International Journal of Yoga
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    Table of Contents - Current issue
Coverpage
September-December 2020
Volume 13 | Issue 3
Page Nos. 175-262

Online since Sunday, September 13, 2020

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EDITORIAL  

Healing in times of crisis p. 175
TM Srinivasan
DOI:10.4103/ijoy.IJOY_90_20  
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REVIEW ARTICLES Top

A systematic review of mindfulness practices for improving outcomes in chronic low back pain Highly accessed article p. 177
Stefanie L Smith, Wendy Hoon Langen
DOI:10.4103/ijoy.IJOY_4_20  
Background: Chronic pain is a serious public health problem that affects people of all ages and backgrounds. Mindfulness-based stress reduction (MBSR) techniques offer an accessible treatment modality for chronic pain patients that may complement or replace pharmacological treatment. This article reviews the literature on the efficacy of MBSR training in patients with back chronic pain syndromes for the outcomes of pain measures, quality of life (QOL), mental health, and mindfulness. Methods: A systemized search was conducted in September of 2018 for studies published between 2008 and 2018 on mindfulness and chronic low back pain. Out of 50 articles on mindfulness and chronic pain, 12 empirical studies were selected for the inclusion in this review. Results: Subjective pain scores and QOL improved for chronic pain patients after mindfulness interventions, compared to control groups, in most of the studies reviewed. Limitations of the studies reviewed included the varied pain measurement instruments, the small sample sizes, and the inability to blind participants to MBSR intervention. Conclusions: MBSR interventions show significant improvements in chronic pain patients for pain measures, QOL, and mental health.
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Pranayamas and their neurophysiological effects Highly accessed article p. 183
Stephany Campanelli, Adriano Bretanha Lopes Tort, Bruno Lob„o-Soares
DOI:10.4103/ijoy.IJOY_91_19  
Introduction: The millenarian breathing exercises from Yoga, commonly called Pranayamas, are known to induce meditative states, reduce stress, and increase lung capacity. However, the physiological mechanisms by which these practices modulate the human nervous system still need to be unveiled. Objectives: The aim of this work was to review studies describing the influence of breathing exercises on the brain/mind of humans. Methodology: We reviewed articles written in English and published between 2008 and 2018. Inclusion and exclusion criteria were based on the PRISMA recommendations to filter articles from Science Direct, PubMed, and Virtual Health Library databases. Patient/Population, Intervention, Comparison, and Outcome technique and Prospective Register of Systematic Reviews registration were also considered. Results: From a total of 1588 articles, 14 attended the criteria. They were critically compared to each other and presented in a table divided into study; country; sample size; gender; age; objective; technique; outcome. Discussion: In general, the 14 papers highlight the impact of yogic breathing techniques on emotional and cognitive performance. Conclusion: In-depth studies focusing on specific aspects of the practices such as retentions, prolonged expiration, attention on fluid respiration, and abdominal/thoracic respiration should better elucidate the effects of Yogic Breathing Techniques (YBT).
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ORIGINAL ARTICLES Top

Determinants of maintaining a daily yoga practice: Health locus of control and self-determination theory perspective p. 193
Adele McKinney
DOI:10.4103/ijoy.IJOY_2_20  
Background: Despite the growing evidence of the health benefits of a yoga practice, little is known about the factors that contribute to its sustained practice. Aims: The objectives of the present study were twofold: (1) to describe the personal characteristics (age, education level, and marital status) and yoga asana-related behavior of participants who practice Ashtanga and (2) to examine the health locus of control (HLOC) (an individual's beliefs about the extent of control that they have over things that happen to them) and self-determination theories. (People are able to become self-determined when their needs for competence, connection, and autonomy are fulfilled in relation to the motivated behavior.) Methods: Ashtanga yoga practitioners (n = 100, age range: 20–62 years) reported practicing yoga at least once a week completed self-report questionnaires: demographics, asana practice, the Perceived Choice and Awareness of Self Scale, HLOC, the General Health Questionnaire-12, the Perceived Stress Scale, and the State-Trait Anxiety Inventory. Results: It was observed that participants practiced yoga for an average 6.43 years, 5 days a week for 93 min representing a sustained, motivated health-related behavior. Years of practice and percentage of time spent in home practice explain 9% of the variance in the awareness of self, and 7% is explained by the number of practice days a week and state anxiety. Ashtanga yoga practitioners have a high internal HLOC; this is related to reduced trait anxiety and increased perceived choice. Conclusions: The Mysore system of yoga appears to facilitate sustained health-related behavior; it is suggested that health promotion should acknowledge the three aspects of self-determination theory: competence, autonomy, and relatedness, while focusing on the increasing intrinsic motivation and internalizing HLOC.
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Autonomic tone and baroreflex sensitivity during 70° head-up tilt in yoga practitioners p. 200
Boligarla Anasuya, Kishore K Deepak, Ashok K Jaryal
DOI:10.4103/ijoy.IJOY_29_20  
Introduction: The intervention of yoga was shown to improve the autonomic conditioning in humans evident from the enhancement of parasympathetic activity and baroreflex sensitivity (BRS). From the documented health benefits of yoga, we hypothesized that the experience of yoga may result in adaptation to the orthostatic stress due to enhanced BRS. Aim: To decipher the effects of yoga in the modulation of autonomic function during orthostatic challenge. Materials and Methods: This was a comparative study design conducted in autonomic function test lab, of the Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Heart rate variability (HRV), blood pressure variability, and BRS were analyzed on forty naïve to yoga (NY) subjects and forty yoga practitioners with an average age of 31.08 ± 7.31 years and 29.93 ± 7.57 years, respectively. All participants were healthy. Seventy degrees head up tilt (HUT) was used as an intervention to evaluate the cardiovascular variability during orthostatic challenge. Results: During HUT, the R-R interval (P = 0.042), root mean square of succesive R-R interval differences (RMSSD) (P = 0.039), standard deviation of instantaneous beat-to-beat R-R interval variability (SD1) (P = 0.039) of HRV, and sequence BRS (P = 0.017) and α low frequency of spectral BRS (P = 0.002) were higher in the yoga group. The delta decrease in RRI (P = 0.033) and BRS (P < 0.01) was higher in the yoga group than the NY group. Conclusion: The efferent vagal activity and BRS were higher in yoga practitioners. The delta change (decrease) in parasympathetic activity and BRS was higher, with relatively stable systolic blood pressure indicating an adaptive response to orthostatic challenge by the yoga practitioners compared to the NY group.
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The effects of fast and slow yoga breathing on cerebral and central hemodynamics p. 207
Gabriella Bellissimo, Eric Leslie, Valarie Maestas, Micah Zuhl
DOI:10.4103/ijoy.IJOY_98_19  
Background: Yoga breathing has shown to impose significant cardiovascular and psychological health benefits. Objective: The mechanism (s) responsible for these health benefits remain unclear. The aim of the present study was to assess the differences in cerebral and central hemodynamic responses following fast breathing (FB) and slow breathing (SB) protocols compared to breathing awareness (BA) as a control. Methods: Twenty healthy participants (10 males and 10 females) volunteered to take part in the study. Participants were between ages 18–55 years (group mean: 24 ± 5 years), with a height of 168.7 ± 9.8 cm and a weight of 70.16 ± 10.9 kg. A familiarization trial including FB and SB protocols were performed by each participant at least 24 h before the testing day. The breathing protocols were designed to achieve 6 breath/min for SB and ~ 120 breaths/min for FB. Results: FB resulted in an increase in both right prefrontal cortex (RPFC) and left prefrontal cortex (LPFC) hemoglobin difference (Hbdiff) (brain oxygenation) compared to BA (P < 0.05). FB resulted in an increased Hbdiff in LPFC compared to RPFC SB (P < 0.05). FB resulted in an increased Hbdiff in LPFC compared to SB (P < 0.05). Conclusion: FB may be an effective yoga breathing technique for eliciting cerebral brain oxygenation indicated by increased Hbdiff. These results may be applicable to both healthy and clinical populations.
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The role of yoga in treating stress-related symptoms in dental hygiene students Highly accessed article p. 213
Elizabeth Alire, Christiane Brems, Kathryn Bell, Aubreť Chismark
DOI:10.4103/ijoy.IJOY_5_20  
Context: Research has provided evidence for yoga's effectiveness in the prevention and treatment of pain and stress, both of which have been implicated as significant negative moderators of student performance and experience. Aims: This study investigated the feasibility and preliminary impact of a 10-week yoga intervention with dental hygiene students to reduce perceptions of stress and stress-related symptoms. Settings and Design: Students self-selected into a yoga treatment versus control condition. They completed stress and pain measures at four time points during and after the intervention or control period of 10-weeks. Methods: Participants were students enrolled in a dental hygiene program. All 77 participants completed a 10-week study, self-selecting into an intervention or control group. They completed three self-report questionnaires assessing pain and stress, administered at baseline, mid-point, postintervention, and two follow-ups. The 10-week yoga intervention consisted of 10 90-min yoga sessions that provided check-ins, breathing exercises, sequences of postures, relaxation exercises, and closing meditations. Statistical Analysis Used: Independent samples t-tests were used to compare perceived stress levels of participants in the control versus treatment groups. Paired t-test was used to assess differences in stress-related symptom levels across time. Results: Results suggested that a yoga intervention is feasible for this group and that active yoga practice can lower perceived stress across multiple domains and across time. Conclusions: A specially adapted and designed 10-week yoga protocol appears to be an accessible option for dental hygiene programs that seek to support their students in improving overall wellbeing.
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Immediate effect of Yoga exercises for eyes on the macular thickness p. 223
Dimitrova Galina, Chihara Etsuo, Shoji Takuhei, Junichi Kanno, Ljubic Antonela, Lazarova Olivera, Gjorgjiovska Ana, Kemera Dushan
DOI:10.4103/ijoy.IJOY_28_20  
Background: Yoga exercises for eyes have been advocated as beneficial to eye health. In a previous study, we evaluated the effect of yoga exercises for eyes on the intraocular pressure (IOP). The other aspects of the effects of yoga exercises for eyes to ocular structure have not been investigated yet. Aim: The aim of this study is to evaluate the effect of yoga exercises for eyes on the macular structure using the optical coherence tomography (OCT) and OCT angiography (OCTA) parameters. Methods: Twenty-nine participants were included in this masked within participant comparison of healthy controls. Basic ophthalmic examination was performed, after which patients were evaluated for IOP, OCT, and OCTA before and after yoga exercises for eyes. OCT/A parameters that were evaluated were: average macular thickness (AMT) (μm), central macular thickness (μm), central choroidal thickness (μm) vessel density (%) in the superficial, deep vascular layers, and in the choriocapillaris. Results: IOP was significantly reduced (postexercise IOP = 13.02 mmHg ± 2.82 mmHg) from the initial value (preexercise IOP = 13.86 mmHg ± 2.85 mmHg, P = 0.02). AMT significantly increased (postexercise AMT = 275.40 μm ± 10.85 μm) from the preexercise measurement (preexercise AMT = 274.41 μm ± 10.89 μm; P = 0.02). Conclusion: After yoga ocular exercises, IOP significantly decreased and AMT significantly increased in healthy controls, suggesting an effect of these exercises on the macular thickness.
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A comparative study of yoga with paroxetine for the treatment of premature ejaculation: A pilot study p. 227
Jitendra Rohilla, Charan Singh Jilowa, Pinki Tak, Shazia Hasan, Nitendra Upadhyay
DOI:10.4103/ijoy.IJOY_89_19  
Context: Premature ejaculation (PME) is a common sexual disorder. Drugs used commonly used for its treatment have various side effects and disadvantages. Yoga is being increasingly studied in a variety of medical disorders with positive results. However, its evidence for patients with PME is very limited. Aims: The aims of this study were to investigate the effect of yoga on ejaculation time in patients with PME and to compare it with paroxetine. Settings and Design: This was a nonrandomized nonblinded comparative study in a tertiary care center. Materials and Methods: Among patients with PME, 40 selected paroxetine and 28 yoga. Intravaginal ejaculation latency time (IELT) was measured in seconds once before and three times after intervention. Statistical Analysis Used: Mean, standard deviation, paired and unpaired t-tests, and repeated measures ANOVA were used for statistical analysis. Results: IELT was significantly increased in both groups – paroxetine (from 29.85 ± 11.9 to 82.19 ± 32.9) and yoga (from 25.88 ± 16.1 to 88697 + 26.9). Although the effect of yoga was slightly delayed in onset, its effect size (η2 = 0.87, P < 0.05) was more than paroxetine (η2 = 0.73, P < 0.05). One-fifth of the patients in the paroxetine group (19.5%) and 8% in the yoga group continued to have the problem of PME at the end of the trial. Conclusions: Yoga caused improvement in both intravaginal ejaculation latency time and subjective sexual experience with minimal side effect. Therefore, yoga could be an easily accessible economical nonpharmacological treatment option for the patient with PME.
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Effectiveness of yoga-based exercise program compared to usual care, in improving HbA1c in individuals with type 2 diabetes: A randomized control trial p. 233
Uttio Gupta, Yashdeep Gupta, Divya Jose, Kalaivani Mani, Viveka P Jyotsna, Gautam Sharma, Nikhil Tandon
DOI:10.4103/ijoy.IJOY_33_20  
Background: This study was designed to evaluate the effectiveness of a yoga-based exercise program (YBEP) in improving glycemic control in people with type 2 diabetes mellitus. Materials and Methods: Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5%–10% were randomized in 1:1 ratio. The primary outcome measure was the difference of change in mean HbA1c between groups. Results: The participants (n = 81) had mean (±standard deviation) age of 50.6 (±8.5) years and HbA1c of 8.5 ± 0.7% (68.97 ± 7.42 mmol/mol). The follow-up data were available in 96% (78/81) of participants. Of 40 participants, 25 (62.5%) attended ≥75% (≥10 out of 13) of the sessions in YBEP. On the intention to treat analysis, a favorable reduction (0.21% 95% confidence interval [−0.34, 0.75], P = 0.454) in HbA1c was seen in YBEP group as compared to usual care. The reduction in HbA1c by ≥0.5% was observed in 44.7% of participants in YBEP as compared to 37.5% in usual care arm, respectively. Those who attended ≥75% of the sessions had better HbA1c reduction of 0.3% in comparison to 0.1% reduction seen in those who attended <75% of the sessions. Conclusions: YBEP demonstrated a clinically relevant HbA1c reduction compared to usual care in participants who had attended at least 75% of the yoga sessions. The reduction in HbA1c by >0.5% in 44.7% in the yoga group, suggests, that it can be prescribed as an exercise to individuals who are unable to walk either due to limited joint mobility, adverse weather conditions, lack of space for walking, cultural or religious prohibitions for women for outdoor physical activity, and so on. CTRI registration no: CTRI/2017/05/008564.
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SHORT COMMUNICATIONS Top

Sudarshan Kriya Yoga program in posttraumatic stress disorder: A feasibility study p. 239
Kamini Vasudev, Emily Ionson, Samin Inam, Mark Speechley, Sumit Chaudhari, Sheena Ghodasara, Ronnie I Newman, Akshya Vasudev
DOI:10.4103/ijoy.IJOY_16_20  
Background: Sudarshan Kriya Yoga (SKY), a breath-based yoga intervention, has demonstrated safety and efficacy in posttraumatic stress disorder (PTSD) patients subsequent to natural disaster or war, but has not been explored in civilians with PTSD from a wider range of trauma. We hypothesized that it would be feasible to conduct a clinical trial of SKY in PTSD resulting from a wide range of trauma. Methods: Outcomes were feasibility measures including rates of enrollment and retention, adherence to study protocol; as well as changes in PTSD symptoms, other mood symptoms, and physiological measures. Male and female participants aged 18–75 years were enrolled in a feasibility trial. They attended a 6-day learning phase of SKY followed by 7 sessions over 11 weeks as an adjunct to their usual treatment. Results: Forty-seven participants were screened and 32 were enrolled over 9 months. Consistent with retention rates of other PTSD trials, 13 withdrew from the study prior to week 12. Twenty-one participants met intervention attendance requirements, completed 95% of planned study assessments and were included in final analyses. Participants experienced clinically significant decrease in PTSD symptoms on the posttraumatic stress disorder checklist (PCL-5) scores at week 12 mean difference, Mdiff (standard deviation [SD]) = −10.68 (14.03), P = 0.004; Cohen's d = 0.58, which was sustained at week 24 Mdiff (SD) = −16.11 (15.20), P < 0.001; Cohen's d = 0.91. Conclusions: It is possible to conduct a clinical trial of SKY in a routine psychiatry clinic serving patients with PTSD due to a wide range of trauma. Future studies should include an RCT design.
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The benefits of yoga in the classroom: A mixed-methods approach to the effects of poses and breathing and relaxation techniques p. 250
Erica M Thomas, Erin E Centeio
DOI:10.4103/ijoy.IJOY_76_19  
Background: Disadvantaged youth in the United States are disproportionately likely to be more sedentary and obese and experience more stress than their counterparts with higher socioeconomic status. Yoga and breathing and relaxation techniques have positive effects on stress levels, physical activity levels, and behavior of school-aged children. Aims: Using social cognitive theory to examine behavioral, personal, and environmental factors, the purpose of this pilot study was to examine the multilevel influences of a yoga-based classroom intervention on urban youth. Methods: Using a mixed methodological quasi-experimental design, this pilot study included the third grade students (n = 40) at one urban elementary school. A survey contained stress, yoga behavior, and aggression scales. In addition, individual student interviews, a teacher interview, and classroom observations were conducted. Results: Paired and independent sample t-tests showed pre/post differences in yoga participation both in and out of school for the intervention participants (P < 0.01). Qualitative analysis revealed three main themes: (1) increased use and enjoyment of yoga techniques, (2) behavioral changes both in/out of school, and (3) impact on personal factors. Conclusions: Findings suggest that urban classrooms should include yoga and mindfulness training as it contributes to daily student PA and also can be stress relieving, fun, calming, and easy to perform outside of school.
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Comparative study of the impact of active meditation protocol and silence meditation on heart rate variability and mood in women p. 255
Gunjan Y Trivedi, Vidhi Patel, Meghal H Shah, Meghana J Dhok, Kunal Bhoyania
DOI:10.4103/ijoy.IJOY_18_20  
Aim: The aim of this study was to understand the impact of an active meditation protocol on heart rate variability (HRV) and mood in women as compared to breath-focused silence meditation. Materials and Methods: Women experienced two different practices of 20 min each: (a) control group: silence meditation focusing on breath and (b) experiment group: active meditation that included four activities, each lasting for 5 minutes – (1) simple humming, (2) coherent heart-focused breathing with 5s of inhalation and 5s of exhalation, (3) coherent heart-focused breathing while invoking positive emotions, and (4) guided imagery about a preidentified goal. The silence meditation encouraged women to only focus on the breath. The Positive and Negative Affect Scale measured mood before/after the practice (n = 24), and emWavePro device measured HRV parameters for 5 min before/after the practices (n = 18). Statistical data analysis was done using a paired t-test. Results: HRV (specifically, parasympathetic nervous system [PNS]) parameters showed a statistically significant improvement in the experiment group as compared to the control group. There was a statistically significant reduction in negative affect after both the practices, and the increase in positive affect was observed only for the experiment group. Conclusions: The active meditation provides a significant enhancement in mood and HRV parameters related to PNS as compared to silence meditation where the changes in HRV were not consistent and the positive mood did not increase significantly. Future research in this area could explore the impact of such practice for a longer duration and understand the impact of each component of the meditative practices.
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LETTER TO EDITOR Top

Yoga-related injury in India: Deep silence and closed eyes p. 261
Ganesh Singh Dharmshaktu
DOI:10.4103/ijoy.IJOY_52_20  
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