Yoga-based Lifestyle Intervention Research Articles

Yoga-based lifestyle intervention for antenatal depression (YOGA-D): study protocol for a pilot randomized controlled trial

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI (CTRI/2024/05/067176; 10/05/2024).

Yoga-based lifestyle intervention for antenatal depression (YOGA-D): study protocol for a pilot randomized controlled trial

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI (CTRI/2024/05/067176; 10/05/2024).

A Study on Yoga-Based Lifestyle Intervention versus Dietary Intervention Alone on Cardiometabolic Risk Factors among People with Prediabetes.

Prediabetes is presented as a metabolic state that predisposes persons to a greater risk of diabetes progression in the future. Prediabetes is an intervening stage between normoglycemia and diabetes with impaired fasting glucose and impaired glucose tolerance. This study aimed to compare the effect of the yoga-based lifestyle intervention (including diet) versus dietary intervention (DI) alone on cardiometabolic parameters namely fasting blood glucose (FBG), glycated hemoglobin (HbA1C), lipid profile; triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), heart rate variability (HRV), and carotid intima-media thickness (CIMT) among people with prediabetes. A randomized controlled study was conducted on 250 people with prediabetes who were randomly allocated by computer-generated methods to the yoga-based lifestyle intervention (including diet) (n = 125) and DI alone (n = 125) groups. Yoga sessions were approximately 45 min 6 days a week over a period of 6 months. Assessments were made at baseline and after 6 months of intervention. Post-intervention comparison of cardiometabolic parameters in yoga-based lifestyle intervention (including diet) versus DI alone showed a significant decline in body mass index (P = 0.0002), waist-hip ratio (P = 0.0001), systolic blood pressure (P = 0.0001), diastolic blood pressure (P = 0.0001), perceived stress score (P = 0.0001), FBG (P = 0.0001), HbA1C (P = 0.0001), lipid profile; TG (P = 0.008), LDL (P = 0.0001), VLDL (P = 0.0001), HRV (P = 0.0001), CIMT (P = 0.02) and a nonsignificant decline in, TC (P = 0.22), HDL (P = 0.211), FFQ (P = 0.164). The finding of this study suggests that a 24-week yoga-based lifestyle intervention which includes diet significantly decreased cardiometabolic parameters compared to DI alone among people with prediabetes.

Impact of naturopathy and yoga based intervention on atherosclerotic cardiovascular disease risk among metabolic syndrome individuals – A prospective single arm study

BackgroundCardiovascular diseases are the leading cause of death in most developed and developing countries, thus representing one of the most significant health problems across the globe. The association between metabolic syndrome and increased risk of cardiovascular diseases has been proven by large multicentric studies. Calculating atherosclerotic cardiovascular diseases risk has been advocated as a preventive strategy. A little is known about its utility and applicability of atherosclerotic cardiovascular diseases risk calculation in individuals predisposed to cardiovascular diseases such as individuals with metabolic syndrome. Practice of a multifaceted naturopathy and yoga-based lifestyle is likely to improve cardiovascular health outcomes and may reduce healthcare costs in high-risk populations. Hence the present study aimed to evaluate the impact of naturopathy and yoga-based lifestyle intervention on the calculated atherosclerotic cardiovascular diseases risk among metabolic syndrome individuals. MethodsThis prospective single arm study recruited 70 individuals of both genders, with metabolic syndrome based on eligibility criteria. They underwent 10 days of supervised intensive naturopathy and yoga-based lifestyle intervention in a residential center. Blood pressure, Anthropometric measures and metabolic risk factors were assessed before and after the intervention. ResultsThere was also a substantial decrease in both systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001) compared to baseline. There was a noteworthy decrease in weight (p < 0.001), Body mass index (p < 0.001), Waist circumference (p < 0.001), Hip circumference (p < 0.001) and Waist Hip Ratio (p = 0.005). The metabolic risk factors Fasting blood glucose (p < 0.001), Total cholesterol (p < 0.001), Triglycerides (p < 0.001), High-density lipoprotein (p < 0.01), Low-density lipoprotein (p < 0.01), Very low-density lipoprotein (p < 0.001), TC/HDL (p < 0.001) and non-HDL (p < 0.001) also showed a significant reduction. The 10-year (p < 0.001) and lifetime risk of atherosclerotic cardiovascular diseases risk was assessed and found to be significantly reduced after the intervention. ConclusionA multidimensional intensive naturopathy and yoga-based lifestyle could be explored as a non-invasive and cost-effective measure in the mitigation of atherosclerotic cardiovascular diseases risk in predisposed individuals.

A Study to Evaluate the Effect of a Combined Approach of Yoga and Diet in High-risk Cardiovascular Subjects.

Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease, peripheral artery disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism. The aim of this study was to assess cardiovascular risk factors and evaluate the effectiveness of combined approach of yoga and diet in reducing cardiovascular risk factors among high-risk subjects. This interventional study was conducted at RUHS College of Medical Sciences and Associated Hospitals, Jaipur, on the high-risk population of either sex in the age group of 40-70 years. QRISK3 web calculator was used as the method of measurement for outcome of interest. The combined approach of yoga intervention includes yogic asanas and pranayamas and dietary modification. This study compared physiological parameters (blood pressure) and biochemical parameters (fasting blood sugar, glycosylated hemoglobin, lipid profile) at baseline, three months and six months after yoga and diet intervention in participants who were at high-risk of cardiovascular disease development in future and were found to be having significantly decreased systolic blood pressure (P=0.000), fasting blood glucose (P=0.000), glycosylated hemoglobin (HbA1C) (P=0.011), total cholesterol-high density lipoprotein ratio (P=0.000), low density lipoprotein (P=0.009), triglyceride (P=0.034), and QRISK3 Score (P=0.000) after combined approach of yoga and diet. This study concluded that the short-term combined approach of yoga-based life-style intervention and diet reduced cardiovascular risk factors in subjects at high-risk of developing cardiovascular disease.

Transcriptional modulation of inflammation, and aging in Indian obese adults following a 12-week yoga-based lifestyle intervention: A randomized controlled trial.

IntroductionObesity is one of the major global problems in today's world, both in children, and the adult age group. Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. In recent times complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12 weeks of yoga-based lifestyle intervention with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.MethodsThis was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4, and 12 were collected from 72 adults (male n = 21; female n = 51) of age 20–45 years with a body–mass index (BMI) of 25–35 kg/m2 who were randomized to receive either a 12-week SC (n = 36) or YBLI (n = 36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were all part of the YBLI. Primary outcomes were relative fold change in the expression of genes associated with oxidative stress [Nuclear factor-kappa B (NF-Kappa B)], inflammation [Tumor necrosis factor-α (TNFα), interleukin-6 (IL-6)], and aging [human telomerase reverse transcriptase (TERT)] in peripheral blood mononuclear cells between the two groups at week-12.ResultsThere were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p = <0.0001) vs the SC group at 2 weeks. The relative fold change of TNF α was significantly lower at week 12 in YBLI though the change was not continuous and reliable. Within both groups, TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p < 0.0001). TNF α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.ConclusionThe results while did not confirm our hypothesis, are important to share with the scientific society, to be able to improve prospective study designs and find optimal time/intervention/biological marker settings for this highly important scientific field. The results are suggestive of a positive impact of YBLI and SC on the fold change of aging-related TERT gene in obesity, though the benefit was not evident till week 12. However, the results should be evaluated with caution and in light of other published studies. To better understand the positive effects of YBLI on oxidative stress, inflammation, and aging-related gene expression in obesity, larger studies are recommended.

Beneficial Effect of Yoga-based Lifestyle Intervention on Anxiety and Depression in Young adults: Non-randomized Controlled Study

Beneficial Effect of Yoga-based Lifestyle Intervention on Anxiety and Depression in Young adults: Non-randomized Controlled Study

A 12-Week Yoga-Based Lifestyle Intervention Might Positively Modify Cellular Aging in Indian Obese Individuals: A Randomized-Controlled Trial.

Background: Telomeres and telomerase are considered cardinal biomarkers of cellular aging. Shorter telomeres and low telomerase activity have been associated with obesity and accelerated aging. Objective: To compare the effects of a yoga-based lifestyle intervention (YBLI) with the standard of care (SOC) on cellular aging by estimating telomere length (TL) and telomerase activity in obesity. Design and setting: A parallel, two-arm, randomized-controlled trial was conducted at the Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi, from March 2017 to October 2019. Participants: Obese (n = 72), body mass index (BMI), 25-35 kg/m2, aged 20-45 years, male (21), and female (51). Intervention: Seventy-two obese participants were randomized to receive either a 12-week SOC (n = 36) or YBLI (n = 36). SOC included management of obesity as per Indian guidelines including a hypocaloric individualized diet and physical activity. The pretested YBLI included asana (physical postures), pranayama (breathing exercises), and meditation. Methods: Blood samples were collected from both the groups at baseline, 2, 4, and 12 weeks. DNA was extracted from peripheral blood mononuclear cells. TL was measured by quantitative PCR, and serum telomerase levels by immunoassay. Outcome measures: Primary outcome measures were the changes in the TL and telomerase levels between the two groups at week 12. Secondary outcome measures were the changes in TL and telomerase, and anthropometric parameters (body weight, BMI, waist-to-hip ratio) at 2, 4, and 12 weeks of intervention in both SOC and YBLI groups. Results: There were no significant changes in TL and telomerase levels between the groups at week 12. The TL was significantly greater in the YBLI group versus the SOC group (p < 0.0001) at 2 weeks. The anthropometric and physiological parameters were influenced positively by both SOC and YBLI. Conclusion: The study did not meet the primary objective, although the results are suggestive of a positive impact of YBLI on aging in obesity as noted within the YBLI group. However, the results should be interpreted carefully, and in the light of other published data. Larger studies to better understand the possible positive benefits of YBLI on cellular aging are recommended. Clinical Trail Registration No. CTRI/2016/08/007136.

HLA-G 3'UTR polymorphisms & response to a yoga-based lifestyle intervention in rheumatoid arthritis: A randomized controlled trial.

Human leucocyte antigen (HLA)-G plays a vital role in immunomodulation in rheumatoid arthritis (RA). The mounting evidence suggests a link between HLA-G gene polymorphisms, disease susceptibility and methotrexate treatment response. Various environmental factors influence the onset and progression of RA and its treatment outcomes. The aim is to identify the treatment response of HLA-G 3' untranslated region polymorphisms to yoga-based lifestyle intervention (YBLI). In this eight-week single-blinded randomized controlled trial (CTRI/2017/05/008589), patients with RA (n=140) were randomized into two groups namely, yoga group or non-yoga group. Baseline genomic DNA was isolated using salting-out method. PCR-based methods were used for genotyping. The levels of soluble (s) HLA-G and disease activity were assessed by ELISA and disease activity score-28-erythrocyte sedimentation rate (DAS28-ESR), respectively, at baseline (day 0) and after eight weeks of intervention. Low-producing sHLA-G genotypes, i.e. +3142GG and 14 bp ins/ins, showed a significant increase in sHLA-G levels after YBLI. The association analysis between HLA-G polymorphisms and treatment for RA showed no considerable differential treatment remission in either of the groups (P>0.05). The percentages of improvement were higher in the yoga group as compared to the non-yoga group in both the HLA-G +3142G>C and 14 bp ins/del polymorphisms irrespective of their respective genotypes. No significant association was found between sHLA-G levels and disease activity with respect to genotypes. Yoga intervention results in improvement and reduced severity of RA in patients irrespective of the HLA-G 14 bp ins/del or +3142G>C polymorphisms. YBLI may be used as an adjunct therapy in RA independent of the genotypes.

Effect of Tratak (Yogic Ocular Exercises) on Intraocular Pressure in Glaucoma: An RCT.

Introduction:In healthy subjects, the intraocular pressure (IOP) is maintained by a dynamic equilibrium between continuous production of aqueous humor by ciliary bodies and continuous outflow through the two drainage pathways: trabecular meshwork and uveoscleral outflow. Here, we hypothesized that yogic ocular exercises, including extraocular muscles exercise, and modified Tratak Kriya (mTK), might reduce the IOP as well as stress and improve quality of life (QoL) in patients with glaucoma.Methodology:A parallel two-arm randomized controlled trial (RCT) was conducted in glaucoma patients (Control group and Intervention group). Control group patients were on standard medical treatment and intervention group patients practiced a Yoga-based lifestyle intervention (YBLI) for 4 weeks as add-on therapy with their standard medical treatment. All Participants were assessed at baseline day 1, day 14 (D14), and day 28 (D28). A minimum of 30 patients were recruited in each group.Results:We did not observe any statistically significant different mean IOP of right (IOP-r) or, left eyes at any time point as well as cortisol level and QoL between the two groups. However, with in intervention group, there was a reduction in IOP-r at D14 (15.54 ± 2.81 mmHg) and D28 (15.24 ± 3.1 mmHg), P = 0.006 and 0.001, respectively, compared to their baseline IOP (16.26 ± 2.98).Conclusion:Based on the present RCT, yoga-based ocular exercises practiced here cannot be recommended for management of raised IOP in glaucoma patients. Further larger studies are warranted with yoga-based interventions in patients with glaucoma.Clinical Trial Registration Number:CTRI/2016/03/006703

Effectiveness of a Yoga-Based Lifestyle Protocol (YLP) in Preventing Diabetes in a High-Risk Indian Cohort: A Multicenter Cluster-Randomized Controlled Trial (NMB-Trial).

IntroductionThough several lines of evidence support the utility of yoga-based interventions in diabetes prevention, most of these studies have been limited by methodological issues, primarily sample size inadequacy. Hence, we tested the effectiveness of yoga-based lifestyle intervention against diabetes risk reduction in multicentre, large community settings of India, through a single-blind cluster-randomized controlled trial, Niyantrita Madhumeha Bharat Abhiyan (NMB). Research Design and MethodsNMB-trial is a multicentre cluster-randomized trial conducted in 80 clusters [composed of rural units (villages) and urban units (Census Enumeration Blocks)] randomly assigned in a 1:1 ratio to intervention and control groups. Participants were individuals (age, 20–70 years) with prediabetes (blood HbA1c values in the range of 5.7–6.4%) and IDRS ≥ 60. The intervention included the practice of yoga-based lifestyle modification protocol (YLP) for 9 consecutive days, followed by daily home and weekly supervised practices for 3 months. The control cluster received standard of care advice for diabetes prevention. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. The primary outcome was the conversion from prediabetes to diabetes after the YLP intervention of 3 months (diagnosed based upon HbA1c cutoff >6.5%). Secondary outcome included regression to normoglycemia with HbA1c <5.7%.ResultsA total of 3380 (75.96%) participants were followed up at 3 months. At 3 months post-intervention, overall, diabetes developed in 726 (21.44%) participants. YLP was found to be significantly effective in halting progression to diabetes as compared to standard of care; adjusted RRR was 63.81(95% CI = 56.55–69.85). The YLP also accelerated regression to normoglycemia [adjusted Odds Ratio (adjOR) = 1.20 (95% CI, 1.02–1.43)]. Importantly, younger participants (≤40 years) were found to regress to normoglycemia more effectively than the older participants Pinteraction<0.001. ConclusionBased on the significant risk reduction derived from the large sample size, and the carefully designed randomized yoga-based intervention on high-risk populations, the study is a preliminary but strong proof-of-concept for yoga as a potential lifestyle-based treatment to curb the epidemic of diabetes. The observed findings also indicate a potential of YLP for diabetes prevention in low/moderate risk profile individuals that needs large-scale validation.Trial RegistrationClinical Trial Registration Number: CTRI/2018/03/012804.

EFFECTS OF 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON METABOLIC SYNDROME Z-SCORE, BODY COMPOSITION AND QUALITY OF LIFE IN INDIAN ADULTS WITH METABOLIC SYNDROME

Objective: The study evaluated the effect 12-week yoga-based lifestyle intervention (YBLI) on continuous metabolic syndrome (Met S) z-score, body fat percentage and health related quality of life (HRQoL) in adults having Met S. Design and method: In this prospective, single-arm, lifestyle intervention study 54 adults with metabolic syndrome (as per Joint Interim Statement, 2009) were assigned to pretested 12-week YBLI intervention. It consisted of asanas, pranayama, relaxation techniques, lectures, group support, dietary advice under supervision for ∼2 hrs/day for 2 week followed by continuation of the practices at home for subsequent 10 weeks. Outcome measures were assessed before and after the intervention and included: Met S z-score calculated by summing the standardized values for cardio-metabolic risk factors, body fat percentage assessed by dual energy X-ray absorptiometry, and HRQOL assessed using WHOQOL-BREF questionnaire. Results: Subjects showed (mean age 38.1 ± 5.6 years) significant reduction in Met S z-score {0.3 ± 2.4 vs. -1.3 ± 2.4, p &lt; 0.01) and body fat percentage (32.3 ± 54.3 vs. 31.5 ± 5.5, p &lt; 0.01) from baseline to week 12. Significant improvement was found in the domains of the HRQOL i.e. physical (64.4 ± 14.7 vs. 77.3 ± 12.7, p &lt; 0.01); psychological (61.0 ± 16.8 vs. 74.6 ± 12.6 p &lt; 0.01); social (75.9 ± 14.5 vs. 79.6 ± 12.3, p &lt; 0.01) and environmental (66.4 ± 14.3 vs. 75.8 ± 11.6, p &lt; 0.01). Conclusions: Participation in YBLI led to the improvement in cardio-metabolic risk, body fat percentage and HRQOL in Indian adults having Met S.

EFFECT OF A 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON VASCULAR INFLAMMATORY MARKERS IN PRE-DIABETIC OVERWEIGHT/OBESE INDIAN ADULTS

Objective: To study the effect of a 12-week yoga-based lifestyle intervention (YBLI) on circulating levels of inflammatory markers in prediabetic overweight/obese Indian adults. Design and method: Prospective, single-arm, lifestyle intervention study was conducted in 59 prediabetic (n = 59) (fasting plasma glucose, FPG 100 to 125 mg/dL), overweight/ obese (body mass index; BMI 23–40 Kg/m2) subjects. The subjects were assigned with pretested YBLI consisting of asanas, pranayama, meditation, and relaxation techniques with group support, dietary advice under supervision for approx. 2 hrs each day for 2 weeks followed by continuation of the practices at home for next 10 weeks. Outcome measures were weight, waist to hip ratio (WHR), FPG, serum insulin, blood pressure (BP), homeostatic model insulin resistance (HOMA-IR), and plasma levels of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6) and leptin, adiponectin measured before and after the intervention. Results: Results: After intervention, subjects (mean age = 38.5 ± 5.5 years, BMI = 30.4 ± 4.1 Kg/m2) had significant reduction in weight, WHR, diastolic BP, and HOMA-IR. There was statistically significant reduction in IL-6 {median (range) 1.1 (0.5, 2.4) vs. 0.8 (0.4,1.5) pg/mL, p = 0.02} and leptin {22.9 (13.9, 45.0) vs. 21.6 (12.0, 42.6) ng/mL, p &lt; 0.01)}; and significant increase in adiponectin {6.0 (4.4, 7.6) vs. 6.5 (4.7, 9.2) ng/mL, p &lt; 0.02); while no significant difference was noticed in TNF-alpha levels. Conclusions: Conclusion: A 12-week YBLI might effectively modify levels of IL-6, leptin, and adiponectin as observed in this study and overall reduction in inflammation in obesity.

Yoga-Based Lifestyle Intervention as a Potential Adjuvant in Addressing Anxiety, Fear, Depression, and Perceived Health in Mild-to-Moderate COVID-19 Patients. A Pilot Study

Introduction: Coronavirus infection (COVID-19) has led to a serious public health crisis that has affected both physical and mental health. As we are racing toward a solution for containing the virus, there is a profound need to address the mental health impact of COVID-19 such as anxiety, stress, and depression. The present study evaluates the impact of yoga on mental health issues arising in COVID-19 pandemic. Materials and Methods: Patients who are diagnosed as COVID-19 by polymerase chain reaction and graded as mild-to-moderate COVID-19 as per the ICMR criteria were enrolled for adjuvant yoga and naturopathy-based lifestyle modification, which includes postures, breath regulation, meditation, and eucalyptus essential oil inhalation for 14 days. SpO2 (saturated oxygen) and anxiety, stress, depression, fear, and health were assessed through the depression, anxiety, and stress scale (DASS) at baseline (day 1 of admission) and 7th day, as well as visual analog scale (VAS) at baseline and 7th and 14th day. Results: Statistically significant changes reduction were observed in DASS-21 scores and VAS scores (P &lt; 0.05) but not on SpO2. Slight increase in mean anxiety, depth of fear, sleep disturbance, and health status was observed in VAS between 7th and 14th day, which was statistically nonsignificant. Discussion: Supervised yoga sessions are reported to be of significant impact in alleviating the mental health issues in COVID-19 compared to nonsupervised sessions. Our results suggest the inclusion of yoga therapy into COVID-19 care as an adjuvant considering its impact on mental health. However, future randomized control trials are warranted with more specific end points to ensure enhanced acceptance of yoga in scientific community.

Yoga-based Lifestyle Intervention for Prevention and Management of Type 2 Diabetes Mellitus and Associated Complications: A Clinical Research Review

Yoga-based Lifestyle Intervention for Prevention and Management of Type 2 Diabetes Mellitus and Associated Complications: A Clinical Research Review

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

Various external stressors and environmental challenges lead to the provocation of the immune system in autoimmune diseases like Rheumatoid arthritis (RA). The inappropriate immune response further triggers the cascade of inflammatory changes resulting in precipitation of symptoms and hampers quality of life (QOL). The underlying psycho-somatic component of the disease requires a holistic approach to its treatment dimension rather than the use of pharmacotherapy. The applicability of mind-body interventions has become essential in today’s fast-paced life. Yoga, a mind-body technique, alters the mind’s capacity to facilitate systemic functioning at multiple organ system levels. Hence, we conducted this study to evaluate the impact of 8 weeks of a yoga-based lifestyle intervention (YBLI) on psycho-neuro-immune markers, gene expression patterns, and QOL in RA patients on routine medical therapy. A total of 66 patients were randomized into two groups: yoga group or non-yoga group and were assessed for a panel of inflammatory cytokines (IL-6, IL-17A, TNF-α, and TGF-β), mind-body communicative markers (BDNF, DHEAS, β-endorphin, and sirtuin) and transcript levels of various genes (IL-6, TNF-α, NFKB1, TGF-β, and CTLA4). We assessed disease activity and QOL using the DAS28-ESR and WHOQOL-BREF questionnaire, respectively. Yoga group observed significant improvements in the levels of markers, which influenced the psycho-neuro-immune axis (p < 0.001) with an estimated effect size from small to medium range. In the yoga group, there was a significant reduction in DAS28-ESR (p < 0.001) and improvement seen in the physical health, psychological, social relationships domains (p < 0.001) of QOL, except environmental (p > 0.05). The yoga group showed downregulation of IL-6, TNF-α, and CTLA4 and upregulation of TGF-β. These results suggest that a decrease in disease activity after yoga practice is associated with a significant reduction in inflammatory cytokines, the elevation of mind-body communicative markers, and normalization of various transcript levels, which improved QOL. Thus the adoption of YBLI improves clinical outcome in RA, and decreases systemic inflammation by its beneficial effects on psycho-neuro-immune axis and normalization of dysregulated transcripts. Thus YBLI may be used for RA patients as an adjunctive therapy.

Physical Activity Patterns in India Stratified by Zones, Age, Region, BMI and Implications for COVID-19: A Nationwide Study.

Rationale:India has a high prevalence of noncommunicable diseases (NCDs), which can be lowered by regular physical activity. To understand this association, recent population data is required which is representative of all the states and union territories of the country.Objective:We aimed to investigate the patterns of physical activity in India, stratified by zones, body mass index (BMI), urban, rural areas, and gender.Method:We present the analysis of physical activity status from the data collected during the phase 1 of a pan-India study. This (Niyantrita Madhumeha Bharata 2017) was a multicenter pan-India cluster sampled trial with dual objectives. A survey to identify all individuals at a high risk for diabetes, using a validated instrument called the Indian Diabetes Risk Score (IDRS), was followed by a two-armed randomized yoga-based lifestyle intervention for the primary prevention of diabetes. The physical activity was scored as per IDRS (vigorous exercise or strenuous at work = 0, moderate exercise at home/work = 10, mild exercise at home/work = 20, no exercise = 30). This was done in a selected cluster using a mobile application. A weighted prevalence was calculated based on the nonresponse rate and design weight.Results:We analyzed the data from 2,33,805 individuals; the mean age was 41.4 years (SD 13.4). Of these, 50.6% were females and 49.4% were males; 45.8% were from rural areas and 54% from urban areas. The BMI was 24.7 ± 4.6 kg/m2. Briefly, 20% were physically inactive and 57% of the people were either inactive or mildly active. 21.2% of females were found physically inactive, whereas 19.2% of males were inactive. Individuals living in urban localities were proportionately more inactive (21.7% vs. 18.8%) or mildly active (38.9% vs. 34.8%) than the rural people. Individuals from the central (29.6%) and south zones (28.6%) of the country were also relatively inactive, in contrast to those from the northwest zone (14.2%). The known diabetics were found to be physically inactive (28.3% vs. 19.8%) when compared with those unaware of their diabetic status.Conclusion:20% and 37% of the population in India are not active or mildly active, respectively, and thus 57% of the surveyed population do not meet the physical activity regimen recommended by the World Health Organization. This puts a large Indian population at risk of developing various NCDs, which are being increasingly reported to be vulnerable to COVID-19 infections. India needs to adopt the four strategic objectives recommended by the World Health Organization for reducing the prevalence of physical inactivity.

Comparative Analysis of Depth of Meditation Between Long-Term and Short Term Meditators using Electroencephalography

Background and Aim: The present study was designed to evaluate the brain electrical activity among Long-term meditators (LTMs) and Short-term meditators (STMs) using Electroencephalography (EEG). Methods: This prospective study involved 40 mins of EEG recordings, carried out twice i.e. at Day 0 (Baseline) and at Day 10 (During meditation) in thirty-four (34) participants. Twelve (12) apparently healthy male, right-handed, practicing preksha meditation (Since >5 years, at least 5 days a week) were recruited as long-term meditators; Twelve (12) subjects who attended the 10-days short-term yoga-based lifestyle intervention program were recruited as short-term meditators; Ten (10) male healthy controls, who did not participate in any dietary/yoga intervention were recruited among the staff members. The EEG waves were analyzed at Day 0 and at Day 10 using Wilcoxon Signed Rank test and Repeated measured ANOVA respectively. One-way ANOVA was used for the baseline EEG waves activity comparison among LTMs vs. STMs vs. Controls. The response to photic stimulation was also assessed during meditation. Results: Significant different patterns of alpha and theta waves (p<0.05) activity was observed for LTM vs. STM during meditation vs. baseline. Also, significant different baseline EEG waves (p<0.05) were observed among LTM vs. STM vs. Controls. Conclusion: Findings may be useful in defining the basic EEG features to differentiate meditators based on the duration of practice of meditation and depth of meditation.

Predictors of Health-Related Quality of Life in Indians with Metabolic Syndrome Undergoing Randomized Controlled Trial of Yoga-Based Lifestyle Intervention vs Dietary Intervention

The present study explores the efficacy of 12-week yoga + diet-based lifestyle intervention (YBLI) vs dietary intervention (DI) on health-related quality of life (HRQoL) and identifies the predictors of change in HRQoL in Indians with metabolic syndrome (Met S). Data from the historical randomized controlled trial was used including adults (n = 260, 20–45 years) with Met S. Four domains of HRQoL were measured at baseline, 2 and 12 weeks using WHOQOL-BREF questionnaire. Generalized estimating equation and chi-square test was used to compare 12-week changes in HRQoL domains and proportion of subjects, respectively. Changes in HRQoL were predicted using regression models concerning changes in body mass index (BMI), physical activity, total calorie intake, adiponectin, and superoxide dismutase (SOD) levels. Exploratory mediation analysis was carried out using Baron & Kenny approach. YBLI resulted in a significantly greater increase in the physical domain score of HRQoL than DI. A significantly greater proportion of subjects in YBLI group (71%) showed an increase in physical domain scores compared to DI (51%). A unit change in BMI negatively predicted a unit change in physical, psychological and environmental health. Whereas, a unit change in adiponectin and SOD levels positively predicted a unit change in physical and environmental health. Partial mediation between YBLI intervention and physical HRQoL domain was observed via adiponectin. In conclusion, a 12-week YBLI has a positive and greater effect on HRQoL physical domain score than following DI alone. Changes in BMI, adiponectin, and SOD levels may predict changes in HRQoL domains after lifestyle intervention.

EFFECT OF A 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON BLOOD PRESSURE, INSULIN RESISTANCE AND INFLAMMATORY MEDIATORS IN PRE-DIABETIC OVERWEIGHT/OBESE INDIANS

Objective: Background: Obesity is an independent risk factor for type-2-diabetes and other cardio-metabolic conditions, mediated by insulin resistance and disturbed inflammatory adipokines profile. To study the effect of a 12-week Yoga-based lifestyle intervention (YBLI) on blood pressure, insulin resistance, and systemic inflammatory markers in pre-diabetic, overweight/obese Indian adults. Design and method: Methodology: Prospective, single-arm, lifestyle intervention study was conducted in pre-diabetic (n = 55), overweight/ obese (fasting plasma glucose, FPG 100 to 125 mg/dL; body mass index; BMI 23–40 Kg/m2) subjects. The subjects were assigned with pretested YBLI consisting of asanas, pranayama, meditation and relaxation techniques with group support, dietary advice under supervision for approx. 2 hrs each day for 2 weeks followed by the continuation of the same practices at home for next 10 weeks. Outcome measures were weight, waist to hip ratio (WHR), FPG, serum insulin, blood pressure (BP), homeostatic model insulin resistance (HOMA-IR) and plasma levels of tumor necrosis factor (TNF) -alpha, interleukin-6 (IL-6) and leptin, adiponectin measured before and after the intervention. Results: After intervention, subjects (mean age = 38.5 ± 5.5 years, BMI = 30.4 ± 4.1 Kg/m2) had significant reduction in weight, WHR, systolic BP, diastolic BP, and HOMA-IR. There was statistically significant reduction in IL-6 {median (range) 1.1 (0.5, 2.4) vs. 0.8 (0.4,1.5) pg/mL, p = 0.02} and leptin {22.9 (13.9, 45.0) vs. 21.6 (12.0, 42.6) ng/mL, p < 0.01)}; and significant increase in adiponectin {6.0 (4.4, 7.6) vs. 6.5 (4.7, 9.2) ng/mL, p < 0.02)}; while no significant difference was noticed in TNF-alpha levels. Conclusions: Conclusion: Pre-diabetic Indians who underwent 12-week YBLI showed favourable beneficial changes in blood pressure, insulin resistance, and systemic levels of IL-6, leptin and adiponectin, resulting in overall reduction in cardiovascular risk.