Effects of Single Bouts of Walking Exercise and Yoga on Acute Mood Symptoms in People with Multiple Sclerosis

Impact of cognitive-aerobic exercise training on brain-derived neurotrophic factor, dual-tasking abilities, and mood state in individuals with multiple sclerosis

OBJECTIVES

Multiple sclerosis (MS) is a chronic neurological disorder characterized by demyelination and neurodegeneration, leading to various physical, cognitive, and emotional challenges. Dual-task (DT) training, involving performing mental and physical tasks simultaneously, addresses the complex interaction between motor and cognitive functions.

PURPOSE

Given the extensive physical, cognitive, and mood-related issues in this population, this study aimed to examine the effects of combined aerobic-cognitive training (Brythonic) and aerobic training on brain-derived neurotrophic factor (BDNF), DT performance, and mood state in MS patients.

METHODS

Thirty patients (22 women and 8 men) with relapsing-remitting multiple sclerosis (RRMS) and an expanded disability status scale (EDSS) score below four were randomly assigned to three groups: aerobic-cognitive training (Brythonic), aerobic training, and control. The training groups participated in 10 weeks of home-based online training, with two sessions per week. Each session included a 10-minute warmup, 15 to 35 min of exercise, and a 5-minute cool-down. The Brythonic group performed aerobic movements while reciting motivational words, forming a complete positive sentence over ten weeks. The aerobic group performed the same movements without cognitive tasks. Serum BDNF levels, DT performance, and profile of mood states (POMS) were measured before and after the 10-week training period. A two-way ANOVA with repeated measures was used to analyze differences between and within groups, with a significance level of P ≤ 0.05.

RESULTS

BDNF levels significantly increased in the Brythonic group (P = 0.048) and significantly decreased in the control group compared to baseline. In the DT test, the Brythonic group showed significant improvements in the number of correct answers and DT values compared to the aerobic and control groups. The Brythonic group also had a significantly reduced response time compared to the control group. Additionally, selective speed significantly increased in both training groups. In the POMS test, the Brythonic group showed significant improvements in all items except depression compared to the control group. Within the Brythonic group, all items significantly improved from baseline.

CONCLUSION

This study demonstrated that combining motivational words with aerobic movements significantly impacts BDNF levels, DT performance, and mood states. Adding mental exertion to physical activity appears beneficial for patients with MS. Future studies should re-examine these findings with a larger patient cohort.

Impact of physical activity, physical fitness and exercises on cognitive impairment in patients with multiple sclerosis: A review of evidence and underlying mechanisms

Cognitive impairment in persons with MS (pwMS) occurs commonly, early and independently of other clinical features of the disease. MS-related cognitive impairment is mainly characterized by weakening of information processing speed, working memory and episodic memory. Much evidence, based on both neuropsychological and neuroimaging outcomes, highlights successful cognitive rehabilitation interventions. In this context, promotion of physical activity and exercise training could be a dual, motor and cognitive, rehabilitation method. The aim of this article is, firstly, to review existing evidence regarding the effects of exercise on cognition among pwMS, and secondly, to explore the possible mechanisms of action of the cognitive-motor coupling.

Affective Responses to Acute Exercise: A Meta-Analysis of the Potential Beneficial Effects of a Single Bout of Exercise on General Mood, Anxiety, and Depressive Symptoms

OBJECTIVE

Acute exercise elicits various biobehavioral and psychological responses, but results are mixed with regard to the magnitude of exercise-induced affective reactions. This meta-analysis examines the magnitude of general mood state, anxiety, and depressive symptom responses to acute exercise while exploring exercise protocol characteristics and background health behaviors that may play a role in the affective response.

METHODS

A total of 2770 articles were identified from a MEDLINE/PubMed search and an additional 133 articles from reviews of reference sections. Studies had to have measured general mood before the acute exercise bout and within 30 minutes after exercise completion. Effect sizes were estimated using Hedges' g , with larger values indicating improvement in the outcome measure.

RESULTS

A total of 103 studies were included presenting data from 4671 participants. General mood state improved from preexercise to postexercise ( g = 0.336, 95% confidence interval [CI] = 0.234-0.439). Anxiety ( g = 0.497, 95% CI = 0.263-0.730) and depressive symptoms ( g = 0.407, 95% CI = 0.249-0.564) also improved with exercise. There was substantial and statistically significant heterogeneity in each of these meta-analyses. This heterogeneity was not explained by differences in participants' health status. Meta-regression analyses with potential moderators (intensity of exercise, mode of exercise, usual physical activity level, or weight status of participants) also did not reduce the heterogeneity.

CONCLUSION

This meta-analysis shows significantly improved general mood, decreased anxiety, and lower depressive symptoms in response to an acute bout of exercise. There was substantial heterogeneity in the magnitude of the effect sizes, indicating that additional research is needed to identify determinants of a positive affective response to acute exercise.

Physical Activity Moderates the Association Between Pain and Depressive Symptoms Among Persons with Multiple Sclerosis

OBJECTIVE

The present study examined physical activity as a possible moderator in the relationship between pain and depressive symptoms among persons with multiple sclerosis (PwMS).

METHOD

Fifty-three PwMS completed a comprehensive neuropsychological test battery and psychosocial questionnaires. Pain was operationalized as a composite of measures from the Brief Pain Inventory. Metabolic equivalents (METs) of energy expended during self-reported vigorous activity (VA), moderate activity (MA), and walking, as well as global physical activity which combined the three, were derived from the International Physical Activity Questionnaire-Short Form. Self-reported physical activity was measured using the Cognitive Health Questionnaire Exercise Scale. Regressions on depressive symptoms (Beck Depression Inventory-Fast Screen) examining both conceptualizations of physical activity, pain, and their interactions were explored.

RESULTS

Regression analyses revealed that interactions between pain and each measure of global physical activity were significant (p = .01). Simple effects tests revealed that pain only influenced depressive symptoms in PwMS with low global physical activity METs (p < .001) and low overall self-reported physical activity (p < .001). The separate interactions between pain and METs during self-reported VA, MA, and walking on depressive symptoms were not significant.

CONCLUSION

We found that global physical activity moderated the relationship between pain and depressive symptoms in MS. Specifically, pain influenced depressive symptoms in PwMS who engaged in less overall physical activity. These results highlight the importance of screening PwMS for pain and suggest that behavioral interventions aimed at increasing overall lifestyle physical activity may be useful in improving depressive outcomes in PwMS with pain.

The Effects of Prescribed Physical and Cognitive Exercise on Life Satisfaction, Self-Efficacy and Mood States in Adults with Down Syndrome: The MinDSets Study

Down syndrome (DS) is characterised by a duplication of chromosome-21 and is linked to co-occurring physical and mental health conditions, including low self-efficacy and disturbed mood states. The purpose of this study was to investigate the effects of an eight-week prescribed physical and/or cognitive training intervention on measures of mood disturbance, life satisfaction and self-efficacy in a population of adults with DS. Eighty-three participants (age 27.1 ± 8.0 years) from across five continents volunteered. Participants were assigned using matched groups based upon performance in a modified six-minute walk test to either an exercise (EXE) 3 × 30 min of walking/jogging per week, cognitive training (COG) 6 × 20 min per week, a combined group (COM) or the control (CON) who did not complete any intervention. Profile of Mood States (POMS) were assessed using a five-point scale across 65 categories pre- and post-study as well as upon completion of each week of the intervention. In addition, Satisfaction with Life Scale (SWLS) and self-efficacy using the Generalised Self-Efficacy scale (GSE) were recorded before and after the intervention. GSE increased for all participants by 1.9 ± 5.2 (p = 0.002) from pre- to post-intervention, while POMS showed significant changes for the whole group from pre- to post-intervention for tension (p < 0.001), depression (p < 0.001) and for anger (p < 0.001). In addition, significant correlations were observed between SWLS and ΔTMD, Δtension, Δanger, and Δfatigue (p < 0.05) for EXE. Both COG and EXE provide a framework for empowering enhancements in life satisfaction, self-efficacy and mood states fostering improvements in quality of life.

The role of worry in exercise and physical activity behavior of people with multiple sclerosis

Purpose:

This study is a secondary analysis of data from a mixed methods exploration of fatigue in people with multiple sclerosis (MS), a chronic autoimmune disease affecting the central nervous system. During initial analysis, worry emerged during discussions of the fatigue experience. The purpose of this study is to explore worry in relationship to exercise and physical activity behavior.

Methods:

Mixed methods were used to address the research question. 55 people with MS provided demographic and survey data (habitual physical activity, body perception, functioning). 35 participated in semi-structured interviews on the topics of fatigue, body sensations, emotions, and their effects on physical activity. Qualitative data were analyzed utilizing constructivist grounded theory. Quantitative data were analyzed utilizing multiple regression.

Results:

Qualitative theory described participants’ thoughts and experiences regarding the consequences of fatigue during activity, and how they appear to influence subsequent actions. Worry played a critical role in thought processes regarding physical activity. Aspects of body perception were weak quantitative predictors of physical activity behavior after control of physical functionality.

Conclusions:

The most significant finding of this study was the description and dialogue about worry as a factor that shapes perceptions of the benefits and value of exercise and physical activity. Physical activity practitioners could benefit from seeking to understand physical-activity-related worry when examining physical activity behavior and designing programming.

PE augmented mindfulness: A neurocognitive framework for research and future healthcare

Various well-controlled studies have suggested that practitioners in mindfulness can be prone to patient drop-out (e.g., due to chronic stress, pathology, cognitive reactivity), despite researchers having identified the underlying mechanisms that link mindfulness to mental health. In this article, a framework for physical exercise (PE) augmented mindfulness is proposed, which posits that consistently practiced PE before meditation can support (early-stage) mindfulness. Neurocognitive research shows PE (aerobic exercises or yoga) and mindfulness to impact similar pathways of stress regulation that involve cognitive control and stress regulation, thereby supporting the proposed synergistic potential of PE augmented mindfulness. Research focused on the psychophysiological impact of PE, showed its practice to promote short-term neurocognitive changes that can promote both cognitive control and the attainment of mindful awareness (MA). In order to chart dose responses required for protocol development, further research will be presented. Together these findings are discussed in light of future research on this multidisciplinary topic, protocol development, mindful walking, and further application in healthcare and beyond.

Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery

BACKGROUND AND OBJECTIVES

The present study aimed to assess the effectiveness of guided imagery on fatigue, stigma, and mood in patients with multiple sclerosis.

METHODS

This clinical trial is a double-blind study that was conducted on 60 patients with multiple sclerosis referred to the largest center for special diseases in the southeast of Iran in 2020. The convenience sampling method was used to select the participants who were later divided into two groups of intervention (n = 30) and control (n = 30) using block randomization method. The intervention group listened to the guided imagery audio file at home for 25 min. The control group did not receive any intervention. Data were collected by demographic information questionnaires, Fatigue Severity Scale (FSS), Reece Stigma Scale for Multiple Sclerosis (RSS-MS), and the Profile of Mood States (POMS) before and one month after the intervention.

RESULTS

According to the results, there was no significant difference between the two groups before the intervention in terms of the score of fatigue (P < 0.0 = 67), stigma (P < 0.64), and mood (P < 0.17). However, after the intervention, a significant differences was observed in this regard (P < 0.0001). In the intervention group, the mean score of fatigue decreased from 59.72 ± 18.32 to 35.8 ± 16.15, and the mean score of stigma decreased from 17.31 ± 15.62 to 5.09 ± 8.06, showing a significant reduction in the levels of fatigue (P < 0.0001) and stigma (P < 0.0001) compared to before intervention. Also, the mean score of mood decreased from 36.90 ± 12.21 to 28.55 ± 11.87, indicating an improvement in the mood of samples in the intervention group (P < 0.0001).

CONCLUSIONS

The results indicated that guided imagery, as a cost-effective method, can decrease the fatigue and stigma, and enhance the mood of patients with MS. Therefore, nursing staff can use this method to improve MS patients' mood and decrease their fatigue and stigma.

The Relationship between Compulsive Exercise, Self-Esteem, Body Image and Body Satisfaction in Women: A Cross-Sectional Study

PURPOSE

In this study, we aimed to test the relationship between compulsive exercise and self-esteem, body image, and body satisfaction as potential predictors of eating disorders.

METHODS

Self-report measures of compulsive exercise beliefs and behaviors, self-esteem, body image, and body satisfaction, were completed by 120 female participants through an online questionnaire. Factor analyses with varimax rotation were performed to create exercise-frequency groups. ANOVA's were performed on Body Mass Index (weight adjusted for height squared, BMI), current minus ideal weight, self-esteem, body image, and body satisfaction to determine if there were differences depending on these exercise groups.

RESULTS

Factor analysis revealed two factors for compulsive exercise beliefs and behaviors: (1) Exercise Fixation, and (2) Exercise Frequency and Commitment. Based on those factors, participants were subdivided into four clusters: (1) pathological obligatory exercisers, (2) exercise fixators, (3) committed exercisers, and (4) non-exercisers. No differences were found between these groups for BMI or current minus ideal weight. Pathological obligatory exercisers and committed exercisers spend significantly more hours on exercise weekly compared to exercise fixators or non-exercisers. No differences between pathological obligatory exercisers, exercise fixators, and non-exercisers were found on self-esteem or body satisfaction, where the committed exercisers scored significantly better. Both committed exercisers and non-exercisers scored significantly better on body image flexibility compared to pathological obligatory exercisers and exercise fixators.

CONCLUSION

Compulsive exercise has both an exercise volume and an emotional component. The level of compulsive exercise is linked to one's self-esteem, body image, and body satisfaction and those factors could be a target for future interventions.

Yoga Interventions Used for the Rehabilitation of Stroke, Parkinson's Disease, and Multiple Sclerosis: A Scoping Review of Clinical Research

Objectives: The current body of literature was reviewed to compile and describe yoga interventions that have been applied in clinical research and neurologic rehabilitation settings with patients affected by stroke, Parkinson's disease (PD), and multiple sclerosis (MS). Design: Available literature on yoga therapy (YT) was mapped following a five-stage framework to identify key concepts, knowledge gaps, and evidence to inform practice. Publications were identified through Medline, CINAHL, EMBASE, and PsycINFO. Selected studies required subjects with a clinical diagnosis of stroke, PD, and MS to participate in a yoga intervention and have physical, cognitive, and/or psychosocial outcome measures assessed. Results: A total of 50 studies were included in this review. Study characteristics, patient demographics, description of the yoga intervention, reported outcome measures and the main findings were extracted from the studies. Conclusion: Implementing YT in neurorehabilitation can help health care professionals integrate a more holistic approach that addresses the fundamental physical and psychological challenges of living with a chronic and debilitating neurologic disorder. The included studies described yogic interventions consisting of group or individual therapy sessions lasting 60-75 min that were carried out one to three times per week for 8-12 consecutive weeks across all three conditions. All studies described in this scoping review used different yoga protocols confirming the lack of specific interventional parameters available for implementing yoga into the rehabilitation of individuals affected by stroke, PD, or MS.

Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial

BACKGROUND

Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity.

OBJECTIVE

The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy.

METHODS

The participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels.

RESULTS

Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants.

CONCLUSIONS

Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537.

The effect of yoga practice on muscular strength improvement in patients with multiple sclerosis

Background/Aims

Multiple sclerosis is a common condition in the central nervous system where patients experience many issues, including muscle weakness. This study offers an investigation of continuous hatha yoga exercises on patients with multiple sclerosis.

Methods

A total of 22 participants with multiple sclerosis were selected, 11 were allocated to the intervention group, and 11 to the control group. In both groups, surface electromyography and dynamometer were performed at the beginning and the end of the study. The intervention group undertook 90-minute sessions of hatha yoga training three times a week for 6 months and the control group did not do any particular exercise during this period.

Results

Dynamometer results indicated that yoga significantly improved the muscle strength of the participants with multiple sclerosis (before the intervention: 40.00 Nm ± 14.66 Nm vs 56.82 Nm ± 20.28 Nm after the intervention, P=0.037). However, there was no significant difference in muscle strength changes between the intervention and control groups (16.82 Nm ± 23.26 Nm vs -2.86 Nm ± 23.36 Nm, P=0.171). Yoga significantly increased participants muscle strength according to the surface electromyography signals (before the intervention: 39.91 V ± 8.86 V vs 54.09 v ± 8.95 V after the intervention, P=0.007). The muscle strength of the control group participants with multiple sclerosis decreased after 6 months, however it was not statistically significant (41.55 Nm ± 9.3 Nm vs 34.55 Nm ± 8.36 Nm, P=0.073). The comparison of changes showed that the surface electromyography signals in the intervention group were significantly higher than those of the control group (P=0.001).

Conclusions:

Yoga exercises, in addition to common multiple sclerosis treatment methods, can be considered as a complementary therapy to improve the physical aspects of multiple sclerosis symptoms.

Effects of a Single Bout of Aquatic Exercise on Mood in Multiple Sclerosis: A Pilot Study

Background

Physical activity is known to be an effective way of managing multiple sclerosis (MS)-related symptoms. Furthermore, it has been reported that even a single bout of physical activity can yield improvements in mood in persons with MS. Aquatic exercise can be an effective and enjoyable physical activity in persons with MS. However, there is little research on the immediate effects of aquatic exercise on mood in people with MS. Thus, we assessed the acute effects of a single bout of aquatic exercise on mood.

Methods

Eight adults with MS participated in a 45-minute aquatic exercise class as well as 45 minutes of a seated rest control condition. The Profile of Mood States questionnaire was given before and after each condition (rest and aquatic exercise). Repeated-measures analysis of variance and paired-samples t tests were used to examine whether aquatic exercise resulted in improvement in mood. Due to the small sample size, effect sizes were considered.

Results

Moderate-to-large effect sizes indicated a condition × time interaction such that mood increased and fatigue decreased after a single bout of aquatic exercise compared with after rest.

Conclusions

This proof-of-concept study suggests that mood symptoms are improved immediately after a short bout of aquatic exercise. Future research is needed to explore whether these effects are reliable and whether they can be sustained with more frequent bouts of aquatic exercise.

Acute effects of Pilates on mood states among young adult males

BACKGROUND

Evidence supports positive effects of acute exercise on mood states. Non-traditional exercise modalities, including Pilates, remain understudied, particularly among males. This study examined mood state responses to a single Pilates bout among young adult males, and explored if responses differed according to analogue Generalized Anxiety Disorder (AGAD) or depression status, or physical activity level.

METHODS

Eighty-seven young adult males completed 30-min of mat-based Pilates. Outcomes included state anxiety, worry, feelings of tension, depressed mood, anger, energy and fatigue, and total mood disturbance (TMD). Paired samples t-tests compared pre- and post-session means within the group; magnitude of change was quantified with standardized mean differences. Two condition X two time repeated measures ANOVA examined outcome differences according to AGAD and depression status, and physical activity level.

RESULTS

Acute Pilates significantly reduced state anxiety, feelings of fatigue, and TMD, and significantly increased feelings of energy (allp ≤ 0.007). Small-to-moderate effect sizes were found for state anxiety, feelings of energy and fatigue, and TMD (all d = 0.22-0.51). Pilates resulted in significant improvements in state anxiety, feelings of fatigue and energy, and TMD among participants with AGAD (n = 28) (all d = 0.10-0.32, p < 0.007) and depressed (n=41) participants (all d = 0.01-0.19, p < 0.008).

CONCLUSIONS

Notwithstanding potential limitations, including the absence of a control group and a lack of follow-up beyond immediate effects, this is the first report to support potential positive mood state responses to an acute bout of Pilates among young adult males. Findings varied based on analogue GAD and depression statuses, and physical activity level.

Impact of alemtuzumab on health-related quality of life over 6 years in CARE-MS II trial extension patients with relapsing-remitting multiple sclerosis

Background:

In CARE-MS II (Comparison of Alemtuzumab and Rebif^® Efficacy in Multiple Sclerosis; NCT00548405), alemtuzumab (12 mg/day; baseline: 5 days; 12 months later: 3 days) significantly improved health-related quality of life (HRQL) outcomes versus subcutaneous interferon beta-1a (SC IFNB-1a) in relapsing-remitting multiple sclerosis (RRMS) patients over 2 years. Patients completing CARE-MS II could enter a 4-year extension study (NCT00930553).

Objective:

The aim of this study is to assess 6-year HRQL outcomes in alemtuzumab-treated CARE-MS II patients, including those with highly active disease (HAD).

Methods:

During extension, patients could receive additional alemtuzumab for clinical/magnetic resonance imaging (MRI) activity or other disease-modifying therapies per investigator’s discretion. Assessments include Functional Assessment of Multiple Sclerosis (FAMS), 36-Item Short-Form Health Survey (SF-36), and EQ-5D visual analog scale (EQ-VAS).

Results:

Alemtuzumab-treated patients improved or stabilized all HRQL measures over 6 years with significant improvements from baseline at all time points on EQ-VAS and for up to 5 years on FAMS, SF-36 MCS, and SF-36 PCS. Alemtuzumab-treated patients with HAD showed significant improvements versus baseline at Year 2 on all HRQL measures, and significant improvements versus SC IFNB-1a on SF-36 PCS and EQ-VAS; however, the improvements did not reach the threshold for clinical relevance.

Conclusion:

Alemtuzumab-treated CARE-MS II patients improved or stabilized HRQL versus baseline over 6 years. This is the first study to show long-term HRQL benefits in patients with HAD.

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

CONTEXT

There is a little evidence about the influence of yoga as a complementary therapy for postural balance and its influence on activities of daily living in multiple sclerosis (MS) patients.

OBJECTIVE

To evaluate the influence of a six-month yoga program on postural balance and subjective impact of postural balance impairment on activities of daily living in people with MS.

DESIGN

Randomized controlled pilot study.

SETTING

Protocol developed at the Adaptive Physical Activity Study Department, College of Physical Education, State University of Campinas, Brazil.

SUBJECTS

A total of 12 (11 women) yoga naive people with MS randomly divided into two groups as follows: Control (C-waiting list, n = 6) and Yoga (Y-Yoga training, n = 6).

INTERVENTIONS

Yoga group practiced postures, breathing exercises, meditation, and relaxation on weekly 60-min classes for a six-month period.

MAIN OUTCOME MEASURES

The following evaluations were performed at study entry (baseline), and after six months (six months): Berg Balance Scale (BBS), Expanded Disability Status Scale (EDSS), and self-reported postural balance quality and influence of postural balance on activities of daily living.

RESULTS

There was a significant improvement in BBS score from baseline to six months only in the Yoga group, especially in subjects with higher EDSS score, with increased quality of self-reported postural balance, and decreased influence of postural balance impairment on activities of daily living. In conclusion, a six-month yoga training is beneficial for people with MS, since it improves postural balance and decreases the influence of postural balance impairment on activities of daily living. A greater sample size is necessary to increase generalization, but it seems that yoga could be included as a feasible complementary therapy for people with MS.

Yoga research review

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy.