International Journal of Yoga
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    Table of Contents - Current issue
Coverpage
January-April 2021
Volume 14 | Issue 1
Page Nos. 1-86

Online since Friday, February 5, 2021

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EDITORIAL  

Role of Faith in Yoga p. 1
TM Srinivasan
DOI:10.4103/ijoy.IJOY_132_20  
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REVIEW ARTICLES Top

Managing lymphedema, increasing range of motion, and quality of life through yoga therapy among breast cancer survivors: A systematic review Highly accessed article p. 3
Vasudevan Saraswathi, Satish Latha, K Niraimathi, Elangovan Vidhubala
DOI:10.4103/ijoy.IJOY_73_19  
Lymphedema is a common complication of breast cancer treatment. Yoga is a nonconventional and noninvasive intervention that is reported to show beneficial effects in patients with breast cancer-related lymphedema (BCRL). This study attempted to systematically review the effect of yoga therapy on managing lymphedema, increasing the range of motion (ROM), and quality of life (QOL) among breast cancer survivors. The review search included studies from electronic bibliographic databases, namely Medline (PubMed), Embase, and Google Scholar till June 2019. Studies which assessed the outcome variables such as QOL and management of lymphedema or related physical symptoms as effect of yoga intervention were considered for review. Two authors individually reviewed, selected according to Cochrane guidelines, and extracted the articles using Covidence software. Screening process of this review resulted in a total of seven studies. The different styles of yoga employed in the studies were Iyengar yoga (n = 2), Satyananda yoga (n = 2), Hatha yoga (n = 2), and Ashtanga yoga (n = 1). The length of intervention and post intervention analysis ranged from 8 weeks to 12 months. Four studies included home practice sessions. QOL, ROM, and musculoskeletal symptoms showed improvement in all the studies. Yoga could be a safe and feasible exercise intervention for BCRL patients. Evidence generated from these studies was of moderate strength. Further long-term clinical trials with large sample size are essential for the development and standardization of yoga intervention guidelines for BCRL patients.
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Sudarshan kriya yoga: A breath of hope during covid-19 pandemic Highly accessed article p. 18
Sameer Anil Zope, Rakesh Anil Zope, Gabriella Andrea Biri, Charushila Sameer Zope
DOI:10.4103/ijoy.IJOY_102_20  
Important counter measures to combat an infectious disease pandemic include vaccination, antiviral therapy, and immunomodulation therapy. Vaccinations are disease specific and moreover strain specific, so the protection provided is also specific and limited. Antiviral therapies are costly and require bulk production of drugs, hence globally there is an increased interest toward low-risk, cost-effective complementary alternative therapies, such as Yoga and Ayurveda to tackle the infectious pandemic, coronavirus disease 2019 (COVID-19). There is clinical evidence available on the potential complementary role of yogic practices in the management of noncommunicable and communicable diseases. Various online databases were searched for articles published between 2000 and 2020. Databases explored were Medline, EMBASE, Indian Citation Index, PsycINFO, Index Medicus for South-East Asia Region, and Google Scholar. All search results were screened, and articles related to keywords such as COVID-19, yoga therapy, and Sudarshan Kriya Yoga (SKY) were selected for data extraction. Quality of the studies included was evaluated on the basis of the construct validity, content validity, relevance, bias, credibility relating to information, and data sources. SKY is a unique yogic practice that includes specific sequential breathing techniques. It balances the autonomic nervous system and thus can alleviate anxiety, routine stress, depression, stress-related medical disorders, and posttraumatic stress. It potentiates natural host immune defenses that are essential to tackle a plethora of microbial infections. This narrative review article provides an overview of potential therapeutic benefits that SKY can offer to the population at large during this COVID-19 pandemic.
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A review on role of yoga in the management of patients with cardiac arrhythmias p. 26
Gautam Sharma, Mooventhan A, Gitismita Naik, L Nivethitha
DOI:10.4103/ijoy.IJOY_7_20  
Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.
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ORIGINAL ARTICLES Top

Effect of Raja yoga Meditation on psychological and functional outcomes in spinal cord injury patients p. 36
Ekta Chalageri, Gayatri Vishwakarma, Randhir Lal Ranjan, Ramajayam Govindaraj, Harvinder Singh Chhabra
DOI:10.4103/ijoy.IJOY_68_20  
Background: Spinal cord injury (SCI) is a debilitating disorder with dysfunction in daily activities and psychological consequences like anxiety as well as depression impacting the quality of life substantially. Existing treatments focus mainly on rehabilitation, symptom reduction, and secondary complications. However, psychological, social, and existential issues are least addressed in the prevailing models. Aims: To study the role of meditation in addressing psychological impairment and any resultant improvement in functional outcomes in SCI patients. Methods: Nonrandomized controlled study was conducted in a tertiary care center for SCI patients. Hospital inpatients were recruited into either experimental intervention group (add on easy raja yoga with conventional rehabilitation-ER n = 50) or control intervention group (conventional rehabilitation alone-CR n = 50). Patients in the ER group received easy raja yoga for 1 month, along with conventional rehabilitation and the CR group patients received only conventional rehabilitation. All the subjects were assessed for psychological (perceived stress scale [PSS], Hospital Anxiety and Depression Scale [HADS]) and functional impairment (spinal cord independence measure (SCIM), numeric pain rating (NPR) and WHO quality of life-BRIEF (WHOQOLBREF)] at baseline and after 1 month. Results: After 1 month of add-on easy raja yoga, there was significant decrease in the scores of HADS (F[1,88] = 272.92, P < 0.001), PSS (F[1,88] = 274.41, P < 0.001) and NPR (F[1,88] = 60.60, P < 0.001) and significant increase in the scores of WHOQOLBREF (F[1,88] = 349.94, P < 0.001) and SCIM (F[1,88] = 29.09, P < 0.001) in the ER group compared to CR group in analysis of covariance. Conclusion: One-month add-on easy raja yoga improves psychological and functional outcomes (HADS, PSS, NPR, WHOQOLBREF and SCIM) in patients with SCI. Future studies with robust designs are needed to validate the results.
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Effects of yoga exercises on diabetic mellitus as validated by magnetic resonance imaging p. 43
Arush Arun Honnedevasthana, S Vatsalya, Shivaprasad Ashok Chikop, Sairam Geethanath
DOI:10.4103/ijoy.IJOY_30_20  
Context and Aims: Effects of practicing yoga in diabetic mellitus (DM) patients have been identified to improve in control of blood glucose levels. The purpose of this work is to evaluate changes in blood flow of calf muscles after specific yoga postures for patients with DM using magnetic resonance imaging (MRI) techniques. Time of flight (TOF) magnetic resonance angiography maximum intensity projection (MIP), T1 maps, T2 maps, and diffusion-weighted Imaging are performed on volunteers and DM patients both pre- and post-exercise. Materials and Methods: TOF MIP, T1 maps with variable flip angles, and T2-weighted spin-echo imaging were performed on four volunteers (aged 30 ± 5) and DM patients (aged 32–68) preexercise, on a 1.5 T Siemens scanner. The total acquisition time was 6 min 20 s. Each volunteer and DM patient were then requested to perform yoga postures Supta Padangusthasana, Utkatasana, and Calf raise for 6 min 30 s at maximum effort, outside the scanner, and subsequently rescanned. To calculate significant signal increase, region of interests was drawn on TOF MIP coronal images in arteries of calf muscles. Student t-tests were performed to determine statistical significance. Results: Among volunteers, a significant signal increase in arteries of calf muscles was noticed, signal intensity graphs were plotted. In DM patients, signal increase in TOF MIP, T2-weighted images were seen in specific arteries (posterior, anterior tibial, and posterior tibial) of calf muscles postexercise. Discussion and Conclusions: The study indicates that yoga has a positive short-term effect on multiple DM-related foot complications. This study depicts that MRI provides potential insight into the benefits of yoga for DM patients through deriving biomarkers for preventive medicine relevant to yoga interception.
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Community-based yoga for women undergoing substance use disorder treatment: A descriptive study p. 50
Mary Lou Galantino, Sarah Turetzkin, Shauna Lawlor, Lafutima Jones, Jennifer C Brooks
DOI:10.4103/ijoy.IJOY_103_20  
Background: Women with substance use disorders (SUD) receive medication-assisted treatment (MAT) with behavioral interventions and counseling for recovery. Evidence supports the use of yoga for SUD; however few studies specifically feature women. Objectives: Community-based yoga may add to health promotion through preferable physical activity for women in recovery. The aims of this study are to explore demographics and quantitative measures relevant to recovery and capture and understand the subjective experience of one session of yoga. Study Design: The study design involves Descriptive/Cross-sectional. Methodology: Women in an inpatient SUD center attending weekly optional off-site yoga for recovery were recruited to capture first-time attendance. Survey data included Medical Outcomes Survey 12-item short-form (SF-12), Toronto Mindfulness Scale (TMS), and Brief Resilience Scale (BRS), demographics, and narrative reflections. Recruitment opportunities occurred weekly during ongoing hour-long classes. Results: Twenty-nine women (average age 36.6) with primarily opiate-based addictions completed surveys. SF-12 was below the normative value of 50 for both subscales. BRS scores showed averages on the low end of normal resiliency. The frequency of responses to writing prompts confirmed physical and mental well-being through yoga intervention. Women shared potential relapse prevention specifically attributed to the mindfulness component of the intervention. Conclusion: The SF-12, BRS, and TMS are brief, valid, and reliable and can be easily incorporated in clinical practice or future research. Suboptimal SF-12 scores were found in women with SUD and, therefore important to note in the context of recovery to optimize treatment. Subjective reports from the participants find community-based yoga an enjoyable and beneficial type of physical activity. Yoga may be a viable option for comprehensive mind-body intervention for this population.
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Effect of yogasana intervention on standing balance performance among people with diabetic peripheral neuropathy: A pilot study p. 60
Jinny P Kanjirathingal, Rajani P Mullerpatan, Girish Nehete, Nagarathna Raghuram
DOI:10.4103/ijoy.IJOY_75_20  
Background: Diabetic peripheral neuropathy (DPN) is known to cause impaired balance and eventually increased risk of fall. Yogasanas characterized by slow, gentle transitions into postures with a varying base of support and focus on body awareness during movement hold potential for training balance control. Therefore, the current study aimed to evaluate effect of structured Yogasana intervention compared to conventional balance exercise on static and dynamic balance performance among people with diabetic neuropathy. Methods: Thirty-five people with DPN aged 42–70 years were recruited to Yogasana intervention group (n = 11), conventional balance exercises group (n = 10), and Control group (n = 14) following ethical approval. All participants were evaluated at baseline and post 12-week intervention on star excursion balance test, single-limb stance test, and center of pressure (CoP) excursion for balance performance, Modified fall efficacy scale for fear of falls and lower extremity strength using chair stand test and step-up test. Results: Balance performance (static and dynamic measured by star excursion balance test, single-limb stance test, and CoP excursion, lower extremity strength (using chair stand test and step-up test) demonstrated improvement and fear of fall reduced among Yogasana intervention group (p = 0.05) and conventional balance exercises group (p = 0.05) post 12-week intervention. CoP excursion increased in the control group indicating deterioration in balance performance after 12 weeks (p = 0.05). Post hoc comparison revealed that Yogasana intervention was marginally more effective in improving static and dynamic balance performance compared to conventional balance exercises in all variables of standing balance performance (p = 0.025). Conclusion: Yogasana and conventional balance exercises were effective in improving static and dynamic balance performance, lower extremity muscle strength, and reducing fear of fall among people with DPN. Yogasana intervention demonstrated marginally greater improvement in static and dynamic balance performance and lower extremity muscle strength compared to conventional exercise.
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SHORT COMMUNICATIONS Top

Association between hamstring flexibility and sprint speed after 8 weeks of yoga in male rugby players p. 71
Tilak Raj, Michael J Hamlin, Catherine A Elliot
DOI:10.4103/ijoy.IJOY_79_20  
Background: A Yoga-asana-based intervention has demonstrated its ability to improve flexibility of individuals, but has not been explored in rugby players. We hypothesized that a structured yoga intervention may have an effect on flexibility and sprint performance in male rugby union players. Methods: It was a controlled trial research design and players were assigned using random sampling to one of the two groups; a yoga group (n = 16) that practised yoga for 1 h 2 times a week for 8 weeks in addition to their normal rugby training and a control group (n = 15) with regular rugby training but no yoga intervention. Yoga intervention included 32 yoga postures to address both the upper and lower extremities of the body. Data were collected during preseason and mid-season on hamstring flexibility (sit and reach test), and sprint performance (measured at 5, 10, and 30 m). Results: One hundred and twenty participants were screened and thirty-one players volunteered for the study. Interactions between groups and differences between pre- and post-intervention scores were analyzed using analysis of variance using SPSS (version 24.0). Significance was set at an alpha level of P = 0.05. The yoga group showed a small nonsignificant decrease (-1.2% ± 21.4%, P = 0.05) in hamstring flexibility compared to the control group which demonstrated a large significant decrease (-14.8% ± 23.7%) (mean % change ± 95% confidence interval [CI], P < 0.05). The yoga group also showed minor nonsignificant improvements in sprint times -3.2% ± 10.4%, -0.7% ± 9.0% for the 5 and 10 m sprints, respectively, (mean % change ± 95% CI) compared to controls -0.4% ± 10.2%, 0.4% ± 7.9%. Conclusions: Findings suggest that completing a structured yoga intervention alongside normal rugby training during the rugby season, yoga helped rugby players maintain their hamstring flexibility but did little to improve sprint performance during the season.
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Yoga as a novel adjuvant therapy for patients with idiopathic inflammatory myopathies p. 75
Steve S Kong, Thanh Pham, Allyson Fortis, Alpa Raval, Neha Bhanusali
DOI:10.4103/ijoy.IJOY_78_20  
Context: Recent studies have demonstrated that physical activity is well tolerated by patients with idiopathic inflammatory myopathies (IIMs) and can have additional benefits as an adjuvant therapy to pharmacologic agents, especially if started early. To date, no studies have examined the effects of yoga on patients with IIMs. Aims: The aim of this study was to evaluate the effects of yoga on self-reported difficulty in performing activities of daily living (ADL) and muscle strength in patients with mild-to-moderate IIMs. Subjects and Methods: A longitudinal cohort study in which participants were assessed using the Myositis Activities Profile (MAP) and manual muscle testing (MMT) before and after the completion of an 8-week instructor-guided yoga course was performed. Statistical Analysis Used: Wilcoxon signed-ranked test was performed for statistical analysis. Results: The average posttreatment MAP scores of six participants demonstrated an increase of 2.51 points, while the average MMT score of four participants demonstrated an increase of 11 points. Conclusions: This study is the first study to date to examine the effect of yoga as an adjuvant complementary therapy for patients with IIM. Continued research should be done on the effect of yoga as an adjuvant therapy, for in addition to increase in muscle strength and ability to perform ADL, yoga may offer potential improvements in mood, mental health, and sleep.
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Tele-yoga therapy for common mental health disorders: Need for assessment tool and guidelines p. 83
Aarti Jagannathan, Shree Raksha Bhide, Shivarama Varambally, Prabha S Chandra, BN Gangadhar
DOI:10.4103/ijoy.IJOY_99_20  
Introduction: Tele-yoga is a cost-effective method of teaching yoga using cloud technology to relay from one source (trainer's venue) to multi-point video conferencing centers (participants' homes). However, there is a need to assess the tele-yoga trainer and the training itself to ensure safety and effectiveness. Materials and Methods: The Tele-Yoga Trainers Assessment (TYTA) tool was developed through (a) review of existing tools, (b) key informant interviews, and (c) validation by experts. It was tested for its feasibility in six persons with common mental disorders. A trained yoga therapist conducted tele-yoga therapy sessions which was webcast from NIMHANS Integrated Center for Yoga to NIMHANS Center for Well-Being for the first 15 days and to the respective homes of the participants using “Skype” in the remaining 15 days. Participants were assessed on (a) mental well-being, (b) satisfaction with overall health and were administered the (c) TYTA tool on the 1st, 15th, and 30th day. Results: The TYTA was easy to administer for assessing the performance of the yoga trainer. The qualitative case reports of individual participants depicted that over 30 days, mental well-being and satisfaction with overall health improved trainer's performance. Conclusion: Tele-yoga therapy is feasible with minimum technology and availability of good internet access at the relay and reception site. The trainer must be assessed for his/her suitability and be provided guidelines for achieving desired outcomes.
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