

CONCLUSIONS

BT + AT and YG may be more advantageous in improving lung function in adult asthmatics.

Transcriptional modulation of inflammation, and aging in Indian obese adults following a 12-week yoga-based lifestyle intervention: A randomized controlled trial

Introduction

Obesity is one of the major global problems in today's world, both in children, and the adult age group. Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. In recent times complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12 weeks of yoga-based lifestyle intervention with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.

Methods

This was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4, and 12 were collected from 72 adults (male n = 21; female n = 51) of age 20-45 years with a body-mass index (BMI) of 25-35 kg/m2 who were randomized to receive either a 12-week SC (n = 36) or YBLI (n = 36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were all part of the YBLI. Primary outcomes were relative fold change in the expression of genes associated with oxidative stress [Nuclear factor-kappa B (NF-Kappa B)], inflammation [Tumor necrosis factor-α (TNFα), interleukin-6 (IL-6)], and aging [human telomerase reverse transcriptase (TERT)] in peripheral blood mononuclear cells between the two groups at week-12.

Results

There were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p = <0.0001) vs the SC group at 2 weeks. The relative fold change of TNF α was significantly lower at week 12 in YBLI though the change was not continuous and reliable. Within both groups, TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p < 0.0001). TNF α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.

Conclusion

The results while did not confirm our hypothesis, are important to share with the scientific society, to be able to improve prospective study designs and find optimal time/intervention/biological marker settings for this highly important scientific field. The results are suggestive of a positive impact of YBLI and SC on the fold change of aging-related TERT gene in obesity, though the benefit was not evident till week 12. However, the results should be evaluated with caution and in light of other published studies. To better understand the positive effects of YBLI on oxidative stress, inflammation, and aging-related gene expression in obesity, larger studies are recommended.

Impact of yoga breathing and relaxation as an add-on therapy on quality of life, anxiety, depression and pulmonary function in young adults with bronchial asthma: A randomized controlled trial

BACKGROUND

The impact of combinations of yogic practices on bronchial asthma have been studied. Such yoga modules tend to be too lengthy for comfortable practice long-term, giving high dropouts. Returning to conventional medicine despite improvement is common. This study tested a shorter, easier yoga routine to improve asthma condition.

MATERIAL AND METHODS

Sixty young adults aged 18-30 years diagnosed with bronchial asthma of mild to moderate severity were randomly assigned to the Yoga Group, add-on yoga therapy and continuing prescribed medication, or the Control Group, continuing prescribed medication only. Measurements on days 0 and 90, included Asthma Quality of Life Questionnaire, Hamilton Anxiety Rating Scale, Beck's Depression Inventory and Pulmonary Function Tests. The yoga therapy module, practised 30 mins daily, included four kinds of yoga breathing practices, and ended with guided relaxation.

RESULTS

All Asthma Quality of Life subdomains improved greatly for the Yoga Group as did Hamilton Anxiety and Becks Depression Inventory scores, t statistics were high (40 -75), all p<.0001. Pulmonary Function also improved greatly in all variables, with smaller t statistics from 2 to 14. The Control Group showed some small improvements. Differences observed in scores were highly significant, with large effect sizes. Finally, no dropouts occurred.

DISCUSSION

Zero dropouts represents an unprecedented result. The yoga module was completely acceptable to participants, Yoga Group improvements were highly significant. The study indicates that the new yoga module effectively improves quality of life, levels of anxiety, depression and pulmonary function in young adults with above-stated bronchial asthma.

A 12-Week Yoga-Based Lifestyle Intervention Might Positively Modify Cellular Aging in Indian Obese Individuals: A Randomized-Controlled Trial

Background: Telomeres and telomerase are considered cardinal biomarkers of cellular aging. Shorter telomeres and low telomerase activity have been associated with obesity and accelerated aging. Objective: To compare the effects of a yoga-based lifestyle intervention (YBLI) with the standard of care (SOC) on cellular aging by estimating telomere length (TL) and telomerase activity in obesity. Design and setting: A parallel, two-arm, randomized-controlled trial was conducted at the Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi, from March 2017 to October 2019. Participants: Obese (n = 72), body mass index (BMI), 25-35 kg/m², aged 20-45 years, male (21), and female (51). Intervention: Seventy-two obese participants were randomized to receive either a 12-week SOC (n = 36) or YBLI (n = 36). SOC included management of obesity as per Indian guidelines including a hypocaloric individualized diet and physical activity. The pretested YBLI included asana (physical postures), pranayama (breathing exercises), and meditation. Methods: Blood samples were collected from both the groups at baseline, 2, 4, and 12 weeks. DNA was extracted from peripheral blood mononuclear cells. TL was measured by quantitative PCR, and serum telomerase levels by immunoassay. Outcome measures: Primary outcome measures were the changes in the TL and telomerase levels between the two groups at week 12. Secondary outcome measures were the changes in TL and telomerase, and anthropometric parameters (body weight, BMI, waist-to-hip ratio) at 2, 4, and 12 weeks of intervention in both SOC and YBLI groups. Results: There were no significant changes in TL and telomerase levels between the groups at week 12. The TL was significantly greater in the YBLI group versus the SOC group (p < 0.0001) at 2 weeks. The anthropometric and physiological parameters were influenced positively by both SOC and YBLI. Conclusion: The study did not meet the primary objective, although the results are suggestive of a positive impact of YBLI on aging in obesity as noted within the YBLI group. However, the results should be interpreted carefully, and in the light of other published data. Larger studies to better understand the possible positive benefits of YBLI on cellular aging are recommended. Clinical Trail Registration No. CTRI/2016/08/007136.

A systematic review of the characteristics of interventions that promote physical activity in adults with asthma

Physical activity is promoted in the asthma population through pulmonary rehabilitation, but limited funding and facilities are available. This review aimed to examine the effectiveness of interventions that promote physical activity and identify the behaviour change techniques (BCTs) and other intervention components used. Five databases were searched, and 25 studies met the inclusion criteria. Interventions had a significant positive effect on physical activity, sedentary behaviour, quality of life and asthma symptoms. BCTs used across intervention and control groups were similar in studies that showed effects and those that did not. Future interventions should employ techniques that help to maintain behaviour change.

Non-Invasive Measurement of Exercise-Induced Oxidative Stress in Response to Physical Activity. A Systematic Review and Meta-Analysis

Physical activity may benefit health by modulating oxidative stress and inflammation. However, the selection of suitable exercise-induced oxidative stress biomarkers is still challenging. This study aimed at systematically summarizing the available evidence on exercise-induced oxidative stress measured in urine and/or saliva. Two meta-analyses including the most frequently quantified biomarkers of oxidative stress, namely, urinary isoprostane and DNA oxidation products, were performed. Three electronic databases (PubMed, EMBASE and Cochrane CENTRAL) were interrogated. Among 4479 records, 43 original articles were included in the systematic review and 11 articles were included in meta-analysis I and II, respectively. We observed a pooled trend of increase of urinary isoprostanes in response to physical activity (+0.95, 95% CI: -0.18; 2.09). In comparison with aerobic exercise, anaerobic training determined a greater induction of isoprostanes (+5.21, 95% CI: 2.76; 7.66, p < 0.0001), which were markedly increased after vigorous physical activity (+6.01, 95% CI: 1.18; 10.84, p < 0.001) and slightly decreased in response to exercise interventions protracted over time (e.g., months) (-1.19, 95% CI: -2.25; -0.12, p < 0.001). We recommend the most integrative approach of oxidative stress multi-marker panels in response to physical activity instead of selecting one preferential biomarker to quantify physical activity-induced oxidative stress in humans.

Yoga Therapy as an Adjuvant in Management of Asthma

OBJECTIVE

To assess the effect of yoga on control of asthma in children with bronchial asthma.

METHODS

This hospital-based interventional randomized controlled trial conducted in the Department of Pediatrics at a tertiary care center of North India from November 2017 to October 2018 enrolled 140 newly diagnosed cases of asthma of age 10-16 y who were randomly divided into two groups. Seventy children in the case group practiced yoga under supervision for a period of 3 mo in addition to pharmacological treatment. Seventy controls received only pharmacological treatment. Pulmonary-function tests were done at baseline, 6 wk, and 12 wk along with quality of life (QOL) assessment by Pediatric Asthma Quality of Life Questionnaire (PAQLQ). The outcome measures assessed were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC and peak expiratory flow rate (PEFR). QOL evaluation was done in 3 domains: activity limitation, symptoms, and emotional function.

RESULTS

The asthmatic children practicing yoga have shown significant improvement in FVC, FEV1, FEV1/FVC and PEFR which was better as compared to controls. Improvement was also noted in mean-PAQLQ score in cases which was statistically significantly better as compared to controls.

CONCLUSION

Yoga appears to have significant positive effect on control of asthma measured by pulmonary-function test and QOL. Therefore yoga therapy can be recommended as an adjuvant in management of asthma along with standard pharmacological management.

Effects of yoga on pulmonary functions among asthmatic patients: A protocol synthesis

OBJECTIVE

This study aimed to synthesize protocol of yoga pranayama's practice through combining yoga pranayama's steps into the new integrated formations of yoga pranayama's steps for adult asthmatic patients as a protocol.

METHOD

Literature review from the last 20 years publication of original trial articles on adult asthmatic subjects from 4 databases: PubMed, Science Direct, EBSCO, and Scopus was conducted. Review and non-trial articles were excluded. Articles were appraised using Joanna Bridge Institute (JBI) critical appraisal tools.

RESULTS

There were 4 out of 252 articles which met the criteria and being included in this study. The synthesized protocol resulting 11 pranayama steps in the new synthesized protocol.

CONCLUSIONS

The regular 13 yoga pranayama steps within 11 pranayama steps based on synthesized protocol takes 30-45min for each session and can be conducted 2-5 times a week for 2-6 months to be able to reveal pulmonary function outcomes.

The effects of yoga on dyspnea, sleep and fatigue in chronic respiratory diseases

PURPOSE

This study was carried out to find out the effects of yoga applied to chronic respiratory disease patients on dyspnea, sleep quality and fatigue.

MATERIAL AND METHOD

The study was conducted between May and August 2020 as a randomized controlled study. 'Personal Information Form', 'Respiratory Functions Monitoring Form', 'COPD and Asthma Fatigue Scale (CAFS), "Asthma and COPD Sleep Impact Scale (CASIS)" and Modified Medical Research Council Dyspnea Scale (mMRC) were used in data collection.

RESULTS

When the post-test mean scores of the patients in the experimental and control group were compared, it was found that CAFS, CASIS and mMRC mean scores of the patients in the experimental group decreased positively compared to the patients in the control group and the difference between was found to be statistically significant (p < 0.05).

CONCLUSION

Yoga has been found to reduce the severity of dyspnea and fatigue and improve sleep quality in chronic respiratory diseases.

Asthma: New Integrative Treatment Strategies for the Next Decades

Asthma is a chronic disease whose main anatomical-functional alterations are grouped into obstruction, nonspecific bronchial hyperreactivity, inflammation and airway remodeling. Currently, the Global Initiative of Asthma 2020 (GINA 2020) suggests classifying it into intermittent cases, slightly persistent, moderately persistent and severely persistent, thus determining the correct guidelines for its therapy. In general, the drugs used for its management are divided into two groups, those with a potential bronchodilator and the controlling agents of inflammation. However, asthmatic treatments continue to evolve, and notable advances have been made possible in biological therapy with monoclonal antibodies and in the relationship between this disease and oxidative stress. This opens a new path to dietary and herbal strategies and the use of antioxidants as a possible therapy that supports conventional pharmacological treatments and reduces their doses and/or adverse effects. This review compiles information from different published research on risk factors, pathophysiology, classification, diagnosis and the main treatments; likewise, it synthesizes the current evidence of herbal medicine for its control. Studies on integrative medicine (IM) therapies for asthmatic control are critically reviewed. An integrative approach to the prevention and management of asthma warrants consideration in clinical practice. The intention is to encourage health professionals and scientists to expand the horizons of basic and clinical research (preclinical, clinical and integrative medicine) on asthma control.

The Impact of Environmental Chronic and Toxic Stress on Asthma

Several factors have been associated with the development of asthma and asthma-related morbidity and mortality. Exposures in the environment such as allergens and air pollutants have traditionally been linked to the risk of asthma and asthma outcomes. More recent literature has identified chronic psychosocial stress as an additional environmental exposure to consider in relation to asthma. Adverse childhood events (ACEs) and chronic and toxic stress have been associated with chronic diseases such as cardiovascular disease, cancer, and chronic obstructive pulmonary disease. Chronic stress has also been shown to result in biological changes such as expression of immunologic genes, changes in expression of the beta-adrenergic (B2AR) and the glucocorticoid receptor (GR-α) genes, cytokine regulation, and alterations in the hypothalamic pituitary axis and cortisol levels which all may affect asthma pathophysiology and therapeutic response among patients exposed to chronic stress. Recent research has revealed associations between ACEs and chronic and toxic stress and asthma risk in pre-conception to early childhood as well as morbidity and response to asthma treatments among pediatric and adult age groups. As some populations are more significantly impacted by asthma such as racial and ethnic minority groups, the influence of psychosocial stress has also been explored as a potential factor responsible for observed disparities in asthma prevalence and outcomes among these groups which also experience higher rates of psychosocial stress. Racial discrimination has specifically been shown to affect asthma-related outcomes among minority groups. Interventions to address the impact of chronic and toxic stress such as yoga and meditation have been shown to improve asthma outcome measures. Chronic and toxic stress is an important environmental exposure to further consider as we continue to explore the differences in underlying asthma pathophysiology leading to various disease phenotypes among patients and clinical/therapeutic response to interventions and treatments.

Breathing exercises for adults with asthma

BACKGROUND

Breathing exercises have been widely used worldwide as a non-pharmacological therapy to treat people with asthma. Breathing exercises aim to control the symptoms of asthma and can be performed as the Papworth Method, the Buteyko breathing technique, yogic breathing, deep diaphragmatic breathing or any other similar intervention that manipulates the breathing pattern. The training of breathing usually focuses on tidal and minute volume and encourages relaxation, exercise at home, the modification of breathing pattern, nasal breathing, holding of breath, lower rib cage and abdominal breathing.

OBJECTIVES

To evaluate the evidence for the efficacy of breathing exercises in the management of people with asthma.

SEARCH METHODS

To identify relevant studies we searched The Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL and AMED and performed handsearching of respiratory journals and meeting abstracts. We also consulted trials registers and reference lists of included articles. The most recent literature search was on 4 April 2019.

SELECTION CRITERIA

We included randomised controlled trials of breathing exercises in adults with asthma compared with a control group receiving asthma education or, alternatively, with no active control group.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study quality and extracted data. We used Review Manager 5 software for data analysis based on the random-effects model. We expressed continuous outcomes as mean differences (MDs) with confidence intervals (CIs) of 95%. We assessed heterogeneity by inspecting the forest plots. We applied the Chi2 test, with a P value of 0.10 indicating statistical significance, and the I2 statistic, with a value greater than 50% representing a substantial level of heterogeneity. The primary outcome was quality of life.

MAIN RESULTS

We included nine new studies (1910 participants) in this update, resulting in a total of 22 studies involving 2880 participants in the review. Fourteen studies used Yoga as the intervention, four studies involved breathing retraining, one the Buteyko method, one the Buteyko method and pranayama, one the Papworth method and one deep diaphragmatic breathing. The studies were different from one another in terms of type of breathing exercise performed, number of participants enrolled, number of sessions completed, period of follow-up, outcomes reported and statistical presentation of data. Asthma severity in participants from the included studies ranged from mild to moderate, and the samples consisted solely of outpatients. Twenty studies compared breathing exercise with inactive control, and two with asthma education control groups. Meta-analysis was possible for the primary outcome quality of life and the secondary outcomes asthma symptoms, hyperventilation symptoms, and some lung function variables. Assessment of risk of bias was impaired by incomplete reporting of methodological aspects of most of the included studies. We did not include adverse effects as an outcome in the review. Breathing exercises versus inactive control For quality of life, measured by the Asthma Quality of Life Questionnaire (AQLQ), meta-analysis showed improvement favouring the breathing exercises group at three months (MD 0.42, 95% CI 0.17 to 0.68; 4 studies, 974 participants; moderate-certainty evidence), and at six months the OR was 1.34 for the proportion of people with at least 0.5 unit improvement in AQLQ, (95% CI 0.97 to 1.86; 1 study, 655 participants). For asthma symptoms, measured by the Asthma Control Questionnaire (ACQ), meta-analysis at up to three months was inconclusive, MD of -0.15 units (95% CI -2.32 to 2.02; 1 study, 115 participants; low-certainty evidence), and was similar over six months (MD -0.08 units, 95% CI -0.22 to 0.07; 1 study, 449 participants). For hyperventilation symptoms, measured by the Nijmegen Questionnaire (from four to six months), meta-analysis showed less symptoms with breathing exercises (MD -3.22, 95% CI -6.31 to -0.13; 2 studies, 118 participants; moderate-certainty evidence), but this was not shown at six months (MD 0.63, 95% CI -0.90 to 2.17; 2 studies, 521 participants). Meta-analyses for forced expiratory volume in 1 second (FEV1) measured at up to three months was inconclusive, MD -0.10 L, (95% CI -0.32 to 0.12; 4 studies, 252 participants; very low-certainty evidence). However, for FEV1 % of predicted, an improvement was observed in favour of the breathing exercise group (MD 6.88%, 95% CI 5.03 to 8.73; five studies, 618 participants). Breathing exercises versus asthma education For quality of life, one study measuring AQLQ was inconclusive up to three months (MD 0.04, 95% CI -0.26 to 0.34; 1 study, 183 participants). When assessed from four to six months, the results favoured breathing exercises (MD 0.38, 95% CI 0.08 to 0.68; 1 study, 183 participants). Hyperventilation symptoms measured by the Nijmegen Questionnaire were inconclusive up to three months (MD -1.24, 95% CI -3.23 to 0.75; 1 study, 183 participants), but favoured breathing exercises from four to six months (MD -3.16, 95% CI -5.35 to -0.97; 1 study, 183 participants).

AUTHORS' CONCLUSIONS

Breathing exercises may have some positive effects on quality of life, hyperventilation symptoms, and lung function. Due to some methodological differences among included studies and studies with poor methodology, the quality of evidence for the measured outcomes ranged from moderate to very low certainty according to GRADE criteria. In addition, further studies including full descriptions of treatment methods and outcome measurements are required.

The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: A randomized controlled study

AIM

This study was conducted to find out the effect of yoga applied to asthma patients on the patients' respiratory functions, symptom control and quality of life.

METHODS

The sample of the study consisted of a total of randomly chosen 112 asthma patients, 56 in the experimental group and 56 in the control group, who met the research criteria and who agreed to participate in the study. A total of 12 yoga sessions, 2 sessions a week for 6 weeks, was applied to the patients in the experimental group. The patients in the control group did not receive any intervention.

RESULTS

In the intragroup comparison of average pre-test and post-test scores of respiratory function and Asthma Control Test (ACT) and Asthma Quality of Life Scale (AQLQ) total and sub-dimension scores of the patients in the experimental and control group, the difference was found to be statistically significant (p < 0.05). In addition, post-test score averages were found to increase in the experimental group, while they were found to decrease in the control group.

CONCLUSION

It was found that yoga influenced respiratory functions, symptom control and quality of life positively in asthma patients. The clinical trial registration number is NCT04107415/https://clinicaltrials.gov/ct2/show/NCT04107415.

Effect of pranayama breathing technique on asthma control, pulmonary function, and quality of life: A single-blind, randomized, controlled trial

OBJECTIVE

This study evaluated the effect of pranayama on asthma control, pulmonary function, and quality of life in people with asthma.

METHODS

Pranayama was applied to the pranayama group for 20 min once daily for 1 month, and relaxation was applied to the relaxation group similarly in addition to the standard treatment. The outcome measurement tools used were the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), pulmonary function test (PFT), and patient observation chart.

RESULTS

The pranayama group had significantly higher ACT score, overall AQLQ score, and subscale scores than the relaxation group (p < 0.05). However, there was no significant difference between the groups in terms of PFT parameters and peak expiratory flow values (p > 0.05).

CONCLUSION

Pranayama improved asthma control and asthma-related quality of life in people with asthma, but it did not show a significant difference in PFT values.

Behavioral interventions for asthma self-management in South Asian populations: a systematic review

OBJECTIVE

Asthma outcomes are significantly worse for minority groups, including South Asians (SAs), in high-income settings. Despite this, comparatively few existing studies have focused on SAs when studying the effectiveness of behavioral interventions on asthma self-management, and no prior study has synthesized these findings. We review the effectiveness of behavioral interventions on asthma management in adults and children of SA origin across low- (LICs), middle- (MICs), and high-income countries (HICs).

METHODS

Data sources included EMBASE, MEDLINE, Cochrane Library and Trial registries: WHO, ICTRP and ClinicalTrials.gov. Eligibility criteria: randomized controlled trials (RCTs), quasi-RCTs and non-RCTs (controlled before-after [CBA] studies), published in English, with no publication year or country restrictions in adults and children of South Asian origin. Exclusion criteria: those focusing solely on pharmacological interventions. Search terms were "asthma" and "South Asian".

RESULTS

We included 33 studies, 27 from MICs and 6 from HICs (education [n = 10], self-management plans [n = 6], yoga/breathing exercises [n = 10]) organizational interventions [n =1], diet therapy [n = 1] and combined interventions [n = 5]). Outcome measures included: blood biochemistry, lung function, healthcare utilization and quality of life. A meta-analysis was not performed due to significant study heterogeneity.

CONCLUSION

Behavioral interventions for asthma management in SAs are effective. Educational interventions that aim to optimize asthma knowledge, control, and inhaler technique, and yoga/breathing exercises are most effective for improved long-term outcomes in adults and children across LICs and MICs. Further research is needed to evaluate the effectiveness of all behavioral interventions for SAs in HICs to better inform current guidance by policy makers and health care providers.

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.

Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction

Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to patients and athletes with EIB.

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.

Impact of Yoga and Meditation on Cellular Aging in Apparently Healthy Individuals: A Prospective, Open-Label Single-Arm Exploratory Study

This study was designed to explore the impact of Yoga and Meditation based lifestyle intervention (YMLI) on cellular aging in apparently healthy individuals. During this 12-week prospective, open-label, single arm exploratory study, 96 apparently healthy individuals were enrolled to receive YMLI. The primary endpoints were assessment of the change in levels of cardinal biomarkers of cellular aging in blood from baseline to week 12, which included DNA damage marker 8-hydroxy-2'-deoxyguanosine (8-OH2dG), oxidative stress markers reactive oxygen species (ROS), and total antioxidant capacity (TAC), and telomere attrition markers telomere length and telomerase activity. The secondary endpoints were assessment of metabotrophic blood biomarkers associated with cellular aging, which included cortisol, β-endorphin, IL-6, BDNF, and sirtuin-1. After 12 weeks of YMLI, there were significant improvements in both the cardinal biomarkers of cellular aging and the metabotrophic biomarkers influencing cellular aging compared to baseline values. The mean levels of 8-OH2dG, ROS, cortisol, and IL-6 were significantly lower and mean levels of TAC, telomerase activity, β-endorphin, BDNF, and sirtuin-1 were significantly increased (all values p < 0.05) post-YMLI. The mean level of telomere length was increased but the finding was not significant (p = 0.069). YMLI significantly reduced the rate of cellular aging in apparently healthy population.

Assessment of significance of Yoga on quality of life in asthma patients: A randomized controlled study

Background:

Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath and a tight feeling in the chest. The current study is based on the effect of Yoga on quality of life in asthmatics in Northern India.

Materials and Methods:

A total of 300 participants of mild-to-moderate persistent asthma (FEV₁ >60%) aged between 12 and 60 years were recruited from the Department of Pulmonary Medicine. Their quality of life was assessed with the help of mini asthma quality-of-life questionnaire (AQLQ) at baseline and then after 3^rd and 6^th month from baseline. Forty-five participants were dropped out during the study while 255 participants completed the study successfully.

Results:

In “the Yoga group,” significant improvements were found in all the subdomains of AQLQ at 3^rd month and at 6^th month in comparison to “the control group.” The number needed to treat was found to be 2.67 for the total AQLQ score which was greater than the minimal important difference.

Conclusion:

“The Yoga group” got significantly better improvement in asthma quality-of-life scores than “the control group.” Thus, Yoga can be used as an adjuvant therapy in the management of asthma.

Yoga Therapy in Children with Cystic Fibrosis Decreases Immediate Anxiety and Joint Pain

This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7-20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p < 0.001). Joint pain improved (3.25 to 3.65, p = 0.028). CFQ-R emotion subscale improved from 79.2 to 85 (p = 0.073), and the respiratory subscale improved from 66.7 to 79.2 (p = 0.076). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.

Yoga for asthma

BACKGROUND

Asthma is a common chronic inflammatory disorder affecting about 300 million people worldwide. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally. A number of clinical trials have been carried out to evaluate the effects of yoga practice, with inconsistent results.

OBJECTIVES

To assess the effects of yoga in people with asthma.

SEARCH METHODS

We systematically searched the Cochrane Airways Group Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched PEDro. We searched ClinicalTrials.gov and the WHO ICTRP search portal. We searched all databases from their inception to 22 July 2015, and used no restriction on language of publication. We checked the reference lists of eligible studies and relevant review articles for additional studies. We attempted to contact investigators of eligible studies and experts in the field to learn of other published and unpublished studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared yoga with usual care (or no intervention) or sham intervention in people with asthma and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events.

DATA COLLECTION AND ANALYSIS

We extracted bibliographic information, characteristics of participants, characteristics of interventions and controls, characteristics of methodology, and results for the outcomes of our interest from eligible studies. For continuous outcomes, we used mean difference (MD) with 95% confidence interval (CI) to denote the treatment effects, if the outcomes were measured by the same scale across studies. Alternatively, if the outcomes were measured by different scales across studies, we used standardised mean difference (SMD) with 95% CI. For dichotomous outcomes, we used risk ratio (RR) with 95% CI to measure the treatment effects. We performed meta-analysis with Review Manager 5.3. We used the fixed-effect model to pool the data, unless there was substantial heterogeneity among studies, in which case we used the random-effects model instead. For outcomes inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and summarised the findings narratively.

MAIN RESULTS

We included 15 RCTs with a total of 1048 participants. Most of the trials were conducted in India, followed by Europe and the United States. The majority of participants were adults of both sexes with mild to moderate asthma for six months to more than 23 years. Five studies included yoga breathing alone, while the other studies assessed yoga interventions that included breathing, posture, and meditation. Interventions lasted from two weeks to 54 months, for no more than six months in the majority of studies. The risk of bias was low across all domains in one study and unclear or high in at least one domain for the remainder.There was some evidence that yoga may improve quality of life (MD in Asthma Quality of Life Questionnaire (AQLQ) score per item 0.57 units on a 7-point scale, 95% CI 0.37 to 0.77; 5 studies; 375 participants), improve symptoms (SMD 0.37, 95% CI 0.09 to 0.65; 3 studies; 243 participants), and reduce medication usage (RR 5.35, 95% CI 1.29 to 22.11; 2 studies) in people with asthma. The MD for AQLQ score exceeded the minimal clinically important difference (MCID) of 0.5, but whether the mean changes exceeded the MCID for asthma symptoms is uncertain due to the lack of an established MCID in the severity scores used in the included studies. The effects of yoga on change from baseline forced expiratory volume in one second (MD 0.04 litres, 95% CI -0.10 to 0.19; 7 studies; 340 participants; I(2) = 68%) were not statistically significant. Two studies indicated improved asthma control, but due to very significant heterogeneity (I(2) = 98%) we did not pool data. No serious adverse events associated with yoga were reported, but the data on this outcome was limited.

AUTHORS' CONCLUSIONS

We found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms in people with asthma. There is more uncertainty about potential adverse effects of yoga and its impact on lung function and medication usage. RCTs with a large sample size and high methodological and reporting quality are needed to confirm the effects of yoga for asthma.

Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases

Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.

Yoga as a Therapy for Adolescents and Young Adults With Cystic Fibrosis: A Pilot Study

Rationale:

Yoga has been shown to improve outcomes in patients with asthma but has not been investigated in cystic fibrosis (CF) patients.

Methods:

This was a prospective pilot study to evaluate the safety of a standardized yoga program among CF patients aged 12 to 25 years. Participants engaged in a 50-minute yoga session twice weekly for 8 weeks conducted by a certified yoga instructor using a standardized program designed to be safe for health-compromised individuals. Yoga sessions were individual to avoid transmission of infections. Primary outcome was safety and tolerability. Secondary outcome measures included respiratory symptoms, the Cystic Fibrosis Quality of Life instrument (CFQ-R), lung function, Ease of Breathing Score (measure of exercise tolerance), and weight.

Results:

Eleven participants were enrolled, and 10 completed the study. Adherence was very good; the mean (SD) number of sessions completed was 14.2 (1.3) out of 16 sessions. Eight patients reported 25 adverse events. The most common was cough, reported in 7. Two events were possibly related to study procedures: calf pain and headache. There were no significant changes in dyspnea or pain scales. The mean (SD) CFQ-R respiratory domain score increased from screening to end of study: 67.9 (11.4) to 82.1 (9.9), P=.04. There were no significant changes in the other outcome measures.

Conclusions:

In this pilot study, a standardized 8-week yoga program was safe and well tolerated among adolescent and young adult CF patients with mild to moderate lung disease. This study may be helpful to yoga instructors who are interested in working with CF patients. Larger controlled trials are warranted to determine further benefits.

The Effects of Bikram Yoga on Health: Critical Review and Clinical Trial Recommendations

Bikram yoga is a style of hatha yoga involving a standarized series of asanas performed to an instructional dialogue in a heated environment (40.6°C, 40% humidity). Several studies evaluating the effect of Bikram yoga on health-related outcomes have been published over the past decade. However, to date, there are no comprehensive reviews of this research and there remains a lack of large-scale, robustly-designed randomised controlled trials (RCT) of Bikram yoga training. The purpose of this review is to contextualise and summarise trials that have evaluated the effects of Bikram yoga on health and to provide recommendations for future research. According to published literature, Bikram yoga has been shown to improve lower body strength, lower and upper body range of motion, and balance in healthy adults. Non-RCTs report that Bikram yoga may, in some populations, improve glucose tolerance, bone mineral density, blood lipid profile, arterial stiffness, mindfulness, and perceived stress. There is vast potential for further, improved research into the effects of Bikram yoga, particularly in unhealthy populations, to better understand intervention-related adaptations and their influence on the progression of chronic disease. Future research should adhere to CONSORT guidelines for better design and reporting to improve research quality in this field.

Comparing the effectiveness of selective laser trabeculoplasty with topical medication as initial treatment (the Glaucoma Initial Treatment Study): study protocol for a randomised controlled trial

Background

Glaucoma is the leading cause of irreversible blindness in the world. Estimated to affect 60 million people worldwide, this figure is expected to rise to 80 million by 2020. Untreated, glaucoma leads to visual decay and eventually to blindness, and can significantly reduce quality of life. First-line treatment in patients with primary open-angle glaucoma and exfoliative glaucoma is topical medical therapy with ocular hypotensives as eye drops. However, eye drops have several disadvantages including cost, possible local and systemic side effects, and adherence and perseverance issues. Randomised controlled trials have demonstrated that selective laser trabeculoplasty is equally as effective in lowering intraocular pressure as eye drops. However, the impact of these two treatment modalities from the patient and economic perspectives has not been adequately determined. Thus, it remains unclear whether topical medical therapy or selective laser trabeculoplasty should be recommended as first-line treatment for glaucoma.

Methods/Design

This protocol describes an international, multi-centre, randomised controlled trial to determine the optimum first-line therapy for people with primary open-angle glaucoma and exfoliative glaucoma. This study will compare the effect of selective laser trabeculoplasty and topical medication with respect to patients’ generic and glaucoma-specific quality of life. The trial will also provide a detailed cost-effectiveness analysis and compare the clinical effectiveness with respect to the degree of intraocular pressure lowering and rates of treatment failure. Research coordinators in each centre will identify and recruit previously untreated patients with primary open-angle glaucoma and exfoliative glaucoma. Those who meet the eligibility criteria will be invited to enter a randomised controlled trial with either selective laser trabeculoplasty or topical ocular hypotensive therapy, according to a stepped regimen. Outcome assessment will be measured at 6 weeks and at 6, 12, and 24 months post-treatment. Regular clinic follow-ups will continue as clinically indicated between study outcome visits.

Discussion

The Glaucoma Initial Treatment Study is the first multi-centred RCT to determine the optimum first-line therapy for people with glaucoma. Our trial will have an unprecedented capacity to meaningfully transform the treatment and management of glaucoma in Australia and overseas.

Trial registration

ACTRN12611000720910; Date registered: 11 July 2011

A group-based yoga therapy intervention for urinary incontinence in women: a pilot randomized trial

OBJECTIVE

The aim of this study is to examine the feasibility, efficacy, and safety of a group-based yoga therapy intervention for middle-aged and older women with urinary incontinence.

METHODS

We conducted a pilot randomized trial of ambulatory women aged 40 years and older with stress, urgency, or mixed-type incontinence. Women were randomized to a 6-week yoga therapy program (n = 10) consisting of twice weekly group classes and once weekly home practice or a wait-list control group (n = 9). All participants also received written pamphlets about standard behavioral self-management strategies for incontinence. Changes in incontinence were assessed with 7-day voiding diaries.

RESULTS

The mean (SD) age was 61.4 (8.2) years, and the mean baseline frequency of incontinence was 2.5 (1.3) episodes/d. After 6 weeks, the total incontinence frequency decreased by 70% (1.8 [0.9] fewer episodes/d) in the yoga therapy versus 13% (0.3 [1.7] fewer episodes/d) in the control group (P = 0.049). Participants in the yoga therapy group also reported an average of 71% decrease in stress incontinence frequency (0.7 [0.8] fewer episodes/d) compared with a 25% increase in controls (0.2 [1.1] more episodes/d) (P = 0.039). No significant differences in reduction in urgency incontinence were detected between the yoga therapy versus control groups (1.0 [1.0] versus 0.5 [0.5] fewer episodes/d; P = 0.20). All women starting the yoga therapy program completed at least 90% of the group classes and practice sessions. Two participants in each group reported adverse events unrelated to the intervention.

CONCLUSIONS

Findings provide preliminary evidence to support the feasibility, efficacy, and safety of a group-based yoga therapy intervention to improve urinary incontinence in women.

Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial

BACKGROUND

Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments.

METHODS/DESIGN

This is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions.

DISCUSSION

Although the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect.

TRIAL REGISTRATION

Clinicaltrials.gov; Identifier: NCT02065258.

An overview of integrative therapies in asthma treatment

Treatment of asthma lends itself to an integrative medicine approach due to the multifactorial nature of the disease. It is well established that asthma has a neuromuscular component (bronchospasm), an immunological component (inflammation), and a psychological component. This encourages the use of diverse approaches to address all avenues of pathophysiology, aiming for the most effective blend of treatment approaches possible. Integrative medicine is defined by NIH NCCAM ( http://nccam.nih.gov ) as medicine that blends the use of evidence-based complementary therapies with conventional medicine. Statistics from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), showed that approximately four out of 10 adults and approximately one in nine children and more than 50 % of children living with chronic illness, including asthma, used complementary therapies in the USA in 2007. Asthma and allergies rank among the top 15 most common medical conditions in which integrative therapies are used in both children and adults. To date, integrative treatment approaches with some evidence for benefit in asthma treatment include the following: nutrition modification, mind-body medicine, physical activity, and certain dietary supplement interventions.

Comparison groups in yoga research: a systematic review and critical evaluation of the literature

OBJECTIVES

Comparison groups are essential for accurate testing and interpretation of yoga intervention trials. However, selecting proper comparison groups is difficult because yoga comprises a very heterogeneous set of practices and its mechanisms of effect have not been conclusively established.

METHODS

We conducted a systematic review of the control and comparison groups used in published randomized controlled trials (RCTs) of yoga.

RESULTS

We located 128 RCTs that met our inclusion criteria; of these, 65 included only a passive control and 63 included at least one active comparison group. Primary comparison groups were physical exercise (43%), relaxation/meditation (20%), and education (16%). Studies rarely provided a strong rationale for choice of comparison. Considering year of publication, the use of active controls in yoga research appears to be slowly increasing over time.

CONCLUSIONS

Given that yoga has been established as a potentially powerful intervention, future research should use active control groups. Further, care is needed to select comparison conditions that help to isolate the specific mechanisms of yoga's effects.

Characteristics of randomized controlled trials of yoga: a bibliometric analysis

Background

A growing number of randomized controlled trials (RCTs) have investigated the therapeutic value of yoga interventions. This bibliometric analysis aimed to provide a comprehensive review of the characteristics of the totality of available randomized yoga trials.

Methods

All RCTs of yoga were eligible. Medline/PubMed, Scopus, the Cochrane Library, IndMED, and the tables of content of yoga specialty journals not listed in medical databases were screened through February 2014. Bibliometric data, data on participants, and intervention were extracted and analyzed descriptively.

Results

Published between 1975 and 2014, a total of 366 papers were included, reporting 312 RCTs from 23 different countries with 22,548 participants. The median study sample size was 59 (range 8–410, interquartile range = 31, 93). Two hundred sixty-four RCTs (84.6%) were conducted with adults, 105 (33.7%) with older adults and 31 (9.9%) with children. Eighty-four RCTs (26.9%) were conducted with healthy participants. Other trials enrolled patients with one of 63 varied medical conditions; the most common being breast cancer (17 RCTs, 5.4%), depression (14 RCTs, 4.5%), asthma (14 RCTs, 4.5%) and type 2 diabetes mellitus (13 RCTs, 4.2%). Whilst 119 RCTs (38.1%) did not define the style of yoga used, 35 RCTs (11.2%) used Hatha yoga and 30 RCTs (9.6%) yoga breathing. The remaining 128 RCTs (41.0%) used 46 varied yoga styles, with a median intervention length of 9 weeks (range 1 day to 1 year; interquartile range = 5, 12). Two hundred and forty-four RCTs (78.2%) used yoga postures, 232 RCTs (74.4%) used breath control, 153 RCTs (49.0%) used meditation and 32 RCTs (10.3%) used philosophy lectures. One hundred and seventy-four RCTs (55.6%) compared yoga with no specific treatment; 21 varied control interventions were used in the remaining RCTs.

Conclusions

This bibliometric analysis presents the most complete up-to-date overview on published randomized yoga trials. While the available research evidence is sparse for most conditions, there was a marked increase in published RCTs in recent years.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6882-14-328) contains supplementary material, which is available to authorized users.

Effect of Bhramari pranayama and OM chanting on pulmonary function in healthy individuals: A prospective randomized control trial

Background/Aim:

Yoga is an ancient Indian science as well as the way of life. Pranayama is a part of yoga, which improves pulmonary function in combination of many pranayama, but the aim of our study is to evaluate the effect of only Bhramari pranayama and OM chanting on pulmonary function in healthy individuals.

Materials and Methods:

A total of 82 subjects were randomized into the study group (SG) (n = 41) and control group (CG) (n = 41). Baseline assessment was performed before intervention for both groups. SG practiced Bhramari pranayama and OM chanting for the duration of 10 min (5 min for each practice)/day for the period of 6 days/week for 2 weeks and CG did not practice so. After intervention post-assessment was performed for SG (n = 40) and CG (n = 39). Statistical analysis was performed by Independent samples t-test and Student's paired t-test with the use of Statistical Package for the Social Sciences version 16 (2007, USA).

Results:

The result showed a significant improvement in peak expiratory flow (PEF), forced expiratory flow (FEF)_25% and maximal voluntary ventilation (MVV) along with a significant reduction in weight in SG compared with CG in independent samples t-test. Significant improvement in slow vital capacity (SVC), forced expired volume in 1 s (FEV₁) along with PEF, FEF_25% and MVV; Significant reduction in weight and body mass index were observed in SG unlike in CG in Student's paired t-test. No significant changes were found in forced vital capacity, FEV₁ /SVC and FEF_50% , between and within the group analysis of SG and CG.

Conclusion:

Bhramari pranayama and OM chanting are effective in improving pulmonary function in healthy individuals.

Yoga and health

Yoga has been the subject of research in the past few decades for therapeutic purposes for modern epidemic diseases like mental stress, obesity, diabetes, hypertension, coronary heart disease, and chronic obstructive pulmonary disease. Individual studies report beneficial effect of yoga in these conditions, indicating that it can be used as nonpharmaceutical measure or complement to drug therapy for treatment of these conditions. However, these studies have used only yoga asana, pranayama, and/ or short periods of meditation for therapeutic purposes. General perception about yoga is also the same, which is not correct. Yoga in fact means union of individual consciousness with the supreme consciousness. It involves eight rungs or limbs of yoga, which include yama, niyama, asana, pranayama, pratyahara, dharana, dhyana, and samadhi. Intense practice of these leads to self-realization, which is the primary goal of yoga. An analytical look at the rungs and the goal of yoga shows that it is a holistic way of life leading to a state of complete physical, social, mental, and spiritual well-being and harmony with nature. This is in contrast to purely economic and material developmental goal of modern civilization, which has brought social unrest and ecological devastation.

Effect of yogic breathing techniques in new sputum positive pulmonary tuberculosis

A 24-year-old, unmarried woman diagnosed of pulmonary tuberculosis (PTB) visited our hospital out-patient department in the month of August-2013. Patient came with the complaint of sever cough with expectoration; evening raise of temperature; gradual loss of appetite and weight since 2-weeks. We referred the patient to our hospital's Revised National Tuberculosis Program, direct observed treatment short-course center for sputum fluorescence microscopic examination (FME). FME report suggested the new smear positive, 2+ PTB. Our patient received yogic breathing techniques (YBT) for 45-min daily under the supervision for three alternate-days/week with anti-tuberculosis treatment (ATT) for the period of 8-weeks. After intervention our result showed better improvement in weight gain, body mass index, symptom scores, pulmonary function and health related quality of life with conversion of positive to negative FME for acid fast bacilli. It suggests YBT with ATT are effective in treating PTB and further studies required to warrant this effect.

Yoga for asthma: a systematic review and meta-analysis

BACKGROUND

Although yoga is frequently used by patients with asthma, its efficacy in alleviating asthma remains unclear.

OBJECTIVE

To systematically assess and meta-analyze the available data on efficacy and safety of yoga in alleviating asthma.

METHODS

MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through January 2014. Randomized controlled trials of yoga for patients with asthma were included if they assessed asthma control, symptoms, quality of life, and/or pulmonary function. For each outcome, standardized mean differences (SMDs) or risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane tool.

RESULTS

Fourteen randomized controlled trials with 824 patients were included. Evidence for effects of yoga compared with usual care was found for asthma control (RR, 10.64; 95% CI, 1.98 to 57.19; P = .006), asthma symptoms (SMD, -0.37; 95% CI, -0.55 to -0.19; P < .001), quality of life (SMD, 0.86; 95% CI, 0.39 to 1.33; P < .001), peak expiratory flow rate (SMD, 0.49; 95% CI, 0.32 to 0.67; P < .001), and ratio of forced expiratory volume in 1 second to forced vital capacity (SMD, 0.50; 95% CI, 0.24 to 0.75; P < .001); evidence for effects of yoga compared with psychological interventions was found for quality of life (SMD, 0.61; 95% CI, 0.22 to 0.99; P = .002) and peak expiratory flow rate (SMD, 2.87; 95% CI, 0.14 to 5.60; P = .04). No evidence for effects of yoga compared with sham yoga or breathing exercises was revealed. No effect was robust against all potential sources of bias. Yoga was not associated with serious adverse events.

CONCLUSION

Yoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.