International Journal of Yoga
Users online: 937 
Ahead of print | Login 
 
Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
About us Editors Current Issue Past Issues Instructions submission Subscribe Advertise
 


 
   Table of Contents     
REVIEW ARTICLE  
Year : 2021  |  Volume : 14  |  Issue : 3  |  Page : 175-187
War-related mental health issues and need for yoga intervention studies: A scoping review


1 Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research; CCRYN Center for Mind Body Interventions through Yoga PGIMER; Centre for Cognitive Sciences and Phenomenology, Panjab University, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Internal Medicine, Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India
5 Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
6 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
7 Department of Physical Education, Panjab University, Chandigarh, India

Click here for correspondence address and email

Date of Submission04-May-2021
Date of Decision13-Aug-2021
Date of Acceptance13-Aug-2021
Date of Web Publication22-Nov-2021
 

   Abstract 


Conflicts and humanitarian crises lead to serious mental health disorders, including depression, anxiety, stress, and cognitive decline. Exposure to these circumstances in early life can lead to the development of disorders such as mild cognitive impairment, dementia, and Alzheimer's disease (AD), for which no treatments are available. In this review, various research papers have been compiled to develop an understanding about mental health of population affected due to wars and conflicts and how stress and depression can accelerate the development of dementia and AD. Due to failure of drugs in the treatment of dementia and AD, yoga and mindfulness-based approach has been proposed for future investigations. Although studies have shown that yoga and mindfulness can be helpful in the management of stress, anxiety, depression, and posttraumatic stress disorder in the war-afflicted areas, limited mechanistic studies in yoga and mindfulness remain the chief cause precluding its clinical application in such warzones. The molecular studies in the field of yoga can be undertaken by targeting these warzones. This review provides a scientific evaluation of mind–body techniques as a justification for mental health rehabilitation in the war-afflicted zones in face of failed clinical trials for various drugs. This may help reduce the risk of developing dementia and AD in this susceptible population.

Keywords: Cognitive impairment, dementia, memory, stress, war-prone area, yoga

How to cite this article:
Anand A, Ghani A, Sharma K, Kaur G, Khosla R, Devi C, Podder V, Sivapuram MS, Maity K, Kaur H. War-related mental health issues and need for yoga intervention studies: A scoping review. Int J Yoga 2021;14:175-87

How to cite this URL:
Anand A, Ghani A, Sharma K, Kaur G, Khosla R, Devi C, Podder V, Sivapuram MS, Maity K, Kaur H. War-related mental health issues and need for yoga intervention studies: A scoping review. Int J Yoga [serial online] 2021 [cited 2021 Dec 2];14:175-87. Available from: https://www.ijoy.org.in/text.asp?2021/14/3/175/330794



   Introduction Top


War and conflicts cause extensive morbidity and mortality among the civilian population and military personnel in the war-affected area.[1] Along with those killed in violent conflicts, those who have experienced and suffered through these deaths (for example, maternal and infant mortality) are adversely affected at mental level.[2] It has been studied that people of war-prone areas suffer from various disorders which include various disabling injuries and adverse effects on the mental health, and these may even impair the future generations. Posttraumatic stress disorder (PTSD) and depression are the most common mental disorders among children and adults of war-affected areas.[3],[4] Effects of war and conflicts in early life can affect mental health and development of mental disorders, such as depression and anxiety. In adverse cases, it may lead to the development of dementia and Alzheimer's disease (AD).[5] The locals of war-prone areas and armed forces in the area of conflicts are continuously being affected by such stressful conditions.[6] Studies have shown that 25%–75% of survivors of artificial disasters develop PTSD.[7] A UNICEF study estimated in 1990 that, for every child death in war, three or more children are physically and psychologically disabled which ultimately led to 14 million children who were physically or psychologically traumatized by war during the 1980–1990.[8]

A study concluded that 22.1% of conflict-affected people have propensity to develop disorders such as depression, anxiety, stress, bipolar disorder, or schizophrenia at any time of ongoing conflict. The conditions such as these can lead to the development of dementia and AD,[9] and currently, no reliable treatment options and drugs are available for dementia and AD. Due to lack of an effective treatment for these disorders, there is a need to understand potentially modifiable risk factors for these conditions.[10] As there is high prevalence of these disorders in armed forces and residents of conflict-ridden areas, there is a need to identify the individuals at high risk for the prevention of disease in the presymptomatic stage; this can also be considered as a matter of high priority not only for Defense Department but also for the Alzheimer's research community.

Rehabilitation and treatment of conflict-affected population is one of the major concerns for the war-affected population as it is at high risk of being affected at mental, social, psychological, and physical well-being due to their routine stressful environment. The guidelines for mental rehabilitation have been published by certain national and professional agencies, e.g. the US Institute of Medicine 34; the American Psychiatric Association; the UK National Institute of Clinical Excellence; the World Federation of Societies of Biological Psychiatry; the Australian National Center for PTSD; and the British Association for Psychopharmacology.[11],[12],[13],[14],[15] These guidelines point toward the need of preventive measures for the management of mental health disorders due to war-afflicted stress that empower an endeavor to confide any unintimated trauma and consequent PTSD. Interventions such as psychotherapy, psychoeducation, yoga and mindfulness-based intervention, and certain psychopharmacological interventions have been considered as both preventive and promotive in the management of disorders associated with conflict and war-related conditions. Of all the preventive measures prescribed for health management in war and conflict-related conditions, yoga can be a major rehabilitative intervention. Several studies have found that yoga can help in relieving stress,[16] perceived stress and work-related stress,[17] anxiety,[18],[19] depression,[20] and PTSD.[21] Earlier studies suggest that different practices of yoga, such as breath control and meditation, promote good mental health.[22],[23] Yoga practice maintains homeostasis in the physiological conditions, thus improving the overall well-being and quality of life.[24] Yoga practice also helps reduce the allostatic load and influences the parasympathetic activity, which directly reduces the amygdala hyperactivation and elevated cortisol levels, thus reducing stress.[25] Yoga practice also relaxes the mind by slowing the breath and focusing on present, besides shifting the sympathetic brain activity to parasympathetic system and relaxation process.[26] Practice of yoga also inhibits the sense of fear and aggressiveness and stimulates the rewarding centers of the forebrain (e.g. nucleus accumbens). It also influences other areas of the brain for bliss and pleasure. This leads to reduction in anxiety and stabilizes the heart rate, respiratory rate, blood pressure, and cardiac output. Along with reduction in stress hormone, good hormone-like β-endorphin is found to be increased with yoga.[27]

Studies have shown that people living in warzones are prone to mental health problems which compromise their quality of life and this cannot be alleviated with only pharmacological interventions.[28],[29] Worsening quality of life leads to mental disorders which further increase the risk of dementia and AD later in life, thus requiring other interventions to prevent the development as well as health expenditure on such disorders. These may include psychotherapy and psychoeducation which are widely used. However, these interventions can only provide psychological improvement, whereas stress and depression exert its effects not only on the psychological level but also at the endocrine and molecular level. Yoga-based research, which is in its infancy, might provide clues if it can bring the needed psychological and neuroendocrine benefits and mediate alleviation of stress. Hence, studies that examine specific population exposed to warzone stress may not only benefit such population but also generate useful data for understanding the key mediators or markers of prevention.

Hence, the present review evaluates the mental health conditions of locals and veterans in war-affected areas and whether this makes them prone to stress, depression, anxiety, and PTSD later, resulting in the development of dementia and AD. This review further discusses the existing rehabilitative framework and whether it can be modified for better management and prevention of such disorders, such as stress and trauma, in population exposed to war-related conditions. We propose evidence-based mind–body interventions in the prevention and management of these disorders through its effect on the biochemical and neuroendocrine profile of biomarkers of mental health.

To understand the current updates and gaps, studies related to the mental health in the warzones were searched through online databases such as PubMed/Medline, Scopus, and Google Scholar. Further, studies describing mental health issues pertaining to the development of dementia and AD were searched. Ongoing and failed clinical trials in development of drugs for these disorders were also cited. To gain insights into yoga-based intervention for these mental disorders, randomized, nonrandomized, controlled, noncontrolled yoga and mindfulness-based trials for war-associated mental health issues were cited in this scoping review. Based on this search, the need for examining the molecular and neuroendocrine effect of yoga intervention in the war-related mental health conditions has been suggested for researchers.


   Extent of Stress, Anxiety, Depression in War-Prone Areas Top


War adversely affects both combatants and noncombatants of the war-prone areas. Currently, countries including Afghanistan, Iraq, Nigeria, Somalia, South Sudan, Syria, and Yemen are facing conflicts and humanitarian crises. In 2005, the WHO estimated the prevalence of psychiatric disorders among people affected by the humanitarian crisis, which highlights the need for rehabilitative practices for the people living under crisis conditions.[30] The psychological and physical effects of war and conflicts cannot be eliminated from the survivors. The conflict-associated psychosocial stress can cause neuroendocrine and immune system modulation.[28],[29] War survivors show a significant lifestyle, behavioral and emotional changes leading to various mental health disorders[31] and this can also adversely affect the health conditions of the future generations[32],[33] due to the epigenetic changes in the hypothalamic-pituitary-adrenal (HPA) axis.[34],[35] This creates a growing interest in the mental health subjects, affected by conflicts of humanitarian crisis, and provides an opportunity of proposing an intervention studies that impact the HPA axis and neuroendocrine system. The wide variation in the prevalence rate of mental disorders in people across different areas of conflict is depicted in [Table 1]. Psychiatric epidemiological research in conflict-affected areas typically exhibits varying results, with extremely high statistical heterogeneity.[41] This might be due to differences in the study designs and innumerable factors affecting the experience and expression of mental distress in this population. A report has shown that during armed conflicts, the humanitarian crises of the native population are equal to those of army personnel.[51],[57] Wars and conflicts between the countries are harmful and hazardous for civilian's mental health. In the conflict-affected states, people were constantly affected by psychological, emotional, and other personality crises, due to armed conflicts and associated circumstances for the last two decades.[58] Such stressful conditions highlight the importance of carrying out studies that examine the effects of mindfulness and yoga, because studies have shown the positive effects of yoga practices in stress.[59],[60] However, it cannot be ignored as mentioned in a WHO study, such studies required to be double blinded and should also include molecular and neuro endocrinal assessments in order to analyze the prevalence of depression, anxiety and PTSD.[30] Therefore, in such studies along with questionnaire based self-reported assessments additional biomarkers assessment has to be added. Molecular assessment can not only underline the severity of the condition but also enable screening the outcomes of an intervention.
Table 1: Representation of the prevalence of anxiety, depression posttraumatic stress disorder, and later development of dementia population exposed to war related conditions

Click here to view



   Conversion of War-Related Stress, Anxiety, and Depression to Dementia or Alzheimer's Disease Top


Traumatic events experienced any time in life can have a lasting mental health effect characterized by depression, anxiety, and PTSD.[43] [Table 2] shows studies from various countries with war-related mental health conditions. In 2019, an estimation of mental disorders in the war conditions found that 22.1% of the conflict-affected population is affected by depression, anxiety, PTSD, or other neurological disorders at any time point.[30] A study on stress in military volunteers found progressive deterioration in cognitive function during stressful combat-like training (e.g. reaction time and vigilance, memory, and logical reasoning) compared to baseline prestress function.[68] High prevalence of mild cognitive impairment (MCI) and dementia is also reported in military personnel who are continuously exposed to stressful environment in the war zones.[69] Due to development of mental health conditions such as stress, depression, anxiety, and PTSD in a war-affected population, there are chances of conversion to dementia and AD-like disorders.
Table 2: Studies from various countries, population of which has stress, posttraumatic stress disorder, depression, anxiety, dementia etc., due to exposure to war related conditions

Click here to view


Studies have also shown that history of depression and PTSD further increases risk of dementia.[66],[67]

The underlying reasons of conversion of PTSD to dementia are not clear; however, several symptoms of PTSD such as sleep impairment[70] may contribute to reduction in hippocampal volume and abnormal protein processing besides the accumulation of amyloid-beta (Aβ), tau, and hyperphosphorylated tau,[71],[72] which are the signs of dementia and AD.

Stress leads to activation of norandrogenic pathways which stimulate the release of cortisol via HPA axis activation, and hence, under stress and depression, the serum and cerebrospinal fluids levels of cortisol are elevated. The elevation in levels of cortisol may increase Aβ brain burden which may consequently induce cerebral AD pathology.[65]

As the mechanisms of how stress and PTSD lead to dementia or AD are not clearly understood (other than HPA axis involvement), it is attractive to analyze the neuroimmunological effectors in PTSD and dementia in a defined war-affected population making it ideal to examine. It is well known that there is increasing incidence of wars and conflicts in the world. It may render the local population and the armed forces to dementia and AD later in life. This raises the importance of nonpharmacological and cost-effective rehabilitative therapies, including yoga and mindfulness. It has been postulated that yoga acts by alteration of HPA axis and sympathetic nervous system, thus reducing the stress-induced hormonal activation.[73] Thus, yoga and mindfulness might be useful not only in the management of stress, PTSD, and depression but also an early prevention of dementia and AD in the war-affected population and affected military personnel.

Yoga and mindfulness have not been identified as a rehabilitative intervention for this population due to lack of studies describing the effects and benefits of yoga for war-related mental health conditions. Furthermore, very limited molecular studies in the field of yoga have been conducted in the context of stress, depression, PTSD, MCI, and dementia. This highlights the need of more studies on homogenous populations which could generate evidence whether yoga and mindfulness can be useful as a rehabilitative and preventive intervention such as war-related mental health and PTSD.


   Failure of Pharmacological Drugs for Treatment of Dementia and Alzheimer's Disease Top


Current treatment strategies are widely believed to provide symptomatic and limited relief in AD, dementia, and MCI pathologies.[70] As the current pharmacological research is based on the reductionist and whole-person approach in the field of stress and dementia,[71] repeated failure in developing pharmacotherapeutics in such complex disorders has raised questions about the efficacy of existing drugs used to treat AD and related dementia.[72] Currently, the FDA has approved a few drugs for cognitive improvement in the AD patients. These medications include choline esterase inhibitors such as donepezil and galantamine. These drugs, however, provide only symptomatic relief and have their side effects.[73] Donepezil and galantamine have been found to be helpful in neurological functions in patients with poststroke cognitive impairment but have not been shown to alter the neuroendocrine system.

Besides, most of the drugs have not been accepted for the treatment of dementia due to associated side effects and limited efficacy. Nimodipine has been found to have a short-term effect on cognitive function but not for AD or vascular cognitive impairment.[74] However, a review has compiled studies in which patients with MCI and dementia have shown improvement in cognitive function when yoga is provided as a primary or as a part of the multicomponent intervention.[75] There were limitations with the above-mentioned yoga studies that lacked details of the interventions, including variability in the frequency/duration and components of the yoga interventions.[75]

Accumulation of amyloid has remained unaltered even with the discovery of drug solanezumab, which targets the amyloid plaques, considered as a pathological hallmark of AD.[76] It has failed in a clinical trial led by Lilly. Lilly announced a major change to its closely watched clinical trial for the Alzheimer's drug solanezumab (which binds with β-amyloid), which failed to show statistical significance in offering relief in the symptoms of AD.[77] All the above-mentioned treatment paradigms fundamentally target a molecule and inhibit the downstream signaling involved in AD. Disease pathology of MCI and AD is much more complex than genetic disorders, and therefore, the reductionist approach is often argued as inappropriately applied to alleviate cognitive impairment in such disorders of the brain. [Table 3] describes the repeated failure of drugs for AD from time to time.
Table 3: Failure of drugs in the clinical trials for neurodegenerative diseases

Click here to view



   Yoga as an Intervention to the Population of War-Prone Regions Top


Rehabilitation for the war-affected people is important to bring positive change in the quality of life and reduce the cognitive decline, besides preventing various lifestyle disorders.[84] Although yoga is a well-studied and re-emerging mind–body technique in stress management, there is a major gap in studies that have investigated its impact on the war-affected people through molecular assessment. A study by Carter et al. found a significant reduction in PTSD score in Vietnamese veterans after 6 weeks of SKY intervention. The assessment was done using Clinician-Administered PTSD Scale.[85] Another study by Gordon et al. was conducted on the Palestinian adults in Gaza to determine the effects of mind–body skills group (MBSG) on symptoms of PTSD, depression, and quality of life among these adults. After 10 sessions of MBSG included meditation, guided imagery, breathing techniques, autogenic training, biofeedback, genograms, and self-expression through words and drawings. The levels of PTSD, depression, and quality of life were assessed in 92 Palestinian adults with PTSD. Immediate improvement in the symptoms of PTSD, depression, and improvement in quality of life was observed. After 10 months, all these improvements remained persistent among the participants.[86] A systematic review conducted by Cushing et al. analyzed the studies about the impact of mind–body therapy such as meditation, yoga, and mindfulness in the post-9/11 veterans with PTSD, which showed significant improvement in PTSD symptoms in these interventions.[87] [Table 4] shows the studies where yoga intervention has improved the mental health of the war-affected people. However, none of these studies examined the effects of mind–body practices at the molecular, cellular, and neuroendocrine level. In addition, these studies included a smaller number of participants.
Table 4: Several mind–body techniques administered to the war-affected people as an alternative intervention for reducing stress-induced cognitive problems and other associated factors

Click here to view



   Yoga versus Psychosocial Interventions in Prevention for Mental Health Problems Such as Stress, Anxiety, Depression, Mild Cognitive Impairment, and Dementia Top


Yoga combines physical activity with mindful practices and breath control. Meditation is typically performed regularly with an aim to achieve homeostasis via regulation of various neuroendocrine and regulatory mechanisms.[89],[90] Several systematic reviews and meta-analyses have demonstrated that yoga is effective in ameliorating symptoms of depression across a range of different clinical disorders, including mild dementia.[91],[92]

A meta-analysis has investigated the effects of yoga practice on physiological markers of stress and has found that studies including yoga practice showed improved regulation of sympathetic nervous system and HPA system.[93] Yoga is known to improve autonomous nervous system[94] and HPA axis, with consequent reduction in cortisol,[95] blood pressure,[96] heart rate,[97] fasting blood glucose, cholesterol, and low-density lipoprotein,[98] which are the biomarkers associated with conditions of chronic stress. Yoga is also known to improve sleep,[99] which is one of the related risk factors for PTSD.[91] It has been found that yoga practice through regulation of sympathetic nervous system and HPA axis reduces the conditions of depression and anxiety.[100] Similarly, yoga also improves mental well-being.[101] However, none of these reports have led to further attempts to examine the same in the vulnerable population of warzones that suffer from constant stress.[2] Li et al. reviewed yoga and mindfulness-based studies to examine its efficacy in reduction of stress and anxiety, they found that, out of 35 human trials, 25 showed promising results however, the limitations of these studies were smaller sample size and lack of control group a which could be a reason of non conclusiveness of the studies.[102] A clinical trial assessed the effects of SKY in comparison to electroconvulsive therapy and imipramine on 45 untreated melancholic depressive participants, who were randomly divided; however, all three groups showed significant reduction in depression scales, but SKY group showed better scores as compared to the other groups. To conclude that SKY can be a potential alternative to drugs in melancholia as a first-line treatment,[103] such studies should be designed as randomized control trails which include molecular and neuroendocrinal estimation. A review has also compared yoga with aerobic exercise for health-related quality of life (HRQoL) and multiple physical functions in older adults. The meta-analysis revealed significant results favoring yoga group in comparison to inactive control and active control groups with overall improvement in multiple physical function and HRQoL outcomes.[104] Some other studies have compared psychological aspects in long-term meditators in comparison to novices or no meditation practitioners and have found meditation to show overall improvement in psychological aspects as compared to nonmeditators.[105],[106],[107]

Yoga-based studies have shown positive results but lack robust study designs, smaller sample size, no randomization and blinding, etc., Furthermore, very few yoga-based studies provide sufficient information regarding the yoga intervention, compliance, and the proportion of time spent practicing each of the its components (i.e. Asanas, Pranayama, and Dhyana), partly due to the dissociation of basic scientists from yoga practitioners and partly due to absence of quality assurance programs that govern compliance in yoga intervention studies. Such quality assurance programs are often done in research laboratories and it is called good laboratory practice,[108],[109] and such practices are absent in yoga research. Few studies from reputed research groups show adherence to quality assurance principles.[110],[111],[112] All these limitations make yoga and meditation practices unrecognizable in the global scientific fraternity. Hence, limited studies that have tried to use these interventions for the much-needed population in the warzones, and the veterans from the war areas need to be supplemented by multicenter studies. Additional planned studies analyzing not only the psychological aspects but also the biological aspects of yoga on this population would not only help this population to cope with the circumstances but also help develop an understanding about the biological aspects of yoga and meditation, which has been studied to a limited extent. [Table 5] shows that yoga-based interventions have helped in improvement of depression, anxiety, stress, and dementia. The studies mentioned in [Table 4] could be used as reference studies for warzone populations as these yoga-based protocols have shown promising results.
Table 5: The list of some yoga protocols used across the world for the management of anxiety, depression, stress, and dementia which are also the health problems faced by people exposed to war related conditions

Click here to view



   Role of Neuroendocrine System in Alleviation of Stress and Dementia by Mindfulness Approach Top


Experience of a traumatic event can lead to the long-term consequences on mental health along with cellular and molecular changes, which can cause long-term impact responsible for onset of diseases such as depression, MCI, dementia, AD, and many other related disorders.[120] Traumatic events are known to alter the neuronal morphology, function, and neurochemistry.[121] Brain-derived neurotrophic factor (BDNF) is actively involved in the regulation of neurogenesis. A low level of BDNF has been found to be involved in the pathophysiology of depression,[122] anxiety,[123] and dementia and Alzheimer's like syndromes.[124] BDNF reduction is associated with stressful life events, but it increases after physical training.[125] Yoga practice along with its positive impact on quality of life[24] has shown to increase BDNF levels.[126]

Sociocultural background also has an important aspect in the psychological problems of traumatized individuals.[127] A 2005 study has reported the association of low socioeconomic status with the higher vulnerability to develop PTSD and low capacity to cope with symptoms of PTSD.[128] Another 2011 study from the US has reported lower prevalence of minority people to seek treatment for PTSD than majority population, with less than half of the minority individuals taking treatment,[129] which again emphasizes the importance of awareness among different sociocultural groups. Another study has reported that direct impact of socioeconomic and cultural factors has major role in understanding psychological problems of traumatized individuals with a direct impact on the social functioning ability.[127],[130]

In addition, depression and stress-like syndromes are characterized by the central and peripheral release of various markers of inflammation such as interleukins,[131] e.g., IL-6, IL-2, TNF, which are reported to be higher in depressed subjects than in non depressed subjects.[132] However, physical exercise reportedly influences the immune system and expression of its related molecules. Various inflammatory cytokine levels are reported to change during and after exercise (including IL-1 and IL-6),[133],[134] some of which are directly related to pathologies related to stress.[135] The practice of yoga has also shown to reduce inflammatory cytokines.[136] Yoga can improve the antioxidant levels[137] and has also been shown to alter the levels of biomolecules associated with stress, including cortisol, IL-6, beta-endorphins, sirtuin-1, and BDNF.[138] Studies have shown that mind–body interventions can modulate the inflammatory gene expression induced with persistent stress conditions.[139]

During past few years, yoga is being recognized in the prevention and management of stress, depression, anxiety, MCI, and related disorders, but not many studies have been carried out to correlate the physiological outcome with molecular markers induced by yoga in relation to these disorders.

Furthermore, the molecular changes leading to these disorders have not been explored in the warzone population being highly prone to these disorders. Therefore, it is imperative to analyze the biochemical, molecular markers related to pathways of inflammation, angiogenesis, and neurogenesis, which are directly affected with the above-mentioned disorders. During the past few years, mind–body intervention is gaining interest as it has been found to be beneficial in reducing stress, depression, anxiety, MCI, and related chronic diseases, but again comparative studies are still lacking.

Hence, employing study designs based on yoga protocols in warzones and paramilitary barracks can provide insights about the molecular and sociocultural impact of yoga besides improving management of the mental stress among this population.


   Recommendations for Future Research Top


The higher probability of disorders such as stress, anxiety, depression, dementia, and AD in the locals of war-prone areas and the army combats have been well defined in the literature. Yoga is proposed as an intervention for the vulnerable population. However, very few studies have been devoted to investigating the efficacy of yoga on the war combatants and war-exposed civilians and PTSD-related conditions. In this review, several new research questions were identified. For example, what is the extent of war-prone–related anxiety, depression, in war-prone areas, and if these convert to dementia? Are mind–body techniques acceptable to such vulnerable populations? Could yoga intervention be superior to other psychosocial interventions for mental health issues confronted by such a population? Can yoga prevent progression of stress and dementia into AD? What is the role of neuroendocrine system in alleviation of stress and dementia by mindfulness approach? Much more data are required to not only understand the benefits and barriers in implementing such techniques but also bridge the chasm of knowledge and practice of mindfulness-based yoga. Can practicing these techniques reduce PTSD among individuals immediately after war trauma and in the war-prone area? For advancing our understanding further, the benefits of yoga as an intervention need analysis at the physiological and molecular level.


   Conclusion Top


Wars and conflicts affect the social and mental well-being of the individuals who are directly or indirectly involved. Residents of war-prone areas, along with the military combats, are the most vulnerable population for the war-related effects. The war-related stress may lead to development of various disorders such as depression, anxiety, stress, and PTSD and these can later lead to the development of dementia and AD. Mental health of the war-afflicted population and the military personnel has not been given much importance. They are continually exposed to such circumstances as this population is highly prone to develop various mental disorders affecting their social, emotional, and physical well-being. There are limitations in fulfillment of the mental and medical needs of this population, and evidence-based yoga and mindfulness interventions can bridge these gaps. As shown by studies, yoga not only provides anxiety related relief, but it also acts through the cell survival mechanisms, thus improving the overall health of the practitioner. Hence, inclusion of Yoga and Mindfulness in the daily routine of the military personnels and population of war afflicted areas can be helpful in the prevention and management of war related mental health disorders. For yoga and mindfulness to be adopted by the medical healthcare fraternity, there is a need to learn new methods to change health providers' attitude, by launching new studies with rigorous guidelines based on evidence generated by engagement of military forces and residents of war-affected areas before integrating them with healthcare for effective rehabilitation. This will not only help in understanding of molecular pathways of cognitive impairment and how stress alleviation is achieved by yoga intervention but also is discerning the public health model for wellness. In addition, if the medical staff/patients/families/caregivers are provided some basic, practical resources of yoga and mindful techniques, this would encourage active participation in enrollment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Levy BS, Sidel VW. Documenting the effects of armed conflict on population health. Annu Rev Public Health 2016;37:205-18.  Back to cited text no. 1
    
2.
Murthy RS, Lakshminarayana R. Mental health consequences of war: A brief review of research findings. World Psychiatry 2006;5:25-30.  Back to cited text no. 2
    
3.
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA 2009;302:537-49.  Back to cited text no. 3
    
4.
Priebe S, Bogic M, Ajdukovic D, Franciskovic T, Galeazzi GM, Kucukalic A, et al. Mental disorders following war in the Balkans: A study in 5 countries. Arch Gen Psychiatry 2010;67:518-28.  Back to cited text no. 4
    
5.
Singhal S. Early life shocks and mental health: The long-term effect of war in Vietnam. J Dev Econ 2019;141:102244.  Back to cited text no. 5
    
6.
Mohlenhoff BS, O'Donovan A, Weiner MW, Neylan TC. Dementia risk in posttraumatic stress disorder: The relevance of sleep-related abnormalities in brain structure, Amyloid, and inflammation. Curr Psychiatry Rep 2017;19:89.  Back to cited text no. 6
    
7.
Myles P, Swenshon S, Haase K, Szeles T, Jung C, Jacobi F, et al. A comparative analysis of psychological trauma experienced by children and young adults in two scenarios: Evacuation after a natural disaster vs forced migration to escape armed conflict. Public Health 2018;158:163-75.  Back to cited text no. 7
    
8.
UNICEF. The State of the World's Children. Oxford, England: Oxford University Press for UNICEF; 2002.  Back to cited text no. 8
    
9.
Staples JK, Abdel Atti JA, Gordon JS. Mind-body skills groups for posttraumatic stress disorder and depression symptoms in Palestinian children and adolescents in Gaza. Int J Stress Manag 2011;18:246.  Back to cited text no. 9
    
10.
Zilkens RR, Bruce DG, Duke J, Spilsbury K, Semmens JB. Severe psychiatric disorders in mid-life and risk of dementia in late- life (age 65-84 years): A population based case-control study. Curr Alzheimer Res 2014;11:681-93.  Back to cited text no. 10
    
11.
Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, et al. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry 2004;161:3-31.  Back to cited text no. 11
    
12.
Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S. Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry 2007;190:97-104.  Back to cited text no. 12
    
13.
Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ; WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disoders, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders-first revision. World J Biol Psychiatry 2008;9:248-312.  Back to cited text no. 13
    
14.
Forbes D, Creamer M, Phelps A, Bryant R, McFarlane A, Devilly GJ, et al. Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder. Aust N Z J Psychiatry 2007;41:637-48.  Back to cited text no. 14
    
15.
Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005;19:567-96.  Back to cited text no. 15
    
16.
Amaravathi E, Ramarao NH, Raghuram N, Pradhan B. Yoga-based postoperative cardiac rehabilitation program for improving quality of life and stress levels: Fifth-year follow-up through a randomized controlled trial. Int J Yoga 2018;11:44-52.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Rao M, Metri KG, Raghuram N, Hongasandra NR. Effects of mind sound resonance technique (yogic relaxation) on psychological states, sleep quality, and cognitive functions in female teachers: A randomized, controlled trial. Adv Mind Body Med 2017;31:4-9.  Back to cited text no. 17
    
18.
Maddux RE, Daukantaité D, Tellhed U. The effects of yoga on stress and psychological health among employees: An 8- and 16-week intervention study. Anxiety Stress Coping 2018;31:121-34.  Back to cited text no. 18
    
19.
Kirkwood G, Rampes H, Tuffrey V, Richardson J, Pilkington K. Yoga for anxiety: A systematic review of the research evidence. Br J Sports Med 2005;39:884-91.  Back to cited text no. 19
    
20.
Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: A systematic review and meta-analysis. Depress Anxiety 2013;30:1068-83.  Back to cited text no. 20
    
21.
Cushing RE, Braun KL, Alden C-Iayt SW, Katz AR. Military-tailored yoga for veterans with post-traumatic stress disorder. Mil Med 2018;183:e223-31.  Back to cited text no. 21
    
22.
Tiwari N, Sutton M, Garner M, Baldwin DS. Yogic breathing instruction in patients with treatment-resistant generalized anxiety disorder: Pilot study. Int J Yoga 2019;12:78-83.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Lee MY, Zaharlick A, Akers D. Impact of meditation on mental health outcomes of female trauma survivors of interpersonal violence with co-occurring disorders: A randomized controlled trial. J Interpers Violence 2017;32:2139-65.  Back to cited text no. 23
    
24.
Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga 2011;4:49-54.  Back to cited text no. 24
[PUBMED]  [Full text]  
25.
Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012;78:571-9.  Back to cited text no. 25
    
26.
McCall T. Yoga as medicine: The Yogic Prescription for Health and Healing. New York: Bantam Dell; 2007.  Back to cited text no. 26
    
27.
Mahajan A. Role of yoga in hormonal homeostasis. Int J Clin Exp Physiol 2014;1:173.  Back to cited text no. 27
  [Full text]  
28.
Tsigos C, Kyrou I, Kassi E, Chrousos GP, Feingold KR, Anawalt B, et al. Stress: Endocrine Physiology and Pathophysiology. Endotext 2000.  Back to cited text no. 28
    
29.
Segerstrom SC, Miller GE. Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol Bull 2004;130:601-30.  Back to cited text no. 29
    
30.
Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. Lancet 2019;394:240-8.  Back to cited text no. 30
    
31.
Wang SJ, Salihu M, Rushiti F, Bala L, Modvig J. Survivors of the war in the Northern Kosovo: Violence exposure, risk factors and public health effects of an ethnic conflict. Confl Health 2010;4:11.  Back to cited text no. 31
    
32.
Van den Bergh BR, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev 2020;117:26-64.  Back to cited text no. 32
    
33.
Monk C, Lugo-Candelas C, Trumpff C. Prenatal developmental origins of future psychopathology: Mechanisms and pathways. Annu Rev Clin Psychol 2019;15:317-44.  Back to cited text no. 33
    
34.
Holsboer F. The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology 2000;23:477-501.  Back to cited text no. 34
    
35.
Devakumar D, Birch M, Osrin D, Sondorp E, Wells JC. The intergenerational effects of war on the health of children. BMC Med 2014;12:57.  Back to cited text no. 35
    
36.
Blair RG. Risk factors associated with PTSD and major depression among Cambodian refugees in Utah. Health Soc Work 2000;25:23-30.  Back to cited text no. 36
    
37.
von Lersner U, Wiens U, Elbert T, Neuner F. Mental health of returnees: Refugees in Germany prior to their state-sponsored repatriation. BMC Int Health Hum Rights 2008;8:8.  Back to cited text no. 37
    
38.
Nicholson BL. The influence of pre-emigration and postemigration stressors on mental health: A study of Southeast Asian refugees. Soc Work Res 1997;21:19-31.  Back to cited text no. 38
    
39.
Hollifield M, Warner TD, Jenkins J, Sinclair-Lian N, Krakow B, Eckert V, et al. Assessing war trauma in refugees: Properties of the comprehensive trauma inventory-104. J Trauma Stress 2006;19:527-40.  Back to cited text no. 39
    
40.
Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese L. Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict. JAMA 2003;290:635-42.  Back to cited text no. 40
    
41.
Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: A systematic literature review. BMC Int Health Hum Rights 2015;15:29.  Back to cited text no. 41
    
42.
Craig CD, Sossou MA, Schnak M, Essex H. Complicated grief and its relationship to mental health and well-being among Bosnian refugees after resettlement in the United States: Implications for practice, policy, and research. Traumatology 2008;14:103-15.  Back to cited text no. 42
    
43.
Gerritsen AA, Bramsen I, Devillé W, van Willigen LH, Hovens JE, van der Ploeg HM. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2006;41:18-26.  Back to cited text no. 43
    
44.
Bhui K, Abdi A, Abdi M, Pereira S, Dualeh M, Robertson D, et al. Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees – preliminary communication. Soc Psychiatry Psychiatr Epidemiol 2003;38:35-43.  Back to cited text no. 44
    
45.
Birman D, Tran N. Psychological distress and adjustment of Vietnamese refugees in the United States: Association with pre- and postmigration factors. Am J Orthopsychiatry 2008;78:109-20.  Back to cited text no. 45
    
46.
Schweitzer R, Melville F, Steel Z, Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust N Z J Psychiatry 2006;40:179-87.  Back to cited text no. 46
    
47.
Hinton L, Jenkins CN, McPhee S, Wong C, Lai KQ, Le A, et al. A survey of depressive symptoms among Vietnamese-American men in three locales: Prevalence and correlates. J Nerv Ment Dis 1998;186:677-83.  Back to cited text no. 47
    
48.
Carlson EB, Rosser-Hogan R. Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. J Trauma Stress 1994;7:43-58.  Back to cited text no. 48
    
49.
Stige SH, Sveaass N. Living in exile when disaster strikes at home. Torture 2010;20:76-91.  Back to cited text no. 49
    
50.
Onyut LP, Neuner F, Ertl V, Schauer E, Odenwald M, Elbert T. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – An epidemiological study. Confl Health 2009;3:6.  Back to cited text no. 50
    
51.
Matheson K, Jorden S, Anisman H. Relations between trauma experiences and psychological, physical and neuroendocrine functioning among Somali refugees: Mediating role of coping with acculturation stressors. J Immigr Minor Health 2008;10:291-304.  Back to cited text no. 51
    
52.
Yaffe K, Vittinghoff E, Lindquist K, Barnes D, Covinsky KE, Neylan T, et al. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry 2010;67:608-13.  Back to cited text no. 52
    
53.
Bonanni L, Franciotti R, Martinotti G, Vellante F, Flacco ME, Di Giannantonio M, et al. Post traumatic stress disorder heralding the onset of semantic frontotemporal dementia. J Alzheimers Dis 2018;63:203-15.  Back to cited text no. 53
    
54.
Qureshi SU, Kimbrell T, Pyne JM, Magruder KM, Hudson TJ, Petersen NJ, et al. Greater prevalence and incidence of dementia in older veterans with posttraumatic stress disorder. J Am Geriatr Soc 2010;58:1627-33.  Back to cited text no. 54
    
55.
Flatt JD, Gilsanz P, Quesenberry CP Jr., Albers KB, Whitmer RA. Post-traumatic stress disorder and risk of dementia among members of a health care delivery system. Alzheimers Dement 2018;14:28-34.  Back to cited text no. 55
    
56.
Santa Barbara J. Impact of war on children and imperative to end war. Croat Med J 2006;47:891-4.  Back to cited text no. 56
    
57.
Levy BS, Sidel VW. Health effects of combat: A life-course perspective. Annu Rev Public Health 2009;30:123-36.  Back to cited text no. 57
    
58.
Housen T, Lenglet A, Shah S, Sha H, Ara S, Pintaldi G, et al. Trauma in the Kashmir Valley and the mediating effect of stressors of daily life on symptoms of posttraumatic stress disorder, depression and anxiety. Confl Health 2019;13:58.  Back to cited text no. 58
    
59.
Tellhed U, Daukantaitė D, Maddux RE, Svensson T, Melander O. Yogic breathing and mindfulness as stress coping mediate positive health outcomes of yoga. Mindfulness 2019;10:2703-15.  Back to cited text no. 59
    
60.
Sharma M. Yoga as an alternative and complementary approach for stress management: A systematic review. J Evid Based Complementary Altern Med 2014;19:59-67.  Back to cited text no. 60
    
61.
Ahmad A, Sofi MA, Sundelin-Wahlsten V, von Knorring AL. Posttraumatic stress disorder in children after the military operation “Anfal” in Iraqi Kurdistan. Eur Child Adolesc Psychiatry 2000;9:235-43.  Back to cited text no. 61
    
62.
Alpak G, Unal A, Bulbul F, Sagaltici E, Bez Y, Altindag A, et al. Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional study. Int J Psychiatry Clin Pract 2015;19:45-50.  Back to cited text no. 62
    
63.
Cardozo BL, Bilukha OO, Crawford CA, Shaikh I, Wolfe MI, Gerber ML, et al. Mental health, social functioning, and disability in postwar Afghanistan. JAMA 2004;292:575-84.  Back to cited text no. 63
    
64.
Charlson FJ, Steel Z, Degenhardt L, Chey T, Silove D, Marnane C, et al. Predicting the impact of the 2011 conflict in Libya on population mental health: PTSD and depression prevalence and mental health service requirements. PLoS One 2012;7:e40593.  Back to cited text no. 64
    
65.
Gautam S, Gupta ID, Batra L, Sharma H, Khandelwal R, Pant A. Psychiatric morbidity among victims of bomb blast. Indian J Psychiatry 1998;40:41-5.  Back to cited text no. 65
[PUBMED]  [Full text]  
66.
Razik S, Ehring T, Emmelkamp PM. Psychological consequences of terrorist attacks: Prevalence and predictors of mental health problems in Pakistani emergency responders. Psychiatry Res 2013;207:80-5.  Back to cited text no. 66
    
67.
Donley GA, Lönnroos E, Tuomainen TP, Kauhanen J. Association of childhood stress with late-life dementia and Alzheimer's disease: The KIHD study. Eur J Public Health 2018;28:1069-73.  Back to cited text no. 67
    
68.
Lieberman HR, Bathalon GP, Falco CM, Morgan CA 3rd, Niro PJ, Tharion WJ. The fog of war: Decrements in cognitive performance and mood associated with combat-like stress. Aviat Space Environ Med 2005;76:C7-14.  Back to cited text no. 68
    
69.
Weiner MW, Veitch DP, Hayes J, Neylan T, Grafman J, Aisen PS, et al. Effects of traumatic brain injury and posttraumatic stress disorder on Alzheimer's disease in veterans, using the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2014;10:S226-35.  Back to cited text no. 69
    
70.
Mehta D, Jackson R, Paul G, Shi J, Sabbagh M. Why do trials for Alzheimer's disease drugs keep failing? A discontinued drug perspective for 2010-2015. Expert Opin Investig Drugs 2017;26:735-9.  Back to cited text no. 70
    
71.
Yiannopoulou KG, Papageorgiou SG. Current and future treatments for Alzheimer's disease. Ther Adv Neurol Disord 2013;6:19-33.  Back to cited text no. 71
    
72.
Becker RE, Greig NH, Giacobini E. Why do so many drugs for Alzheimer's disease fail in development? Time for new methods and new practices? J Alzheimers Dis 2008;15:303-25.  Back to cited text no. 72
    
73.
Sharma K. Cholinesterase inhibitors as Alzheimer's therapeutics (Review). Mol Med Rep 2019;20:1479-87.  Back to cited text no. 73
    
74.
López-Arrieta JM, Birks J. Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database Syst Rev 2002;3:CD000147.  Back to cited text no. 74
    
75.
Brenes GA, Sohl S, Wells RE, Befus D, Campos CL, Danhauer SC. The effects of yoga on patients with mild cognitive impairment and dementia: A scoping review. Am J Geriatr Psychiatry 2019;27:188-97.  Back to cited text no. 75
    
76.
Espargaró A, Ginex T, Vadell MD, Busquets MA, Estelrich J, Muñoz-Torrero D, et al. Combined in vitro cell-based/in silico screening of naturally occurring flavonoids and phenolic compounds as potential anti-Alzheimer drugs. J Nat Prod 2017;80:278-89.  Back to cited text no. 76
    
77.
Doody RS, Thomas RG, Farlow M, Iwatsubo T, Vellas B, Joffe S, et al. Phase 3 trials of solanezumab for mild-to-moderate Alzheimer's disease. N Engl J Med 2014;370:311-21.  Back to cited text no. 77
    
78.
Holmes C, Boche D, Wilkinson D, Yadegarfar G, Hopkins V, Bayer A, et al. Long-term effects of Abeta42 immunisation in Alzheimer's disease: follow-up of a randomised, placebo-controlled phase I trial. Lancet 2008;372:216-23.  Back to cited text no. 78
    
79.
Mullane K, Williams M. Alzheimer's therapeutics: Continued clinical failures question the validity of the amyloid hypothesis-but what lies beyond? Biochem Pharmacol 2013;85:289-305.  Back to cited text no. 79
    
80.
Saumier D, Duong A, Haine D, Garceau D, Sampalis J. Domain-specific cognitive effects of tramiprosate in patients with mild to moderate Alzheimer's disease: ADAS-cog subscale results from the Alphase study. J Nutr Health Aging 2009;13:808-12.  Back to cited text no. 80
    
81.
Lilly E. Company Announces Top-Line Results on Solanezumab Phase 3 Clinical Trials in Patients with Alzheimer's Disease. Acquir. Media. 2012;24.  Back to cited text no. 81
    
82.
Wood KM, McCush F, Conboy JJ, Durham R, Tate B, Bednar MM, et al. IP/MS analysis of human CSF Aβ following a single dose of the C-terminal anti-Aβ antibody ponezumab (PF-04360365) to Alzheimer patients. Alzheimers Dement 2010;6:S311.  Back to cited text no. 82
    
83.
Servick K. Another major drug candidate targeting the brain plaques of Alzheimer's disease has failed. What's left. Science 2019;10.  Back to cited text no. 83
    
84.
Nosè M, Ballette F, Bighelli I, Turrini G, Purgato M, Tol W, et al. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis. PLoS One 2017;12:e0171030.  Back to cited text no. 84
    
85.
Carter J, Gerbarg P, Brown R, Ware R, D'ambrosio C. Multi-component yoga breath program for Vietnam veteran post traumatic stress disorder: Randomized controlled trial. J Trauma Stress Disor Treat 2013;3:1-10.  Back to cited text no. 85
    
86.
Gordon JS, Staples JK, He DY, Atti JA. Mind–body skills groups for posttraumatic stress disorder in Palestinian adults in Gaza. Traumatology 2016;22:155.  Back to cited text no. 86
    
87.
Cushing RE, Braun KL. Mind-body therapy for military veterans with post-traumatic stress disorder: A systematic review. J Altern Complement Med 2018;24:106-14.  Back to cited text no. 87
    
88.
Rees B, Travis F, Shapiro D, Chant R. Reduction in posttraumatic stress symptoms in Congolese refugees practicing transcendental meditation. J Trauma Stress 2013;26:295-8.  Back to cited text no. 88
    
89.
Gard T, Noggle JJ, Park CL, Vago DR, Wilson A. Potential self-regulatory mechanisms of yoga for psychological health. Front Hum Neurosci 2014;8:770.  Back to cited text no. 89
    
90.
Albracht K. Effects of Emotional Exposure on State Anxiety and Physiological Measures of Stress Reactivity after an Acute YogaFit Session; 2014.  Back to cited text no. 90
    
91.
Mathersul DC, Rosenbaum S. The roles of exercise and yoga in ameliorating depression as a risk factor for cognitive decline. Evid Based Complement Alternat Med 2016;2016:4612953.  Back to cited text no. 91
    
92.
Perraton LG, Kumar S, Machotka Z. Exercise parameters in the treatment of clinical depression: A systematic review of randomized controlled trials. J Eval Clin Pract 2010;16:597-604.  Back to cited text no. 92
    
93.
Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology 2017;86:152-68.  Back to cited text no. 93
    
94.
Udupa K, Sathyaprabha T. Influence of yoga on the autonomic nervous system. In: Research-Based Perspectives on the Psychophysiology of Yoga. Hershey, Pennsylvania: IGI Global; 2018. p. 67-85.  Back to cited text no. 94
    
95.
Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Res 2011;4:189-201.  Back to cited text no. 95
    
96.
Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: Systematic review and meta-analysis. Evid Based Complement Alternat Med 2013;2013:649836.  Back to cited text no. 96
    
97.
Vinay AV, Venkatesh D, Ambarish V. Impact of short-term practice of yoga on heart rate variability. Int J Yoga 2016;9:62-6.  Back to cited text no. 97
[PUBMED]  [Full text]  
98.
Shantakumari N, Sequeira S, El deeb R. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart J 2013;65:127-31.  Back to cited text no. 98
    
99.
Bankar MA, Chaudhari SK, Chaudhari KD. Impact of long term Yoga practice on sleep quality and quality of life in the elderly. J Ayurveda Integr Med 2013;4:28-32.  Back to cited text no. 99
[PUBMED]  [Full text]  
100.
Ramanathan M, Bhavanani AB, Trakroo M. Effect of a 12-week yoga therapy program on mental health status in elderly women inmates of a hospice. Int J Yoga 2017;10:24-8.  Back to cited text no. 100
[PUBMED]  [Full text]  
101.
Büssing A, Michalsen A, Khalsa SB, Telles S, Sherman KJ. Effects of yoga on mental and physical health: A short summary of reviews. Evid Based Complement Alternat Med 2012;2012:165410.  Back to cited text no. 101
    
102.
Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev 2012;17:21-35.  Back to cited text no. 102
    
103.
Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: A randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord 2000;57:255-9.  Back to cited text no. 103
    
104.
Sivaramakrishnan D, Fitzsimons C, Kelly P, Ludwig K, Mutrie N, Saunders DH, et al. The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults- systematic review and meta-analysis of randomised controlled trials. Int J Behav Nutr Phys Act 2019;16:33.  Back to cited text no. 104
    
105.
Manocha R, Black D, Wilson L. Quality of life and functional health status of long-term meditators. Evid Based Complement Alternat Med 2012;2012:350674.  Back to cited text no. 105
    
106.
Brand S, Holsboer-Trachsler E, Naranjo JR, Schmidt S. Influence of mindfulness practice on cortisol and sleep in long-term and short-term meditators. Neuropsychobiology 2012;65:109-18.  Back to cited text no. 106
    
107.
Verma G, Araya R. The effect of meditation on psychological distress among Buddhist Monks and Nuns. Int J Psychiatry Med 2010;40:461-8.  Back to cited text no. 107
    
108.
Kaushal S, Tyagi R, Banik A, Battu P, Mehra P, Sharma NK, et al. A unique data validation process by internal and external quality assurance system aimed to combat research malpractice. Int J Sci Res 2019;8:5-9.  Back to cited text no. 108
    
109.
Kumar S, Mehra P, Anand A. Policy Research Into Quality Assessment of Published Data from Medical Institutes Can Increase the Authenticity of Translation. New Delhi, India: SAGE Publications Sage India; 2020.  Back to cited text no. 109
    
110.
Butzer B, LoRusso A, Shin SH, Khalsa SB. Evaluation of yoga for preventing adolescent substance use risk factors in a middle school setting: A preliminary group-randomized controlled trial. J Youth Adolesc 2017;46:603-32.  Back to cited text no. 110
    
111.
Chaoul A, Milbury K, Spelman A, Basen-Engquist K, Hall MH, Wei Q, et al. Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer 2018;124:36-45.  Back to cited text no. 111
    
112.
Gautam S, Kumar M, Kumar U, Dada R. Effect of an 8-week yoga-based lifestyle intervention on psycho-neuro-immune axis, disease activity, and perceived quality of life in rheumatoid arthritis patients: A randomized controlled trial. Front Psychol 2020;11:2259.  Back to cited text no. 112
    
113.
Streeter CC, Gerbarg PL, Whitfield TH, Owen L, Johnston J, Silveri MM, et al. Treatment of major depressive disorder with Iyengar yoga and coherent breathing: A randomized controlled dosing study. J Altern Complement Med 2017;23:201-7.  Back to cited text no. 113
    
114.
Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, et al. Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatr Scand 2010;121:289-300.  Back to cited text no. 114
    
115.
Brems C. A yoga stress reduction intervention for university faculty, staff, and graduate students. Int J Yoga Therap 2015;25:61-77.  Back to cited text no. 115
    
116.
Eyre HA, Siddarth P, Acevedo B, Van Dyk K, Paholpak P, Ercoli L, et al. A randomized controlled trial of Kundalini yoga in mild cognitive impairment. Int Psychogeriatr 2017;29:557-67.  Back to cited text no. 116
    
117.
Brunner D, Abramovitch A, Etherton J. A yoga program for cognitive enhancement. PLoS One 2017;12:e0182366.  Back to cited text no. 117
    
118.
Eyre HA, Acevedo B, Yang H, Siddarth P, Van Dyk K, Ercoli L, et al. Changes in neural connectivity and memory following a yoga intervention for older adults: A pilot study. J Alzheimers Dis 2016;52:673-84.  Back to cited text no. 118
    
119.
Fan JT, Chen KM. Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities. Int Psychogeriatr 2011;23:1222-30.  Back to cited text no. 119
    
120.
Girgenti MJ, Hare BD, Ghosal S, Duman RS. Molecular and cellular effects of traumatic stress: Implications for PTSD. Curr Psychiatry Rep 2017;19:85.  Back to cited text no. 120
    
121.
Cacciaglia R, Nees F, Grimm O, Ridder S, Pohlack ST, Diener SJ, et al. Trauma exposure relates to heightened stress, altered amygdala morphology and deficient extinction learning: Implications for psychopathology. Psychoneuroendocrinology 2017;76:19-28.  Back to cited text no. 121
    
122.
Lee BH, Kim YK. The roles of BDNF in the pathophysiology of major depression and in antidepressant treatment. Psychiatry Investig 2010;7:231-5.  Back to cited text no. 122
    
123.
Murínová J, Hlaváčová N, Chmelová M, Riečanský I. The evidence for altered BDNF expression in the brain of rats reared or housed in social isolation: A systematic review. Front Behav Neurosci 2017;11:101.  Back to cited text no. 123
    
124.
Ng TKS, Ho CSH, Tam WWS, Kua EH, Ho RC. Decreased serum brain-derived neurotrophic factor (BDNF) levels in patients with Alzheimer's disease (AD): A systematic review and meta-analysis. Int J Mol Sci 2019;20:E257.  Back to cited text no. 124
    
125.
Küster OC, Laptinskaya D, Fissler P, Schnack C, Zügel M, Nold V, et al. Novel blood-based biomarkers of cognition, stress, and physical or cognitive training in older adults at risk of dementia: Preliminary evidence for a role of BDNF, irisin, and the kynurenine pathway. J Alzheimers Dis 2017;59:1097-111.  Back to cited text no. 125
    
126.
Cahn BR, Goodman MS, Peterson CT, Maturi R, Mills PJ. Yoga, meditation and mind-body health: Increased BDNF, cortisol awakening response, and altered inflammatory marker expression after a 3-month yoga and meditation retreat. Front Hum Neurosci 2017;11:315.  Back to cited text no. 126
    
127.
Halimi R, Dragoti E, Halimi H, Sylejmani-Hulaj N, Jashari-Ramadani S. Socio-cultural context and feelings of hatred and revenge in war veterans with post-traumatic stress disorder 15 years after war in Kosovo. Ment Illn 2015;7:5609.  Back to cited text no. 127
    
128.
Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry 2001;158:1467-73.  Back to cited text no. 128
    
129.
Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med 2011;41:71-83.  Back to cited text no. 129
    
130.
Marsella AJ. Ethnocultural aspects of PTSD: An overview of concepts, issues, and treatments. Traumatology 2010;16:17-26.  Back to cited text no. 130
    
131.
Miller AH, Raison CL. The role of inflammation in depression: From evolutionary imperative to modern treatment target. Nat Rev Immunol 2016;16:22-34.  Back to cited text no. 131
    
132.
Liu Y, Ho RC, Mak A. Interleukin (IL)-6, tumour necrosis factor alpha (TNF-α) and soluble interleukin-2 receptors (sIL-2R) are elevated in patients with major depressive disorder: a meta-analysis and meta-regression. J Affect Disord 2012;139:230-9.  Back to cited text no. 132
    
133.
Abd El-Kader SM, Al-Shreef FM. Inflammatory cytokines and immune system modulation by aerobic versus resisted exercise training for elderly. Afr Health Sci 2018;18:120-31.  Back to cited text no. 133
    
134.
Zamani A, Salehi I, Alahgholi-Hajibehzad M. Moderate exercise enhances the production of interferon-γ and interleukin-12 in peripheral blood mononuclear cells. Immune Netw 2017;17:186-91.  Back to cited text no. 134
    
135.
Golovatscka V, Ennes H, Mayer EA, Bradesi S. Chronic stress-induced changes in pro-inflammatory cytokines and spinal glia markers in the rat: A time course study. Neuroimmunomodulation 2012;19:367-76.  Back to cited text no. 135
    
136.
Rajbhoj PH, Shete SU, Verma A, Bhogal RS. Effect of yoga module on pro-inflammatory and anti-inflammatory cytokines in industrial workers of lonavla: A randomized controlled trial. J Clin Diagn Res 2015;9:C01-5.  Back to cited text no. 136
    
137.
Hegde SV, Adhikari P, Shetty S, Manjrekar P, D'Souza V. Effect of community-based yoga intervention on oxidative stress and glycemic parameters in prediabetes: A randomized controlled trial. Complement Ther Med 2013;21:571-6.  Back to cited text no. 137
    
138.
Tolahunase M, Sagar R, Dada R. Impact of yoga and meditation on cellular aging in apparently healthy individuals: A prospective, open-label single-arm exploratory study. Oxid Med Cell Longev 2017;2017:7928981.  Back to cited text no. 138
    
139.
Buric I, Farias M, Jong J, Mee C, Brazil IA. What is the molecular signature of mind-body interventions? A systematic review of gene expression changes induced by meditation and related practices. Front Immunol 2017;8:670.  Back to cited text no. 139
    

Top
Correspondence Address:
Akshay Anand
Department of Neurology, Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoy.ijoy_60_21

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Extent of Stress...
    Conversion of Wa...
    Failure of Pharm...
    Yoga as an Inter...
    Yoga versus Psyc...
    Role of Neuroend...
    Recommendations ...
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed426    
    Printed2    
    Emailed0    
    PDF Downloaded48    
    Comments [Add]    

Recommend this journal