International Journal of Yoga
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    Table of Contents - Current issue
Coverpage
January-April 2020
Volume 13 | Issue 1
Page Nos. 1-86

Online since Monday, December 16, 2019

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EDITORIAL  

Moving from models to mechanisms in yoga research p. 1
TM Srinivasan
DOI:10.4103/ijoy.IJOY_92_19  
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REVIEW ARTICLES Top

Can yoga meet the requirement of the physical activity guideline of India? A descriptive review p. 3
Satyajit Mohanty, Venkatarao Epari, Sandul Yasobant
DOI:10.4103/ijoy.IJOY_5_19  
Background: Physical inactivity is the fourth major risk factor for global mortality accounting for 6% of all deaths globally and it is a key risk factor for noncommunicable disease occurrences. About 54.4% of Indians are physically inactive and <10% engage in recreational activities. On the one hand, India is spreading the message of Yoga, as a form of physical activity (PA) to the whole world. On the other hand, until now, the Physical Activity Guideline (PAG) in India is not yet fully developed. Therefore, we conducted a descriptive review of the rationality of yoga as one of the PA tools with two hypotheses - Does yoga qualify as a PA tool? Moreover, can yoga help to meet the requirement of Indian PAG?. Methods: An in-depth literature review was carried out using databases such as PubMed, ScopeMed, Google Scholar, and Cochrane Library. All the published articles, government reports and policy documents, which met inclusion criteria with specific reference to yoga and energy expenditure, were gathered. Results: The search strategy yielded 838 articles, of which 16 documents were considered for review. The review included 7 policy documents and/or studies that discussed PAGs/policy/strategy globally and 9 research studies targeted toward the energy expenditure and yoga. Huge variability was documented in the recommended PAGs globally and yoga found to be the moderate metabolic equivalents of tasks in the form of energy expenditure in this review. Conclusion: The compendium of physical activities should add a separate category for energy expenditure by yoga. This will help build-up newer exercise formats involving yogic physical activities to comply with the daily-recommended PA dose. In the national PA plan for India, yoga should get a prominent place. Further, in the Indian perspective, an exclusive PA plan is justified instead of a PA embedded within the national health programs in lieu of wider scope.
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Molecular signature of the immune response to yoga therapy in stress-related chronic disease conditions: An insight p. 9
HN Venkatesh, H Ravish, C R Wilma Delphine Silvia, H Srinivas
DOI:10.4103/ijoy.IJOY_82_18  
The world Health Organization defines health as complete well-being in terms of physical, mental and social, and not merely the absence of disease. To attain this, individual should adapt and self-mange the social, physical and emotional challenges of life. Exposure to chronic stress due to urbanization, work stress, nuclear family, pollution, unhealthy food habits, lifestyle, accidental death in the family, and natural calamities are the triggering factors, leading to hormonal imbalance and inflammation in the tissue. The relationship between stress and illness is complex; all chronic illnesses such as cardiovascular disease and asthma have their root in chronic stress attributed by inflammation. In recent times, yoga therapy has emerged as an important complementary alternative medicine for many human diseases. Yoga therapy has a positive impact on mind and body; it acts by incorporating appropriate breathing techniques and mindfulness to attain conscious direction of our awareness of the present moment by meditation, which helps achieve harmony between the body and mind. Studies have also demonstrated the important regulatory effects of yoga therapy on brain structure and functions. Despite these advances, the cellular and molecular mechanisms by which yoga therapy renders its beneficial effects are inadequately known. A growing body of evidence suggests that yoga therapy has immunomodulatory effects. However, the precise mechanistic basis has not been addressed empirically. In this review, we have attempted to highlight the effect of yoga therapy on immune system functioning with an aim to identify important immunological signatures that index the effect of yoga therapy. Toward this, we have summarized the available scientific evidence showing positive impacts of yoga therapy. Finally, we have emphasized the efficacy of yoga in improving physical and mental well-being. Yoga has been a part of Indian culture and tradition for long; now, the time has come to scientifically validate this and implement this as an alternative treatment method for stress-related chronic disease.
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ORIGINAL ARTICLES Top

Gender and ethnicity: Are they associated with differential outcomes of a biopsychosocial social-emotional learning program? p. 18
Ronnie I Newman, Odilia Yim, David E Shaenfield
DOI:10.4103/ijoy.IJOY_85_18  
Context: Social-emotional learning (SEL) program outcomes may be enhanced when programs take into account gender and ethnicity differences, yet few studies directly examine these variables. The limited literature further suggests improved outcomes accrue by integrating physiological techniques, such as yoga and meditation, directly into SEL curricula to reduce stress. Aims: This study investigated the association between outcomes of a yogic breath-based biopsychosocial SEL intervention across gender and ethnicity. Methods: Fifty-nine high school students were evaluated on 4 positive (self-esteem, identity formation, anger coping ability, planning, and concentration) and 3 negative SEL outcomes (impulsivity, distractibility, and endorsement of aggression). Using a repeated-measures design, group differences between gender and ethnicity were assessed. Results and Conclusions: Significant improvements on all 7 outcomes were found for the sample, suggesting that participants performed better after the intervention. There were neither significant differences between males and females on outcomes nor between different ethnic groups with the exception of African-Americans scoring lower on one of three emotion regulation outcomes. This study, one of the first to directly analyze SEL outcomes by sociodemographic variables, demonstrated the program's biopsychosocial approach was associated with beneficial SEL outcomes across genders and ethnicities. Future studies of biopsychosocial programs taking into account sociodemographics will allow SEL programs to be more effective across diverse populations.
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The lived experience and patient-reported benefits of yoga participation in an inpatient brain injury rehabilitation setting p. 25
Rebecca Seeney, Janelle Griffin
DOI:10.4103/ijoy.IJOY_46_19  
Context: The multifactorial benefits of yoga have been well documented in the literature, with the integration of yoga therapy into healthcare being an emerging field. In general, yoga therapy programs are utilized in the community as an adjunct to other therapy. At present, limited rehabilitation units routinely incorporate integrative therapy options within a hospital environment. Aims: The aim of this study is to explore the lived experience and patient-reported benefits of yoga in an inpatient brain injury rehabilitation setting. Settings and Design: Thirty-one participants were recruited to the study after voluntarily participating in a yoga class within an inpatient brain injury rehabilitation unit of a major metropolitan hospital. Yoga sessions were held weekly for 60 min and consisted of a modified Hatha yoga style. This was a mixed-methods, quasi-experimental one-group pretest–posttest study. Methodology: Quantitative data were collected to measure perceptions of relaxation and well-being before and after yoga classes, along with the satisfaction of the class. Semi-structured interviews were utilized to collect qualitative data of experiences and perceptions associated with yoga participation. Statistical Analysis Used: Thematic analysis was completed for qualitative data. Quantitative data were analyzed using nonparametric statistical methods, and descriptive statistics were also provided. Results: The benefits described by participants are reported in this paper. These include improved relaxation, physical well-being, emotional well-being, being present, and self-awareness. Conclusions: This study describes the personal benefits experienced from regular yoga participation within an inpatient rehabilitation setting.
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Feasibility and pilot efficacy testing of integrated yoga and Shirodhara (Ayurvedic oil-dripping) intervention on clinical symptoms, cognitive functions and sleep quality of adults with anxiety disorder p. 32
Deepa Hegde, Praerna H Bhargav, Hemant Bhargav, Harish Babu, KA Varsha, Nagarathna Raghuram
DOI:10.4103/ijoy.IJOY_44_19  
Background: Beneficial effects of yoga therapy in anxiety disorders (ADs) are known. Traditional texts describe usefulness of Ayurvedic oil-dripping, Shirodhara technique, in relieving anxiety. Thus, present study was planned to assess the feasibility and synergistic value of Shirodhara as an add-on to yoga therapy in adults with AD. Materials and Methods: Thirty adults (males = 14, females = 16) admitted in a residential holistic health care center with an age range of 29.66 ± 6.63 years and diagnosis of one of the ADs (generalized AD, n = 18; social phobia, n = 8; and panic AD, n = 4) as per mini-international neuropsychiatric interview (M. I. N. I. English version 5.0) by a psychiatrist were randomly divided into two groups: (1) integrated yoga-based lifestyle program (YT; n = 15) and (2) YT + Ayurveda (YA; n = 15). Both groups continued to receive conventional treatment and were on stable medications throughout the study period except in cases of emergency. Assessments were done by an independent assessor at baseline and after 2 weeks of intervention for clinical symptoms (HAM-A, State and Trait Anxiety Inventory, and Brief Psychiatric Rating Scale), sleep quality (sleep rating questionnaire), and cognition (Stroop test and digit letter substitution test) using standard validated tools. Parametric tests were applied using SPSS 10.0 to analyze the data. Results: Twelve subjects in yoga group and thirteen subjects in YA group completed the trial. No side effects were reported in any of the groups. Within-group comparisons showed a significant improvement in clinical symptoms, cognition and sleep quality in both the groups. Between-group comparisons showed significantly better scores in Stroop word task for YA group as compared to YT group. Furthermore, there was a trend toward better improvement in sleep quality for YA group. Conclusion: Adding of Shirodhara technique to YT was feasible and may be useful in improving executive memory and sleep quality in adults with ADs.
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Effect of an integrated naturopathy and yoga program on long-term glycemic control in type 2 diabetes mellitus patients: A prospective cohort study p. 42
Srinivas Bairy, M Raghavendra Rao, Srinivas Reddy Edla, Satyanarayana Raju Manthena, N V Gnana Deep Tatavarti
DOI:10.4103/ijoy.IJOY_32_19  
Aim: Lifestyle is an important risk factor for increasing the prevalence of diabetes in the Indian population. In this study, we evaluate the effects of naturopathy treatment, salt-restricted low-calorie diets, and yoga in long-term glycemic control in patients with type 2 diabetes mellitus. Methods: In this prospective, longitudinal, two-arm cohort study, patients with type 2 diabetes mellitus referred from a tertiary care center undergoing a 3-month residential naturopathy treatment were compared with those undergoing only conventional management on glycemic control. Both fasting and postprandial blood glucose (PPBG) levels were assessed at baseline, 3 months following intervention, at 6 months, and 12 months from the study start. Data were analyzed using repeated-measures ANOVA with post hoc Bonferroni correction. Results: Naturopathy and yoga intervention significantly reduced PPBG levels (P < 0.001), glycated hemoglobin levels (P < 0.001), and reduced requirement for antidiabetic medications (P < 0.008) in the intervention group compared to controls. The effects were more profound immediately following intervention and lasted up to 6 months from the start of the study. Conclusion: The results suggest benefit with an intensive residential naturopathy-based lifestyle intervention program. Randomized controlled trials are needed to further validate the findings.
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Effectiveness of a comprehensive yoga program on convicted extremist offenders p. 50
Divya Kanchibhotla, Shashank Kulkarni, Shweta Singh
DOI:10.4103/ijoy.IJOY_79_18  
Objective: The present study aimed to explore the effect of yoga techniques on well-being and behavior among those who have propagated and participated in extreme violence and aggression. The sample comprised 219 United Liberation Front of Assam militants selected immediately after surrender of arms in the year 2012 from all over northeast region of India. Methodology: The study design was a single group with pre- and posttest assessment. All participants attended a 40-day intensive Yoga workshop (Sudarshan Kriya Yoga, Pranayama, Physical postures or Hatha Yoga, Meditation) conducted at Art of Living International Centre, Bengaluru. The impact of spiritual practices was observed on peace, aggression, life satisfaction, and quality of life in individuals using the aggression Buss Perry questionnaire, WHOQOL-BREF, and Satisfaction with Life Scale. The questionnaires were administered at the beginning and at the end of the 40-day workshop. Results: Significant results using paired t-test clearly demonstrate that by following yoga techniques (Sudarshan Kriya, Yoga, and Meditation), a reduction in aggression, quality of life, and life satisfaction can be obtained. These practices can be useful for people who want to rehabilitate themselves after incarceration or experience of militancy. The purpose of these measures is to reduce the risk of future criminality by those already convicted of violent extremist offenses, thereby protecting public safety while also benefiting individuals and communities.
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The use of yoga as a group intervention for pediatric chronic pain rehabilitation: Exploring qualitative and quantitative outcomes p. 55
Heidi Kempert
DOI:10.4103/ijoy.IJOY_13_19  
Purpose: With the increase in opioid use over the last decade, mind–body approaches to pediatric pain management have been trending. To date, there is limited research regarding the use of yoga with pediatric chronic pain. This study aims to gauge the effectiveness of group yoga as part of chronic pain rehabilitation and one's ability to continue practicing independently by exploring qualitative and quantitative information. Methods: A single therapist used yoga as a group physical therapy intervention once a week for 60 minutes. Yoga education, iyengar yoga components, relaxation, and stretching were incorporated into the therapeutic yoga session. Qualitative and quantitative information was collected. Results: Qualitative outcomes provided valuable data about distractions and benefits. Quantitative outcomes showed that there were significant improvements in areas such as mental tension, emotional tension, muscle tension, and pain (all P < 0.001 significant). Conclusion: Pediatric chronic pain patients can identify many benefits after a single group yoga session. It combines the physical and cognitive aspects of interdisciplinary pain rehabilitation for continued use after discharge. The use of yoga is an economical means of physical activity after discharge to promote long-term benefits.
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Development and testing of an audio-visual self-help yoga manual for Indian caregivers of persons with schizophrenia living in the community: A single-blind randomized controlled trial p. 62
Ameer Hamza, Aarti Jagannathan, Sudarshan Hegde, Naresh Katla, Shree Raksha U Bhide, Jagadisha Thirthallli, Shivarama Varambally, HR Nagendra
DOI:10.4103/ijoy.IJOY_70_18  
Background: To test the feasibility and effectiveness of an audio-visual self-help audio-visual yoga manual on burden of Indian caregivers of persons with schizophrenia, living in the community. Methods: An earlier developed yoga program for caregivers of schizophrenia was remodeled into an audio-visual self-help manual in three languages and validated by mental health and yoga experts. 48 consenting primary family caregivers of outpatients with schizophrenia were screened, recruited, and allotted randomly to Yoga or Care as Usual Group. Participants in Yoga group were taught yoga from the self-help manual (1 session of 1 h every month for 5 months). The caregivers were asked to follow the manual for the remaining month at home. Assessments of burden, perceived stress, quality of life, and anxiety-depression were conducted by a rater blind to the group status at baseline and at the end of every month. Results: Post factoring for missing data, Repeatedmeasure ANOVA was conducted; which showed that there was no significant difference between the group that practiced the selfhelp yoga manual and the care as usual group. The caregivers who practiced yoga at home maintained an average of 50% attendance and “very well” level of yoga performance. Conclusion: The audio-visual self-help yoga manual was found to be feasible to use by the caregivers even though its effectiveness could not be ascertained due to high attrition.
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SHORT COMMUNICATIONS Top

Individually tailored yoga for chronic neck or back pain in a low-income population: A pilot study p. 70
Adrienne Renelle Hampton, Emily G Temte, Bruce P Barrett
DOI:10.4103/ijoy.IJOY_23_19  
Background: Low-income people are disproportionately affected by chronic back and neck pain. Yoga may be an effective therapy. Aims: This feasibility pilot study evaluated an individualized yoga plan for the treatment of chronic spinal pain. Methods: Participants were recruited from a federally qualified health center in Madison, Wisconsin, USA. Each participant received an individually tailored yoga prescription and practice plan. Pain and quality of life were measured pre and post intervention using the standard 10-cm pain scale and the well-validated EQ-5D-3L, respectively. Qualitative data regarding participants' attitudes and experience were also collected and analyzed. Results: Individuals showed a mean change of −2.4 from pre/post 10-cm pain scale recordings (P = 0.028, 95% confidence interval [CI]: −0.390–−4.477) and a mean increase of 0.26 on the EQ-5D-3L (P = 0.029, 95% CI: 0.04–0.47). The intervention was well-received. Conclusions: An individually tailored yoga program was acceptable to these participants. Pain and quality of life scores appeared to improve.
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Effect of 90-min bikram yoga on basic psychological needs among practitioners in the Southwestern United States p. 73
Richard Ibrahin Rodriguez
DOI:10.4103/ijoy.IJOY_87_18  
Background: In our modern society, physical activity is a lifestyle choice. Bikram Yoga is a low impact; moderate exercise and the understanding of motivation and adherence to the practice is unknown. This study aimed to evaluate the effect of 90 min Bikram Yoga practice on basic psychological needs of competence (the sense of skill mastery), autonomy (volitionally performing a task), and relatedness (a connection with others) as postulated in self-determination theory for motivation. Methods: The sample included Bikram Yoga practitioners in the Southwestern United States (n = 126) averaged between the age group of 35 and 64, predominately female, and highly educated. Responses to the Psychological Need Satisfaction in Exercise Scale were analyzed using multivariate analysis of variance. Results: Results showed a statistically significant effect of frequency of Yoga attendance on the satisfaction of basic psychological needs (i.e., competence, autonomy, and relatedness); (P = 0.025); specifically, Yoga practitioners who attended four or more classes per week had higher satisfaction levels of Basic Psychological Need for competence (P = 0.013) and relatedness (P = 0.034). A statistically significant effect of the level of experience on the satisfaction of basic psychological needs (i.e., competence, autonomy, and relatedness) (P = 0.014) found in experienced Bikram Yoga practitioners, specifically for competence (P = 0.013) and relatedness (P = 0.023) compared to novice counterparts. Conclusion: The study provides some evidence of an individual's motivation for a 90 min Bikram Yoga practice and possible adherence. Future investigation of Bikram Yoga practice adopting self-determination theory appears worthwhile.
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Effect of yoga ocular exercises on eye fatigue Highly accessed article p. 76
Satish Kumar Gupta, S Aparna
DOI:10.4103/ijoy.IJOY_26_19  
Background: Comfortable working at near and intermediate tasks depend on the efficiency as well as coordination of accommodation and vergence systems. At present, the need for near and intermediate visual tasks has been dramatically increased, requiring prolonged computer- and gazette-related works. It demands excessive working of the extraocular and ciliary muscles. It may cause eye fatigue and other associated asthenopic symptoms. Globally, eye fatigue is one of the most commonly reported conditions in nonpresbyopic population with asthenopic symptoms. It is necessary to get relief from eye fatigue for better near and intermediate tasks. Materials and Methods: Thirty-two undergraduate optometry students who were symptomatic based on a validated eye fatigue questionnaire were included after a baseline comprehensive eye examination. Based on the eye fatigue symptoms score, they were equally assigned to a control group and an exercise group with sixteen participants in each. The exercise group performed yoga ocular exercises for up to 6 weeks after which the eye fatigue symptoms were reassessed in both groups. Results: In the exercise group, there was a statistically significant reduction in eye fatigue scores (P = 0.003), whereas the eye fatigue scores showed significant increment in the control group after 6 weeks (P = 0.044). Conclusions: Yoga ocular exercises reduce the eye fatigue symptoms score by increasing the efficiency of extraocular muscles. Hence, it could be considered as a therapeutic and nonpharmacologic intervention for reducing the eye fatigue and associated asthenopic symptoms.
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Protective role of moolabandha while practicing Bhastrika and Kapalabhati by women vulnerable to bladder dysfunction: A preliminary ultrasound study p. 80
Unnati Nikhil Pandit, Hemant Pakhale, Bharati Bellare
DOI:10.4103/ijoy.IJOY_38_18  
Aim: Obstetrical trauma and chronic exposure to increased intraabdominal pressure (IIAP) are known to increase vulnerability toward stress urinary incontinence. Bhastrika and Kapalabhati being fast yogic breathing maneuvers (FYBM), their association with IIAP is likely. Therefore, a preliminary descriptive study was conducted using transabominal ultrasound mode, to find whether impact of FYBM reinforced by prevailing risk factors had any adverse effect on the bladder neck status and urethral mobility of female yogic practioners and whether simultaneous application of Moolabandha inhibited such impact. Material: Mindray DC N3 model of diagnostic ultrasound unit with M probe was used for assessment. Methods: This study included 15 heterogenous female yoga teachers having average age, years of practice, and body mass index as 42.7 years, 7.33 years, and 24.86 kg/m2, respectively. Retrovesical angle (RVA) and posterior displacement (PD) and inferior displacement (ID) of urthetrhra were assessed while performing Bhastrika and Kapalabhati maneuvers with and without applying Moolabandha. Data obtained were then used for descriptive analysis. Results: Analysis showed a mixed picture, i.e., negative impact as well as preservation of protective strain-levator reflex in certain variables while practicing FYBM. Complicated labor and practice of power yoga appeared to reinforce the impact of FYBM. The values of RVA as well as PD and ID dropped and were statistically significant when FYBM was performed with Moolabandha. Aging factor, uneventful vaginal labor, or obesity could not confirm as prevailing risk factors. Conclusion: Moolbandha proved its protective behavior while practicing Bhastrika and Kapalabhati by vulnerable women.
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BOOK REVIEW Top

Ancient science of mantras – Wisdom of the sages p. 84
Srinidhi K Parthasarathi
DOI:10.4103/ijoy.IJOY_81_19  
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