Acceptability and feasibility of two types of asynchronous online yoga interventions in adults with moderate-to-high stress.

Mindful Yoga for Symptom Management in Metastatic Breast Cancer (S738)

Objective: To determine if a 12-week yoga intervention (YI) was associated with increased gamma aminobutyric acid (GABA) levels and decreased depressive symptoms in participants with major depressive disorder (MDD). Methods: Subjects were randomized to a high-dose group (HDG) of three YIs a week and a low-dose group (LDG) of two YIs a week. Thalamic GABA levels were obtained using magnetic resonance spectroscopy at Scan-1 before randomization. After the assigned 12-week intervention, Scan-2 was obtained, immediately followed by a YI and Scan-3. Beck Depression Inventory II (BDI-II) scores were obtained before Scan-1 and Scan-3. Settings/Location: Screenings and interventions occurred at the Boston University Medical Center. Imaging occurred at McLean Hospital. Subjects: Subjects met criteria for MDD. Intervention: Ninety minutes of Iyengar yoga and coherent breathing at five breaths per minute plus homework. Outcome measures: GABA levels and the BDI-II. Results: BDI-II scores improved significantly in both groups. GABA levels from Scan-1 to Scan-3 and from Scan-2 to Scan-3 were significantly increased in the LDG (n = 15) and showed a trend in the total cohort. Post hoc, participants were divided into two groups based on having an increase in GABA levels at Scan-2. Increases in Scan-2 GABA levels were observed in participants whose mean time between their last YI and Scan-2 was 3.93 ± 2.92 standard deviation (SD) days, but not in those whose mean time between their last YI and Scan-2 was 7.83 ± 6.88 SD. Conclusions: This study tentatively supports the hypothesis that one of the mechanisms through which yoga improves mood is by increasing the activity of the GABA system. The observed increase in GABA levels following a YI that was no longer observed 8 days after a YI suggests that the associated increase in GABA after a YI is time limited such that at least one YI a week may be necessary to maintain the elevated GABA levels.

Chronic low back pain (CLBP) is prevalent among IT professionals and often accompanied by psychological symptoms such as depression, stress, and sleep disturbances. While conventional treatments primarily target pain management, holistic approaches like yoga show promising results in addressing both physical and psychosomatic factors. This randomized controlled trial (RCT) aims to assess the impact of a yoga intervention on depression, stress, and sleep quality in IT professionals with CLBP. A total of 83 IT professionals with CLBP were randomly allocated to either a yoga (n = 40) intervention group or a control group (n = 40) receiving standard care. The intervention group underwent a structured yoga program tailored for CLBP, while the control group followed a standard care protocol. Outcome measures, including pain intensity, depression levels, perceived stress, and sleep quality, were assessed using validated standard questionnaires. Preliminary analysis reveals significant enhancements in the yoga intervention group compared to the control group. Specifically, participants in the yoga group reported a statistically significant reduction in pain intensity (p < 0.05), along with notable decreases in depression scores (p < 0.05), anxiety score (p < 0.05), and stress levels (p < 0.05). Additionally, the yoga intervention group demonstrated enhanced sleep quality (p < 0.05) compared to the control group. This RCT provides compelling evidence for the efficacy of yoga as an adjunctive therapy for CLBP management in IT professionals. The findings emphasize the potential of yoga in alleviating both physical and psychological symptoms associated with CLBP. Healthcare providers may consider incorporating yoga into treatment programs for CLBP in IT professionals to optimize outcomes and enhance overall well-being. Moreover, these results emphasize the importance of holistic interventions in addressing the complex nature of CLBP in the workplace.

Background: The COVID-19 pandemic posed significant challenges globally, with asymptomatic carriers forming a notable proportion and concerns regarding isolation resulting in stress and sleep disturbances. This study aimed to assess the efficacy of tele-based yoga interventions in improving sleep patterns among asymptomatic COVID-19 patients. Material and Methods: A pre-and-post- study design was employed, implementing structured breathing exercises and mindful meditation via telemedicine to evaluate their impact on sleep quality. Participants consisted of asymptomatic individuals aged 18 to 85 years who tested positive for COVID-19. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) before and after a fourteen-day tele-based yoga program. Results: Analysis of 86 participants revealed a pre-intervention mean global PSQI score of 10.22 ± 2.22, indicating poor sleep quality. Following the intervention, the mean global PSQI score improved to 5.99 ± 1.81. Subgroup analysis demonstrated significant enhancements in various sleep domains, including subjective sleep quality, sleep latency, and sleep disturbances. Discussion: The findings suggest efficacy of yoga interventions in ameliorating sleep quality in patients with sleep disturbances among asymptomatic COVID-19 patients. Tele-based yoga interventions showed promise in improving sleep patterns among asymptomatic COVID-19 patients. Further research is warranted to investigate long-term effects and refine intervention strategies for optimal sleep management.

Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

Background: Fear of cancer recurrence (FCR), cancer-distress, depression, and anxiety are prevalent concerns among women with gynecologic and other understudied cancers, especially among women of color and lower socioeconomic status (SES). Evidence indicates that mind-body interventions are effective in reducing such distress. This study evaluates (1) proof-of-concept of an integrated group yoga and psychological intervention in alleviating distress among women with gynecologic, gastrointestinal, and thoracic cancers and (2) differences in efficacy across social and economic factors. Methods: One hundred twenty-five participants were enrolled in a 10-week, single-arm, integrated group intervention utilizing mindfulness meditation, psychotherapy skills, and yoga. They completed measures of FCR, cancer-distress, depression, and anxiety at baseline and following intervention. Mixed-linear models evaluated change in outcomes across the intervention and moderating effects of age, minority status, and SES among 51 participants with available data. Results: Reductions in total (b = −2.06, P = .012) and somatic depressive symptoms (b = −1.79, P = .002) and state anxiety (b = −6.21, P = .005) were observed across the sample. Higher SES was associated with greater reductions in psychosocial distress related to FCR (b = −0.74, P = .050), and in total (b = −1.06, P = .049) and affective depressive symptoms (b = −0.76, P = .006). Women of color experienced greater declines in somatic symptoms compared to non-Hispanic White women (b = −2.71, P = .031), with women of color experiencing lower SES exhibiting greatest reduction in these symptoms (b = 1.73, P = .026). Conclusions: This study demonstrates proof-of-concept that an integrated psychological and yoga intervention may reduce depressive symptoms and state anxiety among women with gynecologic, gastrointestinal, and thoracic cancers, with racial and/or ethnic minority status and SES moderating some of these effects. Future research should examine intervention feasibility and acceptability among diverse women with cancer and evaluate efficacy using a randomized controlled trial design.Trial registration: ClinicalTrials.gov NCT03385577

Impact of Weight on Symptom Burden Outcomes in Myeloproliferative Neoplasm Patients Participating in an Online Yoga Intervention

Breast cancer is the cancer most frequently diagnosed in women worldwide. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation. It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types. To assess effects of yoga on health-related quality of life, mental health and cancer-related symptoms among women with a diagnosis of breast cancer who are receiving active treatment or have completed treatment. We searched the Cochrane Breast Cancer Specialised Register, MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), Indexing of Indian Medical Journals (IndMED), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov on 29 January 2016. We also searched reference lists of identified relevant trials or reviews, as well as conference proceedings of the International Congress on Complementary Medicine Research (ICCMR), the European Congress for Integrative Medicine (ECIM) and the American Society of Clinical Oncology (ASCO). We applied no language restrictions. Randomised controlled trials were eligible when they (1) compared yoga interventions versus no therapy or versus any other active therapy in women with a diagnosis of non-metastatic or metastatic breast cancer, and (2) assessed at least one of the primary outcomes on patient-reported instruments, including health-related quality of life, depression, anxiety, fatigue or sleep disturbances. Two review authors independently collected data on methods and results. We expressed outcomes as standardised mean differences (SMDs) with 95% confidence intervals (CIs) and conducted random-effects model meta-analyses. We assessed potential risk of publication bias through visual analysis of funnel plot symmetry and heterogeneity between studies by using the Chi2 test and the I2 statistic. We conducted subgroup analyses for current treatment status, time since diagnosis, stage of cancer and type of yoga intervention. We included 24 studies with a total of 2166 participants, 23 of which provided data for meta-analysis. Thirteen studies had low risk of selection bias, five studies reported adequate blinding of outcome assessment and 15 studies had low risk of attrition bias.Seventeen studies that compared yoga versus no therapy provided moderate-quality evidence showing that yoga improved health-related quality of life (pooled SMD 0.22, 95% CI 0.04 to 0.40; 10 studies, 675 participants), reduced fatigue (pooled SMD -0.48, 95% CI -0.75 to -0.20; 11 studies, 883 participants) and reduced sleep disturbances in the short term (pooled SMD -0.25, 95% CI -0.40 to -0.09; six studies, 657 participants). The funnel plot for health-related quality of life was asymmetrical, favouring no therapy, and the funnel plot for fatigue was roughly symmetrical. This hints at overall low risk of publication bias. Yoga did not appear to reduce depression (pooled SMD -0.13, 95% CI -0.31 to 0.05; seven studies, 496 participants; low-quality evidence) or anxiety (pooled SMD -0.53, 95% CI -1.10 to 0.04; six studies, 346 participants; very low-quality evidence) in the short term and had no medium-term effects on health-related quality of life (pooled SMD 0.10, 95% CI -0.23 to 0.42; two studies, 146 participants; low-quality evidence) or fatigue (pooled SMD -0.04, 95% CI -0.36 to 0.29; two studies, 146 participants; low-quality evidence). Investigators reported no serious adverse events.Four studies that compared yoga versus psychosocial/educational interventions provided moderate-quality evidence indicating that yoga can reduce depression (pooled SMD -2.29, 95% CI -3.97 to -0.61; four studies, 226 participants), anxiety (pooled SMD -2.21, 95% CI -3.90 to -0.52; three studies, 195 participants) and fatigue (pooled SMD -0.90, 95% CI -1.31 to -0.50; two studies, 106 participants) in the short term. Very low-quality evidence showed no short-term effects on health-related quality of life (pooled SMD 0.81, 95% CI -0.50 to 2.12; two studies, 153 participants) or sleep disturbances (pooled SMD -0.21, 95% CI -0.76 to 0.34; two studies, 119 participants). No trial adequately reported safety-related data.Three studies that compared yoga versus exercise presented very low-quality evidence showing no short-term effects on health-related quality of life (pooled SMD -0.04, 95% CI -0.30 to 0.23; three studies, 233 participants) or fatigue (pooled SMD -0.21, 95% CI -0.66 to 0.25; three studies, 233 participants); no trial provided safety-related data. Moderate-quality evidence supports the recommendation of yoga as a supportive intervention for improving health-related quality of life and reducing fatigue and sleep disturbances when compared with no therapy, as well as for reducing depression, anxiety and fatigue, when compared with psychosocial/educational interventions. Very low-quality evidence suggests that yoga might be as effective as other exercise interventions and might be used as an alternative to other exercise programmes.

BackgroundNursing students experience poorer mental and physical health relative to students in other health-related disciplines and young adults of similar age outside post-secondary school. Compromised mental and physical health has numerous negative impacts on nursing students and can result in burnout and development of chronic diseases.PurposeTo determine whether an asynchronous online yoga intervention would improve mental and physical health of students.MethodsAn asynchronous online 6-week yoga intervention was carried out between January and December 2021, using a pre/post design. Participants’ symptoms of depression, anxiety, stress, and self-compassion were assessed using the Depression, Anxiety, and Stress Scale and Self-Compassion Scale and core endurance was assessed using the Mackenzie Core Endurance Test prior to commencement and at the conclusion of the program.ResultsOf 114 participants, 68 completed the online program and pre and post measures showed that the mean depression, anxiety, stress, self-compassion and core endurance scores improved significantly (p<0.001) between baseline and study completion.ConclusionA six-week virtual yoga program significantly improved mental and physical health of undergraduate nursing students. Targeted modifications to the yoga program might enhance participant retention.

The purpose of this study is to identify the amount and scope of knowledge on sleep disturbance in cancer survivors who have lymphedema. The research question investigated was "what are the known sleep disturbances in cancer survivors with lymphedema?" A literature search was performed on February 15 to March 27, 2021, in four databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and structure recommended by Arksey and O'Malley. An iterative process of study selection was performed by two reviewers for abstract and full-text review. The Joanna Briggs Institute's critical appraisal tools were used to analyze study quality. One hundred twenty-one unique references were reviewed, and seven met the inclusion criteria. One article had the primary aim of assessing sleep and noted that the presence of lymphedema did increase the risk for sleep disturbance. Four cross-sectional studies compared sleep quality between cancer survivors with lymphedema and cancer survivors without lymphedema. These studies found that lymphedema is a significant predictor of insomnia and is a risk factor for insomnia. Two randomized control trials compared sleep among breast cancer survivors with lymphedema after an intervention. Sleep improved with a yoga intervention and was unchanged after adding a night-time compression garment. In this scoping review, breast and gynecological cancer survivors with lymphedema report increased sleep disturbance compared to survivors without lymphedema. Further research is needed to characterize the specific sleep disturbances in cancer survivors with lymphedema for improved screening and treatment.

Introduction Nursing staff are at risk for impaired sleep due to irregular schedules, long work hours, and other occupational stress. Yoga has demonstrated beneficial effects on sleep in healthy adults and patients with chronic diseases. However, yoga interventions are generally offered as 60-75-minute sessions; this long duration might not be suitable as a workplace program for nursing staff. The objective of this study is to examine workplace yoga program features and associations with shift work and sleep among nursing staff. Methods Online Qualtrics surveys were distributed among nurses and nursing assistants at a community hospital in the northeast U.S. Hypothetical workplace yoga program features were assessed including general interest, duration, frequency, timing with respect to work shift, and interest in home practice. Sleep duration and disturbances were assessed. Results Among the 541 participants (94% female; age 43±13y), over a third reported sleep ≤6hrs/day (38%) and sleep disturbances (38%), and 79% reported interest in workplace yoga. Among those reporting interest, after work (61%), 30min/session (73%), 3 sessions/week (56%), and interests in home practice (64%) were yoga features endorsed by nursing staff. Night or ≥12hr shift was associated with less interest in workplace yoga. Evening or ≥12hr shift was associated with less interest in yoga after work, while day or night shift was associated with less interest in yoga before work. Mild sleep disturbances were associated with more interest while severe disturbances were associated with less interest in yoga after work. Nursing staff with sleep≤6hrs/day reported less interest in yoga before work, but more interest in home yoga practice. Conclusion Nursing staff reported a high prevalence of short and disturbed sleep and interest in workplace yoga. Workplace yoga programs need to be designed according to nursing staff’s interest while considering the effect of shift work and sleep problems reported by nursing staff. Support Drs. Yuan Zhang and Jeanne F. Duffy were supported by NIH grant R01 AG044416.

BackgroundMyeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn’t been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers.MethodsPatients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor-alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test.ResultsSixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = − 0.26 to − 0.61), pain intensity (d = − 0.34 to − 0.51), anxiety (d = − 0.27 to − 0.37), and depression (d = − 0.53 to − 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (− 1.3 ± 1.5 pg/ml).ConclusionsOnline yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy.Trial registrationThis trial was retrospectively registered with clinicaltrials.gov (ID: NCT03503838) on 4/19/2018.

Introduction Sleep health is often compromised among individuals undergoing cardiac rehabilitation and does not consistently improve over the course of treatment. Behavioral sleep and circadian interventions may improve the sleep health of cardiac rehabilitation patients but have not been widely tested in this context. We conducted a preliminary test of an adapted version of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with Veterans in cardiac rehabilitation to evaluate its acceptability with these unique patients. Methods Eight Veterans with sleep disturbance and/or sleep-related impairment who were participating in outpatient cardiac rehabilitation completed the adapted TranS-C intervention and post-intervention acceptability measures. Intervention acceptability was assessed quantitatively with subscales from the Multidimensional Treatment Satisfaction Measure (subscale scores range from 0-4; higher scores indicate greater satisfaction) and qualitatively via semi-structured interviews. We calculated descriptive statistics for quantitative measures and analyzed semi-structured interviews using a rapid qualitative analysis approach. Results Participants felt the intervention was suitable to their needs (M=3.00, SD=.94) and useful for increasing their knowledge and understanding of sleep problems and how to manage them (M=3.50, SD=.69). Participants endorsed positive attitudes toward the intervention (M=3.63, SD=.58) and high likelihood of recommending the intervention to others similarly experiencing sleep problems (M=3.63, SD =.58). Following the intervention, 62.5% of participants indicated that their sleep disturbance and sleep-impairment were ‘much better’ than at the first study visit and 37.5% indicated their sleep disturbance and sleep-related impairment were ‘somewhat better’. Qualitative findings converged with the noted quantitative findings. Conclusion Veteran cardiac rehabilitation patients expressed satisfaction and positive attitudes toward the adapted TranS-C intervention. All participants reported subjective post-intervention improvements in sleep disturbance and sleep-related impairment. These findings provide preliminary support for further large-scale testing of adapted TranS-C in cardiac rehabilitation. Support (if any) Dr. Tighe is supported by a Career Development/Capacity Building Award (IK2 RX003393) from the United States Department of Veterans Affairs Rehabilitation R&amp;D (Rehab RD) Service. This material is the result of work supported with resources and use of facilities at the VISN 4 Mental Illness Research, Education, and Clinical Center at VA Pittsburgh Healthcare System.

BackgroundThe popularity of yoga and the understanding of its potential health benefits have recently increased. Unfortunately, not everyone can easily engage in in-person yoga classes. Over the past decade, the use of remotely delivered yoga has increased in real-world applications. However, the state of the related scientific literature is unclear.ObjectiveThis scoping review aimed to identify gaps in the literature related to the remote delivery of yoga interventions, including gaps related to the populations studied, the yoga intervention characteristics (delivery methods and intervention components implemented), the safety and feasibility of the interventions, and the preliminary efficacy of the interventions.MethodsThis scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Item for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Scientific databases were searched throughout April 2021 for experimental studies involving yoga delivered through technology. Eligibility was assessed through abstract and title screening and a subsequent full-article review. The included articles were appraised for quality, and data were extracted from each article.ResultsA total of 12 studies of weak to moderate quality were included. Populations varied in physical and mental health status. Of the 12 studies, 10 (83%) implemented asynchronous delivery methods (via prerecorded material), 1 (8%) implemented synchronous delivery methods (through videoconferencing), and 1 (8%) did not clearly describe the delivery method. Yoga interventions were heterogeneous in style and prescribed dose but primarily included yoga intervention components of postures, breathing, and relaxation and meditation. Owing to the heterogeneous nature of the included studies, conclusive findings regarding the preliminary efficacy of the interventions could not be ascertained.ConclusionsSeveral gaps in the literature were identified. Overall, this review showed that more attention needs to be paid to yoga intervention delivery methods while designing studies and developing interventions. Decisions regarding delivery methods should be justified and not made arbitrarily. Studies of high methodological rigor and robust reporting are needed.

A sleep hygiene and yoga intervention conducted in affordable housing communities: Pilot study results and lessons for a future trial